INTRODUCTION:

Since the origin of mankind child plays an important role in our society. Growth refers to an increase in the size of an organism, as a result of an increase in the number of cells. Child development refers to when a child can do complex things as it grows. Every milestone is age-specific, which is attained by a normal developing child. Children remain the centre of hope, dedication and the future of the nation. For the high standard of life and society, all aspects of a child’s health and welfare should be considered.

The development of society is broadly affected by the growth of children.¹Identifying signs of cognitive delay (especially language and communication) is more difficult than identifying physical delay. Some children might have calm personalities, may be shy and less socialize with others, however, it does not mean that they have delayed milestones. Missed or delayed developmental milestones may be signs of some serious medical condition or disease. Regular developmental screening should be done for the children whose parents suspect missed milestones and consult with the latest reports.² The right perspective in the care of children is very important children. Every family wishes their children to grow up ass good and healthy people having adequate growth for their age, good mental and appropriate physical health, social well-being with proper life skills, appropriate cognitive development, good discipline and responsibility.¹Parental knowledge and upbringing of the child had a significant impact on child’s physical development, intelligence and emotional maturity. The child-rearing skills of the parents play an important role in developing a child’s thought process.³A mother who has less knowledge of child development has unrealistic expectations and adopts harsh, inconsistent discipline resulting in poor child developmental outcomes.⁴ The children with delayed developmental milestones are having low scholastic performance in school and subsequent mental, emotional, social, and financial consequences in adulthood.⁵To investigate the hidden factors for developmental delay research is required. The health care providers should be more observant towards this issue as it plays a pivotal role in the lives of our future generation.⁶Early intervention and management for developmental problems can be done with initial assessment.⁷

Therefore the need of this study is to assess the growth pattern and developmental milestones of children under 5 years of age as the first five years is a crucial period of a child’s growth and development. Growth of the brain is generally accepted as a good start at the beginning of life, which makes a child an efficient person in society.

MATERIAL AND METHOD:

The research approach was a quantitative descriptive design. The target population comprised children under the age of five years. A purposive and convenient sampling technique was used. The study was conducted in selective government hospitals (name does not disclosed due to ethical reasons) of Punjab. During January and February 2023, 300 children up to the age of five years were coming to the hospital for immunization or not attending the well-baby clinics for routine check-ups. Parents were randomly selected to participate in the study. The informed consent is obtained from their parents. Interview schedule was developed by the researcher and used to record the socio-demographic data of children and their parents. After literature review content validity and relablity was done. Denver Developmental scale was used to assess the milestones that includes gross motor, language, fine/problem solving, social/adaptive milestones. Standardised scoring pattern of Denver Developmental scale was used. The response was scored as Yes =1, No=0

RESULTS:

Table 1: Frequency and percentage distribution of the subjects as per their demographic variables. N=300

Variables	Frequency(f)	Percentage%
Age of child
a) 1 month to 12 month	082	27.3
b)1 year to2 year	075	25
c) 2-year to 3-year	052	17.3
d) 3-year to 5 year	091	30.3
Gender
a)Male	161	53.7
b)Female	139	46.3
Birth Order of child
a)1st	162	54
b)2nd	105	35
c)3rd	029	9.7
d)4th	004	1.3
Type of family
a)Nuclear family	107	35.7
b)Joint family	193	64.3
Education of mother/parent
a) Postgraduate	032	10.7
b) Graduate	061	20.3
c) Higher secondary	082	27.3
d) High school	094	31.3
e) Primary school	014	4.7
f) no formal education	017	5.7
Occupation of mother
a) Housemaker	265	88.3
b) Government	006	2
c) Private	029	9.6
Duration of illness 15 days prior to study
a) 2 days	097	32.3
b) 3 days	038	12.7
c) 4 days	019	6.3
d) 5 days	146	48.7
Gravida of mother
a) Primigravida	120	40
b) Multigravida	180	60
Gestational age
a)Term	287	95.7
b) Preterm	006	2
c) Post term	007	2.3
Type of delivery
a) N.V.D	178	59.3
b) Cesarean section	122	40.7
Did the baby cry at time of birth
a)Yes	298	99.3
b) No	002	0.7

Inference:

Maximum participants were from 3-5year age group (30.3%) and majority of participants were first born (54%). Maximum of participants (60%) living in joint family and majority of participants mother (31.3%) were high school pass. Majority of participants mothers’s (88.3%) were house maker and maximum of participants (48.7%) were having illness 5 days prior to study. Maximum of participants (95.7%) were born full term and mothers (60%) were multigravida. Maximum of participants (99.3%) were cried at time of birth.

Table 2: Frequency and percentage distribution of subjects as per gross motor domain. N=300

S. No	GROSS MOTOR	YES f (%)	NO f (%)
1	Does your baby have equal movements of arms and legs at the age of one month?	299 (99.7)	001 (0.3)
2	Does your baby lift his head at the age of 2 months?	297 (99)	003 (1)
3	Can your child lift head at 45 at the age of 3 months?	296 (98.7)	004 (1.3)
4	Does your child lift his head at 90 and can sit his head steady at the age of 4 months?	289 (96.3)	011 (3.7)
5	Can your child bear weight on your legs and chest up with the help of arms at the age of 5 months?	282 (94)	018 (6)
6	Does your child roll over and pull to sit without head lag at 6 months?	271 (90.3)	029 (9.7)
7	Does your child sit upright at the age of 7 months?	256 (85.3)	044 (14.7)
8	Does your child stand holding on at age 9 months?	248 (82.7)	052 (17.3)
9	Does your child start walking alone at the age of 12 months?	222 (74)	078 (26)
10	Does your child creep upstairs, and walk, backwards independently at the age of 15 months?	205 (68.3)	095 (31.7)
11	Does your child walk up and down steps, 2 feet per step without help at age 24 months?	163 (54.3)	137 (45.7)
12	Does your child alternate feet when going up steps, or pedal tricycle at age 3 years?	122 (40.7)	178 (59.3)
13	Does your child hop, skip, and alternate feet going down steps at age 4 years?	069 (23)	231 (77)
14	Does your child skip alternate feet, and jump over low obstacles at the age of 5 years?	028 (9.3)	272 (90.7)

Inference- majority of participants (99.7%) were having normal gross motor assessment.

Table 3: Frequency and percentage distribution of subjects as per language domain. N=300

S. No	LANGUAGE	YES f (%)	NO f(%)
1	Is your child alert to sound at the age of 1 month?	299 (99.7)	001 (0.3)
2	Does your child smile socially (after being stroked or talked to) for 2 months?	297 (99)	003 (1)
3	Does your child coos at the age of 3 months?	296 (98.7)	004 (1.3)
4	Does your child laugh, or orient to voice at the age of 4 months?	291 (97)	009 (3)
5	Does your child babble, ah-goo, razz, lateral orientation to bell at the age of 6 months?	274 (91.3)	026 (8.7)
6	Does your child say ‘mama, dada ’indiscriminately, gestures waves by bye understands no at the age of 9 months?	247 (82.3)	053 (17.7)
7	Does your child use 2 words other than “mama “dada, jargoning (running several unintelligible words together with tone or inflexion), one step command with a gesture at the age of 12 months?	220 (73.3)	080 (26.7)
8.	Does your child use 4-6 words, and follow one-step commands without gestures at the age of 15 months?	194 (64.7)	106 (35.3)
9.	Does your child speak 7-10 word vocabulary, and knows 5 body parts at the age of 18 months?	160 (53.3)	140 (46.7)
10.	Does your child use pronouns (I, you, me ) inappropriately, follow two-step commands, and use two-word sentences at the age of 24 months?	154 (51.3)	146 (48.7)
11	Does your child use 250 words, 3-word sentences, use plurals, know all pronouns, and repeat 2 digits at the age of 3 years?	116 (38.7)	184 (61.3)
12	Does your child know colour, say songs or poems from memory, and ask questions at the age of 4 years?	065 (21.7)	235 (78.3)
13	Does your child ask the meaning of words at the age of 5 years?	028 (9.3)	272 (90.7)

Inference-majority of participants (99.7%) were having normal assessment of language milestone.

Table 4: Frequency and percentage distribution of subjects as per fine motor domain. N=300

S. No	FINE MOTOR/ PROBLEM SOLVING	YES f (%)	NO f (%)
1	Does your child have a tight grasp, and follow at midline at the age of 1 month?	299 (99.7)	001 (0.3)
2	Does your child no longer fists tightly, or follows objects past midline at the age of 2 months?	297 (99)	003 (1)
3	Does your child hold a hand at rest, follow circularly, and respond to visual threats at the age of 3 months?	296 (98.7)	004 (1.3)
4	Does your child bring hands at the midline at the age of 4 months?	291 (97)	009 ( 3)
5	Does your child use unilateral reach, a raking grasp, and transfer objects at the age of 6 months?	274 (91.3)	026 (8.7)
6	Does your child use an immature pincer grasp, probe with the foreigner, hold a bottle, or throw objects at the age of 9 months?	251 (83.7)	049 (16.3)
7	Does your child use a mature pincer grasp, and can make crayon mark releases voluntarily at the age of 12 months?	227 (75.7)	073 (24.3)
8	Does your child scribbles in imitation, and builds a tower of 2-3 blocks at the age of 15 months?	206 (68.7)	094 (31.3)
9	Does your child scribble spontaneously, build a tower of 2-3 blocks, and turn 2-3 pages at a time at age 18 months?	167 (55.7)	133 (44.3)
10	Does your child imitate stroke with a pencil, build a tower of 7 blocks, turn pages one at a time, remove shoes, pants etc at the age of 24 months?	159 ( 53)	141 (47)
11	Does your child copy a circle, undress completely, dress partially, and unbutton at the age of 3 years?	119 (39.7)	181 (60.3)
12	Does your child copy a square, buttons, catch ball, and dress self completely at the age of 4 years?	063 (21)	237 (79)
13	Does your child copies triangle, and ties shoes at the age of 5 years?	027 ( 9)	273 (91)

Inference-majority of participants (99.7%) were having normal fine motor /problem solving milestone.

Table 5: Frequency and percentage distribution of subjects as per social adaptive domain. N=300

S. No	Social /adaptive	YES f (%)	NO f (%)
1	Does your child regards face at age of 1 month?	299 (99.7)	001 (0.3)
2	Does your child recognize the parent at age of 2 month?	297 (99)	003 (1)
3	Does your child reaches for familiar people or objects, anticipates feeding at age of 3month?	295 (98.3)	005 (1.7)
4	Does your child enjoys looking around at age of 4 month?	290 (96.7)	010 (3.3)
5	Does your child recognize stranger at age of 6 months?	271 (90.3)	029 (9.7)
6	Does your child starts exploring environment, plays gesture games (pat a cake) at age of 9 months?	250 (83.3)	050 (16.7)
7	Does your child imitates action, comes when called, cooperate in dressing at age of 12 months?	231 (77)	069 (23)
8	Does your child uses spoon and cup at age of 15 months?	205 (43)	095 (31.7)
9	Does your child copies parent in task, plays in company of other children at age of 18 months?	171 (57)	129 (43)
10	Does your child parallel play at age of 24 months?	161 (53.7)	139 (46.3)
11	Does your child group play, shares toys, takes turn knows full name, age and gender at age of 3 years?	120 (40)	180 (60)
12	Does your child tells tall tales, plays cooperatively with group of children at age of 4 year?	066 (22)	234 (78)
13	Does your child plays competitive games, abide by rules likes to help household tasks at age of 5 years ?	028 (9.3)	272 (90.7)

Inference - majority of participants (99.7%) were having normal assessment of social adaptive domain.

SCORING KEY FOR ASSESSMENT OF DEVELOPMENTAL MILESTONES:

S. No	Findings	Score
1	All item done	Normal
2	One item is not done	Questionable
3	Two items are not done	Suspected
4	Three or more not done	Delayed

Table 6: Frequency distribution of subjects as per delayed, suspected, questionable and normal assessment of gross motor milestones. N=300

	GROSS MOTOR MILESTONE
AGE		Normal	Questionable	Suspected	Delayed
	Total	f (%)	f (%)	f (%)	f (%)
1 month	002	002 (100)	Nil	Nil	Nil
2 month	001	001 (100)	Nil	Nil	Nil
3 month	005	005 (100)	Nil	Nil	Nil
4 month	008	007 (87.5)	001 (12.5)	Nil	Nil
5 month	009	007 (77.7)	002 (22.2)	Nil	Nil
6 month	014	012 (85.7)	002 (14.2)	Nil	Nil
7 month	009	008 (88.8)	001 (11.1)	Nil	Nil
8-9 month	019	018 (94.7)	001 (5.26)	Nil	Nil
10-12 month	024	018 (75)	006 (25)	Nil	Nil
1-2year	087	041 (47.1)	043 (49.4)	002 (2.2)	001 (1.1)
3 year	053	053 (100)	Nil	Nil	Nil
4 year	041	039 (95.1)	Nil	Nil	002 (4.87)
5 year	028	028 (100)	Nil	Nil	Nil

Inference - Maximum number of participants in age group 1 to 2 year, (25%) participants were questionable, (2.2%) participants were suspected whereas (1.1%) participants were delayed in gross motor milestone. In age group 4 years, maximum number of participants (4.87%) were having delayed milestone.

Table 7: Frequency distribution of subjects as per delayed, suspected, questionable and normal assessment of language milestone. N=300

	LANGUAGE MILESTONE
AGE	Total	Normal	questionable	suspected	delayed
		f (%)	f (%)	f (%)	f (%)
1 month	002	002 (100)	Nil	Nil	Nil
2 month	001	001 (100)	Nil	Nil	Nil
3 month	005	005 (100)	Nil	Nil	Nil
4 month	008	008 (100)	Nil	Nil	Nil
5 month	009	009 (100)	Nil	Nil	Nil
6 month	014	014 (100)	Nil	Nil	Nil
7 to 9 month	028	018 (64.2)	010 (35.7)	Nil	Nil
10 to 12 month	024	023 (95.8)	001 (4.16)	Nil	Nil
1 to 2 year	087	035 (40.2)	006 (6.8)	037 (42.5)	009 (10.3)
3 year	053	049 (92.4)	001 (1.8)	002 (3.7)	001 (1.8)
4 year	041	035 (85.3)	001 (2.4)	002 (4.87)	003 (7.3)
5year	028	028 (100)	Nil	Nil	Nil

Inference-majority of participants in age group 1 to 2 year, (6.8%) participants were questionable, (42.5%) participants were suspected whereas (10.3%) participants were delayed in language milestone.

Table 8: Frequency distribution of subjects as per delayed, suspected, questionable, and normal assessment of fine motor milestone N=300

	FINE MOTOR MILESTONE
AGE	Total	Normal	Questionable	Suspected	Delayed
		f (%)	f %	f %	f %
1 month	002	002 (100)	Nil	Nil	Nil
2 month	001	001 (100)	Nil	Nil	Nil
3 month	005	005 (100)	Nil	Nil	Nil
4 month	008	008 (100)	Nil	Nil	Nil
5 month	009	009 (100)	Nil	Nil	Nil
6 month	014	014 (100)	Nil	Nil	Nil
7-9 month	028	019 (67.8)	009 (32.1)	Nil	Nil
10-12 month	024	022 (91.6)	002 (8.3)	Nil	Nil
1-2year	087	038 (43.6)	008 (9.1)	038 (43.6)	003 (3.4)
3 year	053	051 (96.2)	002 (3.7)	Nil	Nil
4 year	041	035 (85.3)	005 (12.1)	001 (2.4)	Nil
5 year	028	27 (96.4)	001 (3.5)	Nil	Nil

Inference - Maximum number of participants in age group 1 to 2 year,(9.1%) were questionable, (43.6%) were suspected and (3.4%) were delayed in fine motor milestone.

Table 9: Frequency distribution of subjects as per delayed, suspected, questionable, and normal assessment of social adaptive milestone. N=300

	Social Adaptive/Problem Solving
AGE	Total	Normal	Questionable	Suspected		Delayed
		f (%)	f %	f %	f %
1 month	002	002 (100)	Nil	Nil	Nil
2 month	001	001 (100)	Nil	Nil	Nil
3 month	005	005 (100)	Nil	Nil	Nil
4 month	008	008 (100)	Nil	Nil	Nil
5 month	009	009 (100)	Nil	Nil	Nil
6 month	014	013 (92.8)	001 (7.1)	Nil	Nil
7- 9 month	028	018 (64.2)	008 (28.5)	001 (3.5)	001 (3.5)
10- 12 month	024	024 (100)	Nil	Nil	Nil
1- 2 year	087	040 (45.9)	010 (11.4)	034 (39.0)	003 (3.4)
3year	053	052 (98.1)	001 (1.8)	Nil	Nil
4 year	041	038 (92.6)	002 (4.8)	Nil	001 (2.4)
5year	028	028 (100)	Nil	Nil	Nil

Inference - Maximum number of participants in age group 1 to 2 years, (11.4%) were questionable, (39%) were suspected and (3.4%) were delayed in social adaptive milestone.

DISCUSSION:

Results of the study revealed that 99% of subjects had a normal distribution of the gross motor domain. 99% of subjects were having normal language milestone domain. The majority of subjects had a normal distribution of fine motor milestones and 299 subjects had having normal distribution of social; adaptive domains. It was similar to the study having similar findings was performed by Agarwal D, et al. (2018) conducted a community-based cross-sectional study on the “prevalence of developmental delay and factors affecting developmental status among under 5 children in an urban slum of Agra”. 12.2% of the children were found to be developmentally delayed. Prevalence of developmental delay increased significantly from infancy (0-11 months) (5.7%) to 12-23 months of age, peaking at 12-23 months age (20.3%), after that showing a decreasing trend to 15.3% as the age of the child increased to more than 2 years. Childhood nutrition received attention but overall development of children needs more focus.⁸In the present study the prevalence for delayed language milestone maximum in the age range, 1 to 2 years is 10% there after showing a decreasing trend to 3.4% with the increase in age observed.

Sharma S and Kaur G (2014) conducted a study on “gross motor developmental milestones of children.” A descriptive comparative research design was used for the study. The result of the study reveals that out of 20 samples in each age group 50% had normal gross motor milestones and 50% had mild delayed developmental milestones in rural areas, whereas in urban areas 65% had normal gross motor developmental milestones and 35% had mild delayed milestones. In both areas rural and urban at all age groups, no children had delayed developmental milestones.⁹ The result of this study are also consistent with the present study as the prevalence for delayed gross motor milestones comes in the age range of 4 years i.e 4.8%

Singh A et al. (2017) conducted a study on “a review of developmental delay and its determinants in under five children” This article is based on reviewed literature from google scholar and PubMed Central. Studies selected included processes or outcomes using quantitative methods that studied developmental delay prevalence and factors associated within India among under five children. Result of study reveals that from the studies developmental delayed range from 2.31% to 19.8% among under five children in India. Appropriate norm based tools should be used for earlier identification of developmental delay.¹⁰ The result of this study are also consistent with the present study as the prevalence for delayed developmental milestones comes in the age range of 1 to 2 years and 4 years i.e under five year children. Ali S et al. (2011) had conducted a study to “assess growth and global developmental delay among young children in a rural community of India”. The sample included 530 children of age 3 year. The study result reveals that children displayed delay in personal-social (42.5%), gross motor (38.1%) and problem-solving skills (34.9%). Maternal educational level was significantly associated with communication and problem-solving skills (P=0.000) while monthly household income was also associated with communication, gross motor and problem solving skills (p=0.000).¹¹ The result of this study are consistent to the present study prevalence as for delayed gross motor milestone come in age range 4 year i.e 4.8% and in age range 1 to 2 year prevalence is 1.1%. Prevalence for delayed language milestone maximum in age range, 1 to 2 year is 10% and 7.3% in age range 4 year and 1.8% in age range 3 year. Prevalence for delayed fine motor milestone falls in age range 1 to 2 year is 3.4%. Prevalence for delayed social/adaptive milestone falls in age range 1 to 2 year is 3.4% and in age range 7 to 9 months, it is 3.5%.

Nair M Dhanya (2021) had conducted the explorative study on developmental milestones of toddlers at selected areas of Nedukandam, Kerala. Around 120 subjects having age group of 30-36 months were enrolled in study. Data was collected by use of questionnaire method. The results of the study revealed that 76.7% children were having normal milestones and 20% subjects were having mild delayed and only 3.3% children had delayed milestones. So it was concluded in the study that there is no association of developmental milestones with demographic variables.¹² In the present study it is concluded that most of the children were having normal milestones and there was no association of sociodemographic variables with developmental milestones. Vora H, Shah P, Mansuri S (2013) cross sectional study was conducted on” Developmental delay among children less than 2 year attending Well Baby Clinic”. 200 patients were screened from Well Baby Clinic. 181 children were found to be normal. In 19 children, delay was found. Developmental milestone assessment was done using TDSC (Trivandrum Developmental Screening Test) chart. Keys, ball, pen were used for assessment along with chart. A standardized questionnaire was used to collect information.¹³ The result of this study are also consistent with the present study as the prevalence for delayed developmental milestones comes in the age range of 1 to 2 years there after shows a decreasing trend i.e 3.4% with age increases.

LIMITATIONS:

The study was limited to

1. Selected age group

2. Selected health care centers

3. 300 samples

4. Health profile was not assessed

RECOMMENDATIONS:

· A similar study can be replicated on a large sample to generalize the findings.

· An experimental study can be undertaken with control group for effective comparison of the results.

· Videos, Role playing and self-instructional modules may be developed in all dimensions and aspects of development of milestone.

ETHICAL CONSIDERATIONS:

Ethical approval was obtained from the ethical committee of Institute and hospitals. Informed consent from parents of children were taken.

CONFLICT OF INTEREST:

The author has no conflict of interest.

ACKNOWLEDGEMNTS:

the author would like to thank hospital incharges and participants for their support and guidance.

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Received on 03.07.2025 Revised on 21.10.2025

Accepted on 24.12.2025 Published on 30.04.2026

Available online from May 02, 2026

Int. J. Nursing Education and Research. 2026;14(2):101-106.

DOI: 10.52711/2454-2660.2026.00020

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.