A Child's Milestones Between Weeks 1 and 4
Heather Morris, a Registered General Nurse and a State Certified Midwife of over 25 years, provides an overview of a baby's development in the newborn stage of weeks 1 - 4. The below report details milestones babies may be reaching at this age, advice which may be helpful to parents and, potential red flags to look out for.
Overview of Milestones Expected Between Weeks 1 and 4
Motor skills: limbs flexed; symmetrical pattern; marked head lag on pulling up
Cognitive and fine motor development: follows moving object or a face by turning their head (fixing and following); the visual focal length is about 25 cms; prefers human face (eyes), contrast, colours, high pitched voice.
Hearing, Speech and Language Development: startled by loud noises; roots; sucks; variable cries
Social, Emotional and Behavioural Development: smiles responsively; may cry if hears another infant crying
An In-Depth Review of a Baby’s Development at 4 weeks
During the first four weeks of life there is considerable variation between babies in terms of their behaviour and development. Most babies spend long periods of time asleep, with the time they spend awake gradually increasing. Their senses are highly attuned to the caregiver’s face, voice and touch. A baby’s behavioural cues (crying, gazing, imitation) are designed to elicit responsive care and sensory stimulation. [Dosman, 2012]
At birth, movements are mainly limited to a baby’s arms and legs. This is because they have more muscle tone in their arms and legs compared to the torso and neck areas. When moved into a sitting position, the head needs to be supported otherwise it will fall forwards. At four weeks, a baby can bring their hands to their mouth as well as open and close their fists. At this stage, most babies can latch onto the nipple or a bottle, and their tongue should be able to move forwards and back to suck and then swallow well during feeding.
Reflex rooting and sucking behaviour is apparent unless the baby has just been fed. Protective gag and cough reflexes are also present. A newborn will drink about 60-200mls (2-6 oz) of liquid per feed up to around six times a day. This will vary considerably, depending on the size of the baby and the method of feeding.
Babies are sensitive to light and sound at birth, although visual responsiveness varies. They will turn to look at a source of light and close their eyes in response to sudden bright light. Newborns show a preference for looking at faces or patterns and will turn their eyes slowly to follow a face.
Babies can hear sounds during the last few months of pregnancy and will show recognition of their mother’s voice soon after birth. Sudden loud sounds will startle them, and their eyes will turn to a sound source. They are very sensitive to touch particularly on the mouth, face, hands, soles of their feet and abdomen. Newborn babies recognise their parents or primary care givers by their smell and within a few days of birth a baby will establish an interaction with their carers through eye contact and facial gestures. [Sharma, 2014]
Although nappy rash is not common in neonates, it is estimated to affect between 4–15% of babies in the neonatal period. If it does occur, make sure that an ointment suitable for a newborn’s skin is prescribed or recommended.
Health checks / interventions (weeks 1-4)
- A baby will generally be weighed at birth, then at five and 10 days
- Within 72 hours of birth, a baby will have a thorough physical examination including the eyes, heart, hips and – for baby boys – testicles.
- At 5 to 8 days a baby will have a blood spot (heel prick) test to screen for a number of rare diseases, including cystic fibrosis and sickle cell disease.
Potential ‘red flag’ warnings at week 4
- Baby doesn't startle in response to a sudden loud sound.
- Baby doesn't respond to sounds, music, or voices.
- Lack of eye contact.
- Differences between right and left sides of the body in terms of strength, movement or tone.
- Unable to latch on while breast or bottle feeding.
- Loses a lot of milk from the side of their mouth while feeding.
- Baby frequently resists being held and is not calmed by rocking, touching and gentle sounds having been fed and changed.
Between 1-4 weeks, babies will develop at very different rates and ‘red flag’ indicators tend to be more relevant after 6 months of age.
CF Dosman, D Andrews, KJ Goulden. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health 2012;17(10):561-568.
Ajay Sharma, 2014, Mary Sheridan's From Birth to Five Years: Children's Developmental Progress 4th Edition
Red Flags early identification guide – birth to five years, Childrens Health Queensland hospital
Morris H. Getting to the bottom of nappy rash. Community Pract. 2012 Nov;85(11):37-8.