Your Preemie's Growth: Developmental Milestones

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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).

Adjusted Age

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.

Here's what to do.

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 adjusted age (also called corrected age).

Examples of Adjusted Ages

Actual AgeWeeks Born EarlyAdjusted Age

8 weeks

(2 months)

3 weeks5 weeks (1 month and 1 week)

16 weeks

(4 months)

4 weezks12 weeks (3 months)

24 weeks

(6 months)

5 weeks19 weeks (4 months and 3 weeks)

Calculate your baby's adjusted age.

_________________ -_____________________ =___________________
Actual ageWeeks born earlyAdjusted 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.

Your Child's Progress

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.

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.

At 1 Month (4 Weeks)


  • 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

At 2 Months (8 Weeks)


  • Smiles responsively

  • 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

At 4 Months (16 Weeks)


  • Laughs aloud

  • 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

  • Grasps objects

At 6 Months (24 Weeks)


  • 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

At 9 Months (36 Weeks)


  • 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

At 12 Months (48 Weeks, or 1 Year)


  • Looks for hidden objects

  • Imitates new gestures


  • Uses "Dada" or "Mama" specifically

  • Uses 1 word other than Mama,Dada, or a personal name

  • 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

At 15 Months (60 Weeks, or 1 Years)


  • Imitates scribbling

  • 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

  • Runs

  • Makes marks with crayon

  • Drops object into and takes it out of a cup

At 18 Months (72 Weeks, or 1½ Years)


  • 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

  • Scribbles spontaneously

  • Throws a small ball a few feet while standing

At 24 Months (2 Years)


  • 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

  • Stacks objects

  • Turns book pages

  • Uses hands to turn objects such as knobs, toys, or lids

  • Draws lines

At 2½ Years


  • 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

At 3 Years


  • 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 bigger or shorter

  • Understands prepositions such as on or under


  • Pedals a tricycle

  • Climbs on and off couch or chair

  • Jumps forward

  • Draws a single circle

  • Draws a person with head and 1 other body part

  • Cuts with child scissors

At 4 Years


  • Enters bathroom and has bowel movement by himself

  • Brushes teeth

  • 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

At 5 and 6 Years


  • 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

At School Age

Ongoing Issues Your Child May Face

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.

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. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents [pocket guide]. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.

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