Is your child meeting their developmental milestones?
June 24, 2022
From crawling and talking to picking up toys, there are hundreds of developmental milestones your child should be meeting as they grow. From birth to age 3 is an especially critical time because they are learning at an incredibly rapid rate.
In those early years, you want your child to see everything they can see — and hear everything they can hear — so their brain can map things out and develop. That’s why reading is huge to a child. Just hearing your voice and looking at pictures is important because it maximizes brain development.
There are many milestones from birth to age 5, and parents can follow the Centers for Disease Control (CDC) checklist or download their tracking tool app to check their child's progress. Give us a call if you’re concerned. If a milestone’s not being met, acting early is important because small interventions can make a big difference later.
From birth to age 5, these are the major developmental milestones I’m most concerned with:
The first 2 to 3 months of age: Muscle tone and eye contact
Muscle tone. Babies have low muscle tone naturally, but when you pick up your baby, they should stiffen a little bit to help you support them. Their body shouldn’t slump over your hands and their head shouldn’t slump downward. They should also give a little resistance when you hold them under their armpits.
The first 4 to 8 months: Sitting and rolling
Sitting unsupported. Around 6 to 8 months, your baby should be able to sit unsupported for at least 10 seconds. If not, they should attempt to maintain balance by putting a hand out when falling or trying to brace themselves. If they’re not trying or attempting to maintain balance when seated, that is cause for concern.
Rolling over. Around 4 to 6 months, babies should start rolling over. (If they do this while sleeping, gently turn them to their back, for safety.)
Around 1 year: Crawling, walking and social cues
Crawling. Around their child’s first birthday, parents get distressed if their child isn’t crawling. Some kids never crawl and go straight to cruising and walking, so I am typically reassured if they are meeting their other gross motor milestones. If a 9- to-12-month old is either scooting on their butt or rolling towards places they want to go, I consider it a similar milestone to crawling. If the mobility movement is grossly asymmetric, it may need evaluation by your pediatrician or a neurologist.
Walking. Even though a majority of children are walking by age 1, there are still a number of kids that aren’t walking until age 15 to 18 months. If your child is not walking by 15 to 18 months, you can bring your child in so that we can evaluate their milestones as a whole, as well as ensure that there are no concerns on neurological examination.
Social cues. The first thing I always evaluate when I meet a new baby is for early signs of attention between baby and parent. That means they are looking for their parent’s opinion on things. If someone new walks into the room, your child should make eye contact with you. They’re trying to assess your feelings toward that person. If you’re comfortable, your child decides to be comfortable. If you look anxious, then your child understands that they need to be leery.
Around ages 1 to 3: Talking, gross and fine motor skills
Talking. There is a large variance in the speed at which children ages 1 to 3 acquire language. For all parents, we can’t help but compare our child’s language progress to their peers. In this specific domain, there are a lot of distressed parents.
Usually, we say a child should have a single word by age 1 year. By 18 months, a child typically should say three to five words; however, some children may be saying 50 to 100 words by that time. Many children say two-word phrases by 18 to 24 months as well.
When I do consultations for children with a speech delay, it is common to see a stall or delay in language acquisition during the year after their first birthday. Often, those children struggle with acquiring language, even if they are in speech therapy. But by the time they get to age 3, there’s an explosion of language and they’re picking up multiple words each day.
I always explain to parents that as long as they are acquiring new language milestones and not regressing, they are going to do very well in the end. Remember, speech delay is highly common. Do not hesitate to speak to your pediatrician about it or seek a speech therapy evaluation.
The majority of developmental delays I see involve kids not speaking many or any words by age 2. That’s a specific situation when I recommend that you should give us a call.
Gross motor skills: Toe walking. It’s not uncommon for children to walk on their tiptoes when they are first learning to walk. But if this persists at age 2, a neurologist should make an evaluation. It could be that their Achilles tendon is tight or they can’t flex their foot, which could potentially indicate a neurological issue.
Fine motor skills: Holding utensils, throwing a ball, pulling off shoes. After age 1, kids are beginning to use cups, holding a spoon around 12 to 18 months, and by 2 years old, they should be able to begin to feed themselves with utensils. They should also be pulling off their own shoes and throwing a ball with intention.
Those are the major milestones from ages 0 to 5, but there are many more within each age. If you are concerned at any point, ask your child's physician or reach out to us — my door is always open.
Henry David, MD
Henry David, MD, is a pediatric neurologist who specializes in neurocritical care and treats children of all ages with serious neurological conditions who require acute care to long-term treatment. He also is an expert in cerebrovascular disorders, including ischemic stokes and hemorrhagic strokes, and provides comprehensive, compassionate care to patients and their families.Learn more about Dr. David
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