Milestones
by Noha Salem, MD
From birth through the next 5 years, children reach milestones in how they play, act, speak, listen, and learn.
Parents keep a close eye out for these events, but despite the name, these “milestones” are not necessarily set in stone. There’s a wide range of potential development within various age ranges.
Yet developmental delays can lead to educational difficulties or learning disabilities. Learning disabilities can in turn affect the way the brain functions: specifically, the way it receives, processes, stores, and responds to information. Learning disabilities can then lead to cognitive disorders or behavior problems.
Early intervention can stop the domino effect, but the first step is recognizing the red flags of developmental delays.
The Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities offers a milestone checklist broken down by age—“by the end of” 3 months, 7 months, 1 year, 2 years, 3 years, 4 years and 5 years—and further breaks this checklist down into several categories, including social/emotional, movement, vision, hearing/speech, and, for older kids, cognitive, language, and hand/finger skills.
Onward, upward, and forward
Motor skills are basically any movements generated by using muscles. Fine motor skills are the smaller movements—holding a pencil, cutting in a straight line, brushing teeth, and tying shoes. Gross motor skills are the big ones, including sitting, crawling and walking.
Motor skills seem to cause the most parental angst. Why isn’t Jane pulling herself up to stand? Why did Johnny take his first steps when he was 10 months old, while his sister isn’t walking at 14 months? Why isn’t he toilet-trained? Why isn’t she doing up her own buttons?
Some of these things can be attributed to innocent factors—perhaps there’s an older sibling speaking or doing for the younger sibling. But these are the red flags: difficulty in sucking and swallowing during the first year; persistent toe walking or a wide-based gait after the age of 14 months; having a hard time with things like riding a bicycle or playing catch when most kids already are doing these things without difficulty.
Some of these kids are said to have “clumsy child syndrome,” a condition in which motor skills are delayed yet a neurological exam is normal.
Language and speech
There’s a difference between “language” and “speech,” but lags or lulls in either/or are, in fact, the most common developmental delays in children.
Language is what words mean, how we put words together, and the way we make new words. Speech is how we speak words and how they sound when we say them.
By 3 months, babies should be responding to loud noises and babbling. By 4 months, there should be variety in pitch of voice. By 6 months, they should turn toward sound or voice. At 9 months, we like to hear repetitive “babbling” of consonants.
At the end of the 1-year mark, toddlers should be using single words, and by 18 months, they should be able to point to the things they are talking about. At 2 years, they should be able to verbalize more than point, have a vocabulary of at least a dozen words, and use two-word phrases.
Emotional and social
Temper tantrums in a 2-year-old? Normal. A 9-month-old making strange faces? Normal. Red flags for emotional and social developmental delays are as follows:
By the end of 3 months, babies should enjoy playing and might even cry when it’s time to stop. By 1 year, they often express a preference for certain toys or people.
By 2 years, they engage in more interactive play with other children instead of side-by-side play, and by 5 years, children often want to please others and be just like their friends, yet exhibit independence by wanting to visit friends without Mom or Dad constantly hovering.
Loving to learn
Sometimes the reason behind a developmental delay is a learning disability, but less than half are identified before starting school.
A major sign that a learning disability exists is when children of average or above-average intelligence do poorly in school.
Children with learning disabilities often have to put in more time than their classmates when it comes to understanding lessons and completing homework. To compensate, they may portray themselves as the “class clown” or exhibit anxiety about going to school, which in turn can lead to frequent absences or bullying.
Furthermore, strong evidence suggests that learning disabilities arise from a dysfunction of specific brain regions, and can therefore be inherited.
Misbehaving or misunderstood?
An estimated 17 percent of children across the nation have a developmental delay or learning disability. These kids are not being bad. Nor is it the parents’ fault, assuming there were no risk factors during pregnancy such as drug or alcohol use.
Whether the delay is caused by a physical, genetic, inherited, or cognitive disorder, the bottom line is the same: act early.
There are numerous intervention programs and therapies available to children through pediatricians, specialists, and early childhood educators.
Be proactive and maintain your kids’ well-child checkup schedules. Formal developmental screening at the 30-month visit can identify potential school problems, and, at 48 months (4 years), may identify writing and sound delays.
Any time there is a loss of skills previously learned or mastered, contact your child’s doctor immediately.
For more information
Developmental milestones are often tracked via timetables or checklists and consist of skills that are expected or most common in children based on age. *Source: National Dissemination Center for Children with Disabilities, www.nichcy.org.
To locate early intervention programs in Texas, visit the U.S. Department of Health National Early Childhood Technical Assistance Center at www.nectac.org.
