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Written by Dr. Shilpa Reddy T, MBBS, DNB Pediatrics, IDPCCM — Consultant Paediatrician & Paediatric Critical Care Specialist, Tiny Totz Kids Clinic, Puppalaguda, Hyderabad
Every parent watches their baby closely, looking for signs of growth and development. And every parent worries at some point: my baby isn't doing what other babies seem to be doing — is something wrong?
Developmental milestones are markers — expectations that most children achieve within a certain window. A milestone listed at 6 months does not mean a child is delayed if they achieve it at 6.5 months. But milestones that are significantly late, absent, or regressing do need prompt attention. Here is what to watch for, age by age, across the first two years.
ℹ Red flag: No social smile by 3 months. No alerting to sound. Head that flops completely with no muscle tone when supported. Warrant immediate paediatric assessment.
ℹ Red flag: Not rolling by 6 months. Not reaching for objects. No babbling. Does not respond to voices or familiar faces.
ℹ Red flag: Not sitting without support by 9 months. No pincer grasp developing. Not responding to name. No babbling.
ℹ Red flag: No words at all by 12 months. Not pulling to stand. No pointing or waving. No joint attention — not looking where others point.
ℹ Red flag: No single words by 18 months. Not walking independently by 18 months. No meaningful imitation. No pointing to body parts named by an adult.
ℹ Red flag: No two-word combinations by 24 months. Fewer than 20 meaningful words. Not running. Any regression — loss of previously acquired skills at any age — is ALWAYS a red flag requiring immediate evaluation.
Regression — the loss of a skill a child has already achieved — is always a reason for immediate evaluation, at any age. A child who was saying 10 words and stops speaking, a child who walked independently and stops walking, a child who was interactive and becomes withdrawn — these are never 'phases'. They warrant same-week paediatric assessment.
I assess developmental milestones at every well-child visit — scheduled at 1, 2, 4, 6, 9, 12, 15, 18, and 24 months. These visits exist so any delay is caught early, when intervention is most effective.
Early intervention — speech therapy, physiotherapy, occupational therapy — is dramatically more effective at 18 months than at 3 years. If you have any concern about your child's development between scheduled visits, do not wait for the next appointment. Come in. Monday to Friday, 6:00 PM to 9:00 PM, Tiny Totz Kids Clinic, Puppalaguda. +91 7815933120.
1. My child was born premature. Should I use the same milestones?
No. Premature children's milestones are assessed using corrected age — calculated from the original due date, not the birth date — until 24 months. Always mention prematurity to your paediatrician.
2. My child is 15 months and not walking yet. Should I be worried?
The normal range for independent walking is 9 to 18 months. At 15 months, if your child is pulling to stand and cruising along furniture — reassuring. If not pulling to stand at all by 15 months — a paediatric assessment is appropriate.
3. My toddler uses few words but seems to understand everything. Is that normal?
Receptive language developing ahead of expressive is common. However, fewer than 20 words by 24 months or no two-word combinations by 24 months is below the expected range — warrants assessment even if understanding seems intact. Start with a hearing test.
4. Is screen time causing my child's speech delay?
Excessive screen time displaces the interactive verbal interaction that drives language development. Significantly limit screen time: none before 18 months, limited and co-viewed after 2 years per IAP guidance. It is not the only cause of speech delay, but it is a modifiable contributing factor.
