Baby’s First Year - Age Appropriate Milestones for Ages 4-6 months
In the 4-6 month time frame, all your child's motor skills begin to integrate in a way that brings forth more purposeful movements. Head control is developed, visual acuity begins to sharpen, tummy time is more comfortable and baby begins to roll and sit up. A LOT of big milestones happen within these couple of months.
This guideline has been developed through clinical experience and in combination with references Peabody Developmental Motor Scales 2 + The Beery VMI.
Reminder: Focus on your child’s strengths, not weaknesses. Focus on if your child is making an overall forward progression instead of making sure your child makes EVERY milestone according to plan (you can easily drive yourself and your baby crazy.). Relax and enjoy these fleeting moments!
GROSS MOTOR SKILLS
Prone/On-Tummy:
By now your baby should be very comfortable lifting their head up in this position.
A very important primitive reflex called the Assymetric Tonic Neck Reflex (or ATNR) integrates during the 4-6 month age range. This reflex is automatic and causes ipsilateral (same side) arm extension and contralateral (opposite side) arm flexion when the baby turns his/her head to one side. Basically, when a newborn baby turns his head to one side, you will notice him assume a position with a bent arm on the opposite side and a straight arm on the same side. Weight bearing on both hands during tummy time while turning head left and right in this position is what helps to integrate this reflex (make it go away). This is one of the reasons why tummy time is so important. If the ATNR reflex persists into childhood or is delayed, it can lead to some negative developmental consequences related play, reading, self-feeding, crossing midline, Motor planning and overall motor learning.
See my previous post The Importance of Tummy Time & How to Make it Less Miserable if you’re in the market for some helpful tummy time hints!
0-4 months: baby should be able to lift head and look around
4-6 months: baby should be able to lift entire chest off of the floor while bearing weight on both hands
4-6 months: ATNR reflex should integrate
3-5 months: baby should be able to roll from tummy to back
Supine/On-back:
Continued caution against letting baby spend too much time on their back and especially in car-seats to avoid plagiocephaly deformities and torticollis.
0-4 months: baby should roll from side to side
0-4 months: alternative leg kicking
5-6 months: grabs both feet and brings them to mouth
0-5 months: from their back, baby begins to try to roll over to tummy but gets stuck
5-7 months: baby rolls from back to tummy
6 months: from supine position, baby pulls up into sitting
Sitting Position:
0-4 months: holds head at mid-line when held in sitting (can keep it in alignment when tilted side to side)
0-4 months: can sit up with some support at the waste
5-6 months: can sit briefly while weight bearing on hands (not independent sitting)
6 months: sits with the support of a highchair
VISUAL MOTOR + VISUAL PERCEPTUAL SKILLS
The visual system continue to develop as color and visual acuity sharpen. Now that the eyes have had some practice working together as a unit, visual-motor coordination continues to improve.
0-4 months: baby can visually track moving objects with ease
0-4 months: baby reaches for and hits at dangling objects with hands (baby gym arch) when on back and in sitting
0-4 months: baby looks at and manipulates objects in hand
5 months: babies' depth perception develops
0-5 months: looks at small item (such as a raisin) a few feet away and will reach for it
0-6 months: gets bottle to mouth independently
0-6 months: reaches for their own reflection in the mirror
5-6 months: babies' color development is established
FINE MOTOR + GRASP DEVELOPMENT
The fisted posture of the hands (palmar reflex) should begin to go away around 4-6 months of age and this is when baby begins to volitionally reach for and grab objects.
3-5 months: can grasp and hold rattle and/or cube
4-5 months: can hold bottle independently with one or both hands
0-5 months: uses immature grasp pattern of all fingers against the palm to pick things up (palmar grasp)
0-6 months: grasp begins to mature a bit more and holds objects with fingers against palm on the pinky side (radial palmar grasp)
0-6 months: uses a raking motion to obtain objects from floor/table
0-6 months: holds hands open (rather than in fists) at least 50% of the time
SELF-HELP + FEEDING SKILLS
Around 4-6 months, baby should be more skilled at removing milk from bottle or breast and nursing/bottle feeding times should be more concise.
0-6 months: baby can get bottle to mouth independently and mouthing of all toy items is normal and babies means of oral exploration
0-6 months: finger feeding not yet established but emerging - child will reach for small item (such as a raisin) but not consistently obtain it with a pincer grasp (8 months)
0-6 months: munch and chew patterns emerge and gag reflex present
4-6 months: begins bringing food items to mouth (more successful with larger items that can be held with two hands)
4-6 months: tolerates being spoon fed (and can expresses preference/non-preference)
5-6 months: cooperative while being dressed/hold up arms and legs
Red Flags
Talk to your pediatrician if you have any concerns with the following:
Baby is not yet efficient at removing milk from bottle or breast
Baby hasn't begun parental attachment (noticing and showing affection towards caregivers)
Baby is having difficulty bringing objects (such as a bottle) to their mouth past 5-6 months
Head does not turn to locate sounds by 4 months
Very notable head tilt to one side with difficulty turning head in one direction (noticable mostly in carseats, preferred sleeping patterns)
Noticeable flat spot on posterior (back) head or on either side
Pelvis asymmetry (i.e. trunk rotated left while pelvis/hips rotated right)
Baby not making eye contact or smiling in response to an adults presence
Baby is not reaching for toys placed in front of them
Babies hands are fisted more than 50% of the time
Baby seems floppy or weak
Baby seems tight and stiff
Head lags when pulled to sitting
Baby doesn't roll over onto stomach by 6 months
Coughing throughout a meal or when drinking
