Following a Child's Path of Developmental Milestones

Many of the celebrated human developmental milestones result from motor skills—sitting, feeding oneself, crawling, walking and running. Other areas of development include speech and language, social-emotional, self-help, and cognitive or intelligence.

According to Dr. Franklin Trimm, professor of pediatrics at the University of South Alabama College of Medicine, not all children attain milestones at exactly the same age. However, the sequence is almost always the same—roll over, sit, crawl, stand and walk—in that order.

To illustrate some milestones, typically developing six-month-old infants like to:

• Look at themselves in a mirror (social-emotional)
• Respond to their name and make sounds to show joy and displeasure (language)
• Show curiosity about things and try to get things that are out of reach (cognitive)
• Roll over in both directions and begin to sit with minimal or no support (motor)

Important Milestones to Consider

Dr. Trimm says there are some milestones that if not attained by specific ages should trigger concern and further evaluation of a child’s development. These “red flags” include a child who does not smile or squeal in response to people by six months of age, or a child who doesn't gesture (pointing or waving) or sit without support by nine months old.

Children learn to walk at various ages, from as young as eight months up to 15 months with the entire range being considered normal. Other motor milestones such as crawling, running and kicking a ball also vary by a number of months. However, Dr. Trimm explains that the normal variation for speaking is not as broad. Most children are able to say their first few words and know what those words mean between 10 and 12 months of age.

“When children visit their healthcare provider for routine well-baby check-ups and immunizations, an important part of those visits is developmental screening,” he adds. “The provider will typically observe the child interact with others, move and communicate to determine current milestone levels. Tracking development in this way is similar to tracking height and weight at each visit and helps identify children whose development may not be progressing as usual.”

The American Academy of Pediatrics recommends that monitoring of child development include the use of a standardized developmental screening tool at 9 months, 18 months, and 24 or 30 months of age.

Familiarizing Yourself With Your Child's Milestones

Dr. Trimm says that being familiar with expected upcoming milestones can help parents identify areas that might be of concern.

“When parents are familiar with development milestones, they are able to anticipate the skills their child will be learning next and play with the child in ways that can promote development,” he advises. “If a child doesn’t reach an expected milestone on schedule, parents who know what should be next can consult their healthcare provider in a timely manner.”

According to Dr. Trimm, infants and children’s brains grow and develop rapidly. “When there are problems with development, early recognition and early intervention for those problems can improve overall development,” he adds. “Working on any concerns while the child’s brain is still developing rapidly is more likely to help the child attain the skills and get back on track with milestones.”

Developmental Delays

Dr. Trimm explains that developmental delays may occur for a number of reasons. For instance, some children may not have the opportunity to play or explore in a way that allows them to practice a particular new skill.

“When this is the cause of the delay, adding additional activities to the child's daily routine is likely all that will be needed to help the child catch up,” he notes. “The healthcare provider may be able to make specific suggestions or refer the child to a physical, occupational or speech therapist who can assist.”

Other causes of delayed milestones usually require a more detailed medical evaluation to determine a cause. “There are many medical, genetic and neurological conditions that can delay development,” he continues. “The good news is that most of them are very uncommon.”

While being aware of milestone delays is important for parents, Dr. Trimm says a positive and fun reason to be aware of milestones is to use them as a guide to the best play activities and comfort measures for children. Some positive parenting tips based on a child’s developmental level can be found on the CDC's website.

A good resource for parents to review milestones and see how their children are developing can be found at: http://www.cdc.gov/ncbddd/actearly/milestones/ .

For parents who are concerned about their child’s development, Dr. Trimm recommends contacting their pediatrician or other primary healthcare provider first. If additional evaluations or treatments are needed, the provider can make the necessary referrals.