One quarter of the questions and concerns that parents discuss with their pediatrician are related to child development and behavior. As parents, we want to provide our children with opportunities to optimize development and create an environment in which our children can thrive. We therefore ask our pediatricians about ways to improve our children’s sleep and eating habits, and for their opinions on childcare options. We read books about parenting approaches and discipline techniques. However, when should we be concerned that something is just not right and that there is a problem above and beyond the usual trials and tribulations of childhood?
One way to determine if a child’s development is on track is to review the expected developmental milestones at a given age. A child’s pediatrician will ask a number of questions regarding milestones at the various well-child check-ups in the first few years of life. Some parents may also do this themselves by reviewing milestone tables. However, misinterpretation of milestones can create unnecessary worry. Parenting books and other popular media often fail to elucidate nuances in gauging milestones. When a concern arises, it is important to always consider the input of an experienced pediatrician or pediatric specialist.
Milestones represent 50th percentiles, and thus by definition only ½ of children of a particular age achieve a given milestone. For example, the 12-month milestone for expressive speech is that a child has a spoken vocabulary of two words (a word at this age may represent any kind of sound so long as it is used consistently with meaning). Therefore, 50% of children will have this skill at 12 months of age and the other 50% will develop their two words at some later time. Statistically, it is expected that children should achieve a given number of words in their expressive speech within a typical range of time. When milestones are not met by the tail end of a typical range, it is considered a “red flag”. For example, for expressive speech, having less then 5 spoken words at 18 months of age is considered a red flag and requires conversation with one’s pediatrician to determine if further assessment is needed.
The field of developmental milestones can be complex to navigate. It is helpful to work with a pediatrician who performs developmental screening and surveillance at well-child check-up appointments. The American Academy of Pediatrics recommends that all pediatricians 1) perform informal developmental surveillance by asking questions regarding development and behavior at all doctor visits and 2) perform more formal developmental screening with the use of a standardized developmental screening tool at the 9-month, 18-month and 24-month visits. If concerns are identified through surveillance or screening, then close monitoring, more formal assessment or referral to a developmental-behavioral specialist may be warranted. A specialist can help to better define the situation, identify root causes and create a management plan to help your child develop and thrive. This proactive approach ensures that children requiring early intervention receive it in a timely and effective manner.
Trenna Sutcliffe, MD MS FRCPC FAAP is a Developmental & Behavioral Pediatrician. For more info, visit www.sutcliffedbp.com.