Was your baby born more than 3 weeks early? Read on for information from the American Academy of Pediatrics about developmental milestones for your preterm baby (also known as preemie).
Keep in mind that babies develop at their own speed and in their own way. However, parents of preterm babies will need to adjust their baby’s age to get a true sense of where their baby should be in his development.
Subtract the number of weeks your baby was born early from your baby’s actual age in weeks (number of weeks since the date of birth). This is your baby’s
|Actual Age||Weeks Born Early||Adjusted Age|
|3 weeks||5 weeks (1 month and 1 week)|
|4 weezks||12 weeks (3 months)|
|5 weeks||19 weeks (4 months and 3 weeks)|
Calculate your baby’s adjusted age.
|_________________ –||_____________________ =||___________________|
|Actual age||Weeks born early||Adjusted age|
NOTE: The number of months is based on a 4-week month. Also, by 2 years of age, most children have caught up to the typical milestone range. If your child has not caught up, he may need extra support for a longer period.
You know your child better than anyone else. Even with an adjusted age, you will want to see him move forward in his development. For example, your child should progress from pulling himself up, to standing, and then to walking. When you watch him carefully, you will see ways he is growing well. You will also know whether he needs more help.
Remember to take your child to his recommended well-child (health supervision) visits. At each visit, your child’s doctor will check his progress and ask you about the ways you see your child growing. See the next section, Developmental Milestones.
Here is information about how babies and young children typically develop. Examples of developmental milestones for ages 1 month to 6 years are listed. The developmental milestones are listed by month or year first because well-child visits are organized this way.
For a preterm baby, it is important to use the baby’s adjusted age when tracking development until 2 years of age so that his growth and progress take into account that he was born early.
What is your child’s adjusted age?______________________. See milestone for the adjusted age in the next section.
NOTE: Ask your baby’s doctor about Early Intervention (EI)—extra care some babies and children receive to help them develop.
Looks at parent; follows parent with eyes
Has self-comforting behaviors, such as bringing hands to mouth
Starts to become fussy when bored; calms when picked up or spoken to
Looks briefly at objects
Makes brief, short vowel sounds
Alerts to unexpected sound; quiets or turns to parent’s voice
Shows signs of sensitivity to environment (such as excessive crying, tremors, or excessive startles) or need for extra support to handle activities of daily living
Has different types of cries for hunger and tiredness
Moves both arms and both legs together
Holds chin up when on tummy
Opens fingers slightly when at rest
Makes sounds that show happiness or upset
Makes short cooing sounds
Opens and shuts hands
Briefly brings hands together
Lifts head and chest when lying on tummy
Keeps head steady when held in a sitting position
Looks for parent or another caregiver when upset
Turns to voices
Makes long cooing sounds
Supports self on elbows and wrists when on tummy
Rolls over from tummy to back
Keeps hands unfisted
Plays with fingers near middle of body
Pats or smiles at own reflection
Looks when name is called
Babbles, making sounds such as “da,” “ga,” “ba,” or “ka”
Sits briefly without support
Rolls over from back to tummy
Passes a toy from one hand to another
Rakes small objects with 4 fingers to pick them up
Bangs small objects on surface
Uses basic gestures (such as holding out arms to be picked up or waving bye-bye)
Looks for dropped objects
Plays games such as peekaboo and pat-a-cake
Turns consistently when name called
Says “Dada” or “Mama” nonspecifically
Looks around when hearing things such as “Where’s your bottle?” or “Where’s your blanket?”
Copies sounds that parent or caregiver makes
Sits well without support
Pulls to stand
Moves easily between sitting and lying
Crawls on hands and knees
Picks up food to eat
Picks up small objects with 3 fingers and thumb
Lets go of objects on purpose
Bangs objects together
Looks for hidden objects
Imitates new gestures
Uses “Dada” or “Mama” specifically
Uses 1 word other than
Follows directions with gestures, such as motioning and saying, “Give me (object).”
Takes first steps
Stands without support
Drops an object into a cup
Picks up small object with 1 finger and thumb
Picks up food to eat
Drinks from cup with little spilling
Points to ask something or get help
Looks around after hearing things such as “Where’s your ball?” or “Where’s your blanket?”
Uses 3 words other than names
Speaks in what sounds like an unknown language
Follows directions that do not include a gesture
Squats to pick up object
Crawls up a few steps
Makes marks with crayon
Drops object into and takes it out of a cup
Engages with others for play
Helps dress and undress self
Points to pictures in book or to object of interest to draw parent’s attention to it
Turns to look at adult if something new happens
Begins to scoop with a spoon
Uses words to ask for help
Identifies at least 2 body parts
Names at least 5 familiar objects
Walks up steps with 2 feet per step when hand is held
Sits in a small chair
Carries toy when walking
Throws a small ball a few feet while standing
Plays alongside other children
Takes off some clothing
Scoops well with a spoon
Uses at least 50 words
Combines 2 words into short phrase or sentence
Follows 2-part instructions
Names at least 5 body parts
Speaks in words that are about 50% understandable by strangers
Kicks a ball
Jumps off the ground with 2 feet
Runs with coordination
Climbs up a ladder at a playground
Turns book pages
Uses hands to turn objects such as knobs, toys, or lids
Urinates in a potty or toilet
Spears food with fork
Washes and dries hands
Increasingly engages in imaginary play
Tries to get parents to watch by saying, “Look at me!”
Uses pronouns correctly
Walks up steps, alternating feet
Runs well without falling
Copies a vertical line
Grasps crayon with thumb and fingers instead of fist
Catches large balls
Enters bathroom and urinates by herself
Puts on coat, jacket, or shirt without help
Eats without help
Engages in imaginative play
Plays well with others and shares
Uses 3-word sentences
Speaks in words that are understandable to strangers 75% of the time
Tells you a story from a book or TV
Compares things using words such as
Understands prepositions such as
Pedals a tricycle
Climbs on and off couch or chair
Draws a single circle
Draws a person with head and 1 other body part
Cuts with child scissors
Enters bathroom and has bowel movement by himself
Dresses and undresses without much help
Engages in well-developed imaginative play
Answers questions such as “What do you do when you are cold?” or “What do you do when you are you sleepy?”
Uses 4-word sentences
Speaks in words that are 100% understandable to strangers
Draws recognizable pictures
Follows simple rules when playing a board or card game
Tells parent a story from a book
Hops on one foot
Climbs stairs while alternating feet without help
Draws a person with at least 3 body parts
Draws a simple cross
Unbuttons and buttons medium-sized buttons
Grasps pencil with thumb and fingers instead of fist
Follows simple directions
Dresses with little assistance
Has good language skills
Can count to 10
Names 4 or more colors
Balances on one foot
Hops and skips
Is able to tie a knot
Draws a person with at least 6 body parts
Prints some letters and numbers
Can copy a square and a triangle
As preterm babies get older, some of them may face ongoing physical problems (such as asthma or cerebral palsy). They may also face developmental challenges (such as difficulties paying attention or lack of motor control). This may be especially true for babies who were very small at birth.
Once your child reaches school age, it will be important for you to work closely with his teacher and other school staff to identify any areas of concern. They can also help you find the right resources for help. If the school does not have the resources your child needs, his teachers can help you find local groups or programs to help him do well in school. You are not alone! Your child’s teachers and health care team are dedicated to helping you meet all his health and educational needs.
All children will babble before they say real words. All children will pull up to a stand before they walk. We are sure that children will develop in these patterns. However, children can reach these stages in different ways and at different times. This is especially true if they were born preterm. Take some time to think about your child’s development and answer the following questions. Contact your child’s doctor if you have any questions about your child’s development.
How does my child like to communicate?
How does he let me know what he is thinking and feeling?
How does my child like to explore how to use his body?
Does he prefer using his fingers and hands (small muscles)?
Does he prefer using his arms and legs (large muscles)?
How does my child respond to new situations?
Does he jump right in?
Does he prefer to hang back and look around before he feels safe?
How does my child like to explore?
What kinds of objects and activities interest him?
What do those interests tell me about him?
What are my child’s strengths?
In what ways does my child need more support?
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Developmental milestones are adapted from Hagan JF Jr, Shaw JS, Duncan PM, eds.