Most parents (especially first-time parents) wonder, at some point, whether their child is developing “normally.” It’s human nature to check out other kids’ development at the park, at the grocery store, and on the street for comparison’s sake. The problem with this is that you don’t know the exact age of the child you’re eyeballing. In addition, you don’t know their history or the full picture of how they’re developing.
You may also find yourself comparing your child’s development to that of an older sibling or to a friend’s kid (whose age you do know). Again, this can be risky business because every child is different and parents often forget when their older child reached their developmental milestones. Moreover, other parents (even those who are friends) tend to exaggerate their kids’ abilities.
The Bottom Line: There’s a fairly wide range of “normal” when it comes to development.
Below, We’ll Discuss:
How Doctors Identify Developmental Delays:
At every checkup, the pediatrician will examine your child and ask you a bunch of questions to make sure your little one’s development is on track.
Doctors Look for Growth In the Following 6 Areas:
1. Gross Motor Skills: These are skills that require large muscle groups to work together (think: crawling).
2. Fine Motor Skills: Fine motor skills require small muscle groups to work together (for example, holding a spoon).
3. Oral Motor Skills: Oral motor skills require children to move their mouths and tongue muscles together. Examples include swallowing and expressive language (making sounds & talking).
4. Receptive Language: This is the ability to understand language (i.e. to follow commands).
5. Social-Emotional Skills: These are skills that enable a child to interact with the world around them.
Think: Smiling in response to another person’s smile – aka the “social smile”.
6. Cognitive/Intellectual Ability: This refers to how well a child understands what’s going on around them. An example of cognitive ability is “object permanence” – the understanding that an object still exists even when it’s hidden from view.
As kids get older, school performance and teacher feedback become important markers for how a child is doing developmentally.
Get Wise About the Developmental Milestones for the First Three Years of Life.
PediaTip: When it comes to developmental milestones, remember that doctors look for forward progress and don’t expect kids to hit every milestone at exactly the “right” time.
A Word About Walking:
Doctors usually take notice when a child isn’t walking by 15-months of age, but will often wait until they’re 18 months before intervening.
A Word About Talking:
Three Red Flags That Suggest a Speech Delay Include (But Aren’t Limited To):
1. No babbling, pointing, or gesturing by 1 year of age. (Doctors hope for 1 word plus “Mama” and “Dada” at 12 months).
2. No words by 15 months of age.
3. Not being able to follow simple (one-step) commands by 18 months.
Get Wise(r) About Speech Delays here.
PediaTip – Trust Your Gut: If you’re concerned that your child has a developmental delay, let their doctor know. It can be hard for doctors to pick up on subtle delays during a short visit. You, on the other hand, see your child day in and day out and know them best. If you want to do a deep dive into your concerns, schedule a separate visit with the pediatrician to discuss them in more detail (vs. tacking them onto the end of a routine checkup).
What are the Next Steps If a Developmental Delay Is Suspected?
- If the developmental delay seems mild (i.e. just outside the realm of normal) and it’s the only delay found, your child’s doctor may choose to take a “watch and wait” approach to see if your baby “catches up.”
- If the delay seems moderate to severe or there are global delays (delays in multiple areas), the pediatrician will refer your child to one or more developmental specialists (such as a speech-language pathologist, a physical therapist, or an occupational therapist). Note: Doctors tend to get more amped up about global delays (vs. single, isolated delays).
- Insider Info: If the doctor is concerned about a language delay, they’ll order a hearing test, too.
Why? Because a child needs to hear well for their receptive and expressive language to develop properly.
Note: I typically provide a referral to a speech-language pathologist along with the referral for the hearing test.
Why Both? Because even if the hearing screen is abnormal and we’ve identified the cause of the speech delay, speech therapy is still needed.
Tell Me More About the Different Types of Developmental Specialists:
- “Developmental-Behavioral Pediatricians”: As the name implies, “developmental-behavioral pediatricians” specialize in pediatric developmental and behavioral issues. They do a super in-depth developmental evaluation to see if a delay exists. If one (or more) does, they direct the child to the appropriate specialists.
- Physical Therapists, Occupational Therapists, and Speech-Language Pathologists work directly with children with developmental delays.
Physical therapists primarily focus on strength & getting the body to move properly, whereas occupational therapists assist kids with their “activities of daily living” (such as dressing and feeding themselves).
Speech-language pathologists, on the other hand, help children with speech delays and/or feeding issues.
Physical therapists, occupational therapists, and speech-language pathologists work in private settings AND through Early Childhood Intervention Programs.
What are Early Childhood Intervention Programs?
Early Childhood Intervention Programs help kids under age 3 with developmental delays. They’re great because they’re funded by the government (read: free) and the specialists will often come to the child’s home.
To Find an Early Childhood Intervention Program Near You, You Can Either:
- Call your child’s doctor and ask them for the number.
- Check out the CDC’s list of Early Intervention Programs in the U.S. (and their contact info).
- Google your ZIP Code and the term “Early Childhood Intervention.”
Insider Info: Easterseals is an early childhood intervention program that has child development centers nationwide. The centers offer high quality daycare and education for children with developmental delays (who are 6 weeks to 6 years of age). If you’re interested, go to the Easterseals website or call 1-800-221-6827.
PediaTips:
- If the pediatrician refers your child to a developmental-behavioral pediatrician, make an appointment ASAP.
Why? Because developmental-behavioral pediatricians tend to be popular people with booked schedules. If there’s a long waitlist, ask the doctor for names of other developmental-behavioral specialists in the area. If there aren’t any, see if the pediatrician can pull some strings to get your child an earlier appointment.
- If the pediatrician recommends that your child see both a developmental-behavioral pediatrician and a developmental therapist (such as a speech therapist, a physical therapist, or an occupational therapist), don’t postpone your appointment with the developmental therapist while you wait for your appointment with the developmental-behavioral pediatrician. Call the Early Intervention Program or a private developmental therapist right away.
Why? Because you don’t need an exact diagnosis to start therapy and the early intervention specialist can evaluate your child and start working on the areas of concern. Early intervention is the most important thing you can do to help your child reach their developmental milestones.
Why’s That? Because children’s brains are super plastic (i.e. they have a large capacity for growth and change).
- If your child has multiple delays (i.e. global delays), you might want them to see a private speech therapist, physical therapist, or occupational therapist in addition to an Early Childhood Intervention therapist.
Why? To maximize your child’s services and to help them reach their developmental potential. If the cost is prohibitive, though, don’t worry about it. Just ask the Early Intervention Program specialist to provide you with exercises to do with your child at home.
The Bottom Line
Most kids fall within the normal range when it comes to development. That being said, your child’s pediatrician will be on the lookout for developmental delays at every checkup. Avoid comparing your child to other kids and speak up if you have any concerns. If a delay is suspected, contact the Early Childhood Program (or a private therapist) right away even if the diagnosis isn’t 100% clear.
