Section 2 - Child health checks

Developmental milestones

Information ^1–3

Assessing developmental milestones allows clinicians to identify factors (e.g. disability, malnourishment, chronic conditions) affecting a child to attain expected age-specific tasks, behaviours and skills

Note

This health check is not a thorough developmental screen rather a check to identify a Developmental delay or disability (child) requiring a comprehensive review
Refer any concerns early, do not wait

Health check recommendations

All children under the age of 5 years
Within 3 months of a child < 5 years of age entering foster care

1. Procedure

Note the age appropriate developmental milestones in Table 1. and ascertain if the child has met milestones by:
- asking the parent
- observing the child’s interaction with the parent and environment

Parents are the best historians as to how their child is developing. Listen to any concerns a parent has about their child

If a child’s age falls between two age brackets, assess against the previous age bracket e.g. a 15 month old would be checked against the 12 month old bracket
Determine if the child requires a referral according to the criteria and place them on a follow-up and recall register

Table 1. Age related developmental milestones ^1,2 These are definitive milestone cut-offs. Not achieving a milestone for the child’s age may indicate a delay in development and requires a comprehensive developmental screen, monitoring and follow-up. See2. Results.
6 months
Social-emotional	Smiles or squeals in response to people
Communication	Babbling i.e. oohh, aahh Recognises their name when called
Fine motor and cognition	Reaching for and holding toys (palmer grasp) Explores objects with hands, eyes and mouth Brings hands together at midline
Gross motor	Supports head when held in sitting position Holding head and shoulders up when on tummy
9 months
Social-emotional	Shares enjoyment with others using eye contact or facial expression
Communication	Gesturing e.g. pointing, waving, showing Using 2 part babble e.g. mama, dada, gaga
Fine motor and cognition	Holds objects Gives objects when requested Moves toys from one hand to another
Gross motor	Rolling Sits without support Moves e.g. creeping or crawling motion Bears weight on legs well when held upright
12 months
Social-emotional	Notices someone new Plays early turn based games e.g. peekaboo
Communication	Babbles phrases that sound like talking Responds to familiar words e.g. puppy, mummy
Fine motor and cognition	Feeds self e.g. with finger foods or holding own cup Able to pick up small items using index finger and thumb (pincer grip)
Gross motor	Moves e.g. creeping, crawling motion, bottom shuffle Pulled to stand independently and holds on for support
18 months
Social-emotional	Shows interest in playing and interacting with others
Communication	Clear words spoken Understands short requests e.g. where is the ball?
Fine motor and cognition	Scribbles with a crayon Attempts to stack blocks after demonstration
Gross motor	Attempts to walk without support Stands alone
2 years
Social-emotional	Uses toys for their purpose e.g. cuddles a teddy rather than bangs, drops or throws toys
Communication	Learning new words Puts words together e.g. push car
Fine motor and cognition	Interested in self care skills e.g. feeding or dressing
Gross motor	Walks independently Able to walk up and down stairs holding on
3 years
Social-emotional	Interest in pretend play Notices and understands feelings in themselves and others e.g. happy or sad
Communication	Familiar people understand child’s speech Uses simple sentences e.g. big car go
Fine motor and cognition	Matches similar coloured items Snips with scissors Imitates a person drawing a circle
Gross motor	Runs, jumps, walks up and down stairs Balances on one foot for few seconds
4 years
Social-emotional	Able and willing to play co-operatively
Communication	Speech easy to understand Able to follow 2 step directions e.g. get the ball and give it to me
Fine motor and cognition	Opens bags and containers Draws simple face, lines and circles
Gross motor	Able to walk, run, climb, jump and use stairs confidently Catches, throws and kicks a ball
5 years and over
Any milestone deficits in children > 5 years old will be identified in the school setting

2. Results ^1–3

A comprehensive developmental screen and urgent referral is required if at any age any of the following are present:

Any parental concerns according to Parents’ Evaluation of Developmental Status (PEDS) questionnaire. See child’s PHR booklet
Loose and floppy movements (low tone) or stiff and tense (high tone)
Difference in strength, movement and tone between right and left sides of body
Poor interaction with adults or other children
Lack of response to sound or visual stimuli
Significant loss of skills
Not achieving indicated developmental milestones
Lack of or limited eye contact
Any other clinical concern

Not achieving a milestone for the child’s age may indicate a delay in development and requires a full developmental screen undertaken by a suitably trained clinician using:
- the ASQ-TRAK (for Aboriginal and Torres Straight Islander children) or Ages and Stages Questionnaire (ASQ) (Resource 1.) and
- the Social Attention and Communication Surveillance-Revised (SACS-R) to identify Autism Spectrum Disorder (ASD). See Resource 2.
If all milestones achieved, provide brief intervention

3. Brief intervention ^1–3

Child development refers to how a child acquires complex tasks, behaviours and skills as they get older. Children achieve these milestones at various ages
Parents can promote development by providing their child with a stimulating interactive environment. See Resource 3.
If a child is progressing well with their milestone development provide the parent with expected milestone progression information. See Resource 3.

4. Referral

Provide the completed ASQ-TRAK, ASQ or SACS-R screening tool results to any referred to multidisciplinary team members
Refer to Child Development Services
For delays in the:
- social-emotional domain refer to a speech pathologist, occupational therapist and child health nurse
- communication domain refer to a speech pathologist and child health nurse. See Ears and hearing (child)
- fine motor and cognition domain refer to a physiotherapist, occupational therapist, psychologist and child health nurse
- gross motor domain refer to a physiotherapist, occupational therapist and child health nurse
Manage any delays as per Developmental delay or disability (child)

5. Follow-up

Place the child on a recall register to monitor development if required
Ensure all referrals are actioned
Provide the parent with details for the next scheduled follow-up appointment

6. References

All Chronic Conditions Manual references are available at the Office of Rural and Remote Health website

7. Resources

Last updated: September 2024