Introduction
Early childhood is a period of remarkable growth and development. From birth to age five, children acquire foundational skills across multiple domains that serve as building blocks for future learning and success. As an early childhood educator, your role in observing, supporting, and nurturing this development is crucial. This handbook aims to provide you with comprehensive information about developmental milestones, their significance, and practical strategies for supporting children’s development in educational settings.
Developmental milestones are skills or behaviors that most children can do by a certain age. These milestones serve as general guidelines to help track a child’s progress and identify potential developmental concerns. While each child develops at their own pace, understanding these common patterns and sequences of development enables educators to create appropriate learning environments, plan suitable activities, and identify children who may benefit from additional support or early intervention services.
This handbook reflects the most current understanding of child development, including the significant 2022 updates to developmental milestones by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). These updates represent the first major revision to developmental milestones in over 30 years and reflect our evolving understanding of typical child development.
As you navigate this handbook, remember that while milestones provide valuable benchmarks, each child’s developmental journey is unique. Children develop at different rates and in different patterns, influenced by a complex interplay of biological, environmental, and cultural factors. Your skilled observations, combined with the knowledge contained in this handbook, will help you support each child’s individual developmental path.
Understanding Developmental Milestones
Historical Context
The concept of developmental milestones has evolved significantly over time. Early theories of child development, such as those proposed by Jean Piaget, Lev Vygotsky, and Erik Erikson, laid the groundwork for understanding the predictable patterns of children’s growth and development. These pioneers recognized that development follows a relatively orderly sequence, with each new skill building upon previously acquired abilities.
In the United States, the formal monitoring of developmental milestones gained momentum in the mid-20th century. By the 1990s, the CDC established standardized developmental milestones as part of their “Learn the Signs. Act Early” campaign, designed to help parents and professionals track healthy child development and promote early identification of developmental concerns.
For decades, these milestones reflected the median or average age at which children typically achieved specific skills—essentially the 50th percentile, meaning that half of children would achieve the milestone earlier and half would achieve it later than the stated age. This approach provided a middle-ground reference point but had limitations in identifying children who might benefit from early intervention services.
The 2022 CDC-AAP Updates
In February 2022, the CDC and American Academy of Pediatrics (AAP) announced significant updates to developmental milestones—the first comprehensive revision in over 30 years. These changes were designed to address limitations in the previous milestone framework and improve early identification of developmental delays.
Key changes in the 2022 updates include:
Shift from 50th to 75th percentile benchmarks: Rather than representing what the average child can do (50th percentile), the new milestones indicate skills that most children (75%) can demonstrate at a given age. This change means that if a child is not meeting a milestone, there is a greater likelihood that further evaluation may be beneficial, as 75% of children their age typically can perform that skill.
Addition of new age checkpoints: The revised guidelines added milestone checklists for ages 15 and 30 months, filling important gaps in developmental monitoring.
Removal or adjustment of certain milestones:
Crawling was removed as a developmental milestone
Walking alone was moved from 12 months to 15 months
First words were moved from 12 months to 15 months
Expectations for sentence use by 2- and 3-year-olds were lowered
Clearer language: Vague descriptions like “is beginning to” or “is improving at” were replaced with more concrete, observable behaviors to make it easier to determine if a child has achieved a particular milestone.
Removal of “warning signs” framing: Rather than emphasizing negative indicators, the revised checklists focus on positive skills that children should be demonstrating, making discussions with families more constructive.
Purpose and Benefits
Developmental milestones serve several important purposes in early childhood education:
Providing a roadmap: Milestones offer a general sequence of development that helps educators understand what skills typically emerge when, allowing for appropriate expectations and planning.
Guiding curriculum and activity planning: Knowledge of developmental milestones enables educators to create age-appropriate and developmentally suitable learning experiences.
Informing observation and assessment: Milestones provide a framework for observing and documenting children’s progress across developmental domains.
Identifying potential concerns: Comparing a child’s development to established milestones can help identify when a child might benefit from additional support or evaluation.
Facilitating communication: Milestones provide a common language for discussing child development among educators, families, and other professionals.
Supporting early intervention: Early identification of developmental delays enables timely intervention, which research consistently shows leads to better outcomes for children.
For early childhood educators, understanding developmental milestones is essential for creating environments and experiences that appropriately challenge and support each child’s growth. This knowledge also helps educators recognize when development may not be following typical patterns, allowing for timely referrals and interventions that can significantly impact a child’s developmental trajectory.
Domains of Development
Child development is typically categorized into distinct but interconnected domains. Understanding these domains helps educators observe and support development comprehensively, recognizing that skills in one area often influence development in others. The major developmental domains include physical, cognitive, language, social-emotional, and adaptive/self-help skills.
Physical Development
Physical development encompasses both gross motor skills (large movements involving large muscle groups) and fine motor skills (smaller, more precise movements typically involving hand-eye coordination). This domain also includes sensory development and overall physical growth.
Gross Motor Development
Gross motor skills involve the large muscles of the body and include abilities such as rolling over, sitting up, crawling, walking, running, jumping, and climbing. These skills develop in a predictable sequence, generally progressing from head to toe (cephalocaudal) and from the center of the body outward (proximodistal). For example, babies first gain control of their head and neck before they can control their trunk and limbs.
The development of gross motor skills enables children to explore their environment, engage in physical play, and participate in social activities. These skills are fundamental for later physical activities, sports, and even classroom behaviors like sitting attentively during group time.
Fine Motor Development
Fine motor skills involve the coordination of small muscles, particularly those in the hands and fingers, often in coordination with the eyes. These skills include reaching, grasping, manipulating objects, drawing, cutting, and eventually writing. Like gross motor skills, fine motor development follows a predictable sequence, generally developing from reflexive grasping to precise manipulation.
Fine motor skills are essential for daily activities such as feeding, dressing, and personal hygiene, as well as for academic tasks like writing, drawing, and using tools. In early childhood classrooms, activities that promote fine motor development include manipulating small objects, stringing beads, using scissors, drawing, painting, and building with blocks.
Sensory Development
Sensory development refers to the refinement of the five basic senses (sight, hearing, touch, taste, and smell) as well as proprioception (awareness of body position) and vestibular sense (balance and spatial orientation). Sensory development begins in utero and continues to develop rapidly during early childhood.
Sensory experiences provide essential information about the world and form the foundation for learning. Children learn through sensory exploration, which influences cognitive, language, and social-emotional development. Early childhood environments should offer rich sensory experiences across all sensory systems.
Cognitive Development
Cognitive development encompasses the acquisition of thinking, problem-solving, memory, attention, and conceptual understanding. This domain includes the development of intellectual abilities, conceptual knowledge, and learning processes.
Cognitive Milestones
Cognitive milestones include achievements such as object permanence (understanding that objects continue to exist even when out of sight), cause-and-effect understanding, classification skills, number concepts, spatial awareness, and symbolic thinking. Jean Piaget’s theory of cognitive development outlines four major stages: sensorimotor (birth to 2 years), preoperational (2 to 7 years), concrete operational (7 to 11 years), and formal operational (11 years and beyond).
In early childhood classrooms, cognitive development is supported through activities that encourage exploration, problem-solving, experimentation, and discovery. Materials such as puzzles, sorting games, building blocks, and science experiments promote cognitive skills.
Executive Function
Executive function skills include working memory, inhibitory control, and cognitive flexibility. These skills enable children to remember and follow multi-step instructions, control impulses, focus attention, and adapt to changing situations. Executive function skills develop rapidly during the preschool years and are strong predictors of school readiness and later academic success.
Educators can support executive function development through activities that require planning, problem-solving, turn-taking, and self-regulation. Games like “Simon Says,” activities with rules that change, and projects that require multiple steps all promote executive function skills.
Language Development
Language development encompasses both receptive language (understanding) and expressive language (speaking). This domain includes vocabulary acquisition, grammar development, conversational skills, and eventually, literacy skills.
Receptive Language
Receptive language refers to the ability to understand spoken language. Development begins with an infant’s recognition of familiar voices and progresses to understanding simple words, following directions, and comprehending increasingly complex language structures. By preschool age, children can typically understand complex sentences, follow multi-step directions, and grasp abstract language concepts like time and emotions.
Expressive Language
Expressive language refers to the ability to communicate through spoken language. This progression typically moves from cooing and babbling in infancy to first words around 12-15 months, two-word combinations by 18-24 months, and increasingly complex sentences during the preschool years. The 2022 CDC-AAP updates notably shifted some language milestones to later ages, including moving first words from 12 to 15 months and reducing expectations for sentence complexity in toddlers and preschoolers.
Literacy Development
Emergent literacy skills develop alongside oral language and include phonological awareness (recognizing and manipulating speech sounds), print awareness (understanding that print carries meaning), letter knowledge, and eventually reading and writing. These skills begin developing long before formal reading instruction, through experiences with books, songs, rhymes, and print in the environment.
In early childhood settings, language development is supported through rich conversations, book reading, storytelling, songs, rhymes, dramatic play, and print-rich environments. Educators play a crucial role in modeling language, expanding children’s utterances, asking open-ended questions, and creating opportunities for meaningful communication.
Social-Emotional Development
Social-emotional development encompasses the ability to understand and manage emotions, develop positive relationships, and function effectively in social contexts. This domain includes attachment, self-concept, emotional regulation, social skills, and moral development.
Attachment and Relationships
Secure attachment relationships with primary caregivers provide the foundation for social-emotional development. From these early relationships, children develop trust, security, and a model for future relationships. In early childhood settings, consistent, responsive caregiving helps children build secure relationships with educators.
Self-Concept and Identity
Self-concept refers to a child’s understanding of themselves as individuals with unique characteristics, abilities, and preferences. Identity development includes awareness of personal attributes such as gender, cultural background, and abilities. These aspects of development emerge gradually during early childhood as children explore who they are and how they relate to others.
Emotional Regulation
Emotional regulation refers to the ability to recognize, express, and manage emotions appropriately. This skill develops gradually, from the complete dependence on caregivers for regulation in infancy to increasing self-regulation in the preschool years. The development of language plays a crucial role in emotional regulation, as it gives children tools to express and process their feelings.
Social Skills
Social skills include abilities such as sharing, taking turns, cooperating, resolving conflicts, and understanding social norms. These skills develop through interactions with adults and peers and are essential for successful functioning in group settings like preschool and kindergarten.
In early childhood classrooms, social-emotional development is supported through secure teacher-child relationships, predictable routines, explicit teaching of emotional vocabulary and regulation strategies, opportunities for collaborative play, and guidance in resolving conflicts. Social-emotional learning is increasingly recognized as a crucial component of early education, laying the groundwork for mental health, positive relationships, and academic success.
Adaptive/Self-Help Skills
Adaptive or self-help skills refer to the practical skills needed for daily living and self-care. These include feeding, dressing, toileting, personal hygiene, and eventually more complex skills like helping with chores, managing belongings, and following safety rules.
Self-Care Milestones
Self-care milestones include achievements such as self-feeding with fingers (8-12 months), using utensils (15-18 months), helping with dressing (18-24 months), toilet training (typically between 2-4 years), and increasingly independent hygiene routines during the preschool years. The 2022 CDC-AAP updates specifically highlight self-care skills in the preschool checklists, including abilities like serving food, pouring water, and managing buttons by age 4.
Independence and Responsibility
As children develop, they become increasingly capable of taking responsibility for their needs and contributing to their community. Preschoolers can typically manage simple chores, care for personal belongings, follow multi-step routines, and understand basic safety rules.
In early childhood settings, adaptive skills are supported through consistent routines, opportunities for self-help, appropriate expectations, and specific teaching of self-care sequences. Educators can scaffold these skills by breaking tasks into manageable steps, providing visual cues, offering just enough support for success, and acknowledging children’s efforts and accomplishments.
Understanding these domains provides a framework for observing and supporting children’s holistic development. While presented separately for clarity, these domains are deeply interconnected in real development. For example, fine motor skills enable self-feeding (adaptive), which often occurs in social contexts (social-emotional), involves understanding tools and their functions (cognitive), and provides opportunities for language development (“more please,” naming foods). Effective early childhood education addresses all domains in an integrated, meaningful way.
Developmental Milestones by Age
The following sections outline key developmental milestones by age group, reflecting the most current guidelines including the 2022 CDC-AAP updates. Remember that these milestones represent skills that approximately 75% of children can demonstrate at a given age, not expectations for all children. Individual development varies based on many factors, and children may reach milestones earlier or later while still developing typically.
Infants (0-12 months)
The first year of life is characterized by rapid development across all domains. Infants progress from complete dependence to emerging mobility, communication, and social engagement.
2 Months
Physical: Holds head up when on tummy; moves both arms and legs; opens hands briefly
Cognitive: Pays attention to faces; begins to follow things with eyes
Language: Makes sounds other than crying; turns head toward sounds
Social-Emotional: Smiles at people; calms self briefly (might bring hands to mouth)
Adaptive: Sucks well during feeding
4 Months
Physical: Holds head steady without support; pushes up onto elbows when on tummy; brings hands to mouth
Cognitive: Follows moving objects with eyes; shows interest in faces; responds to affection
Language: Begins to babble; copies some sounds; responds to sounds
Social-Emotional: Smiles spontaneously, especially at people; enjoys social play
Adaptive: Begins reaching for toys with one hand; shows anticipation of feeding
6 Months
Physical: Rolls from front to back; begins to sit without support; supports weight on legs when standing with help
Cognitive: Looks around at things nearby; brings objects to mouth; shows curiosity about things
Language: Responds to sounds by making sounds; makes different sounds like “ba,” “ma,” “da”
Social-Emotional: Knows familiar faces; enjoys looking at self in mirror; responds to others’ emotions
Adaptive: Begins to eat solid foods; rakes small objects with hand
9 Months
Physical: Sits without support; gets into sitting position; pulls to stand; stands holding on
Cognitive: Watches path of something as it falls; looks for things hidden from view; transfers objects from hand to hand
Language: Understands “no”; copies sounds and gestures of others; uses fingers to point
Social-Emotional: May be afraid of strangers; has favorite toys; plays peek-a-boo
Adaptive: Eats with fingers; helps hold bottle; drinks from a cup with help
12 Months
Physical: Pulls up to stand; walks holding on to furniture (“cruising”); may take a few steps without holding on
Cognitive: Puts objects in containers; follows simple directions; explores objects in different ways
Language: Responds to simple verbal requests; uses simple gestures like shaking head “no” or waving “bye-bye”; tries to say words
Social-Emotional: Plays games such as peek-a-boo and pat-a-cake; is shy or anxious with strangers; cries when parent leaves
Adaptive: Helps with dressing; drinks from a cup; may use a spoon with help
Toddlers (1-3 years)
The toddler years are marked by emerging independence, rapidly developing language, and increasingly complex social interactions. Note that the 2022 updates added a 15-month and 30-month checkpoint, recognizing these as important transitional periods.
15 Months
Physical: Walks alone; can walk up steps with help; scribbles with crayon or pencil
Cognitive: Explores objects in many ways; finds hidden objects easily; follows one-step directions
Language: Says several single words; points to ask for something or get help; points to get attention of others
Social-Emotional: Shows affection to familiar people; plays simple pretend games; explores alone but with parent close by
Adaptive: Feeds self with fingers; takes off some clothes with help; holds and drinks from cup
18 Months
Physical: Walks without help; pulls toys while walking; carries large toys while walking
Cognitive: Knows what ordinary objects are for (telephone, brush, spoon); points to get others’ attention; shows interest in a doll or stuffed animal by pretending to feed
Language: Says several single words; says “no” and shakes head; points to show someone what they want
Social-Emotional: Plays simple pretend with dolls; may have temper tantrums; shows increasing independence
Adaptive: Feeds self with spoon; drinks from cup with minimal spilling; helps undress; may show interest in toilet
24 Months (2 Years)
Physical: Stands on tiptoes; kicks a ball; begins to run; climbs onto and down from furniture
Cognitive: Finds things even when hidden under two or three covers; sorts by shapes and colors; completes sentences and rhymes in familiar books
Language: Uses 2-word phrases (“more milk”); points to things or pictures when named; knows names of familiar people and body parts
Social-Emotional: Copies others, especially adults and older children; shows increasing excitement with children; shows defiant behavior
Adaptive: Uses spoon and fork; helps with simple household tasks; removes some clothing items
30 Months
Physical: Jumps with both feet; uses hands to twist things (doorknobs, lids); climbs well
Cognitive: Uses objects in pretend play; understands “one” and “two”; follows 2-step instructions
Language: Says about 50 words; uses 2-3 word sentences; follows simple instructions; understands most of what is said to them
Social-Emotional: Takes turns in games; shows concern for crying friend; engages in make-believe play
Adaptive: Helps put things away; pulls pants up with assistance; washes and dries hands with assistance
36 Months (3 Years)
Physical: Climbs well; runs easily; pedals a tricycle; walks up and down stairs, one foot on each step
Cognitive: Completes puzzles with 3 or 4 pieces; plays make-believe with dolls, animals, and people; understands what “two” means
Language: Follows instructions with 2 or 3 steps; can name most familiar things; understands words like “in,” “on,” and “under”; says first name, age, and sex
Social-Emotional: Shows affection for friends without prompting; takes turns in games; shows concern for a crying friend; dresses and undresses self
Adaptive: Uses spoon, fork, and sometimes a table knife; uses toilet with some help; helps dress and undress self
Preschoolers (3-5 years)
The preschool years are characterized by dramatic growth in independence, imagination, language complexity, and social skills. Children develop foundational academic concepts and increasingly sophisticated physical abilities.
4 Years
Physical: Hops and stands on one foot for up to 2 seconds; catches a bounced ball most of the time; pours, cuts with supervision, and mashes own food
Cognitive: Names some colors and numbers; understands counting; remembers parts of a story; understands “same” and “different”
Language: Tells stories; says first and last name; sings a song or recites a poem from memory; speaks clearly enough for strangers to understand
Social-Emotional: Enjoys doing new things; plays “Mom” and “Dad”; is increasingly creative with make-believe play; would rather play with other children than alone
Adaptive: Uses fork and spoon independently; serves self food with supervision; buttons some buttons; unbuttons some buttons; holds crayon or pencil between fingers and thumb (not fist)
5 Years
Physical: Stands on one foot for 10 seconds or longer; hops, somersaults, swings, climbs; uses fork, spoon, and sometimes table knife; uses toilet independently
Cognitive: Counts 10 or more objects; names some letters when pointed to; copies geometric shapes; knows about everyday items like money and food
Language: Speaks very clearly; tells a simple story using full sentences; uses future tense; says name and address; uses or recognizes simple rhymes
Social-Emotional: Wants to please friends; wants to be like friends; more likely to agree with rules; likes to sing, dance, and act; shows more independence
Adaptive: Gets dressed and undressed independently; brushes teeth independently; can take care of own toilet needs
These milestone charts provide a framework for understanding typical development. However, they should be used as general guidelines, not rigid expectations. Each child’s developmental path is unique, influenced by individual temperament, experiences, and environmental factors.
Observing and Documenting Development
Skilled observation is at the heart of effective early childhood education. By systematically observing and documenting children’s development, educators can gain insights into each child’s progress, plan appropriate learning experiences, and identify potential concerns.
Observation Techniques
Effective developmental observation involves multiple approaches:
Naturalistic Observation
Naturalistic observation involves watching children during their regular activities without intervening. This approach provides authentic information about what children can do independently in everyday contexts. When conducting naturalistic observations:
Observe during different times of day and in various settings (indoor play, outdoor play, mealtimes, transitions)
Watch for spontaneous behaviors rather than prompted responses
Take note of the context, including materials, other people present, and environmental factors
Record observations objectively, separating descriptions from interpretations
Structured Observation
Structured observation involves creating specific opportunities to observe particular skills or behaviors. This might include:
Setting up activities designed to elicit certain skills (e.g., a puzzle to observe fine motor and problem-solving skills)
Using developmental checklists to guide observation
Asking the child to perform specific tasks (e.g., “Can you show me how you jump?”)
Conducting planned observations of all children across the same activities
Participant Observation
As a teacher, you are often a participant in the activities you’re observing. This approach allows you to:
Engage naturally with children while observing their responses
Scaffold skills to see what a child can do with support
Ask questions to probe understanding
Observe social interactions from within
Documentation Methods
Systematic documentation of observations is essential for tracking development and planning effectively:
Anecdotal Records
Anecdotal records are brief, objective notes about significant incidents or behaviors. Effective anecdotal records:
Include the date, time, and context
Focus on objective descriptions of what the child did and said
Are recorded soon after the observation to ensure accuracy
Include direct quotes when possible
Avoid interpretations, judgments, or assumptions
Checklists and Rating Scales
Developmental checklists, like those provided by the CDC, can help organize observations and ensure comprehensive coverage of all developmental domains. When using checklists:
Select tools that align with current research and standards
Complete checklists based on multiple observations over time
Remember that checklists are screening tools, not diagnostic instruments
Use checklists as one part of a comprehensive assessment approach
Work Samples
Children’s work provides concrete evidence of their skills and development. Collect:
Drawings and writing samples
Photos of block structures, art projects, or other creations
Recordings of language, singing, or storytelling
Examples showing progression over time
Photo and Video Documentation
Visual documentation captures moments that might be missed in written notes:
Take photos or videos of children engaged in significant activities
Use photos to document physical skills, social interactions, and engagement
Create photo sequences showing steps in a process
Ensure proper permission for taking and using photos/videos
Learning Stories
Learning stories are narrative accounts that describe significant learning episodes. These stories:
Focus on the child’s strengths and interests
Document learning processes, not just outcomes
Include the child’s perspective when possible
Connect observations to developmental theory and learning goals
Using Checklists and Tools
The CDC’s “Learn the Signs. Act Early” program offers free resources for monitoring development, including:
Milestone Checklists
The updated CDC milestone checklists reflect the 2022 revisions and are available for ages 2 months through 5 years. These checklists:
Focus on skills that 75% of children can do by a certain age
Use clear, concrete language to describe observable behaviors
Include parent-friendly tips for supporting development
Are available in multiple languages
Milestone Tracker App
The CDC’s free Milestone Tracker app allows educators and parents to:
Complete checklists for children at different ages
Track development over time
Get activities to support development
Share results with healthcare providers or other professionals
Other Assessment Tools
In addition to CDC resources, early childhood educators may use:
Curriculum-based assessments that align with your program’s curriculum
Standardized tools like the Ages and Stages Questionnaire (ASQ)
Program-specific observation systems (e.g., Teaching Strategies GOLD, High Scope COR)
State-specific early learning assessment systems
When documenting development, consider these best practices:
Observe regularly and systematically across all developmental domains
Use multiple methods to gather a comprehensive picture
Document both strengths and areas for growth
Note patterns over time, not just isolated incidents
Consider the context and environmental influences
Include multiple perspectives (different staff members, family input)
Maintain confidentiality and follow ethical guidelines
Use documentation to inform planning and individualize support
Effective observation and documentation systems help educators understand each child’s unique developmental profile, communicate clearly with families, design appropriate learning experiences, and identify when additional support may be needed.
Recognizing Potential Concerns
While development varies among children, certain patterns may signal the need for further evaluation. Early identification of developmental concerns is crucial, as early intervention can significantly improve outcomes.
Red Flags by Age
The following signs may indicate the need for further assessment. Note that a single red flag does not necessarily indicate a developmental delay or disorder—look for patterns and multiple indicators.
By 6 months
Doesn’t try to get objects that are within reach
Shows no affection for caregivers
Doesn’t respond to sounds around them
Doesn’t make vowel sounds (“ah,” “oh,” “ee”)
Doesn’t laugh or make squealing sounds
Seems very stiff or very floppy
By 12 months
Doesn’t crawl
Can’t stand when supported
Doesn’t search for objects that are hidden while they watch
Doesn’t use gestures such as waving or shaking head
Doesn’t say “mama” or “dada”
Doesn’t learn gestures like waving or shaking head
By 18 months
Can’t walk
Doesn’t point to show things to others
Doesn’t know what familiar objects are for
Doesn’t imitate others
Doesn’t gain new words
Doesn’t have at least 6 words
Doesn’t notice or mind when a caregiver leaves or returns
By 24 months (2 years)
Doesn’t use 2-word phrases (e.g., “drink milk”)
Doesn’t know what to do with common objects like a brush, phone, fork, or spoon
Doesn’t copy actions and words
Doesn’t follow simple instructions
Doesn’t walk steadily
Loses skills they once had
By 36 months (3 years)
Falls down a lot or has trouble with stairs
Drools or has very unclear speech
Can’t work simple toys with moving parts
Doesn’t use sentences of more than 3 words
Doesn’t understand simple instructions
Doesn’t engage in pretend play
Doesn’t want to play with other children or with toys
Makes poor eye contact
Loses skills they once had
By 4 years
Can’t jump in place
Has trouble scribbling
Shows no interest in interactive games or make-believe
Ignores other children or doesn’t respond to people outside the family
Resists dressing, sleeping, and using the toilet
Can’t retell a favorite story
Doesn’t follow 3-part commands
Doesn’t understand “same” and “different”
Loses skills they once had
By 5 years
Can’t brush teeth, wash and dry hands, or get undressed without help
Doesn’t draw pictures
Doesn’t talk about daily activities or experiences
Doesn’t use plurals or past tense properly
Doesn’t play a variety of games and activities
Can’t give first and last name
Doesn’t respond to name when called
Loses skills they once had
General Red Flags at Any Age
Loss of previously acquired skills (regression)
Lack of response to name by 12 months
Extreme difficulty calming down
Unusual body movements (e.g., hand flapping, rocking)
Persistent difficulty with social interaction
Unusual or limited play patterns
Extreme distress with changes in routines
Excessive sensitivity to sensory input (sounds, textures, etc.)
When to Recommend Further Evaluation
As an early childhood educator, you are often one of the first professionals to notice potential developmental concerns. The decision to recommend further evaluation should be based on:
Consistent observations of developmental concerns across multiple contexts and times
Comparison to typical development using reliable resources like the CDC milestone checklists
Multiple red flags rather than a single isolated concern
Developmental patterns that show significant delays in one or more domains
Regression or loss of previously acquired skills
Functional impact on the child’s ability to participate in daily activities
When concerns arise:
Document observations specifically and objectively
Consult with colleagues or supervisors for additional perspectives
Review developmental checklists to clarify expectations
Consider environmental factors that might influence behavior (recent changes, stressors, cultural differences)
Prepare for a family conference with specific examples and resources
Remember that your role is not to diagnose but to share observations and support families in accessing appropriate resources. The updated CDC milestones, which reflect the 75th percentile rather than the 50th, are designed to reduce the “wait and see” approach that can delay intervention.
