Child development milestones: what to expect at 18 and 24 months and when not to put off seeing a doctor

The US Centers for Disease Control and Prevention (CDC) publish age-based developmental milestones in its “Learn the Signs. Act Early” programme: for 2, 4, 6 and 9 months, 1 year, 15 and 18 months, 2 years and 30 months, and 3, 4 and 5 years. These lists show what a child can typically do at a given age. They help parents follow their child’s development and talk to a doctor in good time.

What to expect at 18 months

• Social and emotional development: moves away from you but checks that you are close by; points to interesting things; looks at a few pages of a book with you; helps with dressing (pushes an arm through a sleeve).
• Language and communication: tries to say three or more words besides “mama” and “dada”; follows a simple instruction without gestures, for example gives you a toy when asked: “Give it to me.”
• Cognition: copies adults doing chores, such as sweeping; plays with toys in a simple way, for example pushing a toy car.
• Movement: walks on their own without support; scribbles; drinks from a cup without a lid, sometimes spilling; eats with their fingers and tries to use a spoon; climbs on and off a couch or chair without help.

What to expect at 2 years

• Social and emotional development: notices when others are hurt or upset; looks at your face to see how to react in a new situation.
• Language and communication: points to things in a book when asked (“Where is the bear?”); says at least two words together, such as “more milk”; points to at least two body parts when asked; uses more gestures than just waving and pointing, for example blowing a kiss or nodding yes.
• Cognition: holds something in one hand while using the other (for example, holding a container and taking the lid off); tries to use switches, knobs or buttons on a toy; plays with more than one toy at the same time.
• Movement: kicks a ball, runs, walks (not climbs) up a few stairs with or without help, eats with a spoon.

When to act without delay

The CDC advises not to wait if a child has not reached one or more milestones, has lost skills they previously had, or you have other concerns. The steps are:

1. talk to the child’s doctor, share what worries you and ask about developmental screening;
2. if you or the doctor are still concerned, ask for a referral to a specialist for a more thorough evaluation;
3. find out whether early-support programmes are available (in the US these are the states’ early intervention programmes).

Milestones are not screening

The CDC materials themselves stress that they are not a substitute for standardised, validated developmental screening tools. According to the American Academy of Pediatrics’ recommendation (as cited by the CDC), general developmental screening is done at well-child visits at 9, 18 and 30 months, and autism-specific screening at 18 and 24 months; children at higher risk (for example, those born preterm, with low birth weight or with a sibling with autism) may need it more often. A screening result is not a diagnosis but a reason for a more thorough evaluation.

An important caveat: these are American benchmarks. In Ukraine the schedule of preventive check-ups is set by the paediatrician or family doctor, and any doubts are best discussed with them. Every child has their own pace, and a departure from the list does not in itself mean a problem, but it is a reason to talk to a doctor.

Sources

• CDC: Learn the Signs. Act Early — developmental milestones
• CDC: milestones at 18 months
• CDC: milestones at 2 years
• CDC: screening for autism spectrum disorder

This material is for information only and does not replace consultation with a doctor or psychologist. Self-medication can be harmful to your health.