Developmental Monitoring: #MilestonesMatter

In the first 5 years, your baby's brain is growing and developing at an amazing rate, faster than at any other time in life. And how a child's brain develops in these early years will have a huge and lasting impact on their future.

It's important for parents to be aware of their child's developmental milestones, as tracking these can help ensure that they are reaching their full potential. Milestones can also help identify any issues that need to be addressed early on.

In this article, we'll discuss why developmental milestones matter, the dangers of "if your doctor isn’t worried, neither should you" and "let's wait and see" approaches, and give you some tips on how to help your child achieve milestones.

In this article:

1. What are developmental milestones?

2. Why are milestones important in child development?

3. Barriers to child development in the US today

4. How can you monitor your baby's developmental milestones today?

Developmental screening

Developmental monitoring

5. The future of developmental monitoring

6. What is a developmental red flag?

7. What happens if a child is delayed?

8. The importance of early intervention

9. How to enhance your child's development

10. Frequently Asked Questions

11. The Takeaway

What Are Developmental Milestones?

Developmental milestones are tasks or skills that most children can do by a certain age. Generally, children achieve developmental milestones in a set pattern: for example, they crawl, then stand, then walk.

Monitoring milestones is a way of tracking a child's development and making sure that they are progressing neurotypically.

Often, missing a milestone or completing milestones late is an indicator of a developmental delay condition that may need to be evaluated further.

The four developmental domains

Pathfinder Health divides child and baby milestones into four major developmental domains:

(1) movement, (2) social and emotional, (3) language, (4) cognitive.

Other sources sometimes divide these developmental domains differently, so don’t be confused if you’ve seen milestones categorized slightly differently elsewhere. Each one of these areas is equally important in helping your child reach full developmental maturity.

Movement

Movement milestones (sometimes referred to as physical or motor milestones) involve the growth and changes in a child’s body, including physical abilities, coordination, and balance.

They can be further divided into gross motor skills and fine motor skills.

Gross motor skills involve the large muscles in the body, such as those in the arms, legs, and torso, and include crawling, walking, running, and kicking a ball.

Fine motor skills involve the small muscles in the hands and fingers and develop as a child learns to control their movements and use their hands and fingers to achieve more intricate milestones like picking up blocks or writing.

Believe it or not, in the early years, making sounds and the ability to coo or babble are also fine motor milestones because they use the small muscles in the mouth, tongue, and jaw!

Some examples of Movement milestones include:

Social and emotional

Social and emotional milestones reflect your child's developing interactions with others and awareness and understanding of themselves. These include milestones like playing with other kids, cooperation, and identifying and responding to emotions.

Some Social and Emotional milestones include:

Language

Language development is the process of building communication skills, both verbal and non-verbal (gestures and facial expressions). Language milestones include acquiring vocabulary (both understanding and using words), learning how to put words together to make sentences, and comprehending others’ communication.

Some examples of Language milestones include:

Cognitive

Cognitive development involves the way a child thinks, learns, and solves problems. Cognitive milestones include skills such as reasoning, understanding cause and effect, thinking abstractly, and engaging in make-believe play.

Some Cognitive milestones include:

Why Are Milestones Important In Child Development?

The first 5 years after your child’s birth are particularly crucial to their health, well-being, and the overall trajectory of their life.

In fact, 90% of your child's brain develops by age 5. This is the time when the foundations for future learning, health, and behavior are established.

Keeping track of developmental milestones is essential for a number of reasons.

Most importantly, they provide a way for both parents and healthcare providers to track a child's development and progress and identify red flags.

Even though every child is different, pediatric experts have identified a range of neurotypical development.

Therefore, if a child achieves a milestone later than the normal age range--or not at all--this is an early warning sign that something may not be right with their development, and a professional should evaluate them more closely.

They, therefore, provide a standard measurement that clinicians can use in assessing developmental health and referring a child to a specialist.

Because developmental milestones form a kind of common language--most parents can name at least a few--they also help parents frame a discussion with their pediatrician.

Developmental milestones also help parents understand what's coming next as their child grows. This can help parents maintain reasonable expectations for their child and as well as guide them in encouraging their child's development, such as through enrichment activities.

Finally, developmental milestones are a way to bond with your child. As your baby or older child reaches a new milestone--whether they begin to sit independently, speak in sentences, or play games--celebrate their accomplishment! This helps to create a strong emotional connection between you and your child and will encourage their further growth.

Barriers to Child Development in the US Today

The Care Gap

In the United States, an estimated 28% of children under age 5 are considered to be at moderate or high risk for developmental, behavioral, or social delay. In fact, there have been significant increases in the percentage of children diagnosed with developmental disabilities. However, only 3% of all children received public early intervention services by 3 years of age.

There are numerous factors that contribute to this problem.

1. Parents may not be aware of milestones or red flags.

Parents don’t have clear ideas of what certain milestones are. Some will say their kid is sitting up but don’t realize that if they have to get their kid into the position, it doesn’t really count.

— Physician (Pathfinder Health survey, November 2022)

The majority of parents are unable to correctly answer questions related to their children developmental milestones.

Source: National Library of Medicine

Even if they do have a sense that something is not right, they can struggle to pinpoint, document, and communicate their developmental concerns to their pediatrician.

2. Too often, pediatricians don't have enough time or training to perform developmental screenings during well-child checkups and have to rely on what parents think their children do or don't do. Yet, 58% of parents believe their pediatrician would notice a delay.

3. Many times, children don't perform as well in the office as they do at home or in a less intimidating environment.

It is difficult to assess the child's development in a short time period during well-child checks. I wish I could see videos or have more time with the children.

— Physician (Pathfinder Health survey, November 2022)

4. Additionally, the first signs of developmental delays involve the absence of typical behaviors — not the presence of atypical ones, and healthcare providers may opt to take a “watchful waiting” approach.

5. Finally, even if parents do receive a referral, they may have to wait for an appointment with a specialist, wasting even more time.

According to the Journal of Developmental & Behavioral Pediatrics, the national average wait time for developmental pediatric evaluations is approximately 5 months.

The wait time to access a specialist who can diagnose a child with autism in the U.S. can be anywhere between 2 and 18 months.

Considering that children get the most benefit from early intervention in their first 3 years, even a 4-month delay is a significant percentage of this time and could negatively affect the success of treatment.

Every child I come across, I should have seen earlier.

— Early Intervention Services (EIS) Provider

The Impact of Covid-19

The time from concern to care has only increased during the Covid-19 pandemic. Some parents skipped well-child visits during this time due to fears of being exposed at their doctor’s office.

Missing a well-child visit between the ages of 1 and 3 years means that healthcare providers are unable to catch critical early signs of developmental delays, delaying diagnosis and possibly missing the optimum time frame for beginning treatment.

As a result, some children are not diagnosed before they begin kindergarten, meaning that they miss out on free Early Intervention Services and other support.

Children being served by the child welfare system and those from non-English speaking families may be at even greater risk of missing out on these services.

In a fall 2020 survey of early childhood programs and systems, 91% of respondents reported that the COVID-19 pandemic “‘highly impacted’ early identification of developmental delays and disabilities in young children from birth to age 5 years.”

Even families who did receive a diagnosis or referral during the pandemic have struggled to receive proper treatment for their children.

Some specialists’ offices reduced the number of available appointments.

Others relied on virtual visits, which shut out families without access to a smartphone or computer (13% of adults with household incomes below $30,000 a year do not have access to either technology).

Virtual visits and other pandemic restrictions also presented challenges for treatments such as speech therapy, which require a large amount of child engagement that can be difficult to sustain over a screen.

Even with in-person visits, masking requirements can seriously interfere with speech therapy and negatively impact results.

How Can You Monitor Your Baby's Developmental Milestones Today?

You are not alone if you feel overwhelmed when it comes to developmental monitoring. Most kids achieve hundreds of milestones within the first 5 years.

How can you keep all of these milestones straight and assess whether your child has successfully achieved them? Never fear -- Pathfinder Health and your healthcare provider are here to help!

During well-child visits, your healthcare provider may assess your child through developmental screening and/or developmental surveillance. These two processes complement one another to identify children at risk for developmental delays.

Developmental screening

Screening is used by medical professionals to detect potential health conditions in people who do not yet show any symptoms. It allows them to quickly and easily assess risk and identify who requires more comprehensive follow-up, such as additional testing.

The type of widespread screening done in early childhood is known as developmental screening.

Developmental screening refers to a formal assessment of the milestones that your child has achieved at a very specific point in time, which provides important insights into how they are developing, where they might need additional help, and what might come next.

The American Academy of Pediatrics (“AAP”) recommends every child receive developmental and behavioral screening at 9, 18, and 30 months and autism screening at 18 and 24 months.

There are only 3 screening tools approved by the American Academy of Pediatrics:

1. the Ages and Stages Questionnaire Version 3 (“ASQ-3”)

2. the Survey of Well-being of Young Children ("SWYC")

3. the Parents' Evaluation of Developmental Status (“PEDS”)

All are relatively quick to complete (under 15 minutes).

You can read more about the different formats and pluses and minuses of these screening tools in Pathfinder's article ASQ-3 vs. SWYC vs. PEDS: Which Screening Tool is Best?

If you have any questions or concerns about the type of screening instrument used or the results of any screening, speak with your child's healthcare provider.

Screening has a number of important benefits.

1. Using a formal screening tool can help guide assessment in a busy clinic.

2. Moreover, formal screenings provide significant guidance for healthcare providers who are not specially trained in pediatrics (such as family care doctors) and may not have the depth of knowledge to be able to assess a child and follow up on concerns.

3. They also give more weight to referrals--a low score on a screening questionnaire communicates the primary care provider's concern in more standardized language and can help the specialist understand the specific issue more quickly.

Unfortunately, the current US healthcare system makes it difficult for many primary care providers to follow screening recommendations–nationally, developmental screening rates are as low as 17%, depending on the state.

Factors contributing to these low rates include insufficient time at well-child visits and unmet needs for translation services.

Screening rates are particularly low for non-pediatricians--the care providers who need the guidance of formal screenings the most.

Fortunately, you don't have to depend on your healthcare provider to screen for milestones -- Pathfinder Health prompts you when it's time to screen your child and offers the questionnaires right on our app!

Developmental surveillance

In contrast to developmental screening, developmental surveillance is the continuous monitoring of milestones and behavior that happens over a longer period of time.

Surveillance relies on a healthcare professional's own expertise in the field, rather than formal screening questionnaires.

Generally, healthcare providers see children for more well-child visits than those when formal screening occurs and pay attention to the child or baby's development anytime they are in the office.

For example, let's consider an important milestone--walking.

The AAP recommends screening at 9, 18, and 30 months. However, these ages are not ideal for assessing this milestone. Nine months would be very early to begin to walk, but by 18 months, failure to walk would be a red flag.

Fortunately, the AAP schedule of well-child visits includes 12 and 15 months, so a doctor will use those visits to survey a baby's progress in walking even without a formal screening.

At these visits, the doctor sees whether the child can bear weight on their legs and looks at other signs if they are not yet walking. This way, the child does not have to wait until the 18-month screening to receive an additional evaluation or a referral for treatment.

You also have a role to play in monitoring your child's development!

Don't worry, you don't need to hover over their child to spot every single milestone--developmental monitoring does not have to feel obsessive or anxiety-provoking.

By regularly using the Pathfinder Health app, you can feel reassured that you are keeping track of the developmental milestones that you do observe--when they happen, how frequently they occur, and what else to look for.

Plus, you can add other family members and caregivers to your child's circle of care, so they can also record milestones and upload videos to help with monitoring!

The Future of Developmental Monitoring

In recent years, there have been rapid increases in the use of artificial intelligence in healthcare.

Unlike a self-reported model, a machine learning (ML) model would automatically detect every instance of a milestone in the input provided.

When trained with the right medical data, machine learning could remove the uncertainty and bias inherent in the manual detection of milestones. It could be trained to detect precise nuances of a milestone and apply them the same way to every child.

>> Related: The Potential for Artificial Intelligence and Machine Learning in Developmental Healthcare

What Is a Developmental Red Flag?

For some of the most significant developmental milestones, failure to achieve the milestone by a certain age range constitutes a "red flag," meaning it may indicate a developmental issue and warrants further evaluation.

It is important to note that there is a difference between a red flag and simply being late to achieve a milestone.

For all milestones, there is an age range where the majority of children will achieve the milestone, so being at the later end of the range is not a red flag in itself.

For example, most children walk between 12 and 15 months, so not walking at 15 months is not a red flag. However, by 18 months, nearly all late walkers will have taken their first steps if there is no underlying developmental condition.

Some of the most important red flags include (but are not limited to):

• 4 months: Baby cannot hold their head steady without support

• 6 months: Baby does not roll

• 9 months: Baby cannot sit up even with support

• 12 months: Baby does not say a single word, such as "mama" or "dada"

• 18 months: Baby does not walk independently

Keep in mind that the ages for these and all red flags are not set in stone--doctors may have different opinions on when the lack of a milestone becomes a concern.

What Happens If a Child Is Delayed?

Causes of developmental delay

There are many potential causes of developmental delay–in fact, anything that interferes with a child's ability to develop normally. These causes include, but are not limited to:

• Premature birth

• Exposure to toxins or infections during pregnancy

• Genetic abnormalities

• Problems with the nervous system

• Intellectual disability

• Environmental factors

The Covid-19 pandemic has also had a significant impact on child development and milestone attainment, particularly language milestones.

Researchers have found that babies born during Covid are beginning to speak later and saying fewer words. With many daycares closed, parents juggling child care and remote work, and a lack of socialization with others outside of the family unit, children have not had the social interactions needed to develop speech at a normal rate.

Restrictions related to the pandemic also resulted in children spending more time inside in front of screens, which has been linked to greatly increased rates of near-sightedness among school-aged children.

An increase of more than 50% was shown in a study of Chinese children, with similar increases found in US children.

"The findings are associated with pandemic-associated restrictions imposed on families, such as lockdowns, causing no to limited outdoor activities and increased screen time,"

Signs of developmental delay

Developmental delays can manifest themselves in a multitude of ways. Parents should be aware of the many different indicators of potential developmental delay so they can recognize them in their child.

If you notice any of the following signs in your child, it's important to talk to your pediatrician or healthcare professional:

• Not meeting developmental milestones when expected

• Delays in speech and language development

• Poor eye contact or social skills

• Lack of interest in toys or playing with others

• Hyperactivity or impulsivity

• Aggressive behavior

Developmental screening by a healthcare professional is an even more reliable way to determine if your child is on track with their developmental milestones.

Screening questionnaires--when scored and interpreted by a trained professional--can catch signs of delay before a parent would notice anything wrong.

The Importance of Early Intervention

What is early intervention?

Early intervention refers to the resources, services, and support programs that are available to babies and young children with developmental delays and disabilities, as well as their families.

If your child is diagnosed with a developmental delay or disability, there are many ways to help them catch up or maximize their learning and growth.

Types of early intervention include:

1. Occupational therapy: Helps children with fine motor skills, sensory processing, and self-care skills

2. Physical therapy: Helps children with gross motor skills such as crawling, walking, and jumping

3. Speech therapy: Helps children with speech production and language development, including hearing impairment and weak mouth or tongue muscles

4. Applied behavior analysis ("ABA"): Designed for children with autism spectrum disorder and helps develop communication, self-help, and social skills, among others.

If they detect a concern, your healthcare provider can refer you to the appropriate type of service.

Additionally, parents can self-refer to Early Intervention Services, publicly funded programs provided by states--a doctor's referral is not required. If you are concerned, you can find more information and links to early intervention services on the Pathfinder Health app or the CDC website.

Why is early intervention critical?

Of the nearly 4 million babies born every year, 20% will have some form of developmental delay condition.

Early intervention is critical--because a child's brain grows so much during the first 5 years, this is the time when it has the highest neuroplasticity (the brain’s ability to essentially "rewire" itself to function in a different way). This flexibility means that treatment has the greatest impact during the early years, especially birth to age 3.

While developmental delays may sound scary, it's important to remember that early intervention and proper support provide many benefits for infants and toddlers with developmental delays or disabilities and can even change your child's developmental path.

Early intervention services can help your young child learn the skills they need to be successful in school and life, reducing the need for more costly special education and related services later on. The key is to identify concerns at the earliest possible age.

Some of the benefits of early intervention services include:

• Improved communication and social skills

• Increased ability to participate in daily activities

• Greater self-confidence and self-esteem

• Improved academic performance and educational attainment

• Increased independence and self-reliance

Early intervention can also play a vital role in supporting parents and caregivers. By building their competence and confidence, early intervention can help parents and caregivers provide the best possible care and support for their children.

On the other hand, the consequences of delay in diagnosis and treatment can be severe. Without early intervention, children’s health conditions are harder to treat, cost families and the healthcare system more money, and increase family stress (including job loss, divorce, and anxiety/depression). The children themselves are also more likely to experience substance abuse and other problematic behaviors.

If your child is diagnosed with a developmental delay, don’t despair–there are many possible treatments that can help them catch up on their milestones. Timely and appropriate access to these services can make a big difference in your child's life and, in some cases, even help them catch up with their peers.

How to Enhance Your Child's Development

There are many different things you can do to promote your child’s development in a variety of areas, such as language and communication skills, physical activity, and healthy eating habits.

Pathfinder Health has developed a framework to help you help your child reach their maximum potential -- the PROE framework.

PROE stands for “Play, Relationships, Observation, Experience”--all of the ways that your child interacts with the world around them.

PROE is not a task list. You don't need special educational toys or enrichment programs—PROE means finding enrichment everywhere in the world and integrating it as a natural part of daily life. Keeping the PROE concepts in mind makes it easier to teach your child and encourage their development.

Early education offers the most cost-effective path to a whole range of social benefits: not just higher future incomes for participants, but a more productive workforce, greater economic growth, lower crime rates, smaller prison population, and substantial savings for taxpayers.

— James Heckman, Nobel-winning economist

Frequently Asked Questions

1. What are the normal baby milestones?

In the absence of a delay, babies will achieve dozens of milestones in their first year–far more than simply sitting, crawling, and first words! These fall into four general categories: (1) cognitive; (2) movement; (3) language; and (4) social-emotional.

2. When should I be concerned about baby milestones?

There is an age range when most children will achieve each milestone. Don’t worry if your child is at the later end of the range—in the absence of other concerns, this is not a developmental delay. Talk to your doctor if your child does not achieve a milestone within the age range.

3. Is there an app for baby milestones?

On the Pathfinder Health app, you can learn about the hundreds of milestones your child will achieve, track their progress, and receive personalized guidance on what comes next, including developmental activities.

4. What are the five developmental milestones?

Developmental milestones can be divided into four domains, each of which has dozens of milestones: (1) cognitive; (2) movement; (3) language; and (4) social-emotional. Movement is sometimes divided into two separate domains: gross motor and fine motor.

5. What are the 4 areas of developmental milestones?

The four general categories of developmental milestones are: (1) cognitive (thinking, learning, and problem-solving); (2) movement (gross and fine motor skills); (3) language (understanding and speaking); and (4) social-emotional (self-awareness and interacting with others).

6. How do you assess developmental milestones?

Make sure you take your child to all scheduled well child visits so their doctor can monitor their progress and conduct developmental screenings. You can also track their development and complete screenings yourself on the Pathfinder Health app.

The Takeaway

When parents know and understand their child's developmental milestones, they can support that growth.

Everyday moments offer countless opportunities for a parent to promote skills or behaviors kids need to become independent and lead healthy and successful lives.

To learn about how you can take full advantage of these opportunities, download the Pathfinder Health app. We offer simple guidance and tools to track your little one's developmental milestones and provide them with help and encouragement at every step!

Join Pathfinder Health in its mission to ensure every child has a chance at reaching their full potential! Participate in the campaign by sharing this article or the importance of milestones monitoring on social media using the hashtag #MilestonesMatter.

Together, we can make a difference in the lives of our children.

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