Development
Month-by-month developmental milestones from 2-36 months, red flags to watch for, M-CHAT-R autism screening, and when to seek evaluation.
Developmental Milestones
| Age | Motor | Social | Language | Red Flags |
|---|---|---|---|---|
| 2 months | Holds head up briefly | Social smile | Coos, gurgling | No social smile, cannot hold head up |
| 4 months | Steady head, pushes up on elbows | Laughs, enjoys play | Babbles, copies sounds | No head control, no sounds |
| 6 months | Rolls both ways, sits with support | Knows familiar vs strangers | Responds to name, vowel strings | Does not reach, no affection |
| 9 months | Sits alone, crawls, pulls to stand | Clingy, favorite toys | Understands "no," copies gestures | Cannot sit, no peek-a-boo |
| 12 months | Pulls to stand, may walk | Cries when parent leaves | 1-3 words, "mama/dada" specifically | No babbling, no gestures |
| 18 months | Walks, climbs, drinks from cup | Simple pretend play | 6-20 words, points to body parts | Not walking, <6 words |
| 24 months | Runs, kicks ball, walks stairs | Parallel play, copies adults | 50+ words, 2-word phrases | No 2-word phrases, <50 words |
| 36 months | Pedals tricycle, runs easily | Takes turns, shows concern | Sentences, asks "why?", 200-1000 words | Unclear speech, no sentences |
M-CHAT-R Autism Screening
Administered at 18 and 24 month well-visits. 20 yes/no questions. Sensitivity ~85% for ASD, specificity ~99% with follow-up.
- Score 0-2: Low risk
- Score 3-7: Medium risk (administer follow-up)
- Score 8-20: High risk (refer immediately)
Key Screening Questions
- Does your child look at you when you call their name?
- Does your child point to ask for something or show you something interesting?
- Does your child play pretend (e.g., feed a doll)?
- Does your child follow where you look when you point?
- Does your child show interest in other children?