Developmental Milestones (OSCE)

Introduction 

Developmental milestones: 

 ‘Median age of acquisition’: when achieved by 50% of children   

 ‘Limit age’: when children should have achieved milestone ✅ 

 If not achieved by ‘limit age’, it is a red flag meaning more investigations are required ❌ 

 You should target your questions based on the child’s age ❓ 

 Offer the child toys to play with to aid assessment  

Developmental areas

Gross motor development: 

 Newborn: flexed limbs, head lag 

 6 to 8 weeks: lifts head to 45° 📐

 6 to 8 months: sits independently, ‘limit age’ = 9 months  

 8 to 9 months: crawls 

 10 months: stands independently, moves around furniture 

 12 months: unstable walking, ‘limit age’ = 18 months 

 15 months: stable walking 

 2.5 years: running and jumping 🏃

Vision and fine motor development: 

 6 weeks: turns head to follow movement, ‘limit age’ = 3 months 

 4 months: reaches for toys, ‘limit age’ = 6 months 

 4 to 6 months: palmar grasp (curl fingers towards palm around object) ✋ 

 7 months: passes toys between hands, ‘limit age’ = 9 months ✋ 

 10 months: mature pincer grip (using thumb and index fingertips to pick up small objects), ‘limit age’ = 12 months 

 16 to 18 months: uses crayons to make marks 

 Brick building: tower of 3 (18 months), tower of 6 (2 years), tower of 8/train of 4 (2.5 years), bridge (3 years), steps (4 years) 

 Pencil skills without copying: draws line (2 years), draws circle (3 years), draws cross (3.5 years), draws square (4 years), draws triangle (5 years) (Pencil skills with copying: 6 months prior) 

Hearing, speech and language development: 

 Newborn: startles at loud noises 👂

 3 to 4 months: vocalises, coos, laughs

 7 months: soft sounds, polysyllabic babble 

 7 months: uses sounds randomly 

 10 months: uses sounds properly to mama/dada 

 12 months: 2 to 3 words (excluding mama/dada) and understands name 👂

 18 months: 6 to 10 words 

 20 to 24 months: 2+ word phrases  

 2.5 to 3 years: 3 to 4 word sentences 

Social, emotional and behavioural development: 

 6 weeks: responds with a smile, ‘limit age’ 8 weeks 

 6 to 8 months: puts food in mouth on own 🍩

 10 to 12 months: waves goodbye and plays peek-a-boo 

 12 months: uses 2 hands to drink from cup 

 18 months: gets food to mouth using spoon  

 18 to 24 months: symbolic play (using objects/actions/ideas in play), ‘limit age’ = 2 to 2.5 years 

 2 years: toilet trained during daytime, removes some of own clothing 

 2.5 to 3 years: parallel play (playing alongside others but do not influence each other), development of interactive play, takes their turn 

Summary:

1. Assess gross motor development
2. Assess vision and fine motor development
3. Assess hearing, speech and language development
4. Assess social, emotional and behavioural development