Is My Child Falling Behind?
Developmental milestones to measure kids’ progress were meant to assist families, not scare them. But sometimes a well-meaning parent can’t help but worry.
Aren’t we really glad, when we think about it, that children aren’t precision instruments? They don’t all grow up on exactly the same schedule. When child-development experts came up with developmental “milestones” to indicate approximately what levels of growth and skill acquisition a child “should” have reached by certain ages, it was meant to help parents—in case a deviation might reveal a problem that should be addressed. It wasn’t meant to be a tyranny.
Theoretically, standardized developmental milestones exist to make parenting less scary. They provide a road map, standardized by the Centers for Disease Control and Prevention (CDC), of skills children should have acquired and tasks they should be able to perform at certain ages. The milestones measure whether a child is experiencing typical growth in specific categories: gross motor skills (using large muscles for fundamental movements such as walking, running and jumping), fine motor skills (making precise movements with the hands and wrists), social skills and communication skills. (The CDC revised its standard milestones back in 2022; now, instead of placing a milestone at the age when 50 percent of children can complete a skill, it is placed when 75 percent of children can.)
“In the first two to three years of life, our babies go through a lot of changes very quickly,” says Monika Reisenauer, an advanced-practice registered nurse and the lead advanced-practice provider for both inpatient and outpatient pediatrics at Paramus’s Valley Health System. “We use milestones to ensure that infants are progressing and developing in the way that we expect. If this isn’t happening, these milestones are a wonderful tool to help clinicians decide when to act and when to escalate to a specialist.”
Milestones can trigger anxiety in parents, says Reisenauer, particularly when a child isn’t hitting one at the exact time he or she should. “It causes a lot of stress,” she says. “But not every delay is catastrophic. Kids can be delayed because of something fixable. Early intervention is always key, because everything affects everything else at a given age. For instance, crawling impacts speech and speech impacts feeding. Sometimes it’s something as simple as a baby not crawling because he or she has low muscle tone in the legs or tummy. If you go to physical therapy for six weeks to address that, you can prevent a late walker.”
Reisenauer spoke with BERGEN about a few common missed milestones:
WALKING DELAYS
The CDC’s new guidelines place this milestone at about a year to 15 months old, and Reisenauer agrees. “I like kids standing independently for about five seconds around 11 months, and taking their first steps around 14 months,” she says. She warns that certain toys, such as exercise saucers, can contribute to late walking because they hold babies in a suspended standing position. “They misalign the hips, and they keep the Achilles tendon really tight,” Reisenauer says. “They are the worst things developmentally.” A way to promote walking? “Get your kid on the floor and practice multiple different sitting positions. If he or she is playing in a seated position, bring the toy to the left or right so the child is forced to turn in order to play with it. We call that ‘taking them off the midline.’ It engages the hip flexors and develops muscles for walking.”
SPEAKING DELAYS
Children should say their first word by about a year old and have a few words in their vocabulary by 15 months, says the CDC. If they don’t, there are many possible explanations, says Reisenauer. For instance, a child in a multilingual household will likely speak later; that’s normal and expected. Reisenauer also says this is a tough one for parents to navigate on their own, because a delay could come from either a motor-control issue—literally being unable to move the mouth in a way that allows speech—or an information issue—not understanding how to communicate.
“For instance, it could happen because a child transferred to solids late,” she says. “You develop the muscle control needed for speech by chewing. Some babies communicate very well; they point and make eye contact and gesture, but they don’t speak. That could be a motor-skill or articulation issue. Sometimes vocal communication and gesturing communication are similar milestones. Your doctor can help you figure out specifically what’s going on.”
Happily, keeping your child on track with speaking can often be as easy as talking to them. “I call it ‘newscasting,’” says Reisenauer. “Tell your child what you’re doing throughout the day, conversationally, as if you expect the child to talk back. Also, read to him or her every night. That’s how the child’s brain learns to communicate.”
FINE-MOTOR DELAYS
One of the most important fine-motor milestones of early childhood is the ability to grip and move objects between the fingers, as in holding and scribbling with a crayon or building with blocks. Our expert wants to see this develop between 15 and 18 months. (CDC guidelines put scribbling at 18 months.) There are two possible reasons for delays here, according to Reisenauer: “Part of it is motor skills, and part of it is sensory, or how well a child can tolerate things that are uncomfortable on his or her hands.” Because of that, she says, “letting a baby get messy may improve the baby’s fine motor skills.” Getting a child’s hands in in sand, dirt, Play-Doh or paint is not only fun; it also helps develop these skills. Snapping crayons to make them shorter and encourage a “handwriting grip” instead of holding them in a fist is also recommended. If a child needs more support, Reisenauer sings the praises of occupational therapy (OT), which specifically focuses on small muscles and sensory problems and can correct issues in this area before they get worse.
EMOTIONAL DELAYS
It can be hard to gauge emotional or behavioral delays in kids. The CDC says that children should start expressing emotions clearly at 15 months and notice emotions in others by 24 months. These are prime ages for temper tantrums and outbursts, all of which cause anxiety in parents, says our expert. Autism Spectrum Disorder (ASD), common symptoms of which include difficulties with social communication and regulating emotion, is often diagnosed between 18 and 24 months. But, says Reisenauer, “a lot of common behavioral concerns that happen between 15 and 24 months can look like autism, but aren’t. Throwing toys is normal up to 18 months. Head banging and biting are common if a child isn’t having his or her needs met and can’t communicate that. If you teach your child to communicate those needs, either verbally or with sign language if there’s a speech delay, that can help. Also remember that, between 15 and 20 months, negative attention and positive attention are the same thing. Don’t make a big fuss over bad behavior. If you just take away a toy or don’t make eye contact instead, you don’t reinforce it.”
WHEN TO WORRY
Of course, sometimes developmental delays are signs of a more systematic issue. Reisenauer explains: “Typically, if there is one area of delay and it’s less than 30 percent, a child probably doesn’t need therapy [physical, occupational or speech]. If there’s a 30 percent delay in one area or delays in more than one area, a child should definitely go to therapy. If a child is at a 50 percent delay or more, or has delays in two or more areas, not only should the child go to therapy, I am going to send him or her to more diagnosticians—in neurology or orthopedics, for example. If a child is that delayed, there’s a problem with how the body is sending or receiving information.”
Once again, early detection is key. The sooner these problems are diagnosed, the sooner the child will receive the care he or she needs. Concludes Reisenauer: “Most of the time, there’s no reason for parents to be nervous about developmental delays—they are problems we’re going to solve together. If there is a cause for concern, your doctor will tell you, and then you take the next steps. There are wonderful resources in the community and wonderful therapies that can help. You don’t have to do any of it alone.”
