Development milestones 2 to 4 months

[mme_highlight] At this age, your baby puts toys and almost everything in the mouth, which indicates the presence of “hand-mouth” coordination. At two months, the baby begins to fixate objects and tracks moving objects with eyes. When the baby is positioned on tummy, she/he can lift the head and chest for 90 degrees while supporting on elbows. [mme_highlight]

Between the second and fourth months of life, a baby continues the rapid development of both motor and cognitive function and also at emotional and social levels. The baby begins to discover its senses during this period.

Motor control over the arms is faster developed than the motor control over the legs, because the development of the nervous system occurs in this specific way – firstly, motor control is established over the muscles of the head and neck, then it follows motor development of arms and back and finally the legs.
Also, control of muscle is established from center to the periphery (e.g. firstly, motor control over the shoulder muscles, then upper arm muscle, then lower arm muscles and finally the muscles of baby’s hand).

Cognitive Development

During this period infants discover their own hands.

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37 % of babies become aware of their own hands between 8th to 10th week of life;
97 % of babies discover their own hands until the end of fourth months.

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At this stage, the baby starts to babble and use a variety of ways to show when he/she is hungry, thirsty or unsatisfied. Baby can mimic the facial expressions of the people they are looking at. Also, babies can recognize the voice of mother and can find ways of claiming for her attention.

Motor Development

At two months, the baby begins to fixate objects and tracks moving objects with eyes. When a baby is positioned on the back, he/she tracks with eyes a colorful toy, as well as the face of the person who moves it. The hands are more frequently open.

During the third month, the baby manages to partially lift the chest from the base relying on the forearm. The legs are now almost fully extended and knees are slightly bent toward the tummy. When baby is positioned on the back, she/ he turns head from side to side, cheerfully react when she/he sees a toy with vivid colors and extends hand in order to reach it. Three months old baby can keep up the head almost for a full minute.

At the age of three months, when the baby is lying on the stomach, she/he can detect the object that is in front of him/her and tries to grab it. Some babies are able to sit with using arms as a support.

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Sitting with support

50 % of babies between 2.5 to 3 months of age;
90% of babies at 4.5 months
<1 % of babies are able to sit without support by the age of 4 months.

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During the fourth month, when the baby is positioned on tummy, she/he can lift the head and chest for 90 degrees while supporting on elbows. While positioned on the back, baby tracks the objects in front of him/her and tries to reach them (do not be afraid if it fails, because hand-eye coordination is not yet completely established). At this age, your baby puts toys and almost everything in the mouth, which indicates the presence of “hand-mouth” coordination.

From the age of 4 months, “eye-hand” coordination is established – baby can see the toy, try to reach and grab it. Some babies can roll over.

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Rolling over

50% of babies by 3 months can roll from stomach to back without rotation (the movement begins from the head)
10 % of babies are able to roll from back to stomach with rotation (more complex movement compared to rolling over without rotation).

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Social/Emotional Development

A baby begins to notice members of family that she/he sees every day. About 90 % of babies laugh by 3 months. Also, when parent tickles baby, loud laughter can be expected. At the age of 4 months, the baby begins to give spontaneous smile to loved ones. It loves to play with people and can start crying if the game stops.

Language/communication

At the age of two months, a baby starts to “communicate” with sounds such as “a”, “u” and “e”. Regarding the development of “sound signals”, at this age baby begins to produce “rrr” voices. At the age of four months, the baby begins to produce sounds.

What are the risk factors that can impair development?

During this period, parents should not give baby small objects. Baby pushes everything in the mouth (“hand-mouth” coordination is developed) and it can cause choking. The baby should be lying on a hard surface, for example on soft pillow. There is a risk of suffocation when the head is buried in a pillow, because the baby cannot to turn her/himself. Note that among children younger than 1 year whose cause of death was unintentional injuries, 81.5% died from suffocation.

Do not leave your baby alone or unattended, especially in places where she/he can fall when she/he is rolling over the bed. Do not ignore your baby’s cries, because it can lead to fear of separation. If you notice that your baby is too rigid, you should contact a pediatrician because it could indicate a developmental anomaly.

What are the alarm signs I should be worried about?

The baby does not seem to be aware of hands by 2 months;
The baby does not react to loud noises ;
The baby does not fixate objects or does not track moving objects with eyes by 2 to 3 months;
The baby can’t support the head;
The baby doesn’t smile;
The baby doesn’t notice new face or act upset when notices new face;
The baby doesn’t grasp objects by 3 to 4 months;
The baby doesn’t babble by 3 to 4 months;
The baby doesn’t try to put objects in mouth by 4 months;
The baby doesn’t try to imitate parents’ sounds by 4 months;
The baby does not push down the leg when she/he feels stable surface under the feet by 4 months;
The baby loses skills he/she had already acquired.

What should parents do to encourage the development of baby at this age?

The baby needs a soothing calm environment. Quiet music or gentle mother’s voice can contribute to the adequate development of a baby. While your baby is awake, you should put her/him lying down on her/his stomach, because this encourages the strengthening of back muscles.
Parents should encourage their baby to look at the toys, to track moving toys with eyes and try to catch it- all of these can be implemented through simple games when the baby is in the mood.

You should spend a lot of time with your baby out in the nature, because this is of major importance for your child to discover the world. Parents should talk and sing to the baby. While your child is on her/his stomach trying to reach a toy or other object, parents should provide stability, for instance, by putting their hand over the baby’s pelvis and press it lightly to the ground.

Also, parents should give a child an interesting toy with vivid colors and toys that make sounds. The rolling skill can be encouraged with this simple game: place a toy next to the right or left side of baby; the baby usually rolls from tummy to back or vice versa.
If your baby looks interested in this game, repeat this over and over again. In addition, parents can help improve the “eye-hand” and “hand- mouth” coordination through simple games.

Summary and Recommendations

Between 2 and 4 months, your baby will show developmental progresses every day. Knowing what to expect makes it easier for you to recognize the progresses and help the child to achieve them.
Cognitive Development: the baby recognizes voices, claims for attention
Motor Development: your baby can now fixate objects and follow a moving object with her/his eyes. Eye-mouth and eye-hand coordination begin to be noticeable at this stage. Chest lift and holding head for at least a minute are also prominent achievements for the period between 2 and 4 months. Your child will also show rolling over skills.
Social/Emotional Development: Your baby recognizes familiar faces and laughs at them.
Language Development: You will hear sounds such as “a”, “u” and “e” from your baby.
Each child has her/his own pace, but if you think your child is not developing adequately or if alarm signs are noticed, parents should contact a pediatrician as soon as possible.

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References

Important Milestones: Your Baby at Four Months. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/actearly/milestones/milestones-4mo.html. Accessed May 13, 2013
Important Milestones: Your Baby at Two Months. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html. Accessed May 13, 2013
Feigelman S. The first year. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 8
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web‐based Injury Statistics Query and Reporting System(WISQARS). National Center for Injury Prevention and Control Website. Unintentional fatal and nonfatal injuries, children ages 19 and under. Available from: http://www.cdc.gov/injury/wisqars/index.html. Accessed May 15, 2013.

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