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.
We all want to make sure our kids are growing up and learning “on schedule.” Still, children aren’t precision instruments— they don’t all develop on the same exact timetable. So the first thing to know about developmental milestones is that they’re meant to be a tool, not a tyranny. They can help spot any significant deviation from what is statistically typical—not to put a label on your child, but to make sure he or she gets the appropriate attention if a discrepancy points to other medical or developmental issues that ought to be addressed.
Standardized by the Centers for Disease Control and Prevention (CDC), the milestones assess skills children “should” have acquired and tasks they “should” be able to perform at certain ages. They 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.)
Says Nonita Mittal, M.D., a Livingston-based pediatrician who practices through Summit Health: “Part of childcare is ensuring that all kids have a normal development. To track that, pediatricians use these developmental milestones. They are based on extensive research.”
The milestones can trigger anxiety in parents, particularly when their child isn’t hitting one at the exact prescribed time. However, “there’s some wiggle room,” says Dr. Mittal. “For example, when we say that a child should have a ‘social smile’ by 2 months, that just means that the majority of kids attain that milestone by then. It’s normal for a baby to have that from as early as 6 weeks. Your child might be an outlier, but still on a perfectly normal schedule for development.” And even if your child is a little bit behind in one milestone, it’s not necessarily a reason for grave concern. “It could be because of something like inadequate stimulation, floor time [time spent playing and moving around on the floor] or social interaction, rather than a neurological or muscular problem,” says the doctor. “Those are things we like to address first.”
While worries are often premature or needless, it’s important to have an open channel of communication with your doctor so that questions can be discussed—even if they turn out to be needless or “silly” ones. Says Dr. Mittal: “It is never too early to discuss any concerns about child development with your pediatrician.”
The doctor spoke with MORRIS & ESSEX about a few common milestone delays.
• Walking. The CDC’s new guidelines place this milestone at a year to 15 months old, and Dr. Mittal agrees. “If your child is not walking by 15 months, you should discuss it with your pediatrician,” she says. She adds that there are some common causes for walking delays, including “the child not having enough floor time at home, or too much support from parents who are not letting the child walk independently.” To avoid this, children should have three to four hours of floor time a day to play, according to the doctor, and parents should avoid toys like “walkers” or exercise saucers, both of which are common reasons for delayed walking. “Vitamin deficiencies like rickets can also cause delays,” says Dr. Mittal. Rickets results from a deficiency in vitamin D and calcium and can be marked by soft bones that aren’t strong enough to walk on. Ensuring that your child has ample sources of these—sunshine and the correct baby formula, respectively—can help prevent this condition.
• Speaking. Children should say their first word by 1 year old, and have a few words in their vocabulary by 15 months, says the CDC. Before that, you can expect other forms of communication—babbling, cooing and gestures. If you don’t see this, there are many possible explanations. For instance, a child in a multilingual household will likely speak later; that’s normal and expected. Other causes include what our expert calls “insufficient stimulation.” “If a child isn’t hitting speaking milestones, we recommend more stimulation,” says Dr. Mittal. “For instance, in the early months of life, it is very important to talk to the child with his or her face very close to your face. That is how babies learn nonverbal communication, such as expressions, and how to move of their mouths for speech. Reading to your child is a great way to increase his or her vocabulary.” She cautions: “Screens cannot replace reading out loud or person-to-person interaction, and their overuse could cause delays. I recommend no screens at all until 2 years.”
• Fine-motor function. One of the most important fine-motor milestones of early childhood is the ability to grip and move objects between the fingers, as with holding and scribbling with a crayon or building with blocks. Dr. Mittal wants to see a mature grasp develop by a year or so, and CDC guidelines put scribbling at 18 months. “Learning to use fingers allows children to start performing daily activities, like independent eating, dressing and eventually writing and typing,” she says. Signs that a child is experiencing a fine-motor delay include not extending a hand to grasp toys and an inability to hold or to pick up food. Dr. Mittal also says that most fine-motor delays are caught between 6 and 12 months, and that they are “common.” “Most of the time, children just aren’t being exposed to these activities,” she explains. “These are the skills where I most often tell parents, ‘Go home. Try to do these things. Let your child do them on his or her own.’ And, most of the time, the kid is fine.”
• Emotions. It can be hard to gauge emotional or behavioral delays in kids. The CDC says that children should start expressing emotions at 15 months and notice emotions in others by 24 months. The latter point verges on the prime age for temper tantrums and outbursts, which can cause anxiety in parents even if they are standard emotional reactions from children.
Autism spectrum disorder (ASD), common symptoms of which include difficulties with social communication and regulating emotion, is often diagnosed between 18 and 24 months. About this concern, Dr. Mittal says: “Watch out for whether the kid makes eye contact, and whether there is some kind of shared interaction with parents or shared excitement at something new. Does the child want to involve parents in his play? If you are not seeing that develop, it’s a cause for concern.”
Children are now screened at 9 months and 2 years for ASD using a standard questionnaire. For older kids, behavioral delays become a concern when they interfere with the child’s ability to go through daily activities such as play and school. Our expert offers two explanations for this: “Excessive screen time is associated with bad behavior,” she says, “and children model what they see. If parents model good behavior, a child will show good behavior, and vice versa.” The doctor offers a possible solution in “focusing more on positive reinforcement than on negative reinforcement. Instead of punishment, if a child does wrong, stop the action and do a “time-out.” When the kid calms down, sit and explain what he or she did wrong. If you start yelling, instead of listening to you, the kid is going to learn that behavior and behave the same way next time.”
• When to be worried. Of course, sometimes developmental delays are signs of a more systematic issue. “For me, it’s a concern when a child hasn’t hit a milestone when 90 percent of other kids have achieved it,” says Dr. Mittal. “Or if they haven’t met multiple milestones in one category. If your child is hitting two or three out of four milestones for that age, I’m not worried. But if your child is not hitting any of the milestones, or only one out of four expected milestones, then I’m worried. There may be a neurological or muscular problem. In that case, time is of essence. Involve the experts early on. If you do have any concerns, get evaluated sooner than later.”
Dr. Mittal urges parents to stay informed. “Read about these developmental milestones and ask questions at well visits.” Her other advice? “Trust your instincts. If you feel that something is wrong, don’t wait. Family and friends are your first advisers. Talk to them and talk to your doctor. Early intervention can make all the difference.”
