Wednesday October 28th 2020

Baby and toddler milestones – what to expect

IS THERE SOMETHING WRONG WITH MY BABY?
A guide to normal development and how to pick up potential problems

by Beth Cooper

Milestones are a double-edged sword for parents. If your child isn’t lifting her head or rolling over when her little friends are, should you panic or just be patient? How accurate are developmental milestones charts and are they the definitive guide to normal growth?

Paediatricians Jennifer Shu and Laura Jana, authors of Heading Home with Your Newborn : From Birth to Reality (American Academy of Pediatriacs, 2005) say that average milestone indicators are just that – indicators. The normal age range at which your baby is likely to master a milestone may fall two to three months either side of the average.

Many babies and toddlers take their time reaching milestones, but moms and dads may be concerned about potential problems and want to know when it’s best to consult a medical professional.

“There is a huge fear in many of us that our babies are not going to be ‘normal’ and that they will be less than perfect,” says Cape Town clinical psychologist Jenny Perkel.

“Excessive prenatal testing for foetal abnormalities is part of this. Our society puts a great deal of emphasis on external achievement, money, power and success. Sometimes it can feel shameful or embarrassing for parents when their babies don’t develop as quickly as friends’ babies.

“Developmental delays sometimes alert parents to the possibility that their baby could suffer from some kind of handicap. This often compromises the level of success that the child is capable of. Anything that hinders (success) is seen as dangerous.”

What’s more important, say paediatricians, is the order in which your baby reaches her milestones and not when she reaches them. Your baby ideally must sit before crawling, as it means, explains Dr Shu, that she’s growing in strength and knowledge in the right areas of both body and brain. This means she is laying the foundation for the next rung of the developmental ladder.

Paediatrician William Sears says that a delayed development is indicated if your child hasn’t reached a developmental milestone by the expected age, taking into account the age range either side of average. Generally, a baby three months behind the average – and a toddler up to six months behind – could be assessed by your paediatrician as being delayed.

This doesn’t mean, however, that something is necessarily wrong. Some babies just take longer than others, while genetics and environment also play a role. It’s possible that if a child’s parent took longer to crawl, he might too, while a baby who was stimulated less in a particular milestone area might take longer to get there on his own.

Babies are not identical, so developmental charts must always allow for flexibility. Don’t use them to fuel concerns – they are simply a guide. Remember that premature babies will likely master milestones several months later than full-term babies.

Head control

Your newborn has rather weak neck muscles at birth and therefore very little control over her head. By about a month old, she’ll probably lift her head and then start holding it up, while in a sitting position, at around four months. Expect more firm and strong head control by around six months.

When to seek advice : Is your baby having difficulty lifting her head slightly at around three months? Premature babies reach this milestone and others later than full-term babies, so bear this in mind.

Grasping

At birth, babies instinctively grasp for objects, but learn over the course of a year how to pick up and firmly hold things. By around three months, your baby starts to develop hand-eye coordination, although he can’t grasp and hold objects correctly yet.

Between four to eight months, babies start picking up larger objects such as building blocks, but can’t manage small items yet. From around nine to 12 months, he can pick up objects, may start favouring his left or right hand and practices his pincer grasp, enabling him to pick up smaller objects between forefinger and thumb.

When to seek advice : Chat to a doctor if your baby makes no effort to touch, play with or pick up a toy by around nine months, or if he shows no interest in anything placed in front of him at around two months of age.

Rolling over

Parents love to watch this large physical movement develop – babies just seem so independent once they can flip from back to tummy and vice versa!

Turning from tummy to back may emerge at around two to three months in some babies, but rolling from back to tummy takes more effort, muscle strength and stronger arms, emerging at around six months.

Your three-month-old will likely lift up her head and shoulders, using arm support, while lying on her tummy – all useful exercises for rolling from front to back and vice versa at around the half-year mark.

Some babies move around by rolling and others skip this stage and go straight to sitting, lunging or crawling. Don’t worry about this – as long as your baby is interested in learning new skills and wants to explore, all is well.

When to seek advice : At around six months, your baby should be trying to roll over or at least showing interest in moving around in other ways, such as trying to sit, scoot or crawl.

Sitting

While experts say independent sitting emerges between four to seven months, many babies take longer. Statistics indicate that 90% of babies sit well for a few minutes, without support, at around eight months.

Once head and neck control are mastered, your baby may sit for a moment or two, without support, at around five months, before toppling. Around seven months, he may move his body to grasp a toy, while sitting.

When to seek advice :

By six months, your baby should be making an effort to prop himself up on his arms and be able to hold his head steadily. Head control is an essential milestone for sitting, which leads to crawling and eventually walking.

Crawling

This skill usually emerges once your baby can sit steadily, unsupported. Her muscles are stronger, she can look around and also prevent herself from falling once she is balanced on her hands and knees.

From about nine to ten months, babies start the process of moving from sitting to all fours, learn to rock back and forth and will then figure out how to move forward. After that, she also starts to master moving from all fours back to a sitting position.

Advanced or ‘cross-crawling’ is mastered when your baby uses an alternate leg and arm to crawl forward. By around twelve months, babies are mostly crawling well.

When to seek advice : The rule of thumb is that your baby should want to move in some way – whether scooting, crawling, rolling or creeping – by a year old. She should also be using her limbs equally.

Walking

The moment all parents anticipate with great excitement, walking is a complex and fascinating step towards independence – and a farewell to young babyhood!

All milestones such as head control, sitting, rolling and crawling help your baby to develop coordination and muscle strength – essential tools for taking those first steps.

Your baby may pull into a standing position at around eight months, with average walking age ranging from nine months to as much as 18 months. Many parents report their babies standing early, but only walking at around 15 months.

When to seek advice : If your baby seems to be taking his time to walk after 15 months, or if you feel concerned that his milestones are taking significantly longer than his peers (and he is not premature) then chat to your doctor.

Talking

Between 13 to 18 months, toddlers will likely say one or two words, but many say nothing at all at this stage. Average vocabulary up to two years is around 50 – 70 words, but again, some children are not even making simple, three-word sentences or singing little songs by the age of two.

At around three, toddlers may have a 300-word vocabulary, use pronouns with lots of practice and hold simple conversations.

When to seek advice :

Some signs of a possible problem are that your baby doesn’t keep eye contact or try to make sounds between six and 12 months – or was babbling but stops at about six months.

If, by around two, your toddler makes no attempts to speak, or didn’t babble before his first birthday, seems frustrated that you can’t understand what he’s saying, uses only one word and no simple sentences, then see your doctor for reassurance and possible evaluation.

By about three, experts suggest a doctor’s visit if your child drops consonants, can’t name simple objects, still uses only one word at a time and if people have difficulty understanding him. Again, though, this doesn’t necessarily indicate a problem – having an evaluation will put your mind at ease and help you to take the right action if there is a developmental issue.

“If you are concerned about your child’s milestones, have him checked by a paediatrician, child psychologist or a developmental specialist using the guidelines in this article,” suggests Perkel.

“The reality, if there is a developmental problem, is that you might need to spend some time, money and a lot of energy on different kinds of therapies for your child, such as occupational therapy, physiotherapy, speech therapy, etc.

“But the more armed  you are with knowledge about your child’s condition, the better equipped you will be to offer her what she really needs to help her with her developmental delay.”

Subs note : this ref to the Red Cross could be in separate box or as part of sources if preferred The Red Cross Developmental Unit in Cape Town have a team of experts that can either do a thorough assessment or refer you to a more appropriate place if necessary, says Perkel.

Milestones myths

  • Stuttering is a problem. Not necessarily. It can be a part of normal development, particularly when children are learning communication skills so fast and get excited. If your child stutters for more than six months, is very frustrated about it and even makes faces and tenses up, then chat to a doctor.
  • Babies walk by their first birthday. According to American physical therapist and paediatric clinical specialist Kati Knudsen, this is nonsense. Average walking age is 13-and-a-half months, while 15 months is perfectly normal. Remember to add two to three months to the average, either side, when assessing your own baby for normal development.
  • Not talking? Must be hard of hearing. You know your child better than anyone else. Check for common red flags (see our section on talking) and seek advice if you’re worried.
  • If baby stops walking, this means trouble. Not so! This simply means that they are tired or have attempted the milestone earlier than their minds and bodies were ready to process permanently.

SOURCES :

Jenny Perkel, clinical psychologist, author of Babies in Mind (Juta Books, 2008) and specialist in parent-infant psychotherapy, parental guidance and therapy with children under five years of age. Contact jenny@perkel.co.za or (021) 461 9153 or visit www.babiesinmind.co.za

Heading home with your newborn : from birth to reality, by Dr Jennifer Shu and Dr Laura A Jana (American Academy of Pediatrics, 2005)

www.babiestoday.com

www.askdrsears.com

www.babycenter.com

www.thelancetstudent.com

© Beth Cooper, 2010.

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