Social-Emotional and Self-care Milestones in Children
Before a child learns to communicate using speech and language, they know to communicate with their parent or caregiver socially and emotionally. Hence, good knowledge of ‘social-emotional’ and ‘self-care’ milestones is crucial. Also, these milestones develop on a well-established trajectory. Consequently, using this knowledge of ‘social-emotional’ milestones can help in identifying developmental conditions such as autism spectrum disorder (ASD), social anxiety disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) early. Similarly, a knowledge of ‘self-care’ milestones can help identify a child with dyspraxic tendencies or screen for developmental coordination disorder (DCD)/Dyspraxia.
An understanding of social-emotional and self-care milestones would give us an insight into a child’s communicative intent, temperament, personality, their interpersonal skills, his/her concept of self, and domestic skills. These milestones are commonly delayed in a child with developmental condition such as ASD or ADHD. Thus, knowledge of milestones can avoid delay and dither in identifying the above conditions and help a child to receive early and effective intervention.
Therefore, knowing and checking for these social-emotional and self-care milestones forms an essential part of preventative health and development supervision visits to your health visitor (HV). A knowledge of these milestones, among other things is what guides a review by your neurodevelopmental paediatrician or any paediatrician with interest in child development.
In this article, I have covered milestones in the ‘social-emotional’ and ‘self-care’ aspects of a typically developing child. But a note of caution before you read any further. While each milestone listed below is important, missing a single or just a couple of these milestones in the absence of anything else may not be significant. Having said that, a delay or lack of development of several of these milestones in a child deserves prompt attention, exploration and or a thorough neurodevelopmental assessment. So, here they are:
0-3 months
- Infant can recognise their mother/parent
- Their first measurable social milestone, i.e., infant’s social smile in response to their parent’s smile develops
- An infant can follow a moving person at close distance with their eye gaze
- He/she can bring their hand to their mouth
3-6 months
- An infant can now spontaneously smile to their parent.
- He/she enjoys ‘to & from’ communication with sounds
- An infant begins turn-taking with their parent using their vocalisations
- He/she recognises primary caregivers by their smell and sight
- He/she greets their parent with squeals & vocalisations
- They can hold their bottle briefly
- They respond to gentle calming when distressed. An infant learns to regulate their emotional stress with a sensitive and firm response from parent/caregiver
6-9 months
- Joint attention develops, i.e., they can follow parents gaze in the same direction as the object and then look back at their parent/caregiver to share or acknowledge their experience
- Gaze monitoring develops, i.e., they can follow an adult’s gaze with their own
- Effective attachment is beginning to be established with a responsive parent/caregiver. Hence, separation anxiety starts emerging with strangers or unfamiliar faces
- He/she begin vocalising to seek attention from their caregiver
- They can hold their own drink bottle
- They begin to finger-feed themselves
- They can pull-off their hat
9-12 months
- An infant’s ‘proto-imperative pointing’ is beginning to be formed. He/she now requests by pointing to ask for an item of interest and integrates their pointing with eye contact between the object and the parent
- A secure attachment is formed with a primary caregiver. Hence, separation anxiety is established
- An infant can put their arms up to be picked up
- They can recognise and consequently respond to their own name being called
- An infant can recognise themself in a mirror, smile and reach out to their image in the mirror
- He/she can engage in interactive play with games such as ‘peek-a-boo’ and copies ‘pat-a-cake’ with a parent
- An infant can give affection to their parent with a kiss, a cuddle, or snuggle up to them
- Infant uses gestures such as waving ‘bye-bye’ to communicate needs and interests
- They become interested in watching other children
- He/she can drink from an open cup if held to lips
12 -18 months
- He/she can engage in a ‘solitary play’ and can play away from a caregiver for a short while
- ‘Functional play’ becomes well established, i.e., a child’s manipulations become object-specific rather than indiscriminate banging
- ‘Proto-declarative pointing’ emerges at this stage when a child points with eye gaze coordination to show an object of interest to others
- He/she enjoys sharing a book with parent/caregiver
- He/she can respond to simple commands, e.g., ‘give me the spoon’ and brings objects to show or give to their caregiver
- They can use a spoon with some spilling. They can pick up and drink from a lidded cup
- A toddler can now be able to remove sock/shoe or a garment
- The child explores his/her surroundings independently and helps with household chores or simple tasks
- He/she becomes more aware of their own emotions and develop empathy for others. They can become upset if others cry or feel proud when applauded for helping with tasks
18 – 24 months
- The child learns to partake in ‘pretend play’ e.g., talking on a toy phone or ‘pat-a-cake.’
- ‘Symbolic play,’ e.g., feeding a doll is emerging
- He/she demonstrates the development of self-identity with concepts such as ‘I’ or ‘Mine.’ Hence, it becomes possessive of their own toys. They cannot share or play cooperatively or imaginatively with peers. His/her play is more alongside a parent or a peer, i.e., ‘parallel play.’
- A toddler can help put toys away on request. They imitate household chores
- He/she can indicate toilet needs by pointing or gestures
- They can help with dressing by putting their arms & legs thro’
- A toddler can use a spoon nicely. They can drink from an open cup
- He/she can suck drinks through a straw
24 – 30 months
- A child is now beginning to share and join others briefly in a cooperative or imaginative play
- Their ‘symbolic play’ is now well established, e.g., rides a broomstick for a horse
- His/her understanding of social etiquette is emerging, e.g., saying ‘thank you.’ They are now beginning to regulate their emotions by minimising or exaggerating these according to the social setting
- Many know their gender and gender awareness is emerging
- He/she can participate in simple group activities
- They can use a fork and a spoon well
- They can wash their hands and dry them
- They can pull-off a T-shirt
30 – 36 months
- Cooperative play with peers or caregiver is emerging. They are learning to take turns in play
- They start to share their toys or an item with siblings/peers. Impulse control is emerging
- Sensitive and thoughtful caregiving helps in a child learning self-control, autonomy, initiative, and a sense of control
- A child knows their age
- Most children become toilet trained by this age.
- He/she can wear a dress, but they need help with buttons and zips
- A child can finish a meal unaided if food is cut into ‘bite-size.’
- He/she can brush teeth with assistance
3 – 4 years
- ‘Imaginative play,’ i.e., child’s imagination, is doing the work versus design & function of the toy by playing with dolls. Their play can have a theme or a storyline
- A child learns to manage their aggression and learns to share and cooperate without prompts
- The child becomes independent with their toileting needs and can take themselves to the toilet in their familiar setting
- He/she can wash their hands & face on their own
- They can unbutton and are learning to button up
- A child can put their shoes on without laces
4 – 5 years
- A child can play in small groups or with 1-2 peers, with turn-taking and joint goals. They can join in play with other children. Hence, this is a time when peer-relationship issues emerge.
- He/she can distinguish between imaginary and real games or things. Imaginary play is becoming more complex
- A child can give their family name or last name
- They can brush their teeth without assistance
- They can put on an overcoat or cardigan
- He/she can fasten buckle of a shoe
5 – 6 years
- A child can play with 3-4 peers. They have a special playmate. They can choose their friends and spend more time in their peer groups
- He/she has learnt adult social skills such as praising others for their excellent work or apologising for their unintended mistakes
- They have developed an understanding to choose their clothes according to the weather, i.e., for summer/winter
- They can follow simple rules and instructions. Hence, they can take part in competitive games
- He/she demonstrate increasing social awareness, and most know their address by this age
- Can spread with a knife
- Can wash hands, face & dry them with no help
6 – 7 years
- They relate more to a group of friends and consequently, prefer to spend more time with them. There is an increasing understanding of relationships and disagreements
- He/she can play board games with rules
- They can distinguish between fantasy from reality
- An increasing sense of their social self develops. Most should know their birthday-date, month, and year
- He/she knows their full address, and many know their postcodes too
- They have become adept at dressing and undressing completely, without help
- He/she can lay the table for dinner with some supervision
7 – 8 years
- A child understands rules and regulations. They learn from their mistakes. Moral understanding of right or wrong, is becoming established
- They show a deeper understanding of responsibilities and can do homework on their own
- He/she have developed a better understanding of relationships and can now help others/younger children
- Identifies and spends more time with children of the same gender. Many have found a best friend. As they get older, spending time with peers and friends becomes more important to them than spending time with family
- They can delay their gratification and can wait for their turn
- He/she can shampoo hair, have a bath or shower on own
- He/she can lay the table completely without supervision. They can tie shoelaces
As you can see from the above, failure to acquire these milestones can be a manifestation of neurodevelopmental disorders such as ASD, ADHD, Anxiety Disorder or DCD. I regularly see children with these developmental conditions who are about to transition to secondary school but have not met the social-emotional milestones for a 3–4-year-old. If screening identifies any delays or concerns, then further prompt developmental testing or a neurodevelopmental assessment is warranted.
Because identifying and addressing these delays can prevent the development of several secondary consequences for the child such as receiving warnings for behaviour at school, peer-relationship difficulties, lack of friendships, disengagement from learning, low self-esteem, poor mental/psychological health, worsening anxiety, self-harm, challenging behaviours, disengagement from learning, school exclusions thus leading to sub-optimal outcomes for the child, his/her family and the wider society. On the other hand, earlier identification and effective interventions can help the child acquire useful qualifications, gain employment, contribute to society and succeed in having a fulfilling life.
References & Further reading
- Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
- Fatima Malik; Raman Marwaha. Developmental Stages of Social Emotional Development in Children. Updated Nov 2020. StatPearls Publishing LLC
‘Red Flags’ in Child Development