Monitoring Milestones

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By Nancy Gottesman

During your child’s first few years, miraculous things happen. Your baby is growing at lightning speed right before your eyes (tripling her birth weight and height in 12 months), all the while developing skills she’ll use for the rest of her life. The development of these skills is measured by a series of milestones, from first steps to first words to first crayon scribbles (in a coloring book, if you’re really lucky). “Milestones are significant measures of a child’s development,” says Sean Cahill, MD, an assistant professor of pediatrics and internal medicine at Loyola University School of Medicine in Chicago. “The rate at which they happen varies from child to child, but the order is invariable.” Meaning your child will crawl (or roll or scoot) before she walks and blurt single words like “mama” before she can put sentences together.

Experts tend to break down children’s development into clinical-sounding categories like gross motor, fine motor, sensory, language and social skills. But we like the approach of Alan Greene, MD (aka “Dr. Greene”), a clinical professor of pediatrics at the Stanford University School of Medicine, who defines your child’s developmental areas like this:

Poet: The development of language and other forms of communication such as pointing at objects or relating to others.

Athlete: The development of the big muscle groups, including controlling the head, rolling over, sitting up and walking.

Scholar: The discovery of how the world works. When a child starts paying attention to where your eyes are focused rather than to your eyes themselves, or when he starts to reach for a toy that’s just beyond arm’s length, he’s developing his “scholar” skills.

Apprentice: The ability to grasp a toy, a spoon and, at about 1 year old, a single Cheerio.

You may not know whether you have a budding poet or a promising athlete in your home until your child is a lot older (perhaps even an adult!). Pediatricians hesitate to put a precise timeline on developmental milestones because the timing varies from child to child, but there are some markers they look for at certain ages. Here’s a general idea of what you can expect to see at 6 months, 12 months and up to 24 months, when your baby will no longer be a baby.

0–12 Months

This will be the most jam-packed year of your child’s life, developmentally speaking. Giant leaps in cognitive and physical skills are made literally every day, so you’ll want to keep your video camera within arm’s reach whenever possible.

The poet communicates. Even if your baby hasn’t pronounced one word by 12 months, it doesn’t mean she’s not “speaking.” “Crying, smiling, babbling are all important preverbal communication skills because they are precursors to verbal skills,” explains Suzanne Bonifert, MS, CCC/SLP, head of speech-language pathology at the University of Texas at Dallas Callier Center for Communication Disorders. Laughing at 2 to 4 months transitions vocal play (vowel sounds) at 4-6 months. Shortly afterward you’ll hear the consonant-vowel combinations (“baba”), and by 10 months you’ll likely notice sequences of syllables and sounds that seem as if your baby is trying to say a sentence or ask a question but it’s coming out as gobbledygook. “Typically, first words are spoken between 12 and 16 months,” says Bonifert.

The athlete rocks and rolls. These big-muscle motor skills are the easiest for parents—and doctors—to assess. From swiping at dangling toys at 3 months, a baby will progress to rolling over (and perhaps over and over) and sitting tripod-style by 6 months. Watch out, mom: By 12 months, your once quietly portable little darling will be transporting himself all over his universe via crawling, cruising or, quite possibly, walking all on his own.

The scholar reflects. Even at three months, your infant may smile at the sound of your voice because he now recognizes familiar people and objects. By seven months, he’ll play peek-a-boo, respond to your emotional expressions (whether it be joy or stress), struggle to get to an out-of-reach toy and love his own reflection in the mirror. “By 1 year, he’ll know the dog’s name, his sibling’s name and he’ll understand directions like ‘Come here,’” says Deb Lonzer, MD, the chair of community pediatrics for the Cleveland Clinic Pediatric Institute and Children’s Hospital in Ohio. “Of course, he’ll also be able to say no or shake his head when you do ask him to do something.”

The apprentice takes hold. As a child’s hand-eye coordination improves during this first year, you’ll see your child evolve from grasping a rattle at 3 months to transferring that rattle from hand to hand at 7 months. At 1 year, the pincer grasp (thumb and forefinger) will be so advanced she’ll be able to stuff her little mouth Cheerio by Cheerio. “Gradually, a child gets more precise—and pretty soon she’ll be ready for neurosurgery,” quips Greene.


13–24 Months

During this transition to toddler behavior, we have just one word of advice for you: babyproof! “If you haven’t done it already, now is the time to take care of the safety issues in your home,” says Cahill. Gate the stairs, lock up the cleaning liquids, medicines and cosmetics, and cover the electrical outlets. And remind your older kids to clean up after themselves. “A 4- or 5-year-old can leave Legos and other small toys around, which become a choking hazard for the younger sibling,” says Cahill.

The poet mimics. Speaking develops quickly now. A few single words at 15 months become simple phrases by 18 months. By 2 years, sentences of two to three words are common. (The short sentence “I want a snack” is bound to become way too familiar.) “By 2 years, most kids speak at least 100 words—some have 300,” says Bonifert. “They hear a word once from you or someone else and now it’s in their vocabulary.”

The athlete climbs and kicks. The little babe you used to wear on your chest not too long ago will be walking all by herself at 18 to 24 months. She’ll also be able to pull some of her big toys behind her and even carry them (saving mom from some schlepping duty). The furniture in your home will become her custom-made obstacle course as she climbs up on couches and under beds and tables. She’ll also kick balls, stand tiptoed and walk—usually with your assistance—up and down stairs. “By 2, a lot of kids can run, but you’ll see a lot of tripping, too,” says Cahill.

The scholar sorts and stacks. Between 15 and 18 months old, an independent streak emerges. At 24 months, she’ll want to show you that she can sort her toys by color and shape—and build a stack of blocks that won’t come tumbling. “Between 18 and 24 months your child will want you to be interested in what she’s doing,” says Lonzer. “Entertainment becomes two-way—rather than the parent doing all the entertaining.”

The apprentice becomes the artist. “Between 15 and 18 months, children start doing things themselves, such as eating with a fork or spoon,” says Lonzer. They also become ardent scribblers, and by 24 months you may notice that your child uses one hand to create her chefs d’oeuvre more often than the other. By age 2, your toddler will also have mastered the art of picking up and pouring out the contents of any container you’ve naively left within her reach.


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.

When to expect them and what they say about your child’s development.

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