This series of articles has been adapted from [Mind Matters in Children] by Dr Kenneth Lyen. It delves into both the normal as well as the abnormal functioning of a child’s mind, and gives practical advice on how to manage children’s mental health and problems like ADHD, dyslexia, autism and depression.
Child development is a continuous process of changes in physical, language, intellectual, behavioural, emotional and social functioning from birth to adolescence. Not everyone develops at the same pace, and indeed there is a wide range in the speed of development between different children. Even the rate of a child can proceed at different spurts. The descriptions below show the developmental milestones in the first year of your child’s life, and what red flags you can look out for.
At Birth
The first thing a baby does at birth is cry and take the first breath. The paediatrician does a full physical examination to make sure the child is healthy.
The newborn is quite weak, and when held under the chest and belly, head facing down (ventral suspension), the spine may be slightly curved. The head may droop a little bit, and the arms and legs should be slightly flexed. When the newborn is more awake, they may respond to the parents’ faces and hear them speak.
Newborns also show primitive reflexes in response to particular stimuli. One common example is the “sucking reflex”, where a baby’s mouth will automatically start sucking when you put in the mother’s nipple or a nursing bottle. This helps the baby to coordinate the muscles needed to drink milk. Such reflex actions usually disappear when the baby is 3 to 6 months old.
1 Month Old
Developmentally, a 1-month-old is quite similar to a newborn. They can turn to light, and if you move your head in front of them, they can follow your face, perhaps a bit more easily than at birth. Indeed, when the mother is breast or bottle feeding, the baby can look at and respond to her face. They can stop whimpering when the parent calls them. At this age, a baby grasps using the entire palm of the hand, and still shows the primitive reflexes.
2 Months Old
A 2-month-old can lift the head when lying on the abdomen. They are happy when they see their mother, and their smile appears to be more genuine, and is referred to as a “social smile”. The baby can follow faces and objects more consistently. If you call a 2-month-old, they can turn in the direction of the sound. The baby is alert for longer periods of time.
4 Months Old
A 4-month-old can roll from front to back. One should be careful, because rolling over carries a risk of falling onto the floor from a bed or couch. They can grasp objects more firmly than just a couple of months earlier, and use sounds to communicate.
6 Months Old
At 6 months, the baby is becoming quite strong, and can struggle energetically when held in one’s arms. When pulled to sit, they flex their neck forward in anticipation of the act. They sit with minimal or no support and their spine is quite straight. When lying prone, the arms are extended and their chest is off the couch. They can lift their leg, grab their foot, and when held standing, the legs can bear the weight without buckling in.
Their hands are also more dexterous. They start to grasp items with both hands, Even though they still grasp objects with their palms, a 6 month old can transfer an object from one hand to the other. They also start to display curiosity by trying to get objects out of reach. They can babble quite extensively.
9 Months Old
A 9-month-old can start to crawl, pull themselves up to stand, and cruise around holding furniture. They can begin to pick up small objects with their finger and thumb, which is described as an immature “pincer grasp”. Whatever they pick up goes straight into their mouth. They can turn the pages of a board book, and say “mama” and “baba” indiscriminately. Some children can say “bye bye” and wave at the same time. When an object is hidden from sight, they know that it continues to exist, and can remove the cover hiding it. This is referred to as “object permanence”. At this age, the child may be upset when a caregiver leaves them alone, a situation described as “separation anxiety”. When holding a baby upright, and then you quickly but gently rotate the body forward and downward, to simulate falling, the infant will automatically extend their arms forwards trying to break the fall. This is known as the “parachute reflex”.
12 Months Old
The first birthday is an important celebration and is an occasion to examine a child closely for developmental milestones. They can pull themselves up to stand more easily, and can walk with one hand held. They can point, shake a rattle, and their pincer grasp is more advanced. “Mama” and “baba” are spoken more accurately and refers correctly to either mother or father. There may be other single words like “ball” or “dog”. Occasionally they can imitate clapping hands or respond to “high five” with a raised hand. They may follow simple commands like “give!” or “come here!” They are now more aware of strangers, and some are frightened by new faces, a phenomenon known as stranger anxiety.
Red Flags
The following are guidelines as when to be concerned if the child is not doing the following activities at these ages:
2 Months Old
- not bringing a hand to the mouth
- not responding to loud sounds
- not focusing on things with the eyes
- never smiling when looking at familiar faces
- never turning head from one side to the other
- limbs are either too stiff or too floppy
4 Months Old
- not trying to swipe at, or reach out and grasp toys
- not bringing objects to mouth
- not able to keep head steady when held upright
- not turning round to locate sound or startling to loud sounds
- not pushing down with legs when placed on a firm surface
- not able to lift head or push up with arms when lying on the abdomen
- not moving eyes in all directions
- not smiling regularly when playing with them
6 Months Old
- not able to roll over from stomach to back
- not able to sit (with help)
- not laughing or squealing
- not reacting specially to those taking care of them
- not following objects well with both eyes
- not reaching out for toys
- not bearing weight on the legs
- stiffness or floppiness in limbs that might have been overlooked earlier
- persistence of primitive reflexes (Moro, grasp, rooting)
9 Months Old
- not able to stand when supported
- not making any efforts to move around
- not able to sit even with help
- not able to babble or attempt to say single words (“baba”, “mama”)
- not able to use gestures (eg wave hand or shake head)
- not showing preference for people who look after them
- startles easily
12 Months Old
- not interested in playing
- not turning to person talking to them, not reacting to loud sounds
- not babbling or making a range of sounds
- not pointing to show what they are interested in
- not crawling or bottom-shuffling (scooting): 25% of normal children do not crawl
- not trying to stand up even when encouraged
- not walking when hand held
When red flags are raised, it is recommended that you consult a doctor to see if there are any medical concerns.
We are often surprised when we follow a child’s development. Newborns spend much of their life sleeping, feeding and crying. They then transform at an amazingly fast pace into a smiling, interactive, energetic infant.
We hope that our babies are normal, but we often compare them with relatives’ and friends’ children of a similar age. We worry when the infant may seem slower by comparison. One needs to bear in mind that children develop at different rates. This article hopes to give you some idea as when to seek further medical help, especially when the red flags are being raised.
It is important to interact with your baby, to talk to them, play with them, and gently calm them down when they are upset and crying. Always remember that safety is a priority, so look out for potential dangers like falling from a bed or couch, cuts with sharp objects, unsafe electrical cables or sockets, being left unattended in a bathtub, etc. Limit the amount of screen time watching television or animated videos on the handphone to no more than a few minutes per day. Many paediatricians actually recommend zero screen time; replacing it with direct human interactions. Looking after children has been a challenge since time immemorial. Get help if you have difficulty coping.
References
Shaw G. Baby’s first year.
https://www.webmd.com/parenting/baby/features/stages-of-development#1
Healthline. Get ready for all these precious first-year milestones. https://www.healthline.com/health/baby/baby-development-stages
Whattoexpect Firstyear. Baby’s development month by month.
https://www.whattoexpect.com/first-year/month-by-month/ Morin A.
Developmental milestones from birth to age 1. https://www.understood.org/articles/en/developmental-milestones-from-birth-to-age-1 Mersch J.
Infant milestones month to month. https://www.emedicinehealth.com/infant_milestones/article_em.htm
Written by Kenneth Lyen
Illustrations by Jasreel Tan
