There are consequences for both our actions and inactions in life. As Einstein said, “Everything that exists in your life, does so because of two things: something you did or something you didn’t do.” The consequences of not acting on a child’s delayed cognition/learning milestones can be profound. As parents, we need to be aware of these milestones, so that we can act if they are delayed. It’s important to act because delayed cognition can have a massive impact on a child’s independence, learning, education, inclusion, career, employment, and their capacity for life-long learning. Moreover, a delay in this important area of development can negatively impact a child’s self-esteem, confidence, emotional well-being, psychosocial health, happiness and much else. And all of this is preventable.
But what does cognition mean? To understand this, we need to remember that learning is the process of achieving a set of skills or acquiring certain knowledge. Cognition, therefore, refers to the mental processes involved in learning. Hence, cognition includes cognitive processes such as the ability to read, think, assess information, recall, reason, imagine, problem-solve, and pay attention. Acquiring and honing these cognitive processes will continue to be vital in our ability to adapt, survive, and thrive in this fast-changing world.
Milestones show whether your child is developing as expected. Cognition milestones have been shown to develop on a well-established trajectory. Therefore, a developmental paediatrician can use this knowledge of cognition milestones to help identify developmental conditions such as Specific Learning Disabilities (SpLD) and Learning/Intellectual Disability (LD/ID). Likewise, the knowledge of cognition milestones can help us identify co-morbid learning difficulties in neurodevelopmental conditions such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and Learning Disabilities (LD).
As one can appreciate, there is variation in the achievement of these cognition/learning skills. In this article, I have covered what are the cognition milestones in a typically developing child. At the end, I have written about how you can help your child reach these milestones. Before you read further, please note that while each milestone listed below is important, missing a single milestone in the absence of anything else is unlikely to be significant. A delay in developing several of these milestones across age bands, deserves prompt attention and merits a neurodevelopmental assessment.
- A child can recognise their mother
- They can follow their face
- They can grasp a rattle when given
- They can look at a toy
- A child can visually explore their environment
- They could follow large contrasting objects
- They can attempt and reach for their parent’s face
- They show interest in a toy when presented to them
- They can now reach for and grasp a rattle
- They can shake a rattle
- A child can pass a rattle from one hand to another
- A child can mouth objects/rattle to explore
- They can regard and look at their image in a mirror
- They can stare longer at stranger faces than familiar ones
- A child can turn their head to look for a dropped toy
- They can bang toys together
- They can find a toy hidden under a cup or cloth
- A child can observe cubes/toys held in each hand
- They can tear or crumple a tissue paper
- A child gets interested in a toy car
- They are keen to explore different aspects of a toy
- They can cast or throw toys to the floor
- They can manipulate and can ring a bell
- A child can look for an object even after it has fallen silently on to the floor
- They can pull a string to obtain a toy that is out of their reach
- A child can hold a pencil and can make random marks on paper
- They can unwrap a toy hidden under a cloth
- A child is interested in pictures shown in a book
- They could complete a single-piece puzzle/form board
- They respond to simple commands, e.g., ‘Give me the cup’
- A child can rattle a spoon in a cup
- They could can lift the lid off a box and remove bricks from inside
- They enjoy playing pushing toy cars along
- A child can identify 4-5 objects e.g., cup, spoon, plate, car, etc.
- They know the function of objects, e.g., comb for hair, spoon to eat, etc.
- They can oblige to simple requests e.g., ‘Give me the car’
- They could complete a two-shape form board
- They enjoy looking through a book with an adult
- They have developed the ability to turn several pages of a book
- They can lift the lid of a box to find toy/contents inside
- They could work through and find a hidden toy under covers
- They could now complete a 3-shape form board
- They can copy a horizontal and a vertical stroke with pencil, if shown
- They could open a screw toy
- They can build a tower of 5–7 cubes/wooden bricks
- They can match an object to a picture
- They can demonstrate use of familiar objects
- They can listen to short stories
- A child can begin to cooperate in play
- They can now match several objects to appropriate pictures
- They can match colours
- They can match several shapes
- They can repeat two digits on request e.g., 2-5, 8-6
- They can count up to 3
- They can point to the correct size, i.e., big and small
- A child can point to pictures in a book
- A child can count up to 4 correctly
- A child can talk about what they did
- They can know their gender
- They can play well with other children
- They could assist with small household tasks on request
- They could notice and point to small details in pictures
- They can identify themselves and can point to self in photos
- They can point to body parts according to function e.g., what do you see with…?
- They can explain 1-2 objects by use e.g., what is a spoon for?
- They can compare two lines for length and can point to e.g., long or short line
- They could compare two brick towers for height and can identify tall/short tower correctly
- They could draw a 2–4-part person e.g., face, trunk, arms, legs
- They can follow a 3-step command e.g., go and get your shoes and socks
- They can count up to 10 correctly
- They can answer correctly to some reasoning questions e.g., ‘Is it right or wrong to hurt someone?’
- They have begun to use ‘why’ and ‘how’ questions in their speech
- They are able to understand big and little, long and short, more and less
- They know their age i.e., how old they are
- They can answer a few understanding questions e.g., what should you do if you feel tired/hungry/cold?
- Their drawings have become more detailed i.e., can draw a 7–8-part person
- They can count correctly up to 15
- Their social/everyday understanding is emerging, and can answer correctly to e.g. ‘Which costs more money, a drink or shoes?’
- They can know and identify correctly over 6+ colours
- They can know 1 or 2 parts of their address e.g., house number, street, etc.
- They can understand functional concepts, e.g., use of microwave, dishwasher, etc.
- A child begin to understand concept of time, i.e., past/present
- They can answer question regarding materials e.g., what is a table made of?
- They can answer some opposites correctly g. ‘A boy is big, a baby is?’
- They can point to letters and numbers when named
- A child will now be able to draw a 10–12-part person
- They can count backwards from 10
- A child can now count up to 30
- They know and can identify up to 10 colours
- A child knows most of the phonics/letters
- They know morning and afternoon
- They can write their first name
- Many could now explain about an incident at school
- They can name many days of the week
- They can understand seasons of the year
- They know many parts of their address, but not the full address including postcode
- Many can identify money and can answer e.g., which costs more, a bicycle or a ball?
- Many can do single digit addition and subtraction
- Many begin to read words, and some can even read a few sentences
- They can count backwards from 15
- They can name all the days of the week in correct order
- They know ‘directions’ and ‘sides of a body’, e.g., left hand/ right leg
- They can count up to 30
- They can draw picture of a person with more detail
- Many can write their full name i.e., including their last name
- They could sound out regularly spelled words
- They can understand and answer some similarities and differences e.g., how are a triangle and a square different?
- They can count backwards from 30
- A child can read sentences (without unusual words) more fluently
- They can copy and say up to 5 digits, e.g., 3–8–1–4–7 when asked
- Many can draw a person or house with use of creativity and imagination
- They start ‘reading to learn’ rather than just ‘learning to read’
- Many could now do two-place addition and subtraction e.g., 11+13, or 22-11?
- Many can answer comprehension questions e.g., what should you do if you are lost?
- They begin to enjoy reading independently
- Many know their full address including postcode
- Many know their full birthday including day, month and year
How we can help our children reach these important milestones
Children learn best through play and experimentation. Hence, involving them in building with Lego/stackable toys, reading books, playing board games, involving them in memory games, telling stories and jokes, etc, can all help in boosting your child’s cognition. Providing them with opportunities to practice and explore will help. Break down the task into smaller chunks and offer them cues and feedback. Moreover, having adequate sleep, a balanced diet, being physically active and time outdoors can all help improve their neuroplasticity, memory, and learning. Alongside this encouragement, praise and reward work wonders. Discouragement or negative feedback can become barriers to their learning.
As you can see from the above, knowing these cognitive milestones can offer crucial indications about your child’s learning and cognitive abilities. These cognitive milestones can help you monitor your child’s progress and development. They can help reassure you and continue to enjoy being part of your child’s learning journey. However, if you are worried about your child’s learning, then don’t ignore your gut feeling. Try and discuss your concerns with your child’s teacher or your health visitor.
I regularly see children who are about to transition to secondary school but have not met the cognitive milestones for a 5-6-year-old. It is crucial to seek help for your child as soon as possible, as early intervention can prevent your child’s learning/cognitive delay developing into a learning disorder or a learning disability. Furthermore, seeking help early can prevent development of psychosocial problems of low self-esteem, reduced confidence, avoidance of learning activities, school refusal, low mood, anxiety and behavioural problems. On the other hand, identifying their difficulties early can lead to effective interventions which in turn can enable their learning and facilitate gaining valuable qualifications and financial independence. Therefore, it’s important to know what the cognition milestones are, and how you can use your knowledge of these to help your child’s development.
- Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
- Aites J, Schonwald A, Augustyn M, Torchia M. Developmental-behavioural surveillance, and screening in primary care. UpToDate Inc. Wolters Kluwer. Accessed on May 2021.
- National Center on Birth Defects and Developmental Disabilities (NCBDDD) Fiscal Year 2018 Annual Report. www.cdc.gov/ncbddd/aboutus/report/
- Centres for Disease Control and Prevention (2013). Developmental Milestones. https://www.cdc.gov/NCBDDD/actearly/pdf/checklists