Baby · Development
CDC Milestone Tracker (LTSAE 2022)
What should your baby or toddler be doing at this age? CDC Learn The Signs Act Early 2022 milestones with Act Early red flags, preterm correction, and what to do if you have concerns.
Last reviewed 28 May 2026
CDC milestone tracker (LTSAE 2022)
Developmental milestones birth – 5 years
Milestones observed
0 / 0
Enter your child’s age in months to see the appropriate milestone checklist.
Milestones from the CDC Learn The Signs. Act Early. 2022 update (Zubler et al., Pediatrics 2022). The 2022 revision changed the threshold from “milestones most children CAN do” to “milestones MOST (≥ 75 %) children DO” — clearer for parents and reduces over-reassurance. This list shows the highest-yield items at each visit; the full CDC list is more extensive. Track progress over time and bring concerns to your routine paediatric visits.
What does this mean?
The 2022 CDC update is more parent-friendly because every item on the list is something ≥ 75 % of children do by the named age — so missing one is a real signal, not a maybe. A child is not behind because they skip ONE item; concern grows when several items from the same domain are missing or when the child loses skills they used to have (a regression — always flag this immediately). The CDC also publishes “act-early signs” for each age — these are the high-yield red flags that warrant a call to your paediatrician or health visitor today, not at the next well-child visit. Early identification + early intervention (before age 3, when neuroplasticity is highest) consistently improves outcomes in autism, language delay, and motor delays. Bring this completed list to each visit so your clinician can screen alongside the formal ASQ or M-CHAT tools.
What should my baby be doing at this age?
Enter your child’s age in months. The tracker shows the milestones for the nearest well-child visit, grouped into four domains: social-emotional, language-communication, cognitive, and movement. Tick items you’ve clearly observed over the past few weeks. Bring observations and any concerns to your routine paediatric visits.
What are developmental milestones?
Skills most children develop by a certain age — social smiling, rolling over, sitting, babbling, first words, walking, pointing to share interest, pretend play. The CDC “Learn The Signs. Act Early.” (LTSAE) checklist is the most widely-used parent-facing tool. Updated in 2022 (Zubler et al., Pediatrics) using the 75th percentile threshold — meaning ~75% of typically-developing children have these by the listed age.
The four developmental domains
- Social / Emotional: attachment, social referencing, emotion expression, friendship-like behaviour.
- Language / Communication: understanding (receptive) and producing (expressive) language; gestures; conversation.
- Cognitive: problem-solving, learning, memory, attention.
- Movement / Physical: gross motor (sit, crawl, walk, run) and fine motor (grasp, pincer, draw, dress).
When do babies usually do each thing? (Quick reference)
- 2 months: social smile; tracks faces; lifts head during tummy time.
- 4 months: laughs; reaches for toys; pushes up with elbows.
- 6 months: babbles; passes object hand to hand; sits with support.
- 9 months: “mama”/“dada” non-specifically; sits without support; crawls.
- 12 months: waves; points; says 1-2 specific words; pulls to stand; possibly first steps.
- 15 months: 2-5 words; follows simple direction; walks alone; uses spoon.
- 18 months: 5-10 words; points to show interest; walks well; scribbles.
- 24 months: 2-word phrases (50+ words); pretend play; runs; kicks ball.
- 30 months: short sentences; toilet awareness; jumps with both feet.
- 3 years: 3-word sentences; plays with peers; climbs stairs alternating feet.
- 4 years: tells stories; recognises letters; hops on one foot.
- 5 years: conversation; counts to 10; writes name.
Act Early red flags — talk to your doctor
Major red flags by age (any one warrants a developmental conversation):
- By 12 months: no babbling, no pointing/waving, no gestures, doesn’t respond to name.
- By 16 months: no single words.
- By 18 months: no pretend play, doesn’t point to show interest, can’t walk.
- By 24 months: no spontaneous two-word phrases, doesn’t follow simple instructions, doesn’t imitate.
- By 3 years: no sentences, doesn’t play with peers, persistent difficulty being understood.
- Any age: loss of language or social skills (regression).
- Any age: doesn’t make eye contact at all.
- Any age: doesn’t look where you point.
What the 2022 CDC update changed
- Threshold: moved from “most CAN do” (50th centile) to “most DO” (75th centile) — gives parents earlier signal.
- New 15-month and 30-month checklists added (previously skipped).
- Duplicate items removed.
- Clearer Act Early red flags.
The 2022 version is what every US state’s Early Intervention programme now uses.
Practical scenarios — what to do
Scenario 1: 14-month-old, walking, babbling, no words yet
15-month checklist suggests 2-5 words. By 14 months still gesturing/babbling without words is on the late side. Watch for the 16-month single-word threshold. If still no words by 16 months, discuss with HV/GP — hearing test, developmental conversation.
Scenario 2: 18-month-old, lots of words, doesn't point or wave
Missing key non-verbal social-communication. Worth raising and doing the M-CHAT-R autism screen at the next 18-month visit. Joint attention (pointing to share, eye contact, gesture) is the most predictive social-communication marker at this age.
Scenario 3: 24-month-old, was saying 10 words, now silent
REGRESSION. Same-week paediatric review regardless of other features. Possible autism, possible Landau-Kleffner (rare epilepsy with language regression), possible severe stressor. Urgent.
Scenario 4: 12-month-old former 30-week preterm baby
Use corrected age. At 12 months chronological, 10 months corrected. Plot at 10 months on the chart. Most preterm babies catch up by age 2.
Scenario 5: 24-month-old bilingual household, slow English-only word count
Common in bilingual children. Combined vocabulary across both languages is what counts — should equal monolingual peers. If combined word count is also below 50, raise it.
What helps development?
- TALK to your baby constantly. Narrate everything. The single biggest driver of language outcomes.
- READ aloud daily from birth onwards.
- PLAY on the floor at baby level.
- SING — songs build phonological awareness.
- Responsive parenting — respond to babbles, smiles, gestures. Builds the conversational turn-taking foundation.
- Tummy time from birth (5-10 min several times a day initially).
- Limit screen time — AAP zero under 18 months (except video calls); 18-24 months high-quality content with co-watching; 2-5 years max 1 hr/day.
- Outdoor play — supports motor, sensory, regulation.
Care guidance — if your child has developmental concerns
- Don’t wait and see. AAP 2020: refer for evaluation AND Early Intervention in parallel when there’s concern.
- Hearing test — rule out hearing loss as cause of language / social concerns. 1-2% of children referred for autism evaluation have undiagnosed hearing loss.
- Early Intervention referral — US Part C of IDEA (free, every state, no diagnosis needed). UK community paediatrics / Portage / SaLT.
- Vision check if cognitive/motor concerns.
- Genetic testing may be offered if multiple domains affected or family history.
- Speech and language therapy for language concerns — available NHS / Medicaid / school.
- Occupational therapy for sensory/motor.
- Parent peer support — NCT, NAS (UK); Autism Speaks, ASAN, Family Voices (US).
Limitations of this tool
- Surveillance checklist, not a diagnostic instrument.
- Formal screening (ASQ-3, M-CHAT-R/F) and diagnostic assessment play distinct roles.
- Doesn’t measure quality, fluency, or context of skills.
- Cultural variation in some milestones not captured.
- Children with syndromic / very preterm backgrounds may follow different trajectories.
Sources
- Zubler JM, et al. Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics 2022;149:e2021052138.
- CDC. Learn The Signs. Act Early.
- AAP. Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders. Pediatrics 2020.
- Hyman SL, et al. AAP. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020.
- Madigan S, et al. Association between screen time and children’s development. JAMA Pediatr 2020.
- NICE NG43. Suspected developmental delay.
Frequently asked questions
What are baby developmental milestones?
Milestones are skills most children develop by a certain age — social smiling, rolling over, sitting, babbling, first words, walking, pointing to share interest, pretend play, and so on. They're grouped into four domains: SOCIAL/EMOTIONAL, LANGUAGE/COMMUNICATION, COGNITIVE, MOVEMENT/PHYSICAL. The CDC 'Learn The Signs. Act Early.' (LTSAE) checklist is the most widely-used parent-facing tool, updated in 2022 (Zubler et al., Pediatrics). Milestones support — they don't dictate. Every child develops at their own pace within a normal range.
When should my baby reach each milestone?
By specific well-child visit ages: 2, 4, 6, 9, 12, 15, 18, 24, 30, 36, 48, 60 months. The CDC 2022 update lists milestones at the 75th percentile — meaning ~75% of typically-developing children have them by that age. So 25% of typically-developing children don't yet have a given milestone at the listed age — and acquire it in the following months. Don't panic about one or two missing. Worry pattern: multiple milestones missing across multiple domains, an 'Act Early' red flag, or LOSS of a previously-acquired skill.
What changed in the CDC 2022 milestone update?
Zubler et al., Pediatrics 2022, revised LTSAE after a multi-year stakeholder process. KEY CHANGES: (1) Threshold moved from 'most children CAN do' (50th percentile) to 'most children (≥75%) DO' — gives parents earlier signal. (2) NEW 15-month and 30-month checklists added (previously skipped). (3) Duplicate-difficulty milestones removed (some 12 and 18-month items were almost identical). (4) Clearer 'Act Early' red flags at each age. The 2022 version is what every state's Early Intervention programme now uses.
Should I worry if my baby isn't doing what other babies their age do?
Probably not. Comparison between babies is rarely useful — every child develops differently. Specific things that ARE worth raising: child can't do MULTIPLE milestones at the listed age across DIFFERENT domains; child has LOST a previously-acquired skill (regression); specific 'Act Early' red flag is present (e.g. no babbling by 12 months, no single words by 16 months, no eye contact at all, no pointing by 18 months). Don't compare to social media — the babies who do things fastest are over-represented online.
What are the 'Act Early' red flags I should know?
Major ones by age: BY 12 MONTHS: no babbling, no pointing/waving, no gestures, doesn't respond to name. BY 18 MONTHS: no single words, no pretend play, doesn't point to show interest, can't walk. BY 24 MONTHS: no spontaneous (not just repeating) two-word phrases, doesn't follow simple instructions, doesn't imitate. ANY AGE: loss of language or social skills. ANY AGE: doesn't make eye contact at all. ANY AGE: doesn't look where you point. If you see any of these, raise it at your next visit — don't wait.
What is M-CHAT-R and when should I do it?
Modified Checklist for Autism in Toddlers Revised — 20-question parent screen for autism. AAP recommends at 18-month AND 24-month well-child visits. Different from this milestone tracker (which is broader developmental surveillance). M-CHAT-R is autism-specific, picks up children who need a fuller assessment. Available at /calculators/mchat-r. Recommend both: milestone tracker for broad surveillance, M-CHAT-R for specific autism screening at 18 and 24 months.
My baby was premature — which age do I use?
Use CORRECTED AGE (chronological age MINUS weeks of prematurity) until age 2. Born at 32 weeks (8 weeks early)? At 6 months chronological age, plot them at 4 months corrected on the milestone chart. Standard practice in UK and US. After age 2, most preterm babies have caught up enough that chronological age becomes the relevant reference. Very preterm babies (<32 weeks) may need specialist follow-up using corrected age into early school years.
When should I refer to Early Intervention?
US: Part C of IDEA — free in every state for under-3s with developmental concerns. Doesn't require a diagnosis. Self-referral or paediatrician referral. UK: health visitor / GP refers to community paediatric services. Don't wait for diagnostic certainty. AAP 2020 (Hyman): refer for evaluation AND intervention in parallel when there's concern. Children who turn out NOT to have a developmental difference still benefit from the support; children who DO benefit measurably from earlier intervention.
How should I encourage my baby's development at home?
PLAY — the universal currency of development. TALK to your baby constantly (narrate what you're doing — 'I'm cutting an apple, look it's red, it makes a crunch sound'). READ together daily from birth onwards. SING. Get on the floor at baby level. RESPONSIVE PARENTING (responding to babbles, smiles, gestures) is more powerful than any toy. Tummy time from birth (5-10 min several times a day). Limit screen time under 18 months (AAP: video calls only); ages 2-5 high-quality content with you co-watching, max 1 hr/day. NHS Start4Life and CDC LTSAE have free age-by-age activity ideas.
What is developmental regression?
Losing a skill or ability the child had previously acquired. Examples: a child who was babbling stops babbling; a child who said 5 words now says none; a child who walked confidently stops walking and crawls again; loss of eye contact, social interest, or pretend play. REGRESSION AT ANY AGE IS A RED FLAG — needs urgent paediatric assessment. Possible causes range widely (autism, Landau-Kleffner syndrome, metabolic conditions, mitochondrial disorders, hearing loss, severe illness, severe stressor). Don't dismiss it as 'a phase'.
Do milestones predict intelligence?
Hardly at all in the early years. Babies who walk early aren't smarter. Babies who talk first aren't smarter. The strongest predictors of long-term cognitive outcomes in healthy children are: socioeconomic environment, responsive caregiving, reading aloud daily, breastfeeding (mild effect), and going to preschool. Early walking can be HEREDITARY (your family pattern) more than developmental superiority. The point of milestone tracking is to spot CHILDREN WHO NEED SUPPORT, not rank children by performance.
How do milestones differ between boys and girls?
Subtle differences only. Girls on average reach language milestones slightly earlier; boys on average reach gross-motor milestones slightly earlier. But individual variation within each sex is MUCH larger than between-sex average difference. CDC milestones don't have separate boy/girl thresholds because the gaps are too small to be clinically useful. Don't dismiss a boy's language delay because 'boys talk later' — get him assessed.
What if my child is bilingual or trilingual?
Bilingual children's TOTAL vocabulary across all languages is typically equivalent to monolingual peers — but their vocabulary in any ONE language may be smaller. The CDC milestones should be assessed against the COMBINED vocabulary. Bilingual children may have a 'silent period' (1-6 months) when they're absorbing the second language without speaking much — normal. Concerns about a bilingual child's language development should still be raised; speech and language therapists can assess across both languages.
When should my child see a paediatrician for development?
Routine visits include developmental surveillance: in UK at 6-8 weeks, 9-12 months, 24-30 months (with ASQ-3 or similar); in US at every well-child visit per AAP Bright Futures. SOONER consultation if: any 'Act Early' red flag, multiple missed milestones, regression, parental concern (your gut). Don't wait for the next routine visit — same-day or same-week appointment for regression or strong concern.
Does screen time affect milestones?
Yes, in dose-dependent way. AAP: ZERO screens under 18 months except video calls. 18-24 months: high-quality content with parent co-watching only. Ages 2-5: max 1 hour/day high-quality content. Excessive screen time in toddlers is associated with delayed language development (Madigan 2020 JAMA Pediatrics), reduced executive function, sleep disruption, behavioural issues. The mechanism: every minute on a screen is a minute NOT in social interaction, reading, or play, which are the actual drivers of development.
How does this relate to other calculators on BumpBites?
Companion: /calculators/mchat-r for autism-specific 18 & 24 month screening; /calculators/baby-percentile for growth tracking; /calculators/asq-3 description for the Ages & Stages questionnaire; /calculators/peds-tool description for PEDS; /calculators/separation-anxiety for social-emotional context; /calculators/weaning-readiness for the eating milestones.