Table 31.1-2
Landmarks of Normal Behavioral Development
Age
Motor and Sensory Behavior
Adaptive Behavior
Personal and Social Behavior
Birth to
4 wks
Hand-to-mouth reflex, grasping reflex
Rooting reflex (puckering lips in response
to perioral stimulation), Moro reflex
(digital extension when startled),
sucking reflex, Babinski reflex (toes
spread when sole of foot is touched)
Anticipatory feeding-approach
behavior at 4 days
Responds to sound of rattle
and bell
Regards moving objects
momentarily
Responsiveness to mother’s face, eyes, and
voice within first few hours of life
Endogenous smile
Independent play (until 2 years)
Quiets when picked up
Impassive face
Differentiates sounds (orients to human
voice) and sweet and sour tastes
Visual tracking
Fixed focal distance of 8 inches
Makes alternating crawling movements
Moves head laterally when placed in
prone position
4 wks
Tonic neck reflex positions predominate
Hands fisted
Head sags but can hold head erect for a
few seconds
Visual fixation, stereoscopic vision
(12 weeks)
Follows moving objects to the
midline
Shows no interest and drops
object immediately
Regards face and diminishes activity
Responds to speech
Smiles preferentially to mother
16 wks
Symmetrical postures predominate
Holds head balanced
Head lifted 90
°
when prone on forearm
Visual accommodation
Follows a slowly moving
object well
Arms activate on sight of
dangling object
Spontaneous social smile (exogenous)
Aware of strange situations
28 wks
Sits steadily, leaning forward on hands
Bounces actively when placed in
standing position
One-hand approach and grasp
of toy
Bangs and shakes rattle
Transfers toys
Takes feet to mouth
Pats mirror image
Starts to imitate mother’s sounds and actions
40 wks
Sits alone with good coordination
Creeps
Pulls self to standing position
Points with index finger
Matches two objects at
midline
Attempts to imitate scribble
Separation anxiety manifest when taken
away from mother
Responds to social play, such as pat-a-cake
and peek-a-boo
Feeds self cracker and holds own bottle
52 wks
Walks with one hand held
Stands alone briefly
Seeks novelty
Cooperates in dressing
15 mos
Toddles
Creeps up stairs
Points or vocalizes wants
Throws objects in play or refusal
18 mos
Coordinated walking, seldom falls
Hurls ball
Walks up stairs with one hand held
Builds a tower of three or four
cubes
Scribbles spontaneously and
imitates a writing stroke
Feeds self in part, spills
Pulls toy on string
Carries or hugs a special toy, such as a doll
Imitates some behavioral patterns with slight
delay
2 yrs
Runs well, no falling
Kicks large ball
Goes up and down stairs alone
Fine motor skills increase
Builds a tower of six or seven
cubes
Aligns cubes, imitating train
Imitates vertical and circular
strokes
Develops original behaviors
Pulls on simple garment
Domestic mimicry
Refers to self by name
Says “no” to mother
Separation anxiety begins to diminish
Organized demonstrations of love and protest
Parallel play (plays side by side but does not
interact with other children)
3 yrs
Rides tricycle
Jumps from bottom steps
Alternates feet going up stairs
Builds tower of 9 or 10 cubes
Imitates a three-cube bridge
Copies a circle and a cross
Puts on shoes
Unbuttons buttons
Feeds self well
Understands taking turns
4 yrs
Walks down stairs one step to a tread
Stands on one foot for 5 to 8 seconds
Copies a cross
Repeats four digits
Counts three objects with
correct pointing
Washes and dries own face
Brushes teeth
Associative or joint play (plays cooperatively
with other children)
5 yrs
Skips, using feet alternately
Usually has complete sphincter control
Fine coordination improves
Copies a square
Draws a recognizable person
with a head, a body, and
limbs
Counts 10 objects accurately
Dresses and undresses self
Prints a few letters
Plays competitive exercise games
6 yrs
Rides two-wheel bicycle
Prints name
Copies triangle
Ties shoelaces
(Adapted from Arnold Gessell, M.D., and Stella Chess, M.D.)
