Monitoring Milestones

Well-Baby Visits

“My exam begins as soon as I walk into the room,” says Cahill. “I immediately take note of head control, eye contact and a child’s coordination even before I say hello.” In addition to their observational skills, pediatricians use a number of tools to assess your child at every checkup. One tool most parents know about is the growth chart, which is used to plot your baby’s weight and height along a specific percentile curve. The higher the percentile, the larger the child in comparison to other kids of the same gender and age. The lower the percentile, the smaller the child. “We don’t care about the number,” says Cahill. “We just want to see a nice smooth curve.” In other words, it doesn’t matter if your child is in the 15th percentile or the 90th as long as he continues to follow that curve and doesn’t deviate. “What we don’t want to see is a child who’s been following the 50th percentile curve suddenly drop to the 25th,” says Cahill. If they do deviate, it could indicate a medical or nutritional problem.

Pediatricians will also assess the development of your child’s language, motor and social skills. Some doctors use what’s called an Ages & Stages Questionnaire, which is given to parents to fill out before the exam. You’ll spend about 10 to 15 minutes answering questions like “Does your baby pick up a crumb or Cheerio with the tips of his thumb and a finger?” Then your doctor will discuss your responses and address any of your concerns. Remember, parents know best. If you have a sense something is amiss, don’t hesitate to say so. The earlier a developmental delay can be identified, the better.

Two resources you may want to check out between well-baby exams: the book What to Expect the First Year by Heidi Murkoff, Sharon Mazel, Arlene Eisenberg and Sandee Hathaway, BSN; and the Centers for Disease Control’s Developmental Milestones website, where you can enter your child’s age and a checklist of age-appropriate milestones pops up, which you can fill out, print and take to your next well-baby appointment. 

Don’t Worry if Your Baby’s Timing Is Off

The most important point to remember about developmental milestones is that babies develop at different rates—and there’s a wide range for what pediatricians consider to be healthy and normal. For instance, your child may say “mama” at 11 months while your neighbor’s daughter doesn’t utter her first word until she’s 16 months old. Comparing your child to other children of similar age can be a double-edged sword: Sometimes, you’re proud (my daughter is already speaking); other times, anxious (why is her son walking already and mine isn’t?). “I hear this all the time,” says Cahill. “‘His brother walked at 11 months and this one is 14 months and hasn’t taken a step—what’s wrong?’ Nothing is wrong. As long as your child is progressing, everything is fine.”
To aid your baby’s growth and development, Dr. Greene advises that you become a “parent detective” by looking for regular progress and challenging your child accordingly. For example, if your 8-month-old is not yet sitting up without assistance (like his hands), he probably won’t be ready to roll a ball back to you just yet. “If you try to engage your child in something he’s not ready for, he’ll get frustrated,” says Greene. “Focus on activities that make you both smile.” Here are some tips from our pediatric experts that will help quell any doubts you may have.

• Be cautious about comparing your child to others. “Normal” varies from child to child. Some kids will be ahead in motor skills, others in speech.

• Don’t be alarmist. “We have to allow kids to develop at their own rate,” says Cahill. “Some kids may be slower than others, but it’s not a big deal.” (However, if your child loses a skill—for example, he was speaking last week but isn’t anymore—see your doctor.)

• Remember that there’s nothing magical about hitting that 1- or 2-year mark. “Nothing is going to change suddenly the minute your child becomes a 1-year-old,” reminds Lonzer. “Developmentally, each day builds on the day prior to it.”

• Ask yourself “Is my child making progress?” If he’s just a tiny bit further along than he was one or two weeks ago, the answer is yes. And you have nothing to worry about.

Call your pediatrician if…

Although it’s reassuring to keep in mind that children develop at different rates and times, you should also be aware of signs that indicate something may be wrong. This is especially important because autism spectrum disorders (ASD) are on the rise. The Centers for Disease Control estimates that one of every 110 U.S. children has an ASD, which is a group of developmental disabilities that include autism and Asperger. It’s vital that you take note of the red flags now because research shows that early intervention and therapy can greatly improve the ability of a child with autism to talk, walk and socialize with others as he grows. “Kids should never lose a skill,” cautions Cahill. “If, for example, he was talking but isn’t anymore, that’s an automatic trip to the pediatrician.” Here are other signs to watch for in your little one:

• Not responding to his name by 12 months old
• Lack of eye contact
• Stiffens when hugged
• Does not point at objects of interest (such as a plane flying overhead) by 14 months
• Has said no words by 16 months old (“You should be able to understand about half of what they say by the time they’re 18 to 24 months old,” says Bonifert. “If not, there may be a speech development issue,” which is different than an ASD.)
• If he is talking, repeats words or phrases again and again
• Does not play pretend or make-believe games by 18 months old
• Repetitive hand flapping or other body movements
• Lack of social or emotional interaction or engagement

Nancy Gottesman, a health writer in Santa Monica, Calif., is a regular contributor to Baby & Toddler.