Child Development by Age: Milestones and When to Be Concerned

Every parent has wondered at some point: "Is it normal that my child isn't talking yet? Not walking? Not playing with other children?" Developmental milestones are not rigid deadlines but ranges within which most children acquire particular skills. But some delays do warrant specialist attention. This article will help you understand what's within the normal range, what isn't, and when to see a doctor.

Developmental milestones: what a child should be able to do at 1, 2, and 3 years

The following are approximate norms. Importantly, children develop differently, and a slight delay in one area with good development in others is not cause for alarm. Reasons to see a doctor include a combination of several delays or regression (loss of previously acquired skills).

By 12 months (1 year), a child typically:

walks with support or independently (normal range up to 15–18 months);
says 1–3 meaningful words ("mama", "give", "no");
understands simple instructions ("give it to me", "come here");
points at objects of interest;
responds to their own name;
plays peek-a-boo, waves goodbye.

Concerning signs at 12 months: no babbling; no pointing; no response to name; no eye contact.

By 24 months (2 years), a child typically:

walks confidently, climbs stairs;
uses at least 50 words and begins to form 2-word phrases ("mummy give", "big car");
understands simple two-step instructions ("pick up the ball and bring it to me");
engages in simple pretend play (feeding a doll, putting it to sleep);
shows interest in other children.

Concerning signs at 24 months: vocabulary below 50 words; no 2-word phrases; doesn't understand simple instructions; loss of previously acquired words.

By 36 months (3 years), a child typically:

speaks in 3–4 word sentences; speech is understood by strangers about 75% of the time;
knows their name, age, and gender;
plays with other children (not just alongside them);
dresses with minimal help;
understands concepts like "big/small", "more/less".

Speech delay: when to be concerned

Speech delay is one of the most common reasons for referral to a neurologist or speech therapist. It's important to distinguish between two concepts:

Speech delay — the child is developing along the same trajectory as peers but more slowly. Intelligence and comprehension of speech are intact.
Language disorder — impairment affecting all components of language: sounds, vocabulary, grammar. Requires specialist intervention.

When to definitely see a specialist:

no babbling and no pointing at 12 months;
no single words at 16 months;
no 2-word phrases at 24 months;
at any age — loss of previously acquired speech skills;
the child doesn't respond to their name or doesn't understand simple instructions.

"Late talker" is not always a pathology. Around 15% of children are late talkers, and many catch up with peers by age 3–4. But without specialist assessment, you can't be sure this is the case. Early intervention significantly improves outcomes.

Early signs of autism

Autism spectrum disorder (ASD) is a neurodevelopmental condition in which social interaction, communication, and behaviour are affected. Signs may be noticeable as early as 12–18 months, though diagnosis is usually made later.

Early signs warranting specialist assessment:

No joint attention — the child doesn't follow an adult's gaze or pointing; doesn't point to show something interesting.
Little or no eye contact — doesn't look at faces during interaction.
No response to name — after 12 months.
No social smile — doesn't smile in response to an adult's smile.
Repetitive movements — hand-flapping, rocking, toe-walking, spinning objects.
Very narrow interests — intense preoccupation with a single object or topic.
Strong reaction to change — marked distress when routines are altered.
Regression — loss of previously acquired skills (especially speech) between 15 and 24 months.

One sign alone is not a diagnosis. But several signs together are a reason for specialist assessment. ASD is diagnosed by a psychiatrist or clinical psychologist experienced with children.

Motor development delay

Motor development is the acquisition of movement: from holding the head up to walking and fine hand movements. Approximate milestones:

holds head up when lying on tummy — by 3–4 months;
rolls over — by 4–6 months;
sits without support — by 6–9 months;
pulls to stand — by 9–12 months;
walks independently — by 12–18 months.

Reasons to see a neurologist:

not holding head up at 4 months;
not sitting at 9 months;
not standing with support at 12 months;
not walking independently at 18 months;
asymmetry of movement (one arm or leg noticeably weaker than the other);
muscle hypotonia (the child is "floppy", struggles to maintain posture).

When to see a neurologist, speech therapist, or psychologist

Don't wait for the child to "grow out of it" if something concerns you. Early intervention — in the first 3 years of life — is most effective, because the child's brain is at its most plastic during this period.

Neurologist — for motor delay, muscle hypotonia or hypertonia, seizures, suspected cerebral palsy or ASD.
Speech therapist — for speech delay, articulation difficulties, stuttering. Sessions can begin from age 2–2.5 years.
Psychologist or neuropsychologist — for behavioural difficulties, anxiety, learning difficulties, suspected ADHD.
Paediatrician — the first point of contact. They will refer to the right specialist and rule out physical causes of delay (hearing impairment, hypothyroidism).

If you're unsure how serious the symptoms are, describe them to our assistant. To find the right specialist, use our doctor-routing service.

Frequently asked questions

My child isn't talking at 2 years old. Is it autism?

Not necessarily. Speech delay can have many causes: hearing impairment, speech delay without other difficulties, bilingualism (children in bilingual families sometimes start speaking later), and neurological causes. Autism is one possible cause, but far from the only one. A proper assessment by a specialist — paediatrician, neurologist, or speech therapist — is needed.

Should hearing be checked for speech delay?

Yes, absolutely. Hearing impairment is one of the most common causes of speech delay. A child may not hear quiet sounds but still respond to loud ones — creating the impression of normal hearing. Audiological assessment (audiometry) should be done before starting speech therapy.

Does screen time affect speech development?

Research shows that passive screen viewing (without interaction) does not develop speech and may delay it in children under 2. Speech develops through live interaction. WHO recommendations: no screens for children under 1; 1–2 years — no more than 1 hour per day with an adult present; 2–5 years — no more than 1 hour per day.

What is ADHD and when can it be diagnosed?

ADHD (attention deficit hyperactivity disorder) is a neurodevelopmental condition characterised by difficulties with attention, impulsivity, and/or hyperactivity. Diagnosis is usually made no earlier than age 5–6, when behaviour in a structured setting (nursery, school) can be assessed. Diagnosed by a psychiatrist or neuropsychologist.

Is it normal for a 3-year-old not to be able to read?

Absolutely normal. Readiness for reading develops around age 5–6. At 3, other skills matter: speech, play, social interaction. Early reading instruction provides no long-term advantage and can create unnecessary stress.

My child walks on tiptoes. Is that normal?

Toe-walking in children up to age 2–2.5 can be within the normal range. If a child over 2.5–3 years continues to walk on tiptoes consistently (not just occasionally), this warrants assessment by a neurologist. Causes may be neurological (cerebral palsy, ASD) or orthopaedic. Sometimes it's simply a habit that can be corrected with physiotherapy.

Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.

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