Normal Development

The following are lists of activities in normal development that babies do as they grow and progress during the first two years of life.

1. Learning to Use Arms and Hands

Here are some general guidelines about what you should be seeing as your child grows and develops.

0-3 months
- Moves both arms in wide circular movements
- Swipes at toys or your face with arms
- Briefly holds an object placed in hand
- Looks at your face
- Watches your face or a toy
4-5 months
- Starts to bring both hands together
- Feels and explores his/her own hands
- Frequently brings hands to mouth
- Reaches for a toy with both arms
- Grasps toys with whole hand and shakes it to make a sound
- Recognizes the bottle visually and will pat the bottle with both hands while feeding
- Takes food off spoon
6 months
- Shakes and bangs toy
- Moves eyes independently of head
- Transfers a toy from one hand to the other
- Finger feeds on breadsticks/teething biscuits
- Drinks from a cup held by an adult
7-9 months
- Pushes/pulls toys with wheels
- Bangs two toys together
- Feeds self a cracker
10-12 months
- Picks up objects using a pinch with thumb and index finger
- Uses index finger to point at and manipulate toys
- Finger feeds consistently
- Holds a spoon
- Holds a cup with both hands and drinks (though may spill a little)
- Starts to take off socks
- Lifts arm or leg to help with dressing
13-15 months
- Grasps an object with the thumb on one side and the index and second fingers on the other side
- Builds a tower of two blocks
- Opens/closes containers
- Will place a circle shape into a puzzle board
- Drops objects into containers/empties objects out of containers
- Brings spoon to mouth, however often it turns it over and spills food
15-17 months
- Takes off socks
- Scribbles with a crayon, holding it with a fisted grasp
- Builds a three to four block tower
- Will hold the handle of a cup and drink with less spillage
- Scoops food and brings spoon to mouth with just a little spillage
18-24 months
- Turns one page of a book at a time
- Puts a cheerio into a small bottle
- Separates pop-beads
- Places three shapes (round, square, triangle) into a puzzle board
- Imitates a vertical stroke or circular scribble with a crayon
- Strings large bead on a shoelace
- Turns the door knob
- Holds a small glass with one hand
- Finds armholes in T-shirt and pushes arms through
- Removes shoes when laces are undone
- Unzips/zips large zipper

2) Learning to Move Normally

Here are some activities to look for to see how your baby is growing and going.

0-3 months
- Lies on tummy and raises head
- Lies on back and moves each arm and leg equally
- Pushes up on arms from tummy and supports self on forearms
- Holds head up when held in a sitting position, with only occasional bobs forward
4-6 months
- On tummy, lifts head up to 90 degrees
- Holds head steady when upright in your arms
- On tummy, pushes up onto arms, lifting chest up
- Begins to roll tummy to back
- Keeps head in line with body when pulled to sitting holding hands
- Sits with support
- Holds head up
- Sits with straight back
- Briefly sits leaning on arms for support
7-9 months
- Stands up when held
- Sits alone
- Works to get an out-of-reach toy
- May begin to pull up on furniture
10-12 months
- Stands holding on to someone or something
- Pulls up to standing
- Gets into standing position
- Turns in a circle when sitting
- Walks holding onto furniture (cruises)
- May stand alone momentarily
- Crawls on hands and knees
12-18 months
- Walks or stands independently
- Walks upstairs with help
- Throws a toy from standing without falling
- Throws ball towards you
- Attempts to kick a large ball
- Rolls ball to you

3) Making Sounds and Learning to Talk

Here are some things to be looking for to help you see if your baby is hearing and talking.

0-3 months
- Turns toward voice
- Laughs
- Smiles in response to other people smiling
- Coos
- Squeals with delight
6 months
- Babbles with consonant-vowel combinations
- Looks directly at you
- Turns towards sound
- Makes raspberries
- Attempts to imitate sounds
- Reacts to loud, angry voices
- Babbles for attention
9 months
- Responds to name
- Produces four or more different sounds
- Frequently uses syllables ba, da, ka
- Understands "no" and "bye-bye"
- Imitates sound
12 months
- Plays peek-a-boo
- Repeats sounds and gestures for attention
- Searches for an object he/she has seen hidden
- Uses long babbling sentences that are inflected (jargon)
- Understands simple commands
- Gives toys on request
- Points to objects desired
- Says two or three words
- Imitates familiar words
- Shakes head for "no"
- Likes to imitate sounds of familiar animals
- Waves bye-bye
18 months
- Can say about 20 words
- Recognizes pictures of people and things he/she knows well
- Points to three body parts (for example, nose, eyes, mouth)
- Begins to combine two words (for example, "all gone" or "go bye-bye")
- Brings familiar objects to you when asked
- Can point to five objects
- Imitates words and sounds more clearly
21 months
- Produces a few short phrases
24 months
- Talks in two and three word sentences (for example, "Daddy go work")
- Uses pronouns me/mine
- Follows two-step commands (for example, "Pick up your shoe and bring it to me")
- Uses these speech sounds: p,b,m,w,h,n
- Says or uses about 300 words
- Answers simple "wh" (where, what, why) questions by pointing or other actions
- Knows four to eight body parts
- Communicates what he/she wants

4) Hearing

Do you know that one in 750 infants born each year has a significant hearing loss? A baby’s hearing can be tested as early as one day after birth. It is never too soon to test a child’s hearing, and treatment is available at every age.

Why is hearing so important? Your baby must hear well in order to learn to talk. As your baby hears sound and words, the foundation for speech and language is being laid. This learning begins at birth!
Who can develop a hearing problem? A child can be born with a hearing problem or can develop one at any age. Some infants are more likely to have a hearing problem and are considered to be "at risk" for hearing loss. These children should have their hearing tested as soon as possible after birth.
When can you have your baby’s hearing tested? A baby’s hearing can be checked as soon as one day after birth, so don’t "wait and see." If you suspect your baby has a hearing problem, contact an audiologist or a physician immediately.
How can you tell if your baby has a hearing problem? Infants respond to sound in very predictable ways. An audiologist is a professional trained to evaluate hearing and can test your child at any age. Use the Communication Developmental chart on the back as a simple guideline to check your baby's hearing and communication development.
What can be done if your baby has hearing loss? There are many ways to help a hearing impaired child develop speech and language. After the hearing evaluation, an individualized treatment program will be developed by your baby's audiologist and other professionals.

Risk Criteria for Hearing Loss

Family history of childhood hearing loss
Mother had rubella (German measles), cytomegalovirus (CMV), toxoplasmosis, herpes or syphilis present at birth of infant and/or during pregnancy
Birth weight less than 3lbs 5oz (1500 grams)
Unusual ear, eye, head or neck development, including cleft lip or palate, absent philtrum, low hairline, ear tags or pits, etc.
Severe jaundice (hyperbilirubinemia) that required an exchange blood transfusion
Presence of bacterial meningitis
Apgar score of 3 or less at 5 minutes after birth, failure to initiate spontaneous respiration by 10 minutes or hypotonia persisting to 2 hours of age
Need for prolonged mechanical ventilation of 5 or more days duration (e.g., Waadrdenburg or Usher's syndrome)
Certain ototoxic drugs or medications including, but not limited to, aminoglycosides used for more than 5 days

Infants (29 days to 2 years)

Parents/caregivers have concerns regarding hearing, speech, language and/or developmental delay
Presence of neonatal risk factors that are associated with progressive sensorineural hearing loss (e.g., CMV, prolonged mechanical ventilation, heredity)
History of head trauma
Presence of neurodegenerative disorders such as neurofibromatosis, myoclonic epilepsy, Werdnig-Hoffman disease, Tay-Sach’s disease, infantile Gaucher's disease, Nieman-Pick disease, any metachromatic leukodystrophy, or any infantile demyelinating neuropathy
History of childhood infectious diseases associated with sensorineural hearing loss (e.g., mumps, measles)

Communication Development

0-4 months

Startles (jumps or blinks) to loud sounds
Can be soothed by a familiar voice
Says “coo” or “ahh” sounds
Stops playing and appears to listen to sounds or speech
Watches a speaker’s face
Usually awakens when sleeping quietly and someone talks or makes a loud noise

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