Your Preemie's Growth & Developmental Milestones

Was your baby born more than 3 weeks early? Read on for information from the American Academy of Pediatrics about developmental milestones for your preterm baby.

Keep in mind that babies develop at their own speed and in their own way. However, as the parent of a preemie, you will need to adjust your baby's age to get a true sense of where they should be in their development.

Your child's progress

You know your child better than anyone else. Even with an adjusted age, you will want to see them move forward in their development. For example, your child should progress from pulling themselves up, to standing, and then to walking. When you watch them carefully, you will see ways they are growing well. You will also know whether they needs more help.

Remember to take your child to his recommended well-child (health supervision) visits. At each visit, your child's doctor will check their progress and ask you about the ways you see your child growing.

Developmental milestones

Here is information about how babies and young children typically develop. Examples of developmental milestones for ages 1 month to 6 years are listed below.

For a preterm baby, it is important to use the baby's adjusted age when tracking development until 2 years of age so their growth and progress take into account that they was born early.

NOTE: Ask your baby's doctor about early intervention (EI)—extra care some babies and children receive to help them develop.

At 1 month (4 weeks)

Social

• Looks at parent; follows parent with eyes

• Has self-comforting behaviors, such as bringing hands to mouth

• Starts to become fussy when bored; calms when picked up or spoken to

• Looks briefly at objects

Language

• Makes brief, short vowel sounds

• Alerts to unexpected sound; quiets or turns to parent's voice

• Shows signs of sensitivity to environment (such as excessive crying, tremors, or excessive startles) or need for extra support to handle activities of daily living

• Has different types of cries for hunger and tiredness

Motor

• Moves both arms and both legs together

• Holds chin up when on tummy

• Opens fingers slightly when at rest

At 2 months (8 weeks)

Social

• Smiles responsively

• Makes sounds that show happiness or upset

Language

• Makes short cooing sounds

Motor

• Opens and shuts hands

• Briefly brings hands together

• Lifts head and chest when lying on tummy

• Keeps head steady when held in a sitting position

At 4 months (16 weeks)

Social

• Laughs aloud

• Looks for parent or another caregiver when upset

Language

• Turns to voices

• Makes long cooing sounds

Motor

• Supports self on elbows and wrists when on tummy

• Rolls over from tummy to back

• Keeps hands unfisted

• Plays with fingers near middle of body

• Grasps objects

At 6 months (24 weeks)

Social

• Pats or smiles at own reflection

• Looks when name is called

Language

• Babbles, making sounds such as "da," "ga," "ba," or "ka"

Motor

• Sits briefly without support

• Rolls over from back to tummy

• Passes a toy from one hand to another

• Rakes small objects with 4 fingers to pick them up

• Bangs small objects on surface

At 9 months (36 weeks)

Social

• Uses basic gestures (such as holding out arms to be picked up or waving bye-bye)

• Looks for dropped objects

• Plays games such as peekaboo and pat-a-cake

• Turns consistently when name called

Language

• Says "Dada" or "Mama" nonspecifically

• Looks around when hearing things such as "Where's your bottle?" or "Where's your blanket?"

• Copies sounds that parent or caregiver makes

Motor

• Sits well without support

• Pulls to stand

• Moves easily between sitting and lying

• Crawls on hands and knees

• Picks up food to eat

• Picks up small objects with 3 fingers and thumb

• Lets go of objects on purpose

• Bangs objects together

At 12 months (48 weeks, or 1 year)

Social

• Looks for hidden objects

• Imitates new gestures

Language

• Uses "Dada" or "Mama" specifically

• Uses 1 word other than "Mama," "Dada," or a personal name

• Follows directions with gestures, such as motioning and saying, "Give me (object)."

Motor

• Takes first steps

• Stands without support

• Drops an object into a cup

• Picks up small object with 1 finger and thumb

• Picks up food to eat

At 15 months (60 weeks, or 1 ¼ years)

Social

• Imitates scribbling

• Drinks from cup with little spilling

• Points to ask something or get help

• Looks around after hearing things such as "Where's your ball?" or "Where's your blanket?"

Language

• Uses 3 words other than names

• Speaks in what sounds like an unknown language

• Follows directions that do not include a gesture

Motor

• Squats to pick up object

• Crawls up a few steps

• Runs

• Makes marks with crayon

• Drops object into and takes it out of a cup

At 18 months (72 weeks, or 1½ years)

Social

• Engages with others for play

• Helps dress and undress self

• Points to pictures in book or to object of interest to draw parent's attention to it

• Turns to look at adult if something new happens

• Begins to scoop with a spoon

• Uses words to ask for help

Language

• Identifies at least 2 body parts

• Names at least 5 familiar objects

Motor

• Walks up steps with 2 feet per step when hand is held

• Sits in a small chair

• Carries toy when walking

• Scribbles spontaneously

• Throws a small ball a few feet while standing

At 24 months (2 years)

Social

• Plays alongside other children

• Takes off some clothing

• Scoops well with a spoon

Language

• Uses at least 50 words

• Combines 2 words into short phrase or sentence

• Follows 2-part instructions

• Names at least 5 body parts

• Speaks in words that are about 50% understandable by strangers

Motor

• Kicks a ball

• Jumps off the ground with 2 feet

• Runs with coordination

• Climbs up a ladder at a playground

• Stacks objects

• Turns book pages

• Uses hands to turn objects such as knobs, toys or lids

• Draws lines

At 2½ years

Social

• Urinates in a potty or toilet

• Spears food with fork

• Washes and dries hands

• Increasingly engages in imaginary play

• Tries to get parents to watch by saying, "Look at me!"

Language

• Uses pronouns correctly

Motor

• Walks up steps, alternating feet

• Runs well without falling

• Copies a vertical line

• Grasps crayon with thumb and fingers instead of fist

• Catches large balls

At 3 years

Social

• Enters bathroom and urinates by themselves
  

• Puts on coat, jacket, or shirt without help

• Eats without help

• Engages in imaginative play

• Plays well with others and shares

Language

• Uses 3-word sentences

• Speaks in words that are understandable to strangers 75% of the time

• Tells you a story from a book or TV

• Compares things using words such as "bigger" or "shorter"
  

• Understands prepositions such as "on" or "under"
  

Motor

• Pedals a tricycle

• Climbs on and off couch or chair

• Jumps forward

• Draws a single circle

• Draws a person with head and 1 other body part

• Cuts with child scissors

At 4 years

Social

• Enters bathroom and has bowel movement by themselves
  

• Brushes teeth

• Dresses and undresses without much help

• Engages in well-developed imaginative play

• Language

• Answers questions such as "What do you do when you are cold?" or "What do you do when you are you sleepy?"

• Uses 4-word sentences

• Speaks in words that are 100% understandable to strangers

• Draws recognizable pictures

• Follows simple rules when playing a board or card game

• Tells parent a story from a book

Motor

• Hops on one foot

• Climbs stairs while alternating feet without help

• Draws a person with at least 3 body parts

• Draws a simple cross

• Unbuttons and buttons medium-sized buttons

• Grasps pencil with thumb and fingers instead of fist

At 5 and 6 years

Social

• Follows simple directions

• Dresses with little assistance

Language

• Has good language skills

• Can count to 10

• Names 4 or more colors

Motor

• Balances on one foot

• Hops and skips

• Is able to tie a knot

• Draws a person with at least 6 body parts

• Prints some letters and numbers

• Can copy a square and a triangle

At school age

Ongoing issues your child may face

As preterm babies get older, some of them may face ongoing physical problems (such as asthma or cerebral palsy). They may also face developmental challenges (such as difficulties paying attention or lack of motor control). This may be especially true for babies who were very small at birth.

Once your child reaches school age, it will be important for you to work closely with their teacher and other school staff to identify any areas of concern. They can also help you find the right resources for help.

If the school does not have the resources your child needs, their teachers can help you find local groups or programs to help them do well in school. Your child's teachers and health care team are dedicated to helping you meet all their health and educational needs.

All children will babble before they say real words. All children will pull up to a stand before they walk. We are sure that children will develop in these patterns. However, children can reach these stages in different ways and at different times. This is especially true if they were born preterm.

Your child's development

Take some time to think about your child's development and answer the following questions. Contact your child's doctor if you have any questions about your child's development.

• How does my child like to communicate?

• How do they let me know what they are thinking and feeling?

• How does my child like to explore how to use their body?

• Do they prefer using their fingers and hands (small muscles)?

• Does they prefer using their arms and legs (large muscles)?

• How does my child respond to new situations? (Does they jump right in? Do they prefer to hang back and look around before they feels safe?)
  

• How does my child like to explore?

• What kinds of objects and activities interest them? What do those interests tell me about them?

• What are my child's strengths?

• In what ways does my child need more support?
  

More information

• AAP Schedule of Well-Child Checkups
  

• Does My Child Have Physical Development Delays?