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. Standardized developmental milestones exist as a tool to assess children’s progress, not to force all kids into an exact mold or tyrannize parents. 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.)
“Milestones are a standardized tool you use to assess development, instead of just asking parents how they think their child is doing,” says Melissa Wallach, M.D., a pediatrician affiliated with the Jersey Shore Medical Center and practicing in Asbury Park and Neptune. “They not only show us when a child is delayed, but when that child is even at risk for a delay. That allows us to give parents guidance and offer intervention.”
Milestones can trigger anxiety in parents, particularly when a child isn’t hitting one at the exact time he or she should, but they don’t have to. “Every child is different,” Dr. Wallach says. “There’s variability and an age range for every milestone; I tell parents and guardians that all the time. If you’re at a 12-month checkup and a child isn’t hitting every single milestone that day, don’t worry. Many of those milestones are going to be achieved by 15 months. For instance, a late walker doesn’t immediately mean that your child has a muscle or motor disorder; it could just be a muscle-tone issue.”
Dr. Wallach spoke with MONMOUTH about a few common missed milestones:
WALKING DELAYS
The CDC’s new guidelines place this milestone at about 1 year to 15 months old, and Dr. Wallach agrees. “There’s a wide range for this one,” she says. “Some of my patients walk before they’re a year old, and some walk at 18 months. However, if a child isn’t even pulling up to stand or walking with assistance at 15 months, it’s best to err on the side of caution and bring it up with your pediatrician.” A way to promote walking? “Babies need to play on the floor. They need supervised ‘tummy time’ with toys. For instance, provide toys that make different sounds, like crinkling placemats. And you should get down on the floor with them! Play with your baby, and he or she will start to learn how to move,” she says. The doctor does not recommend that children spend a lot of time in baby bouncers or exercise saucers.
“If there is a true delay,” the doctor adds, “physical therapists can offer very specific exercises to address the problem.”
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. “Even if they’re not saying ‘Mama’ and ‘Dada’ by a year, they should know who Mom and Dad are and be able to point or reach out,” says the doctor. “I always say I want about 50 words by 2.” There are many possible explanations for speaking delays. For instance, a child in a multilingual household will likely speak later; that’s normal and expected. “One of the first things to test with a speech delay is hearing loss,” says Dr. Wallach. “Every child in New Jersey gets a newborn hearing test, but even if a child passed that, if he or she isn’t speaking, then we check again.”
Happily, keeping children on track with language skills often can be as easy as talking to them. “Read to your babies,” advises the doctor. “Sing to them, talk to them, narrate your day to them.” Another way to encourage language acquisition is to limit access to screens. “The American Academy of Pediatrics really discourages screens under the age of 18 months. Even then, you want to limit it. When you do watch something together, make sure you talk about what you’re seeing on the screen. Ask questions like, ‘What’s Elmo doing? Is he counting?’” says Dr. Wallach.
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.) Pointing to specific things is also an indication of fine motor skills. These skills play a big role in feeding. A child’s being able to pick up food or a utensil and feed him- or herself is an important step in development. “It helps if the child sees you doing the action too,” says Dr. Wallach. “When you’re reading with your child, point to things. He or she will start to mimic you. With feeding, let them try out and use those skills, with the hands and fingers and then with a fork or spoon.”
If a child needs more support, the doctor sings the praises of occupational therapy (OT), which specifically focuses on small muscles and sensory problems and can correct issues 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. By 18 months, children should be responding to their names and showing parents affection. If they’re not, says our expert, some parents get anxious, particularly because autism spectrum disorder (ASD)—common symptoms of which include difficulties with social communication and regulating emotion—is often diagnosed between 18 and 24 months. She says: “Parents sometimes go online, see symptoms and start becoming concerned.” But, Dr. Wallach continues, “Not every child who flaps his or her hands, or doesn’t make eye contact, or displays any of the other symptoms you read about on the internet is autistic.” If your child seems withdrawn or shy or has problems connecting with others, the doctor suggests making sure he or she is getting enough social interaction. “If you can, put your child in day care. Go to a music class. We’re lucky here in Monmouth because we have the beach and an incredible parks system with programs at a lower cost than private options. This is great for the parent’s well-being too.”
WHEN TO WORRY
Of course, sometimes developmental delays are signs of a systematic issue. Dr. Wallach explains: “If a child continues to be very behind in one milestone or a group of milestones, we look into early intervention. We look into physical, occupational or speech therapy, or we escalate to a developmental pediatrician or other specialist. There could be a larger neurological or muscle issue.”
More than anything, the doctor encourages parents and guardians to be watchful, well informed and willing to communicate with their child’s pediatrician. “People take their kids to the doctor at a drop of a hat for diarrhea, fever or a cough, but sometimes don’t realize that they can come in for a development check-in,” she says. “Read these milestones—I recommend the healthychildren.org through the American Academy of Pediatrics, which is made for non-physicians. Partner with your pediatrician and think of him or her as a guide throughout this process.”
