Development Milestones and Delays: When To Get Help

Whether it’s your first child or your third, parents often wonder if their child is meeting their milestones on time. We’ve all felt our stomachs drop as a fellow parent on the playground asks if our toddler or preschooler is doing something yet because their child is.

If you have more than one child, you’ve probably compared one’s development to the other, “Johnny was walking at eleven months but Danny is over a year and hasn’t taken his first step yet … is that normal?”

As both a father and a psychologist, the question, “Is my child meeting their milestones on time?” feels emotionally and intellectually loaded. While the question is about milestones, a parent may want to know if their child is showing signs of a developmental delay. That question is difficult to succinctly answer based on met or unmet milestones alone, which I’ll explain below.

Before we talk about when to talk to your provider about missed or delayed milestones, let’s talk about some of the issues around milestones as they’re commonly used.

What is a Developmental Milestone?

A developmental milestone is a cognitive, physical or behavioral skills that infants, children and teens master as they grow. We’re most familiar with the ones that infants master as they happen so quickly and tend to be the ones that cause parents the most celebration. They’re things like rolling over, saying “mama” and “dada”, waving goodbye, crawling and walking.

You can find the American Academy of Pediatrics (AAP) guide to developmental milestones from birth through the teenage years in the document linked here.

After decades of study, we now have established general age ranges during which most children demonstrate these skills. Things like propping their chest and head up when laying on their stomach, and making two-syllable sounds like “dada”“nana” and “mama” are all developmental milestones in the first year of life. Each developmental skill is usually a precursor to another.

For example, propping themselves up usually comes before being able to sit up on their own, and two syllable sounds comes before mastering more complicated sounds and words.

Most of us have read books or a hand-out by a medical provider that outlines that children should be able to master certain tasks (like building a tower of blocks, or counting to 10) by a specific age. Secondly, many parents worry about the standards that are demonstrated by same-age peers in their environment (for example, Jane and Jack are the same age. Jane is able to climb the stairs to the slide at the park on her own, but Jack still needs help).

Multiple Sources of Guidance Causes Confusion

Having multiple sources of milestone information creates a lot of confusion for parents. We have at least two different points of potential comparison: 1) Textbook-type pediatric standards or 2) What we perceive as on time/early/late within a social group of our peers. Our peer-groups play a major role in shaping our perception of what’s on time and what’s late and those peer groups aren’t always equal.

Not only are peer-groups not equal, but developmental milestones are not created or treated equally. There is significant flexibility in the time frame of when children can reasonably be expected to achieve certain milestones.

If your child hasn’t accomplished a certain skill in the time frame listed on the chart, it’s not necessarily cause for concern. For example, most kids usually walk sometime between 8 and 18 months. But many accomplish this skill before and after that window. While less than 2% of kids walk independently before 8 months or after 18 months, roughly 98% walk between 8 and 18 months of age.

Potential Unhelpful Sibling and Family Comparisons

Many parents often look to themselves or their own siblings to determine if their child is reaching their milestones at a comparable rate. For example, parents often think “I was a late walker, so there’s no need to worry that my child isn’t walking yet.” This topic is more complex than can be adequately addressed here. There are some examples in the literature of a correlation between certain milestones in parents and children, but at present the data does not adequately account for numerous cultural and sociological factors that also impact this issue.

Most importantly, comparing children to their parents or members of their extended families can cause parents to not seek help in a timely manner. This kind of comparison can also create guilt and blame or lead to contentious interactions between families if a disability or delay has been confirmed. Looking within the family for blame or justification can lead to statements like, “he gets this [delay] from your side of the family,” which can be very hurtful and could create another barrier to obtaining help.

Gender Differences

Similarly, parents are often quick to assume that one sex reaches milestones slower than the other. While there are very well documented differences in the onset of language across sex, boys and girls tend to reach their milestones at about the same rate.

Girls do tend to show an earlier onset and quicker acceleration of vocabulary growth than boys. This finding (in a nutshell, most girls talk sooner than most boys) should not be used to dismiss the level of clinical concern one should have if a boy is not saying single words by 18 months of age. If you have a child who is not pointing at things and babbling at them, seek out a referral soon.

Another Variation Source: Culture

We’ve established that developmental milestones aren’t written in stone and can vary from peer group to peer group, the process of reaching them can vary across cultures as well.

Sleepingeating, and toileting (also known as potty training) routines vary tremendously. In a diverse geographic area, these varying habits further magnify the degree of difference in the onset and achievement of milestones.

What Meeting a Milestone Means

So what does it mean to meet a developmental milestone? We tend to view the meeting of a milestone as a binary event: Either they’ve done it or they haven’t.

But milestones are rarely all-or-none in the final analysis. Remember the time you spent repeating “dada” or “mama” over and over to your baby as they studied your lips and tongue to try and mimic the sound. There were likely many attempts that came out as “ada” and “da” before they were able to finally say “dada” or “mama.”

From a developmental perspective, reaching most milestones is what we call in psychology, a continuous, componential process, which means that it’s an ongoing process that involves multiple areas of your child’s brain. This process streamlines and reorganizes how your child’s brain functions and ‘does the business of developing’ in their early years.

Using speech as an example again, we may think of speech in terms of the child babbling and imitation of sounds made by others. However, children often display visual signs of speech before they’re able to say what they want. For example, they point to objects they want or need and otherwise use their hands to convey meaning before they can say the word. These gestures often precede and occur at the same time as spoken language develops. Instead of talking with parents about their child’s first word, I often find myself talking with them about their child’s first point. Pointing, though, is a foundational skill for the development of higher-order language.

Parents often think of milestones as linear, meaning that one leads to another and the child never goes backwards. But the process of reaching developmental milestones is not a straight shot.

You can think of the time you spent coaxing your child to take their first steps. They likely took a step or two that first day, but didn’t immediately take to walking as their primary mode of locomotion. They probably still relied heavily on crawling and had to be coaxed to walk again.

Against the backdrop of an entire childhood, the achievement of developmental milestones may appear linear when in reality there are often temporary setbacks and great leaps forward. Children reconfigure and acquire new skills and then use these news skills so soon to achieve new goals.

Significance of Meeting Milestones

All of this discussion about milestones being continuous, componential, and variable in onset does not mean that meeting them within the expected timeframe is unimportant.

While walking at 7 months does not necessarily predict Ivy League admission rates, being a late talker can impact a child’s development even when their language at an older age is in the average range. Moreover, achieving some milestones sooner seems to confer a beneficial effect.

How to Think About Child Development Milestones

Instead of thinking about developmental milestones in terms of the pressure many parents feel around them, it can be helpful to take this approach:

  • Reward your child’s effort and notice what they are trying to do rather than only what they can do now. There is so much incredible work that goes into developing new skills at a young age, give them lots of verbal praise and get excited when they try.
  • Know the range of motor and language milestones that your child should be working towards. Look at what comes before each major milestone (e.g., first words, walking) and use this to index gains and concerns.
  • Read about the building blocks to these developmental milestones. Gesture precedes spoken language, pulling up with the arms leads to walking with the feet, and eye contact provides a firm foundation upon which social interactions and play can be built. All of these things that “come before” the achievement of milestone are very, very important.

What If You Have Concerns About Your Child?

If you have concerns about your child’s development, consider the following approaches.

  • Don’t play the “wait and see” game. While there is a relatively broad window of time during which milestones can unfold, there are certain things that warrant clear, clinical concern. Record your observations and schedule an appointment with your pediatrician.
  • Do not settle for anything less than an expert opinion. Reach out to your county’s early intervention team, ask for a referral to a developmental medical provider, or look up a local speech/language pathologist. Most of these specialists have additional training to look at developmental differences and to evaluate the need for more support.
  • Do not quickly dismiss the advice of people who care about you and your child. No one wants to hear their family or pediatrician say, “I think you should talk to someone about [this developmental concern].” If someone is taking the time to say something like this to you, I would encourage you to assume it took them a great deal of courage to say this and that they are truly concerned. Make an appointment with your child’s pediatrician today.

After all this, you’re probably wondering what a developmental delay looks like or when you should seek medical advice for a clinical concern. I always tell parents to trust their gut.

If you feel your child might have a delay, it doesn’t hurt to make an appointment with your pediatrician to discuss your concerns. The local early intervention team would be a good place to start, too, in terms of having your child evaluated by your regional educational office.

The National Center on Birth Defects and Developmental Diseases (NCBDDD) at the Centers for Disease Control and Prevention (CDC) has a wealth of resources for parents about normal development and what is cause for concern.  I highly recommend any parent with questions about delays start with NCBDDD.