Developmental milestones: the NCLEX chart

Milestone questions are pattern questions. Learn the hallmark skill at each age — the one that defines the visit — and most options eliminate themselves. This is the chart used throughout the NCLEX Decoded pediatrics module.

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Age	Gross motor	Fine motor	Language / social
2 months	Lifts head briefly prone	Hands mostly fisted	Coos; social smile
4 months	Rolls back→side; head steady	Grasps rattle; brings hands to mouth	Babbles, laughs
6 months	Rolls both ways; sits with support	Transfers hand to hand; raking grasp	Babbling chains; recognizes parents
9 months	Sits unsupported; crawls/creeps	Emerging pincer grasp	"Mama/dada" nonspecific; stranger anxiety; object permanence begins
12 months	First steps; cruises well	Neat pincer; releases objects into containers	1–2 real words; waves bye-bye
18 months	Walks well; runs stiffly; climbs stairs with help	Scribbles; builds 2–3 block tower; uses spoon	10+ words; points to body parts; parallel play
2 years	Kicks a ball; goes up/down stairs one at a time	Builds 4–6 block tower; turns pages	2-word phrases; 200+ words; "mine!" — autonomy
3 years	Rides a tricycle; alternates feet going up	Copies a circle; builds 9–10 block tower	3-word sentences; knows name/age; imaginative play grows
4 years	Hops on one foot; skips emerging	Uses scissors; copies a square	Full sentences; asks endless questions; associative play
5 years	Skips well; ties shoelaces emerging	Prints some letters; draws a person with body parts	Counts; tells stories; cooperative play, friends matter

The hallmark list (if you memorize one line per age)

6 months: rolls both ways, sits with support, transfers objects.
9 months: pincer emerging, stranger anxiety, object permanence.
12 months: walks, neat pincer, first real words. Birth weight has tripled.
2 years: two-word phrases — the language milestone the exam loves.
3 years: tricycle. 4 years: hops. 5 years: skips.

Red flags that mean "refer": no social smile by 3 months, no babbling by 9–12 months, no single words by 16–18 months, no two-word phrases by 2 years, loss of skills at any age (regression is never normal), and a parent who is worried — parental concern is itself a finding.

Module 5 pairs this chart with Erikson's stages, play types by age, and the safety guidance that changes at each stage — crawling changes poisoning risk, walking changes fall risk, adolescence changes everything.

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