As soon as your child is born their health and development become your paramount concern. Family and friends are sure to ask if your little one is rolling over, crawling, walking or talking. It’s best not to get pulled into comparing your child’s progress with others, but it’s also important to educate yourself on what the childhood developmental milestones are so you can recognize if your child might need early intervention services.
Vicki Iannotti, M.D., Chappaqua Pediatrics, a division of Boston Children’s Health Physicians, LLP, says there are volumes of material written on children’s developmental milestones, as it is the cornerstone of what pediatricians do for children. “Currently, one in six children in the U.S. has a developmental disability,” Iannotti says. “It is the stance of the American Academy of Pediatrics (AAP) that general pediatricians take a more active role in the evaluation and diagnosis of developmental delays than in the past.”
At birth, pediatricians assess newborn babies through a physical exam. The results, and the newborn’s prenatal history, age of gestation, maternal health, and delivery give an initial picture of the newborn’s development. “There are five streams of development that when typical, occur in an orderly, timed, sequential pattern, affecting each other in a predictable manner,” Iannotti explains. The five streams of development are gross motor, fine motor, language, visual-motor problem solving, and social skills. See the side bar for specific examples of childhood developmental milestones.
The AAP recommends the use of a formal questionnaire, “Ages and Stages,” to assess development in each of the five areas at 2 months, 4 months, 6 months, 9 months, 12 months, 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months of age. “The questionnaire is completed by the child’s parents, as they know their child best. It identifies strengths and any areas of potential concern to monitor,” Iannotti says.
In addition, Iannotti says, at well-child visits pediatricians use the Modified Checklist for Autism in Toddlers (M-CHAT), a validated developmental screening tool for toddlers between 16 and 30 months of age. It is designed to identify children who may benefit from further evaluation.
When to Be Concerned
Parents should be concerned when their child’s development in any area is not made over one to three months of the expected time frame, or if development regresses.
“If a child has a delay of six months or more in meeting milestones in one or more areas of development, it is significant and should be evaluated further,” Iannotti says. Evaluation can include medical genetics, pediatric specialists including neurology and developmental pediatrics, ENT, and/or audiology to name a few.
Iannotti says if parents are concerned they should schedule an appointment with their pediatrician to initiate an evaluation. “They should not wait until a scheduled well-care visit,” she advises.
The Importance of Early Intervention
The good news is many developmental delays can be positively addressed. “Evaluating developmental delays, determining a diagnosis, and establishing a treatment plan usually involves specialists in neurodevelopmental pediatrics, physiatry, and a therapeutic team of specialists and educators who provide the necessary interventions over a period of months to years,” Iannotti says.
Keep in mind that from infancy to age 3, your child can receive help through early intervention services. The Individuals with Disabilities Act, a federal law, requires states to provide early intervention. You can request a free evaluation from your state’s early intervention service program. If your child qualifies, services may be provided to your child at no cost. A team of educators will develop an Individualized Family Service Plan for your child.
The evidence for early intervention (EI) is irrefutable, Iannotti says. EI programs support parent-child interactions, provide parental education on child development, reduce parental stress and guide parents to become strong advocates for their children.
“Neurocognitive research has shown that there are optimal periods of brain development, more recently termed “sensitive periods,” during which learning is most efficient and almost critical to future success,” Iannotti says. Intervention during these early, sensitive periods of development can maximize the child’s functional potential and further minimize the secondary behavioral, social, and emotional problems that often stem from developmental delays that are not addressed until school age.
In short, EI and targeted therapy has proven to be of tremendous value.
What can parents do to help their baby reach their milestones? “Parents provide the nurturing environment that facilitates brain development, feelings of security and stability to promote emotional well-being,” Iannotti says. “Reading, talking, singing, playing on the floor, supporting motor development through playful situations, and teaching through experiences has immeasurable benefit to the developing infant and child.”
Developmental Milestone Examples
Vicki Iannoti, M.D. describes Gross Motor Milestone Development across a child’s first 15 months and Language Milestone Development in a child’s first 3 years.
Gross Motor Milestone Development
• 1 month old: can lift their head off the table when lying prone
• 2 months old: can lift their head and chest off the table when lying in the prone position
• 3 months old: can lift head and upper chest up to elbows bearing weight on their forearm
• 4 months old: can lift themselves up to support weight of upper body on wrists and can roll from prone to supine
• 5 months old: can roll from supine to prone (back to front) and can sit up with support
• 6 months old: can sit up without support
• 9 months old: pulls himself up to stand and cruises along furniture
• 12 months old: taking steps unassisted
• 15 months old: child is running.
Language Milestone Development
• 1 month old: alerts to sound
• 2 months old: social smile
• 3 months old: coos
• 4 months old: laughs
• 6 months old: babbles
• 8 months old: says “dada” and/or “mama” non-specifically
• 10 months old: understands “No”, says “mama” and “dada” specifically
• 12 months old: follows one-step commands with a gesture, two-word vocabulary
• 18 months old: points to one picture, identifies greater than two body parts, has a seven- to 10-word vocabulary
• 21 months old: points to two pictures, 20-word vocabulary, two-word sentences
• 24 months old: follows two-step commands, 50-word vocabulary, two-word sentences
• 30 months old: understands the concept of “I”, points to seven pictures, uses pronouns
• 36 months old: follows two-step commands, 250-word vocabulary, uses three-word sentences.