The health and safety of children goes hand-in-hand with growth and development. For example, health education involves intellectual development through daily lesson plans that stimulate children and promote decision making skills. Promoting mental health and emotional well-being includes awareness of stranger anxiety and attachment issues. Playground safety involves motor development and selecting age-appropriate equipment.

A crucial part of helping young children grow is observing and assessing development on many levels--how they learn, use their motor skills, and how they use tools and objects around them, as well as how they interact with others, express feelings, or show self-awareness. Your knowledge of developmental milestones and achievements will help you establish the most nurturing environment possible, target specific skills children need to work on, and recognize the need to refer children to specialists.

Milestones

Milestones are behaviors that emerge over time, forming the building blocks for growth and continued learning. They are specific actions, responses, and abilities that can be observed by parents and caregivers and provide important information on whether a child is developing as expected for age or may be showing initial signs of delay or disability.

Logically, milestones are organized by age, usually divided into groups of one-three months for infants because they are developing rapidly, and based on six month or year increments as children get older. The time frames associated with each milestone are based on averages. Some children may achieve milestones earlier than expected, while others may be slower to reach certain milestones, yet ultimately have no mental or physical disability.

Many different lists of milestones exist, and they can be organized using a variety of terms. General categories include physical abilities (gross motor, fine motor, movement, vision, eye-hand skills), cognitive abilities (self-awareness, use of tools, spatial and temporal awareness), language development, and social or emotional abilities (interest in others, expression of feelings).

Monitoring Milestones

Children benefit when caregivers can identify potential delays and early signs of disability and refer these children into important early intervention programs. Referrals should be made early, but only after patterns of concern exist. Missing one milestone should not cause an overreaction.

Parents of children in your care appreciate milestone reports you provide. You can make parents proud and happy, for example, while also helping to educate them about child development by telling them that you observed their child building a tower of blocks well before the age when such an achievement is expected. Expressing concern about milestones that have not been reached can be more difficult; but, it is important and can help parents further observe and provide experiences at home to support healthy development.

Early intervention can help children who may have developmental lags. Physical therapy, play therapy, nutrition counseling, and speech and language therapy are available for children of all ages. Local health departments or a childcare health consultant can connect you with appropriate diagnosis and intervention for children in your care.

Pediatricians often use age-appropriate developmental checklists to record milestones during office visits. Here are some basic milestones, listed by age, that can help gauge a child's development.

Cognitive

• Seven months--reacts to and imitates facial expressions of others, struggles to get objects that are out of reach.
• One year--imitates gestures, finds hidden objects easily, begins to use objects correctly (cups, phone), enjoys picture books.
• Two years--begins make-believe play, begins to sort objects by shape and color, understands words and commands.
• Three years--makes mechanical toys work, matches object in hand or room to picture, completes puzzles with three or four pieces, stacks rings on a peg in order of size.
• Four years--correctly names some colors, follows three-part commands, understands the concepts of same/different, seeks information through "how" and "why" questions.
• Five years--counts 10 or more objects, better understands concept of time, draws, names and describes pictures.

Language & Communication

• Seven months--turns to locate a voice, responds to own name, exchanges or repeats sounds.
• One year--understands the names of familiar people and objects, says a few words, responds/reacts appropriately to "no."
• Two years--points to objects when named, says several single words (by 18 months) and simple phrases (by 24 months), repeats overhead words, begins to use "me," "I," and "you."
• Three years--begins to use adjectives and adverbs, recount events of the day, says name, age, and gender.
• Four years--speaks in sentences of five or six words, tells stories, sings or repeats at least one song or nursery rhyme.
• Five years--understands sequencing of events, expresses causality with "because" or "so," uses future tense.

Social & Emotional

• Seven months--expresses interest in mirror images, responds to expressions of emotion, plays peek-a-boo. Some may be shy or afraid of strangers; this may continue through one year.
• One year--extends arm or leg to help when being dressed, mimics simple actions.
• Two years--recognizes self in pictures or mirrors, expresses negative feelings and feelings of affection for familiar people.
• Three years--start learning to take turns when the wait is not very long, expresses a wide range of emotions, defends possessions.
• Four years--completes simple tasks without assistance, begins to take turns, negotiates solutions to conflicts.
• Five years--wants to please friends, expresses interest in gender differences, shows some understanding of fairness and good and bad behavior.

Movement & Motor Skills

• Seven months--rolls both ways, reaches with one hand, transfers objects from hand to hand, rolls over.
• One year--sits without support, pulls himself up to stand and stands unaided momentarily, throws objects.
• Two years--walks alone and backwards, pushes and pulls objects, stands on tiptoe, builds towers of four or more blocks.
• Three years--runs easily, turns pages one at a time, screws and unscrews lids, strings large beads.
• Four years--draws crosses and circles, balances on one foot, catches bounced ball regularly.
• Five years--turns somersaults, cuts on a line continuously, dresses and undresses without assistance.

Scott G. Allen, Illinois Chapter, American Academy of Pediatrics

The National Child Care Information Center includes the complete manual Quality Care for Infants and Toddlers from the Zero to Three National Center for Infants and Toddlers. Appendix C of this manual features specific developmental milestones for children from birth to age three. www.nccic.org

The Public Broadcasting System's program The Whole Child features a section called The ABC's of Child Development, which provides developmental milestones organized by physical development, social and emotional development, thinking skills, and communication skills. www.pbs.org/wholechild

The National Association for the Education of Young Children (NAEYC) website offers many resources related to developmentally-appropriate practice, including the position statement "Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth through Age 8." www.naeyc.org