Children grow and develop differently, however, parents worry if their child isn't reaching some of the same milestones as their neighbors children. How do you know if your child isn't developing normally?
Listen in as Stacey Anderson, Bryan pediatric occupational therapist, shares milestones children should hit at each age, red flags to look out for, and when you should consider developmental screening.
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Your Child’s Development: What You Need To Know
Featured Speaker:
Stacey Anderson, Bryan pediatric occupational therapist
Stacey Anderson is a pediatric occupational therapist with Bryan Heath. Transcription:
Melanie Cole (Host): Skills such as taking the first step, smiling for the first time, and waving bye-bye, are called developmental milestones, but what if your child doesn’t do all of these things at the time that they’re supposed to do them? When do you worry? My guest is Stacey Anderson. She’s a Pediatric Occupational Therapist at Bryan Health. Stacey, let’s talk about the milestones, but before we do, do all children hit the milestones we’re going to talk about at the same time? If a child isn’t hitting them just at that time, is that when a parent is supposed to worry?
Stacey Anderson (Guest): Thank you, Melanie. No, kids don’t always meet milestones at exactly the same time, but there’s generally a range in which that development of that skill is appropriate. When we start getting beyond that range is where we start to worry. Baby’s who are born prematurely will usually not meet those milestones on time, so babies that are born prematurely, we generally adjust for that prematurity until age two. For example, a baby who is six-months-old, but was born two months early, we might really be looking at them like a four-month-old.
If at any point in time, the parents become concerned about their child and meeting those milestones, it’s very important for that parent to communicate with that pediatrician. The pediatrician is going to be the one most on top of your child, not only medical needs but developmental needs, as well.
Melanie: Let’s start with those little guys, like two-months- to four-months-old, what are some of the milestones that children should try to hit at that point, and what are some red flags if they don’t?
Stacey: Okay. Some of the motor skills that kids should meet at this age would be being able to hold on to items in their hands such as a rattle, being able to support their upper body with their arms when they’re on their tummy, pushing down on their legs – what we call weight bearing – when their feet are placed on a firm surface like the floor. Some of the thinking skills would be responding to voice, being able to watch faces or following moving objects with their eyes. Language skills, you could start noticing some coo-ing noises, some differences in inflection in their voices, just the ability to attend to sound. For example, if they hear a person talk or they hear a toy across the room, they should be able to turn that direction. You should start seeing some eye contact, and you should start seeing what we call a social smile, which is just that baby’s interaction with caregivers. Any of the red flags would be not meeting some of those milestones at those times, or a baby who doesn’t respond to loud noises doesn’t really interact with their caregivers, or not following those objects would be some of the things that you would really watch for as far as red flags.
Melanie: And what about at six-months? They start getting real, little personalities by then. What should we be looking for?
Stacey: Yes, they do. At about six months of age, we should start seeing the ability to sit, unsupported for short periods of time – that would usually come between six- and eight months of age. You should see babies transferring objects from one hand to the other; they should start raking at items – small objects with their whole hand. You should start seeing some rolling from their back to their stomach and vise versa. They should really be able to watch objects with their eyes pretty easily in all directions – side-to-side, up-and-down, and even in circular motions. They should start to reach out and grasp objects that are in front of them.
Language-wise, you should hear them responding to sounds by making sounds. For example, if you’re talking to a six-month-old, they should make some sounds back at you, almost as if you’re having a conversation. They should really be localizing the sound by turning their head toward the source of the sound. You’re going to start noticing some syllable repetition, things like “ma-ma,” “da-da,” “ba-ba,” “bah-bah,” things like that. You should start seeing babies who are interested in engaging in some social play, and for example, really enjoys games like pat-a-cake and peek-a-boo.
Some of the developmental red flags at this stage would be noticing very stiff or tight muscles or the opposite, having very sloppy, almost rag-doll-like movement patterns. You would see a baby who maybe isn’t showing affection or attention to the person who cares for them, especially those that – their parents or whoever is with them most of the time. If you notice something like their eyes consistently turning in or out, that would be a red flag, or not responding to the sounds around them.
Melanie: Now, we’re up to almost a year old, what should we be looking for as they get to be a year old, and maybe even they start to walk or crawl, and then even up to 18-months-old?
Stacey: Up to a year, you should start to notice some crawling, the baby should start to get on their hands and knees, maybe even pulling themselves up to furniture. You should notice some cruising along furniture, which is basically they hold on to furniture and kind of side-step along the furniture. They might even start to stand momentarily, without support. Fine motor wise, you’ll notice improving grasping patterns, such as being able to use their thumb and index finger to pick up small, finger foods. You should notice things like using two hands together or for example, banging blocks together, poking with one index finger into holes or pointing. You should notice shaking, banging, throwing, dropping. This is often the stage where babies like to drop things off their high chair and do the “uh-oh.” You should notice them starting to imitate gestures, such as clapping their hands or waving bye-bye. This is also the stage where really simple games of peek-a-boo, pat-a-cake, rolling a ball back-and-forth really becomes interesting, and they start to engage a little bit more in those tasks.
Language-wise, “ma-ma” and “da-da” start to become a little bit more frequent. They actually maybe start using it for a specific person, versus before where they just were using it inconsistently or not necessarily purposefully. You might start to notice them respond to “no,” and even start to respond to some simple verbal requests, such as “Give me the ball.” You’ll notice finger feeding starts to begin; you’ll notice some assistance with help with being dressed – for example, holding out an arm or a leg as you’re starting to put clothes on, and even starting to hold utensils during meal times. You might start to notice anxiety with strangers and imitating people in play.
Some of the developmental red flags at this point would be dragging one side of the body while crawling, not demonstrating the ability to stand when supported, not noticing any single words like “ma-ma” or “da-da,” or not seeking out a caregiver when they’re upset.
Melanie: Okay, so now as we’re looking toward our children becoming toddlers – and this is where some parents start to really worry about speech and language, or ability to move a certain way – catch a ball and things – so speak about toddler age, maybe even up to age six. And then, give us those red flags, Stacey, but also then what? If they’re not hitting those milestones, what is our next step?
Stacey: At the toddler age, by the time the kid is at least 12- to 16-months of age, really they should be starting to walk alone, maybe pulling some pull toys. By two- to three, maybe even starting to climb well, starting to go upstairs with support, riding pedal carts, those kinds of things. You should start to notice more fine-motor skills, such as scribbling, stacking blocks, doing some simple puzzles. Language-wise, you’re going to start to notice them listening to short stories, identifying body parts, colors, using pronouns, engaging in pretend play, even beginning to categories and name objects.
Some of the developmental red flags that we would look for – one of the big ones would be not being able to walk by 18-months of age -- that would be a red flag that you would want to discuss with the pediatrician – walking on toes, using about 50 words by about age two. At that point in time, you should notice them starting to do two- to three-word sentences; they’re starting to understand more concepts, they’re becoming much more independent in self-care. By the time they reach that 5- to 6-years of age, they should be independent with – pretty much the majority of their self-care, such as brushing their teeth – with a little bit of help to make sure they do a good job -- getting dressed, feeding themselves, those kinds of things.
Again, those developmental red flags would really be lack of communication, lack of speech, falling frequently or being very clumsy, not demonstrating the ability to sit for very long periods of time. For example, five minutes, by the age of five, they should be able to attend to a task. They’re not starting to show interactive play with other kids by 5-years-old or engage in any sort of pretend play. Some other sort of developmental red flags at these stages would be oversensitivity to things like light or sound, oversensitivity to things like movement – for example; they get very anxious on swings, or slides, or rides, or things like that. A child who is constantly seeking out those activities could also be a red flag. Kids who don’t like touch, who seem to be distressed walking on grass, walking on sand, touching wet, messy things would be some other developmental red flags.
Melanie: If we notice some of these and we mention it to our pediatrician, and they suggest developmental screening, tell us what that’s like for a child.
Stacey: Usually, when pediatricians start to recognize some developmental screenings, depending on the area that they’re concerned about, usually pediatricians will recommend some physical therapy to work more on some muscle tone, movement patterns or occupational therapy to work more on the fine-motor or some of those sensory issues – which is what we were talking about with the movement patterns or the not liking touch. If there are language concerns, speech therapy. There are oftentimes – when patients have multiple areas, they might see more than one discipline, but the biggest thing is to really keep on top of letting the pediatrician know what your concerns are so that they can then make the appropriate referrals when necessary.
Melanie: Wrap it up for us, Stacey -- because it’s so important for parents to hear that maybe if their child isn’t hitting all of these milestones, that it’s normal, and children develop at different ages, but that some of them really do send up red flags – wrap it up, with your best advice about watching our children and when it’s time to inquire about developmental screening?
Stacey: My best advice would be to keep track really – there are so many checklists out there for developmental screening – is to keep track of each age group what the child should be doing. If it’s one or two skills here and there, it may not be much of an issue, but when you start noticing red flags, or you start noticing my child really is missing a lot of these skills in the area – for example, fine motor – that that would be an area of concern. If my child is supposed to do all of these things and they’re not really doing a lot of them, then that’s kind of a pattern, and that would be an indication to let that pediatrician know so that there can be some further follow up can happen.
Melanie: Thank you, so much, Stacey, for this great information, and sharing your expertise on children and developmental milestones, and a special “thank you” to our podcast partner, NRC. For more information about today’s topic, you can go to bryanhealth.org/pediatrictherapy, that’s bryanhealth.org/pediatrictherapy. This is Bryan Health Podcast. I’m Melanie Cole. Thanks so much, for tuning in.
Melanie Cole (Host): Skills such as taking the first step, smiling for the first time, and waving bye-bye, are called developmental milestones, but what if your child doesn’t do all of these things at the time that they’re supposed to do them? When do you worry? My guest is Stacey Anderson. She’s a Pediatric Occupational Therapist at Bryan Health. Stacey, let’s talk about the milestones, but before we do, do all children hit the milestones we’re going to talk about at the same time? If a child isn’t hitting them just at that time, is that when a parent is supposed to worry?
Stacey Anderson (Guest): Thank you, Melanie. No, kids don’t always meet milestones at exactly the same time, but there’s generally a range in which that development of that skill is appropriate. When we start getting beyond that range is where we start to worry. Baby’s who are born prematurely will usually not meet those milestones on time, so babies that are born prematurely, we generally adjust for that prematurity until age two. For example, a baby who is six-months-old, but was born two months early, we might really be looking at them like a four-month-old.
If at any point in time, the parents become concerned about their child and meeting those milestones, it’s very important for that parent to communicate with that pediatrician. The pediatrician is going to be the one most on top of your child, not only medical needs but developmental needs, as well.
Melanie: Let’s start with those little guys, like two-months- to four-months-old, what are some of the milestones that children should try to hit at that point, and what are some red flags if they don’t?
Stacey: Okay. Some of the motor skills that kids should meet at this age would be being able to hold on to items in their hands such as a rattle, being able to support their upper body with their arms when they’re on their tummy, pushing down on their legs – what we call weight bearing – when their feet are placed on a firm surface like the floor. Some of the thinking skills would be responding to voice, being able to watch faces or following moving objects with their eyes. Language skills, you could start noticing some coo-ing noises, some differences in inflection in their voices, just the ability to attend to sound. For example, if they hear a person talk or they hear a toy across the room, they should be able to turn that direction. You should start seeing some eye contact, and you should start seeing what we call a social smile, which is just that baby’s interaction with caregivers. Any of the red flags would be not meeting some of those milestones at those times, or a baby who doesn’t respond to loud noises doesn’t really interact with their caregivers, or not following those objects would be some of the things that you would really watch for as far as red flags.
Melanie: And what about at six-months? They start getting real, little personalities by then. What should we be looking for?
Stacey: Yes, they do. At about six months of age, we should start seeing the ability to sit, unsupported for short periods of time – that would usually come between six- and eight months of age. You should see babies transferring objects from one hand to the other; they should start raking at items – small objects with their whole hand. You should start seeing some rolling from their back to their stomach and vise versa. They should really be able to watch objects with their eyes pretty easily in all directions – side-to-side, up-and-down, and even in circular motions. They should start to reach out and grasp objects that are in front of them.
Language-wise, you should hear them responding to sounds by making sounds. For example, if you’re talking to a six-month-old, they should make some sounds back at you, almost as if you’re having a conversation. They should really be localizing the sound by turning their head toward the source of the sound. You’re going to start noticing some syllable repetition, things like “ma-ma,” “da-da,” “ba-ba,” “bah-bah,” things like that. You should start seeing babies who are interested in engaging in some social play, and for example, really enjoys games like pat-a-cake and peek-a-boo.
Some of the developmental red flags at this stage would be noticing very stiff or tight muscles or the opposite, having very sloppy, almost rag-doll-like movement patterns. You would see a baby who maybe isn’t showing affection or attention to the person who cares for them, especially those that – their parents or whoever is with them most of the time. If you notice something like their eyes consistently turning in or out, that would be a red flag, or not responding to the sounds around them.
Melanie: Now, we’re up to almost a year old, what should we be looking for as they get to be a year old, and maybe even they start to walk or crawl, and then even up to 18-months-old?
Stacey: Up to a year, you should start to notice some crawling, the baby should start to get on their hands and knees, maybe even pulling themselves up to furniture. You should notice some cruising along furniture, which is basically they hold on to furniture and kind of side-step along the furniture. They might even start to stand momentarily, without support. Fine motor wise, you’ll notice improving grasping patterns, such as being able to use their thumb and index finger to pick up small, finger foods. You should notice things like using two hands together or for example, banging blocks together, poking with one index finger into holes or pointing. You should notice shaking, banging, throwing, dropping. This is often the stage where babies like to drop things off their high chair and do the “uh-oh.” You should notice them starting to imitate gestures, such as clapping their hands or waving bye-bye. This is also the stage where really simple games of peek-a-boo, pat-a-cake, rolling a ball back-and-forth really becomes interesting, and they start to engage a little bit more in those tasks.
Language-wise, “ma-ma” and “da-da” start to become a little bit more frequent. They actually maybe start using it for a specific person, versus before where they just were using it inconsistently or not necessarily purposefully. You might start to notice them respond to “no,” and even start to respond to some simple verbal requests, such as “Give me the ball.” You’ll notice finger feeding starts to begin; you’ll notice some assistance with help with being dressed – for example, holding out an arm or a leg as you’re starting to put clothes on, and even starting to hold utensils during meal times. You might start to notice anxiety with strangers and imitating people in play.
Some of the developmental red flags at this point would be dragging one side of the body while crawling, not demonstrating the ability to stand when supported, not noticing any single words like “ma-ma” or “da-da,” or not seeking out a caregiver when they’re upset.
Melanie: Okay, so now as we’re looking toward our children becoming toddlers – and this is where some parents start to really worry about speech and language, or ability to move a certain way – catch a ball and things – so speak about toddler age, maybe even up to age six. And then, give us those red flags, Stacey, but also then what? If they’re not hitting those milestones, what is our next step?
Stacey: At the toddler age, by the time the kid is at least 12- to 16-months of age, really they should be starting to walk alone, maybe pulling some pull toys. By two- to three, maybe even starting to climb well, starting to go upstairs with support, riding pedal carts, those kinds of things. You should start to notice more fine-motor skills, such as scribbling, stacking blocks, doing some simple puzzles. Language-wise, you’re going to start to notice them listening to short stories, identifying body parts, colors, using pronouns, engaging in pretend play, even beginning to categories and name objects.
Some of the developmental red flags that we would look for – one of the big ones would be not being able to walk by 18-months of age -- that would be a red flag that you would want to discuss with the pediatrician – walking on toes, using about 50 words by about age two. At that point in time, you should notice them starting to do two- to three-word sentences; they’re starting to understand more concepts, they’re becoming much more independent in self-care. By the time they reach that 5- to 6-years of age, they should be independent with – pretty much the majority of their self-care, such as brushing their teeth – with a little bit of help to make sure they do a good job -- getting dressed, feeding themselves, those kinds of things.
Again, those developmental red flags would really be lack of communication, lack of speech, falling frequently or being very clumsy, not demonstrating the ability to sit for very long periods of time. For example, five minutes, by the age of five, they should be able to attend to a task. They’re not starting to show interactive play with other kids by 5-years-old or engage in any sort of pretend play. Some other sort of developmental red flags at these stages would be oversensitivity to things like light or sound, oversensitivity to things like movement – for example; they get very anxious on swings, or slides, or rides, or things like that. A child who is constantly seeking out those activities could also be a red flag. Kids who don’t like touch, who seem to be distressed walking on grass, walking on sand, touching wet, messy things would be some other developmental red flags.
Melanie: If we notice some of these and we mention it to our pediatrician, and they suggest developmental screening, tell us what that’s like for a child.
Stacey: Usually, when pediatricians start to recognize some developmental screenings, depending on the area that they’re concerned about, usually pediatricians will recommend some physical therapy to work more on some muscle tone, movement patterns or occupational therapy to work more on the fine-motor or some of those sensory issues – which is what we were talking about with the movement patterns or the not liking touch. If there are language concerns, speech therapy. There are oftentimes – when patients have multiple areas, they might see more than one discipline, but the biggest thing is to really keep on top of letting the pediatrician know what your concerns are so that they can then make the appropriate referrals when necessary.
Melanie: Wrap it up for us, Stacey -- because it’s so important for parents to hear that maybe if their child isn’t hitting all of these milestones, that it’s normal, and children develop at different ages, but that some of them really do send up red flags – wrap it up, with your best advice about watching our children and when it’s time to inquire about developmental screening?
Stacey: My best advice would be to keep track really – there are so many checklists out there for developmental screening – is to keep track of each age group what the child should be doing. If it’s one or two skills here and there, it may not be much of an issue, but when you start noticing red flags, or you start noticing my child really is missing a lot of these skills in the area – for example, fine motor – that that would be an area of concern. If my child is supposed to do all of these things and they’re not really doing a lot of them, then that’s kind of a pattern, and that would be an indication to let that pediatrician know so that there can be some further follow up can happen.
Melanie: Thank you, so much, Stacey, for this great information, and sharing your expertise on children and developmental milestones, and a special “thank you” to our podcast partner, NRC. For more information about today’s topic, you can go to bryanhealth.org/pediatrictherapy, that’s bryanhealth.org/pediatrictherapy. This is Bryan Health Podcast. I’m Melanie Cole. Thanks so much, for tuning in.