By Geri Fox, M.D.
Along with the delight of seeing your baby grow and develop new skills, every parent experiences anxiety. You watch and wonder, “Is my baby developing normally?” You may be looking at a list of developmental milestones, and worrying whether or not your baby is coming along okay. This article will define what is normal or typical development, look at developmental milestones from newborns to 18 months, and then discuss common developmental delays in babies.
First, in order to think about the question of normal development in babies, it will help to consider the four different commonly accepted definitions of “normality”.
DEFINITIONS OF NORMALITY
Normality as Health: This is the traditional medical perspective. Your baby is normal if he is “not sick”; if he has no signs or symptoms of illness or medical syndromes.
Normality as Utopia: This is the perspective of functioning according to the ideal. Using this model, your baby is normal if she is “the best that she can be,” or performing at the optimal level. This is a tough standard to be measured by, but is nice to fantasize about.
Normality as Average: This is the perspective of mathematical norms created by studying a large population. This is how developmental milestone charts are created. Using this model, your baby is normal if his behavior falls within the middle of the bell-shaped curve (for example, most babies walk between 9 and 16 months). Using this model, any extreme is abnormal—your baby could develop a skill early and it would be considered “abnormal”! It is essential to remember that these are measures of groups, not individuals.
Normality as a Transactional System: This is probably the most complicated perspective to understand. Basically, it describes how different systems interact over time. For example, your interactions with your 5-month-old baby are normal when he smiles at you and you smile back. Your one-year-old baby is acting normally if she gets upset when you leave the room, crawls after you, and is comforted when she is reunited with you.
When thinking about the question, “Is my baby developing normally?” it is important to remember that there is a wide range of development, with many individual routes to a goal. For example, at 9 months, one baby may be doing a lot of weight bearing on her legs, while another baby may avoid weight-bearing but prefers to roll everywhere. Both babies may still start walking on their first birthdays! On the other hand, it is important to monitor your baby’s development for any serious delays. The challenge is, how can we differentiate individual normal variations from those that are cause for concern, and stay calm at the same time?
In order to monitor effectively, here is a general list of (infant development) milestones. Please remember that all milestones below have been simplified to provide easy “mental markers;” however, there is a wide variation of normal range that is not indicated below, but must be taken into account.
In the first month, your baby is likely to:
At 3 months, your baby is likely to:
At 6 months, your baby is likely to:
At 9 months, your baby is likely to:
At 1 year, your baby is likely to:
At 18 months, your baby is likely to:
Developmental Warning Signs*
What should you do if your baby is not doing some of the activities listed above? First: don’t panic; this does NOT automatically mean that something is wrong. Sometimes, parents are embarrassed or hesitant to bring their concerns to the attention of their pediatrician. Please, don’t be afraid to ask for an evaluation. At best, you will be reassured. If a delay is identified, you have done your baby a favor in getting early intervention. Parents should be proactive in requesting regular developmental screening. If your pediatrician prefers not to do the actual screening, ask for a referral to someone who does developmental screening routinely.
What if it turns out that your child does have a delay? Early intervention is key. You may be wondering what can be done. This of course varies according to the delay. In general, a therapist will show you ways to work with your child to help him in the area of the delay. A good therapist will empower parents to help the baby learn the necessary skills. There are usually many things that you can do as part of your daily activity with the baby.
For example, John was a one-year-old who had wonderful motor skills (crawling, starting to walk) but was socially delayed. He didn’t make good eye contact, rarely smiled, and had poor social interaction. His parents weren’t concerned because his motor skills were excellent. When a developmental evaluation revealed his social delay, he received early intervention. His parents were encouraged to help him focus and interact, playing hide-and-seek and other games, reading to him, etc. He is now a bright, focused, interactive, happy first-grader.
Another example: Mary was 13 months old and could follow directions but wasn’t talking or making sounds. An evaluation revealed that she had fluctuating hearing loss due to multiple ear infections. After she received simple treatment for this problem, her hearing returned to normal and her speech quickly began to catch up.
Okay, you’re sold on the importance of regular development screening, and you’re not afraid to ask for an evaluation or early intervention. However, you may be worried about your rights to an evaluation or the expense of services. You should know about The Individuals with Disabilities Education Act, Program for Infants and Toddlers with Disabilities (IDEA, Part C). This is a federal entitlement program, which ensures that every child has access to developmental screening and early intervention.
Whatever your doubts or concerns are, you need to remember that you are the best expert on your child. And if you are not satisfied or convinced by one professional's opinion, keep exploring. Sometimes your child's challenges or behaviors are not as evident to others as they are to you. Your pediatrician is an excellent resource. Or, you can contact your local school district, or your local health department, either of which can tell you how to receive a free screening. So, please don’t hesitate to have your concerns evaluated. Regular screening and early intervention are the best ways to maximize your child’s development and functioning.
About the Author: Geri Fox, M.D. is Associate Professor of Clinical Psychiatry at University of Ilinois at Chicago/Institute for Juvenile Research. She is a nationally-known educator. Her award-winning 2-part stimulus documentary, Normal Development in the First Ten Years of Life and Normal Development in Middle Childhood and Adolescence, uses short vignettes to follow the growth of one child from infancy through adolescence, and is designed for educators to use in illustrating their teaching points. Clips may be viewed on-line at her faculty page. The complete set, along with "Greatest Hits" samplers of each section, are available for purchase on our website.