Social Development

Last updated: April 1, 2026

Summary of important social milestones

AgeMilestones
1 month oldPrefers human faces, reacts to voice, and establishes eye contact
2 months oldSocial smile
4 months oldSustained social smile, laughs
6 months oldPrefers caretaker, stranger anxiety starts
9 months oldObject permanence; recognises their name; consonant babbling
1 year oldTantrums typically begin
16 months oldHugs parents
18 months oldKisses with a pucker; may recognise themself in the mirror
2 years oldParallel play
2.5 years oldImaginative play; uses pronouns; tantrums peak
3 years oldKnows age and sex; some understanding of fairness
4 years oldTogether play, potty training, and sexual modesty
5 years oldInquisitive; communicates in full sentences; concrete sense of rules

Overview of social development

Social development begins at birth with attachment to the caretaker, especially in the form of mother-infant bonding during breastfeeding.

  • Abnormalities in social development might be a sign of:
    • Underlying emotional issues
      • Neglect
      • Abuse
    • Underlying medical issues
      • Neurodevelopmental disorders, e.g., autism
      • Hearing impairment – language acquisition will also be impaired

Social developmental milestones

  • Newborn to 1 month
    • Preference for human face
    • React to voice at one month of age
    • Crying peaks around 6 weeks of age (up to 3 hours per day)
    • Should re-attain birthweight by 2 weeks and grow 30g/d until 4 months
  • 2 months of age
    • Social smile
    • Will listen to the voice and make a cooing sound
  • 4 months of age
    • Sustained social smile and laughing
    • The infant will begin to show distinct facial expressions in various scenarios
    • May show displeasure if social contact is broken
    • Recognises the sight of food and often becomes excited
    • Growth slows to 20g/d until 1 year of age (birthweight should have doubled)
  • 6 months of age
    • An infant typically prefers their mother or primary caretaker
    • Stranger anxiety begins to develop. This can be directed towards you, the doctor.
    • Peak-a-boo is often fun for the child, as object permanence has not yet developed
  • 9 months of age
    • Object permanence has developed. This makes the separation more difficult as the child realises the caretaker has not disappeared, but is gone
    • Increased wariness of strangers
    • Monosyllabic babbling
    • Should recognise and respond to the name
    • Should understand “bye-bye” and may wave
  • 12 months of age
    • Should be able to say and understand a few words other than “mama” or “dada”
    • Makes postural adjustment to dressing
    • May be able to respond to commands such as “give me”
    • Tantrums often begin (tantrums lasting longer than 15 minutes or occurring more than 3 times/day may reflect underlying medical, emotional, or social problems)
    • Birthweight should have tripled
  • 16 months of age
    • Baby should start to hug parents and show a high preference for familiar people for comfort
    • Preference towards strangers is particularly concerning for potential neglect or abuse
  • 18 months of age (1.5 years)
    • Able to kiss a parent with a pucker
    • May exhibit self-awareness and may recognise themself in the mirror
    • Should indicate some desires by pointing
  • 24 months of age (2 years old)
    • Linguist development expands. Vocabulary has usually expanded to 50-100 words and will dramatically increase after 2 years of age
    • Should be able to properly use a spoon
    • Should be able to respond to two-step commands
    • Engaged in parallel play
  • 30 months of age (2.5 years old)
    • Child begins to engage in imaginative play, but may have difficulty distinguishing reality from fantasy
    • Tantrums peak at 2.5 years of age
    • Refers to self as “I” and “me”
    • Birthweight should have quadrupled
  • 3 years old
    • Should be able to help with getting dressed
    • Washes hands
    • Should know age and sex, and be able to tell someone his/her name when asked
    • Still not able to consider others’ points of view (egocentricism), and fairness is viewed in somewhat concrete terms (everyone gets the same)
  • 4 years old
    • Social interaction and together play should have started
    • Control of bowel and bladder has developed, and potty training is likely accomplished by this age
    • Bed-wetting is normal in girls up to 4 years and boys up to 5 years
    • Children should begin to show modesty about sexual organs and nudity
  • 5 years old
    • Dresses and undresses themself
    • Inquisitive (asks about meanings of words)
    • Should be able to communicate in complete sentences that are understood by strangers
    • A child should develop a sense of rules (only understood in concrete terms)
    • Genital self-touching is still considered normal (but the child should know when it is not appropriate)
    • Excessive sexualised behaviour or acting out adult sexual acts is a troubling sign and may indicate psychiatric issues or abuse

Reference Intervals
Biochemistry
ACTHP: <80 ng/L
ALTP: 5–35 U/L
AlbuminP: 35–50 g/L
AldosteroneP: 100–500 pmol/L
Alk. phosphataseP: 30–130 U/L
α-AmylaseP: 0–180 IU/dL
α-FetoproteinS: <10 kU/L
Angiotensin IIP: 5–35 pmol/L
ADHP: 0.9–4.6 pmol/L
ASTP: 5–35 U/L
BicarbonateP: 24–30 mmol/L
BilirubinP: 3–17 μmol/L
BNPP: <50 ng/L
CRPP: <10 mg/L
CalcitoninP: <0.1 mcg/L
Calcium (ionized)P: 1.0–1.25 mmol/L
Calcium (total)P: 2.12–2.60 mmol/L
ChlorideP: 95–105 mmol/L
CholesterolP: <5.0 mmol/L
VLDLP: 0.128–0.645 mmol/L
LDLP: <2.0 mmol/L
HDLP: 0.9–1.93 mmol/L
Cortisol AMP: 450–700 nmol/L
Cortisol MidnightP: 80–280 nmol/L
CK ♂P: 25–195 U/L
CK ♀P: 25–170 U/L
CreatinineP: 70–100 μmol/L
FerritinP: 12–200 mcg/L
FolateS: 2.1 mcg/L
FSHP: 2–8 U/L ♂; >25 menopause
GGT ♂P: 11–51 U/L
GGT ♀P: 7–33 U/L
Glucose (fasting)P: 3.5–5.5 mmol/L
Growth hormoneP: <20 mu/L
HbA1C (DCCT)B: 4–6%
HbA1C (IFCC)B: 20–42 mmol/mol
Iron ♂S: 14–31 μmol/L
Iron ♀S: 11–30 μmol/L
Lactate (venous)P: 0.6–2.4 mmol/L
Lactate (arterial)P: 0.6–1.8 mmol/L
LDHP: 70–250 U/L
LHP: 3–16 U/L
MagnesiumP: 0.75–1.05 mmol/L
OsmolalityP: 278–305 mosmol/kg
PTHP: 0.8–8.5 pmol/L
PotassiumP: 3.5–5.3 mmol/L
Prolactin ♂P: <450 U/L
Prolactin ♀P: <600 U/L
PSAP: 0–4 mcg/mL
Protein (total)P: 60–80 g/L
Red cell folateB: 0.36–1.44 μmol/L
Renin (erect)P: 2.8–4.5 pmol/mL/h
Renin (recumbent)P: 1.1–2.7 pmol/mL/h
SodiumP: 135–145 mmol/L
TBGP: 7–17 mg/L
TSHP: 0.5–4.2 mU/L
T4P: 70–140 nmol/L
Free T4P: 9–22 pmol/L
TIBCS: 54–75 μmol/L
TriglyceridesP: 0.50–2.3 mmol/L
T3P: 1.2–3.0 nmol/L
Troponin TP: <0.1 mcg/L
Urate ♂P: 210–480 μmol/L
Urate ♀P: 150–390 μmol/L
UreaP: 2.5–6.7 mmol/L
Vitamin B12S: 0.13–0.68 nmol/L
Vitamin DS: 50 nmol/L
Arterial Blood Gases
pH7.35–7.45
PaCO₂4.7–6.0 kPa
PaO₂>10.6 kPa
Base excess±2 mmol/L
Urine
Cortisol (free)<280 nmol/24h
Hydroxyindole acetic acid16–73 μmol/24h
Hydroxymethylmandelic acid16–48 μmol/24h
Metanephrines0.03–0.69 μmol/mmol cr.
Osmolality350–1000 mosmol/kg
17-Oxogenic steroids ♂28–30 μmol/24h
17-Oxogenic steroids ♀21–66 μmol/24h
17-Oxosteroids ♂17–76 μmol/24h
17-Oxosteroids ♀14–59 μmol/24h
Phosphate (inorganic)15–50 mmol/24h
Potassium14–120 mmol/24h
Protein<150 mg/24h
Protein/creatinine ratio<3 mg/mmol
Sodium100–250 mmol/24h
Haematology
WCC4.0–11.0 ×10⁹/L
RBC ♂4.5–6.5 ×10¹²/L
RBC ♀3.9–5.6 ×10¹²/L
Hb ♂130–180 g/L
Hb ♀115–160 g/L
PCV ♂0.4–0.54 L/L
PCV ♀0.37–0.47 L/L
MCV76–96 fL
MCH27–32 pg
MCHC300–360 g/L
RDW11.6–14.6%
Neutrophils2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes1.0–4.5 ×10⁹/L (20–45%)
Eosinophils0.04–0.44 ×10⁹/L (1–6%)
Basophils0–0.10 ×10⁹/L (0–1%)
Monocytes0.2–0.8 ×10⁹/L (2–10%)
Platelets150–400 ×10⁹/L
Reticulocytes0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time10–14 s
APTT35–45 s
Paediatric
Pulse Rate (bpm)
Neonate140–160
Infant <1yr120–140
1–5 years110–130
5–12 years80–120
>12 years70–100
Respiratory Rate (tachypnoea)
0–2 months≥60/min
2–12 months≥50/min
1–5 years≥40/min
>5 years≥30/min
Blood Pressure (mmHg)
Term65/45
1 year75/50
4 years85/60
8 years95/65
10 years100/70
Weight Formulas
3–12 months(a + 9)/2 kg
1–6 years2a + 8 kg
>6 years(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn13–20
1 month11–18
2 months10–15
1–2 years10–13
>2 years11–14
MUAC (6 months–5 years)
Obese>17.5 cm
Normal13.5–17.4 cm
At risk12.5–13.4 cm
Moderate malnutrition11.5–12.4 cm
Severe malnutrition<11.5 cm
Developmental Milestones
Social smile1.5 months
Head control4 months
Sits unsupported7 months
Crawls10 months
Stands unsupported10–12 months
Walks12–13 months
Talks18 months
CSF WBC (/mm³)
Term newborn0–25
>2 weeks0–5
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