#MilestonesMatter: Don't Underestimate Developmental Monitoring

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. 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 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 thei