DEVELOPMENTAL MILESTONES AND WHY NOT TO STRESS OVER THEM

Being a parent is tough! It’s also exhilarating, scary, exciting, exhausting, anxiety-provoking, and probably the most fun you will ever have. As parents we only want the best for our children, and we draw so much pleasure from their achievements, so it’s hard to not notice the developmental differences among siblings, friends or classmates.

A couple of points to keep in mind. First, making comparisons of children is normal. We all do it. There is nothing bad about it, or wrong with you for doing it. Second, and maybe most important, milestones do not correlate with intelligence. While we are proud when our children develop new skills, just because yours did so earlier or later than others doesn’t mean they will be more or less successful than their peers.

  1. What exactly are milestones and how fixated should parents be about them?

Developmental milestones are skills most children can do by a certain age, like waving bye-bye or taking their first steps. Milestones fit into different categories, such as social, communication, cognitive, and motor. They were developed by studying patterns of childhood growth, and thus they help define the recognized pattern of development that children are expected to follow.

Each milestone is expected to occur within a specified age range. For example, the age for when a child starts to feed a doll (a social milestone) ranges from 15 to 24 months. So what that means to a pediatrician is that by 15 months old, about 25% of children can be expected to have developed that skill. By 24 months, this increases to more than 90% of children. What is important to keep in mind is that it doesn’t matter if your child develops the skill on the earlier side (15 months) or on the later side (24 months) as they are both in the expected range for that milestone. This is why I wouldn’t get too stressed if your child isn’t reaching a milestone at the exact same age as another child, as there is a big range for “normal” development.

I can’t stop you from fixating on milestones, but I would urge you to not fixate on any one milestone. Each child develops in his or her own unique way, and so it helps to look at development as a whole. For example, maybe your child is 15 months old and not walking yet (like my own daughter at that age). But, if she is able to pull to stand, balance independently for a few seconds, cruise and walk with assistance, she has developed the skills necessary that will allow her to eventually walk on her own. And, if she is meeting milestones in other domains, like communication or fine motor skills, then the exact age when she begins to walk independently becomes less of a concern.

  1. When should parents start to look out for milestones?

Parents can start looking out for milestones right from the newborn period. Some of the earliest milestones include responding to noise, lifting their head and smiling spontaneously. The CDC has some great information about development (https://www.cdc.gov/ncbddd/actearly/milestones/index.html) and a Milestone Tracker app that you can download for 2 months and older. Keep in mind that if your child is premature (born earlier than 37 weeks gestation), pediatricians will age-adjust for that prematurity up until 2 years of age.

As I mentioned earlier, development is very fluid, so try to not get fixated on any specific milestone. These developmental norms give us a general pattern of development while recognizing the wide variation between individuals.

  1. What can parents do to promote the ‘achievement’ of milestones in those early months?

The good news is that milestones were developed based on children’s natural growth, and so even without a lot of intervention, most milestones will develop over time. That said, a recent  CDC analysis of parenting practices found that the following were key in promoting child development:

  • Responding to children in a predictable way
  • Showing warmth and sensitivity
  • Having routines and household rules
  • Sharing books and talking with children
  • Supporting health and safety
  • Using appropriate discipline without harshness

In terms of motor development, you can start with one exercise as early as infancy – tummy time! Tummy time is placing a baby on his or her stomach only while awake and supervised. It will help your baby develop strong neck and shoulder muscles and promote motor skills. In addition, it gets your little one off the back of his or her head to help prevent flat spots.

On a final note, you know your child the best, and you are his or her best advocate. As pediatricians, we see your children for limited amounts of time (not to mention that kids can behave very differently in the doctor’s office than in other settings). We really rely on your observations and instincts, and those of their teachers, grandparents and caretakers. If you have any concerns about your child’s development, make sure you discuss them with your pediatrician, who can help you determine if a developmental evaluation is warranted.

Kids are all unique, just like their parents. We all have different gifts and interests, both physically and academically, and not all people thrive in the same environment. In other words, we can’t expect our kids to act and develop in the same way either. The fun part comes from learning what makes our children special – their strengths and weaknesses, likes and dislikes, what makes them laugh and what makes them sad. So enjoy the process of finding out who your child is. I can guarantee you will be amazed.

Dr. Beth Rosenberg is a pediatrician and a mom, who lives in Darien with her husband, Daniel, and their 4 year old daughter, Lily. Born and raised in South Florida, Dr. Rosenberg received an undergraduate degree from Duke University and a Master’s degree from the Johns Hopkins School of Public Health. After graduate school, she worked as both a healthcare consultant and policy advisor on Capitol Hill. While Dr. Rosenberg enjoyed her career working on healthcare policy, she decided to follow her passion to become a doctor and returned to South Florida to attend the University of Miami School of Medicine. Dr. Rosenberg completed her pediatric residency at New York-Presbyterian Hospital, Weill Cornell, and worked as a pediatrician for many years at Tribeca Pediatrics in NYC prior to moving to Darien.