Your Baby's Milestones
“You’re writing down everything the pediatrician is saying, trying to grasp every detail. If your child is not exactly there, you’re panicking,” says Diamondstein. In fact, Ethan met his infant milestones within a normal range of time, as did his two younger siblings, although each with a unique trajectory.
Now, says Diamondstein, “I’m not living my life milestones to milestone… I’m using milestones as a reference. I’m not worrying so much.”
For parents, milestones can be a source of anxiety or joy – whether they compare their passively seated infant to the most active crawler in the baby group or proudly document their child’s many firsts with snapshots and videos. For doctors, on the other hand, milestones are an important gauge of a child’s development.
“Aside from growth, milestones are one way we track development,” says Tracy McMahan, M.D., a pediatrician in private practice in San Francisco. Pediatricians have a set of expectations, says McMahan, but emphasizes that each milestone has a developmental range that can span months. She cites crawling as an example, which is considered normal between six and 12 months of age, while some babies skip crawling altogether.
McMahan looks for progress in various domains, including gross motor skills like standing up and fine motor skills like self-feeding; social skills, such as making eye contact and smiling; and verbal skills, which include not just expressive language but also receptive language, as in understanding others. By around six months, McMahan hopes to see babies sitting up (although that can happen as late as nine months), babbling and picking up large objects. (See sidebar).
If McMahan finds a delay in one area, such as not rolling over from tummy to back by four months, she looks to see if there’s a simple reason for it, such as a recent illness, or, conversely, a growth spurt.
“It could be that the baby is just too big” to roll over yet, she says. McMahan will also assess whether the baby has low muscle tone or high (stiff) muscle tone, and she’ll examine how the baby is doing in other areas to help glean if a larger developmental issue is at work.
If the baby’s muscle tone is too low or high, McMahan says she may refer the child to physical therapy. A physical therapist will see the baby more regularly than the pediatrician and can give parents specific exercises to do with their baby, thus “helping encourage the baby to get back on track,” says McMahan.&pagebreaking&Understanding Markers
That opportunity to address issues early is a key reason to discuss milestones with your pediatrician. These markers serve as an early indicator of a baby’s healthy development and help pediatricians determine whether additional attention is required. Tina Gabby, M.D., who specializes in behavioral and developmental pediatrics in Marin County, says, “Early intervention works for many, many issues, so early identification is very, very important.”
Early intervention needn’t always mean a referral to an outside expert. In the majority of cases, parents play the most important role in getting their child to meet his and her milestones on time, says McMahan.
While babies should sleep on their backs, they should spend awake time on their bellies, says McMahan. Tummy time is the main way infants develop the muscle strength needed to progress to other milestones, such as holding their head up and sitting. McMahan also wants parents and caregivers to get on the floor and play with their babies. She says that kind of interaction helps babies develop not just gross motor skills, but their language and social abilities as well.
Electronic games are no substitute. “Interpersonal feedback is so important for development.... Human beings need human interaction,” stresses McMahan. The good news is that playing with your baby while she’s on her tummy, sitting her up on your lap, talking to her and giving her toys to handle are all “fun ways to interact with your baby. They are developmentally appropriate ways to play with your baby,” says McMahan.
Even if you play with your baby in all the right ways, it doesn’t mean he’ll be the first crawler and earliest babbler in his playgroup. Not only do milestones have broad ranges, but a baby’s development may emphasize one domain over another for a period of time. A child can be very verbal, but not crawling – or, conversely, may have excellent gross motor skills but be less verbal.
“I see that really often,” says Dawn Rosenberg, M.D., a pediatrician who works in San Francisco and Marin. “Many babies excel in one set of skills at a time. They alternate; you don’t have everything all at once.”
That was the experience of San Francisco mother Diamondstein, whose eldest Ethan was very talkative, speaking in complete sentences by 18 months, but less interested in crawling. Ethan’s younger sister, Lily, on the other hand, was a mover from the get-go, walking by 10 months and running soon after. As a petite baby, Lily caught the attention of passers by. “I was self-conscious about it. It was freakish to see such a small baby running,” says Diamondstein.&pagebreaking&A Different Schedule
Premature babies, those born before the 37th week of pregnancy, may reach milestones on a different time scale altogether, depending on how early they’re born. Rosenberg, whose own daughter Jacqueline was born at 35 weeks weighing just four pounds, says premature babies are given an adjusted age to reach milestones, which is their chronological age minus the number of weeks they were born early.
Milestones are “not just about how long you’ve been in the outside world, they’re about how long you’ve had to develop inside,” says Rosenberg. Preemies are generally tracked on this adjusted schedule for the first two years of life, although some can get on track with their chronological age sooner or later than that, says Rosenberg.
Bay Area hospitals have infant development clinics for preemies and other high-risk births to provide the additional assistance they’ll need to get on track. “It takes a lot of patience… [Parents of premature babies] are really anxious about milestones and want to know if their child will catch up,” says Rosenberg.
Marin mother Rekha Strader’s son, Stone, was born at 28 weeks. At 20 weeks of age, his adjusted age was just six weeks. They’ve benefitted from home visits organized through the Whitney Development Clinic at California Pacific Medical Center, which have helped to teach Rekha and her husband how to play with Stone. “We’re specifically working on muscle strength and eye coordination when we play with Stone,” says Strader. Their hard work has paid off, as Stone did roll over by his fourth month.
Less commonly, delays in reaching milestones can reflect more serious issues. A gross motor delay could have a medical explanation, such as a cardiac condition that is creating weakness in the muscles, says developmental pediatrician Gabby. Gabby also notes that, with the increasing incidence of autistic spectrum disorders, parents are “hyper focused and hyper aware” of such social milestones as making eye contact, pointing and engaging in reciprocal play.
But even in the unlikely scenario of a neurodevelopmental disorder, Gabby seeks to reassure parents. Early intervention programs such as behavioral, speech and occupational therapy, coupled with social skills training, have shown to be very helpful for children with autism, says Gabby. That’s why milestones matter and why, if you have a concern, you should “bring it to the attention of your pediatrician,” says Gabby.
Rosenberg agrees. She says parental input is very important when she is assessing a child’s development. Although she’d like to see a child walking by age 15 months, she may take a wait and see approach, since up to 18 months is still considered normal for this skill. However, if parents are really worried, Rosenberg may make a referral to physical therapy sooner.
“The parents’ level of anxiety weighs in…. If they’re not reassured, I’ll give them the option. I’ll say maybe you can go to one session of physical therapy,” says Rosenberg. Sometimes that one session is enough to give the parents tips on how to help their baby reach her next goal.
Ultimately, Rosenberg hopes parents don’t stress too much about each individual milestone and get too tied to a specific timeline, since each child is unique.
Rebecca Diamondstein certainly saw this in her own children. She says, “When you have multiple kids, you see that different people reach milestones at different times. It’s not a comparison. You need to celebrate each one.”&pagebreaking&Some Common Milestones
(Compiled from the CDC. See the complete list at www.cdc.gov/ncbddd/actearly/milestones/)
Begins to smile
Coos and gurgles
Can hold head up
Reaches for toys
Rolls tummy to back
Responds to own name
Rolls in both directions
Begins sitting up
Is aware of strangers
Uses pincer grasp
Says words like “mama” and “dada”
Bangs two things together
May cruise (walk holding furniture and walls)
Engages in simple pretend play
Says many single words
Enjoys other children
Says two-word sentences
Noelle Salmi is a Bay Area-based freelance writer and mother of three.