#MilestonesMatter: Don't Underestimate Developmental Monitoring

Updated: Nov 21




It's hard to believe that a tiny human can grow so much in such a short time, but it's true! In the first five years of their life, your child will achieve literally hundreds of milestones.


Babies are constantly learning and developing--each new skill is an important milestone on their lifelong journey.


Pathfinder Health understands that as a parent, you want to do whatever you can to help your child reach the milestones in their age range and keep growing.


In this article, we'll discuss why developmental milestones matter and give you some tips on how to help your child achieve milestones.


In this article:

What Are Developmental Milestones?

The four developmental domains

1. Movement

2. Social and emotional

3. Language

4. Cognitive

What Is a Developmental Red Flag?

Why Are Milestones Important In Child Development?

How Can You Monitor Your Baby's Developmental Milestones?

Healthcare Providers

Why well-child visits are important in tracking child development

Developmental screening

Developmental surveillance

Parents, Family Members, Caregivers

What Happens If a Child Is Delayed?

Causes of developmental delay

Signs of developmental delay

The Importance of Early Intervention

What is early intervention?

Why is early intervention critical?

Barriers to Child Development in the US Today

The Care Gap

The Impact of Covid-19

How Pathfinder Health Can Help

A step-by-step guide to success with Pathfinder Health

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:



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.




Why Are Milestones Important In Child Development?

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.




How Can You Make Sure That Your Baby Is On Track?

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


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



Healthcare Providers


Why well-child visits are important in tracking child development

Well child visits are an essential part of tracking your child's developmental milestones and following up on concerns.


If you are routinely seeing your doctor for well-child visits, they will also be tracking your child's milestones and can let you know if they appear to be delayed in any areas. This gives you the opportunity to have an ongoing conversation about your child's development and to get any help or support that you may need.


During these 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 three screening tools approved by the American Academy of Pediatrics—the Ages and Stages Questionnaire Version 3 (“ASQ-3”), the Survey of Well-being of Young Children ("SWYC"), and 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. Using a formal screening tool can help guide assessment in a busy clinic.


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.


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 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.




Parents, Family Members, Caregivers

Yes, 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.


Moreover, by uploading brief videos of your child several times a month, you can harness all of the developmental knowledge of Pathfinder Health's smart detection to help you detect more subtle developmental milestones.


Plus, you can add other family members and caregivers to your child's circle of care, so they can also record milestones and observations and upload videos to help our smart detection do its job!




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?

The first five 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 five. This is the time when the foundations for future learning, health, and behavior are established.


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 five 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 three.


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.



Barriers to Child Development in the US Today


The Care Gap

In the United States, an estimated one in four children under age five 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 three years of age.


There are numerous factors that contribute to this problem.


Parents may not be aware of milestones or red flags. Even if they do have a sense that something is not right, they can struggle to pinpoint, document, and communicate their concerns to their pediatrician.


And healthcare providers themselves may opt to take a “watchful waiting” approach that wastes valuable intervention time.


Additionally, as discussed above, rates are low for formal screenings, especially for those healthcare providers who also lack the training to conduct developmental surveillance.


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


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




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 one and three 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 being 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 Pathfinder Health Can Help

Pathfinder Health is here to take the stress and confusion out of monitoring developmental milestones. With our app, you simply create a profile for your child and we will remind you when it's time to complete screening questionnaires and prompt you to upload videos of your child that will help us detect milestones.


Put together, this data enables Pathfinder Health to create a thorough but easily-understood developmental report and video reel (1) highlighting the developmental milestones that your child has already achieved, (2) indicating what to expect next, and (3) explaining how you can help your baby and child succeed developmentally.



A step-by-step guide to success with Pathfinder Health



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, visit Pathfinder Health. We offer simple guidance and tools to track your little one's developmental milestones and provide them with help and encouragement at every step!


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3. Hu Y, Zhao F, Ding X, et al. Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19. JAMA Ophthalmol. 2021;139(10):1115-1121. doi:10.1001/jamaophthalmol.2021.3563.

4. Jimenez ME, Martinez Alcaraz E, Williams J, et al. Access to Developmental Pediatrics Evaluations for At-Risk Children. Journal of Developmental & Behavioral Pediatrics: April 2017 - Volume 38 - Issue 3 - p 228-232.

5. Ou SR, Reynolds AJ. Mechanisms of Effects of an Early Intervention Program on Educational Attainment: A Gender Subgroup Analysis. Child Youth Serv Rev. 2010 Aug 1; 32(8): 1064–1076.

6. Schering, Steve. Missed well-child visits lead to delays in diagnosing developmental disorders. Available at https://publications.aap.org/aapnews/news/19597?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000.

7. Vitrikas K, Savard D, Bucaj M. Developmental Delay: When and How to Screen. Am Fam Physician. 2017;96(1):36-43.

8. Zablotsky B, Black LI, Maenner MJ, et al. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017. Pediatrics. 2019 Oct;144(4):e20190811. doi: 10.1542/peds.2019-0811.