Growth and Development, Ages 1 to 12 Months

Topic Overview

How do babies grow and develop in the first year?

The first 12 months may be the most dynamic period of life. Dramatic changes are taking place in all areas of growth and development, which include:

• Physical development. Most babies double their birth weight by gaining an average of 0.5 oz (14.2 g) to 1 oz (28.4 g) every day for the first 6 months of life. Birth weight usually triples sometime between 9 and 12 months of age. By 12 months of age, most babies have grown in length a total of about 10 in. (25.4 cm) since birth. Head circumference usually increases about 0.25 in. (0.6 cm) to 0.5 in. (1.3 cm) a month.
• Cognitive development. This is the process by which babies develop the abilities to learn and remember. Babies begin to recognize and interact with loved ones and start to understand that people and objects still exist even when they are out of sight (object permanence).
• Emotional and social development. In a loving environment, babies easily bond with their parents. In the first month, newborns express emotion mainly by crying and grimacing or displaying an alert and bright face. By about 4 months, they learn to smile, coo, and move their arms around when excited. By 5 months, babies show a clear preference for a loved one. In the following months, "separation protest" and "stranger anxiety" are two of the ways babies show this growing attachment. A close bond provides a foundation for future relationships: babies learn from their parents how to love and how to trust.
• Language development. Babies' brains are very open to learning, and they quickly absorb the language around them. By about 3 to 6 weeks, babies develop a different crying sound to show a specific need (such as hunger or discomfort). By around 2 months of age, they begin to interact with caregivers by cooing and smiling, which proceeds to babbling and chuckling within about 6 months. Also by 6 months, most babies have learned all of the basic and distinct sounds of their native language. By the first year most babies can say a few words, like "mama" or "dada," and can understand many more.
• Sensory and motor development. A baby's movements become more controlled and deliberate as the newborn reflexes fade. Although seemingly stiff at times, a baby will be limber and coordinated enough in 6 months to suck his or her toes and strong enough to sit with light support. By 10 months, many babies can stand, although they may need support.

When are routine medical visits needed?

Routine checkups, or well-baby visits, should occur after the first month at 2, 4, 6, 9, and 12 months of age. During these visits, your doctor examines your baby for signs of normal growth and development. You will be asked about whether your baby is reaching expected developmental milestones. Immunizations are also given according to the standard schedule.

When should I be concerned about my baby's growth and development?

Talk to your doctor if your baby is not reaching anticipated growth and development milestones. But keep in mind that every child develops at a different pace. A child who is slow to reach milestones in one area, such as interactive babbling with caregivers, may be ahead in another area, such as crawling or walking. Usually it is of more concern when a child reaches developmental milestones but then loses those abilities.

Also, call your doctor if your child shows signs of hearing problems, such as not responding to your voice or to loud noises.

Do not hesitate to talk to your doctor any time you have concerns about your child, even if you aren't sure exactly what it is that worries you.

How can I help my baby during the first year?

You can help promote healthy development by interacting with your child and providing a loving and stimulating environment. Also, learn about normal behavior and development patterns. This information helps you to understand your baby's changes and healthy ways of responding to them.

Allow your baby to explore safely. Offer guidance and limits, but respect your baby's curiosity and growing abilities. This can help your child develop the confidence needed to try new skills and to grow and develop into a healthy child.

Frequently Asked Questions

What to Expect

Babies usually progress in a natural, predictable sequence from one developmental milestone to the next. During the first year you will see gains in five major areas.

• Physical development is rapid during the first year of life. Babies steadily gain weight and grow in length throughout this first year. Your baby's birth weight doubles around 6 months of age and triples by about 12 months. But remember that each child is different. Your child may be smaller or larger than other children of the same age. As long as your child continues to grow at a regular pace, your doctor will likely assure you that your baby's growth is within the normal range.
• Cognitive development, or how the brain develops its abilities to learn and remember, progresses rapidly. Babies soon begin to recognize familiar people. As their memory develops, they gradually realize that people and objects exist even when they are out of sight, a cognitive skill called object permanence. Sensory integration evolves throughout the first year, which is the process by which a baby's brain begins to connect what is seen with what is tasted, heard, and felt.
• Emotional and social development begins with the bonds babies form with their parents and other caregivers. When cared for in a loving and consistent way, most babies begin to engage and interact with others. By 2 months of age, your baby smiles as a way to engage you. This is called a "social smile." At about 9 months, your baby gets upset when you or another caregiver leaves. This is a normal phase that is known as separation protest. By 12 months, most babies are expressive and have formed a close attachment to their parents. They also experience some degree of separation protest.
• Language development occurs along with brain growth. Babies start communicating with different types of cries, then progress to babbling. By 12 months, they may be able to say a few words. Most babies also understand some words by this time and begin to infer the meaning of many others. For more information, see the topic Speech and Language Development.
• Sensory and motor skill development progresses with the continual growth of the brain, nerves, and muscles. As controlled movements become more refined, newborn reflexes gradually fade. By 4 months of age, your baby will start using the arms with purpose. For example, your baby may move the arms and squirm when excited or "swipe" at dangling objects. By 6 months of age, your baby will likely be able to sit with little or no support. Your baby learns to crawl usually by 8 months of age. Some babies will be walking by their first birthday.

Although most children reach milestones by a specific age, it's important to remember that development occurs at an individual pace. Also, many children tend to make progress in one area, such as learning to say "da-da," while another skill, like motor coordination, levels off. If your child experiences a slight delay in an area, it does not necessarily mean there is a problem. But talk to your doctor if you are concerned.

Premature infants typically reach milestones later than others of the same age. But they are usually on schedule for their expected time of birth. For example, a baby born 2 months prematurely might reach milestones 2 months later than a full-term baby born at the same time. Healthy babies who were born prematurely usually reach normal developmental levels for their age by the time they are about 24 months of age. Cognitive skills usually are first to catch up. Motor skills are often the last the catch up.

Common Concerns

Between 1 month and 12 months of age, it is very common for parents to have concerns about their baby's general well-being. Know that you likely do not have anything to worry about. But it is good to be aware of health, development, and safety issues to help prevent or respond to problems.

Some common concerns include:

• Sudden infant death syndrome (SIDS). SIDS is the death, without a known cause, of a baby who is younger than 1 year old. Typically, a parent or other caregiver puts the baby-who seems healthy-down to sleep and returns later to find the baby has died. SIDS is very rare and it cannot always be prevented. But you can help prevent SIDS by always putting your baby to sleep on his or her back. Also consider giving your baby a pacifier at nap time and bedtime. Keep your baby's crib clear of toys and blankets. Clothing should be just enough for warmth without the risk of overheating. If possible, keep the room where your baby sleeps at a temperature that is comfortable without needing a lot of clothing or blankets. The safest place for your baby to sleep until at least 6 months of age is in your room in a separate crib or bassinet.¹ For more information, see the topic Sudden Infant Death Syndrome.
• Sleeping patterns. You may just start bragging to your friends and family how your baby is sleeping through the night when-BAM-all bets are off. Your baby may suddenly start to cry when it's nap time or bedtime or may wake up during the night. Sometimes a baby gets too excited for sleep after he or she has mastered some new skill, such as jabbering or shaking the crib. Other times, hunger from a growth spurt, a change in routine, or not feeling well may interrupt a good sleep pattern. Try to stay with a nap and bedtime routine. Your baby will adjust if you stay consistent. And remember, napping can be good for tired parents, too!
• Crying. Babies cry a lot, especially in the first 2 months. Crying is your child's first way of communicating. The amount of time your baby spends crying usually increases from birth until your baby is about 6 to 8 weeks old. After that, your baby will gradually cry less as he or she finds other ways of communicating or consoling himself or herself. If your child is crying, try to identify the type of cry. It helps to go through a mental checklist of what might be wrong and make sure your child is safe and cared for. As parents or caregivers respond to the young child's other signals (such as whimpering, facial expressions, and wiggling), the child will usually cry less. For more information, see the topic Crying, Age 3 and Younger.
• Head shape. The back of your baby's head may get a little flat from always placing him or her to sleep on the back. Usually, the flat area is not very noticeable. Your baby's head shape will return to normal after he or she can sit and crawl. But sometimes the head can become very noticeably flat. You can help prevent this by changing his or her head position regularly.
  • Make sure your baby gets "tummy time" every day. Place your baby on his or her tummy for playtime while you are watching closely. Let your baby "squirm" around, making sure that he or she can breathe easily. Tummy time helps your baby develop motor skills. These are important for helping your baby learn to move and hold his or head up.
  • Cuddle your baby while holding his or her head up as much as you can. Don't place your baby in car seat carriers or bouncers for long periods each day. Holding your baby is better for all areas of development.
  • Change your baby's head position during sleep at least every week. (Remember to always keep your baby on his or her back during naps and at bedtime.) A good way to make sure your baby's head rests in different positions is to switch which end of the bed you place him or her each week. One week, place your baby so his or her feet are at one end of the crib. The next week, place the feet at the other end. Babies usually turn their heads away from the wall, toward the inside of a room. If your baby's crib is not against a wall, you can try moving your baby's head position more to one side while he or she is sleeping.
• Choking. Babies love to put objects into their mouths. This habit is a choking hazard. To prevent your baby from choking, be careful about the size of toys he or she plays with. Watch out for everyday items that your baby could swallow, such as coins. Also, choking becomes a concern as you begin introducing solid foods to your baby between 4 and 6 months of age. Help prevent choking on food by not giving your child round, firm foods, such as hot dogs, unless you first completely chop them into very small pieces.
• Diaper rash. Diaper rash (diaper dermatitis) is a skin irritation caused by prolonged skin wetness, friction with the diaper material, and contact with chemicals in the urine and stool. The skin may look red, raw, scalded, or burned. Even though a diaper rash is uncomfortable, normally it is not serious. Diaper rash occurs most often in babies who are at least 6 months old. Usually the rash clears up when you change diapers more often, you are careful about cleaning your baby's bottom, or you apply nonprescription ointments to the rash. For more information, see the topic Diaper Rash.
• Sibling rivalry. It may take a few months before an older child shows signs of jealousy of a new baby. When your child realizes that the baby is there to stay, strong emotions and behavior problems may soon follow. You can help your older child adjust by setting time aside for just the two of you. Also, talk about how important it is for your older child to help care for the baby. Give him or her a role in daily care, such as handing you a fresh diaper when you change your baby. Or you may put your child "in charge" of your baby's favorite toy. Your child can have a special spot for the toy and be the one who always gives it to the baby and puts it away.

Promoting Healthy Growth and Development

Babies thrive when all of their needs are fulfilled consistently and with loving care. A baby goes through so many changes that it can be hard for you to keep up with all the things experts say you "should be" doing to promote healthy growth and development. Remember that the best things for your baby are usually the simplest. Loving, holding, feeding, changing, and talking to your baby are the things to focus on. The rest will fall into place.

But you can always learn more about how to help your baby grow and develop in healthy ways.

To promote physical health and development:

• Breast-feed for at least the first year of life. Introduce solid foods at the appropriate time, ideally after breast-feeding exclusively for the first 6 months.
• Learn your baby's rhythms. You will gradually get a sense of your baby's unique sleeping and eating patterns and be able to help establish a routine by about 3 months of age. But be prepared to make adjustments as needed.
• Always put your baby to sleep on his or her back. This sleep position helps reduce the risk for sudden infant death syndrome (SIDS). For more information on SIDS, see the topic Sudden Infant Death Syndrome (SIDS).
• Allow your baby "tummy time" while he or she is awake and you are closely watching.
• Keep your baby safe from injury, drowning, burns, poisoning, and other dangers.
  • Buy safe baby equipment (What is a PDF document?) and use it properly. Just because a product is marketed for babies does not mean it's safe. For instance, baby walkers are not recommended.
  • Use a car seat every time your baby rides in the car.
  • Do not leave your baby alone with a pet.
  • Never leave your baby alone or in the care of an older child, even for a moment, during baths or while he or she is on a changing table.
• Post emergency numbers near the phone. Include information about how to reach your doctor, friends, and neighbors. Keep your local Poison Control Center number handy, too.
• Never shake your baby. Shaking your baby in anger or frustration can lead to shaken baby syndrome. Get help right away if you feel that you or another caregiver might hurt your baby.
  • Call 911 if it is an emergency.
  • Call your doctor, a friend, a relative, or a parent hotline if you are feeling overwhelmed to the point that you feel you are not able to care for your baby.

For more information, see the topic Health and Safety, Birth to Age 2.

To help promote the healthy emotional development of your baby, you can:

• Encourage bonding. Consistently interact with and provide loving attention to your baby.
• Recognize and reinforce behaviors. For example, when interacting with your baby, encourage smiling and eye contact.
• Respond appropriately to crying. Your baby cries to communicate needs, such as feeling hungry or uncomfortable. You are not spoiling your baby by promptly responding to these cues. Some babies may experience colic, which is the extreme end of normal crying behavior that peaks at about 6 to 8 weeks of age. Using comforting techniques, such as carrying your baby with you in a front pack, may help. For more information on crying behavior, see the topic Colic or Crying, Age 3 and Younger.
• Manage separation protest. Beginning around 6 months of age, your baby begins to feel uneasy when you go away. You can help your baby manage these emotions by making sure your child is well-rested and well-fed before you leave. It may also help to distract your baby, such as with a favorite toy.

To help your baby gain new skills, you can:

• Stimulate learning. You help promote your baby's cognitive development through emotional bonding, interaction and play, and providing unconditional love.
• Nurture speech and language development. Talking to, interacting with, and reading to your baby are all natural ways to promote language development. For more information, see the topic Speech and Language Development.

As a parent or caregiver of children, it is also important for you to:

• Learn and use effective parenting and discipline techniques. Do not spank or use other types of corporal punishment. A baby between 1 month and 12 months is too young to understand what is "good" and "bad" behavior. Try distracting a child who is doing something wrong or something that might be dangerous. For example, if your baby tries to pull the dog's tail, find a toy to get his or her attention and move the dog to another area. You cannot "spoil" a baby between 1 month and 12 months. Hold your child and give him or her as much love and attention as you can. Your love and patience are critical for helping your child develop into a happy and confident toddler. Parenting classes are offered in most communities. Ask your doctor or call a local hospital for more information.
• Learn healthy techniques to manage stress and resolve conflicts. Taking care of your baby is an exciting time, but it can also be stressful. Babies need a lot of love and attention. As a parent or caregiver, you must make changes in your daily routine and some days you may simply feel overwhelmed. Also, parents often find that they have a harder time communicating with each other. Feeling tired can make you more sensitive and lose patience more easily than normal. You can help meet these new challenges by learning stress management skills. For example, think about ways to let others know your feelings before you reach your breaking point. Also, try new ways to relieve stress, such as exercising or listening to relaxing music. For more information, see the topic Stress Management.
• Ask for help when you need it. Call a family member or friend to watch your baby and give you a break if you feel overwhelmed. Investigate community resources that are available to help you with child care or other needed services. Call a doctor or local hospital for some suggestions. Some communities have respite care facilities for children. A respite care facility is a place that provides temporary child care during times when you need a break.

When to Call a Doctor

Talk to your doctor any time you have concerns about your baby's:

• Physical development. It is important to talk with your doctor if your baby's growth seems to slow significantly or if he or she is not consistently eating well.
• Cognitive development. Cognition is the ability to learn and remember. If your baby is not becoming increasingly alert or active, talk to your doctor.
• Emotional and social development. Talk to your doctor if you are concerned about how you and your baby interact or if you feel unable to nurture or emotionally connect with your child.
• Language development. If your baby doesn't babble as expected or respond to your voice, talk to your doctor. These may be signs of a hearing problem.
• Sensory and motor skill development. If your baby does not consistently meet motor skill development milestones, such as purposeful rolling over or crawling, talk to your doctor.

Also see your doctor if your child has lost a skill that he or she had previously mastered.

Remember that babies reach developmental milestones at different times. Just because your child is slow in one area does not mean that he or she has a health problem or developmental delay. But it is important to talk to your doctor whenever you have concerns. Identifying problems early usually offers the best opportunities for successful treatment. Seek other information sources if you feel your concerns are not addressed or if you have any other communication problems with your child's doctor.

Your physical and mental health are also important in helping your baby reach his or her potential. Talk to your doctor if think you might be depressed or if you feel detached or unable to care for your baby in any way.

Routine Checkups

Babies between 1 month and 1 year of age should have routine checkups, sometimes called well-baby visits, at 2, 4, 6, 9, and 12 months of age. During these visits, your baby's growth and development are evaluated to see whether he or she is reaching the milestones for each specific age.

At every checkup, the doctor:

• Looks at your baby's physical growth by measuring weight, length, and head circumference. These measurements are plotted on a growth chart and are compared to previous and later markings to make sure your baby is growing as expected.
• Asks you about your baby's motor and sensory development, vision, and hearing. Your baby receives a thorough exam, and immunizations are given. For more information, see the topic Immunizations or the childhood immunization schedule.
• Assesses your baby's emotional and social development by observing his or her interactions with you. You will be asked questions about how you and the rest of the family are doing, how your baby is eating and sleeping, and whether you have noticed any changes in behavior.

In addition to the above assessments, the doctor will be especially interested in checking specific developments at your baby's:

• 2-month checkup. Is your baby smiling yet? Do you have a routine feeding schedule? Are you bonding with your baby? Is the rest of the family adjusting to the baby?
• 4-month checkup. Is your baby reaching and grasping? Does your baby try to bring objects to his or her mouth? Are crying spells shortening? Is your baby settling in with the family, and is your family enjoying the baby?
• 6-month checkup. Is your baby able to sit? How is your baby's sensory and motor development and hand-eye coordination?
• 9-month checkup. How is your baby eating? Is your baby able to pick up objects? Does your baby respond to his or her name?
• 12-month checkup. Does your baby walk holding on to furniture? Does your baby enjoy playing peekaboo or patty-cake?

At the 9-month checkup, the doctor may do a test to check your child's development.

Routine checkups are a good time for parents to ask about what to expect in the weeks to come. You may find it helpful to keep a running list of questions (What is a PDF document?) .

Other Places To Get Help

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Online Resource

Organizations

Related Information

• Bottle-Feeding
• Breast-Feeding
• Breath-Holding Spells
• Child Car Seats
• Choosing Child Care
• Colic
• Crib Safety
• Crying, Age 3 and Younger
• Diaper Rash
• Environmental Illness
• Gastroesophageal Reflux in Babies and Children
• Growth and Development, Ages 12 to 24 Months
• Health and Safety, Birth to 2 Years
• Immunizations
• Lead Poisoning
• Nursery Equipment Safety Checklist
• Postpartum Depression
• Preventing Poisoning in Young Children
• Shaken Baby Syndrome
• Speech and Language Development
• Stress Management
• Sudden Infant Death Syndrome (SIDS)
• Teething
• Temper Tantrums
• Thumb-Sucking
• Weaning

References

Citations

1. Task Force on Sudden Infant Death Syndrome, American Academy of Pediatrics (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5): 1245-1255. Also available online: http://pediatrics.aappublications.org/cgi/content/full/116/5/1245.

Other Works Consulted

• Richter SB, et al. (2006). Normal infant and childhood development. In JA McMillan et al., eds., Oski's Pediatrics: Principles and Practice, 4th ed., chap. 96, pp. 593-601. Philadelphia: Lippincott Williams and Wilkins.

• American Academy of Pediatrics (2004). Age eight months through twelve months. In SP Shelov, RE Hannemann, eds., Caring For Your Baby and Young Child: Birth to Age 5, 4th ed., chap. 9, pp. 231-264. Elk Grove Village, IL: American Academy of Pediatrics.

• American Academy of Pediatrics (2004). Age four months through seven months. In SP Shelov, RE Hannemann, eds., Caring For Your Baby and Young Child: Birth to Age 5, 4th ed., chap. 8, pp. 201-230. Elk Grove Village, IL: American Academy of Pediatrics.

• American Academy of Pediatrics (2004). Age one month through three months. In SP Shelov, RE Hannemann, eds., Caring For Your Baby and Young Child: Birth to Age 5, 4th ed., chap. 7, pp. 177-200. Elk Grove Village, IL: American Academy of Pediatrics.

• Brazelton TB (2006). Touchpoints, Birth to Three: Your Child's Emotional and Behavioral Development, 2nd ed. Cambridge, MA: Da Capo Press.

• Goldson E, Reynolds A (2007). Child development and behavior. In WW Hay Jr et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., chap. 2, pp. 65-101. New York: McGraw-Hill.

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