Developmental and Delayed Milestones

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Abstract: Child development refers to the process in which child goes through changes in the development of skills during a predictable time. Developmental delay occurs when a child has not reached these milestones until an expected time. Developmental delays can occur in all the five areas of development or in one or more of these areas. Additionally, growth in each area of development is related to the growth in other areas. So, if there is a difficulty in one area (e.g., speech and language), it is likely to influence the development in other areas (e.g., social and emotional).

 

During the foetal stage inside the womb, the child undergoes development and growth, which is a natural process. Inside the womb, its growth and development is judged by the uterine height, foetal movements and its kicks. Ultrasound further helps us to know about the foetal well-being. However, after 9 months of full-term growth, he opens his body in the new world, the world in which he will live, grow, nurture and die. That is not the end of his development. Very strangely, it is the mammalian foetus, which after its full 9 months of intrauterine life cannot do anything and is fully dependent on its parents initially. However, this does not remain for long; soon he will start responding to its environment when his own nervous system starts maturing. This process is called development. It has following sub-categories that are as follows:

Motor development:  Classified further as fine motor and gross motor

Language development: Using body language, gestures, speaking and co-ordinating as well as understanding what others say

Cognitive development: Thinking skills like learning, understanding and reasoning

Social development: Includes interacting and relating with family, friends, teachers etc.

Developmental Milestones

Developmental Milestones is defined as a set of functional skills or age specific task that most children can do at a certain range of age. Different types of developmental milestones at different age are:

One Month

  • Active, alert as well as responsive
  • Body movements are smooth and with greater co-ordination like getting his hand towards the mouth
  • Tries to listen to what you speak. He will watch you as you hold him and occasionally move his own body to respond to you and attract your attention.
  • Makes jerky and quivery arm thrust
  • Bring hand within the range of eyes and mouth
  • Hand will move from side to side while lying on the stomach
  • If unsupported, head flops backward
  • Makes tight fist
  • Has strong reflex movements
  • Can focus till the range of 8-12 inches
  • Eyes are less co-ordinated and occasionally crosses
  • Colour preference is black and white or contrast pattern
  • Prefers human face than other faces
  • Can hear fully and recognize the same sound
  • May turn the head towards familiar sounds
  • Prefers sweet smell and avoids bitter one
  • Recognizes the smell of his own mother’s breast milk
  • Prefers soft and coarse sensation and dislikes rough handling

Three Months

  • Makes transformation from a fully developed newborn to an active and responsive infant
  • Tries to acquire control on his body and try to understand his body parts. You can see him inspecting his own hands for hours and watching his movements.
  • Raises head and chest while lying on the stomach
  • Supports upper body with arms when lying on the stomach
  • Stretches his legs out when lying down and kicks while lying on back and stomach
  • Opens and closes his hand
  • Pushes down his feet when placed on a firm place
  • Grasps the toys and shake them
  • Watches face intently and follow the moving objects
  • Recognizes familiar objects from a distance
  • Starts using hands and eyes in co-ordination
  • Smiles at the sound of your voice
  • Starts babbling and imitating some sounds
  • Turn head towards the direction of sound
  • Develops social smile
  • Plays with people and cries when play stops
  • Facial expressions start developing

Seven Months

Between the age of 4–7 months, child will learn to co-ordinate his emerging perceptive abilities like vision, touch and hearing as well as motor abilities like grasping, rolling, sitting up and crawling.

  • He will roll from front to back
  • Sits with and afterwards without support of his hands
  • Supports his whole body on his legs
  • Reaches with one hand
  • Transfers object from one hand to another hand
  • Able to see all colours and the distant vision also improves
  • Ability to track the moving object also matures
  • Recognizes his name and responds to it
  • Starts responding to the word “NO”
  • Responds according to the tone of voice and distinguishes the emotion behind it. He will respond to it with making sound.
  • Tries to express his joy and displeasure
  • He can find partially hidden objects. He will also struggle to get objects that are out of reach
  • Starts enjoying social play
  • Interested in mirror images

Twelve Months

  • Can drink from the cup with help
  • Can feed himself with some crunches of bread and raisins
  • Can grasp small objects by the thumb and index finger
  • Tries to point through his index finger
  • Can put and take out small blocks from a container
  • Can pull himself to stand and take steps by holding himself to the furniture
  • Can stand alone and can walk by holding one hand
  • Co-operates with dressing
  • Copies sound and action you make
  • Can respond through body movements
  • Tries to accompanist simple goals like fetching a toy
  • Tries to find out the object that fell out of the sight
  • Tries sounds like speaking
  • Starts showing affection to people whom he knows and apprehension to people whom he does not know
  • Raises his hand as an indication to be picked up
  • Shows mild discomfort for being separated from his parents

 

Two Years

  • The baby has now grown to become a toddler and can now not only crawl vigorously but can even walk without support and sometime run too
  • He can pull toys behind him while walking and can carry large toys or several small toys with him
  • Can stand on tiptoe
  • Kicks the ball and climbs on and down the furniture
  • Can scribble spontaneously and can build a tower of 4 blocks
  • Starts using one hand more frequently than the other
  • Points out the object or the picture when it is named for him
  • Recognizes names of familiar people or objects
  • Says several single words
  • Use simple phrases
  • 2-4 word sentences and repetition of the words starts occurring
  • Can now find out the object when hidden under 2-3 covers

Three Years

  • Legs grow faster than arms
  • Circumference of head and chest is equal; head size is in better proportion to the body
  • The fat typical to the baby disappears and neck appears
  • Slightly knock-kneed
  • Can jump from low step
  • Can stand up and walk around on tiptoes
  • Teething stage is over
  • Walks up and down stairs unassisted, using alternate foot; may jump from bottom step, landing on both feet
  • Can walk on one foot and can balance momentarily
  • Can kick big ball-shaped objects
  • Needs minimal assistance in eating
  • Pedals a small tricycle
  • Catches a large bounced ball with both arms extended
  • Enjoys swinging on a swing
  • Enjoys playing with clay; pounds, rolls and squeezes it
  • Manipulates large buttons and zippers on clothing
  • Washes and dries hands; brushes own teeth, but not thoroughly
  • Usually achieves complete bladder control
  • Likes to look at books and may pretend to “read” to others or explain pictures
  • Speech is understandable most of the time
  • Produces expanded noun phrases: “big, brown”

Four Years

  • Head circumference is usually not measured after the age of three
  • Walks a straight line (tape or chalk line on the floor)
  • Hops on one foot
  • Pedals and steers a wheeled toy with confidence; turns corners, avoids obstacles and oncoming “traffic”
  • Climbs ladders, trees and playground equipments
  • Jumps over objects 12–15 cm (5 to 6 in) high; lands with both the feet together
  • Runs, starts, stops and moves around obstacles with ease
  • Forms shapes and objects out of clay — cookies, snakes and simple animals
  • Paints and draws with purpose; may have an idea in the mind, but often has problems implementing it, so calls the creation something else
  • Becomes more accurate at hitting nails and pegs with hammer
  • Threads small wooden beads on a string
  • Can run in a circle
  • Names 18–20 uppercase letters. Writes several letters and sometimes their name.
  • A few children are able to read simple books, such as alphabet books with only a few words per page and many pictures
  • Understands the sequence of daily events
  • When looking at pictures can recognize and identify the missing puzzle parts (of person, car, animal)
  • Can count 1–7 objects loud, but not always in order
  • Speech is almost entirely intelligent
  • Refers to activities, events, objects and people that are not present
  • States first and last name, gender, siblings’ names and sometimes own telephone number
  • Answers appropriately when asked what to do if tired, cold or hungry. Recites and sings simple songs and rhyme
  • Insists on trying to do things independently, but may get so frustrated as to verge on tantrums when problems arise — paints that drips, paper airplane that will not fold right

Five Years

  • May begin to lose “baby” (deciduous) teeth
  • Visual tracking and binocular vision are well-developed
  • Walks backwards, toe to heel
  • Walks unassisted up and down stairs on alternating feet
  • May learn to turn somersaults (should be taught the right way in order to avoid injury)
  • Can touch toes without flexing knees
  • Learns to skip using alternative feet
  • Catches a ball thrown from 1 m (3.3 ft) away
  • Rides a cycle or wheeled toy with speed and skillful steering; some children learn to ride bicycles
  • Reproduces many shapes and letters — square, triangle, A, I, O, U, C, H, L, T.
  • Cuts on the line with scissors (not perfectly)
  • Hand dominance is well established
  • Understands the concepts of smallest and shortest
  • Identifies objects with specified serial position — first, second and last
  • Recognizes numerals from 1 to 10
  • Understands the concepts of ‘less than’
  • Understands the terms dark, light and early
  • Relates clock time to daily schedule: ‘Time to turn on TV when the little hand points to 5’
  • Can state the name of own city or town, birthday and parents’ names
  • Has better self-control over swings of emotions

Six Years

  • Baby teeth begin to get replaced by permanent ones, starting with the two lower front teeth
  • Gains greater control over large and fine motor skills; movements are more precise and deliberate, though some clumsiness persists
  • Has trouble staying still
  • Span of attention increases; works at tasks for longer periods of time
  • Understands time (today, tomorrow, yesterday) and simple motion (things go faster than other
  • Has fun with problem solving and sorting activities like stacking, puzzles and mazes
  • Recognizes some words by sight; attempts to sound out words
  • Able to trace objects
  • Folds and cuts paper into simple shapes
  • Can tie laces, strings (like shoes)
  • Can identify right and left hands fairly consistently
  • Arrives at some understanding about death and dying; expresses fear that parents may die.
  • Able to carry on adult-like conversations; asks many questions
  • Learns 5–10 words a day

Warning Signs of Developmental Delay

 

Behavioural Warning Signs

  • Does not pay attention or stay focused on an activity for as long a time as other children of the same age
  • Focuses on unusual objects for long periods of time; enjoys this more than interacting with others
  • Avoids or rarely makes eye contact with others
  • Gets unusually frustrated when trying to do simple tasks that most children of the same age do
  • Shows aggressive behaviours and appears to be stubborn as compared with other children
  • Displays violent behaviours on a daily basis
  • Stares into space, rocks or talks to self more often than other children of the same age
  • Does not seek love and approval from a caregiver or parent

Gross Motor Warning Signs

  • Has stiff arms and/or legs
  • Has a floppy or limp body posture compared to other children of the same age
  • Uses one side of body more than the other
  • Has a clumsy manner as compared with other children of the same age

Vision Warning Signs

  • Seems to have difficulty following objects or people with her eyes
  • Rubs eyes frequently
  • Turns, tilts or holds head in a strained or unusual position when trying to look at an object
  • Seems to have difficulty finding or picking up small objects dropped on the floor (after the age of 12 months)
  • Has difficulty focusing or making eye contact
  • Closes one eye when trying to look at distant objects
  • Eyes appear to be crossed or turned
  • Brings objects too close to eyes to see

Hearing Warning Signs

  • Talks in a very loud or very soft voice
  • Seems to have difficulty responding when called from across the room, even when it is for something interesting
  • Turns body so that the same ear is always turned towards sound
  • Has difficulty understanding what has been said or following directions after 3 years of age
  • Does not startle to loud noises
  • Ears appear small or deformed
  • Fails to develop sounds or words that would be appropriate at her age

Identifying Developmental Delay in a Child

 

Developmental Screening

Developmental screening test is a quick and general measurement of skills. Its purpose is to identify children who are in a need of further evaluation. A screening test can be in one of the two formats, either a questionnaire that is handed to a parent or childcare provider that asks about the developmental milestones or a test that is given to your child by a health or educational professional. The screening test may either over-identify or under-identify children with delay. As a result, a diagnosis cannot be made simply by using a screening test. If the results of a screening test suggest that a child may have developmental delay, he should be referred for developmental evaluation.

Developmental Evaluation

It is a long and in-depth assessment of a child’s skills and should be administered by a highly trained professional, such as a psychologist. Evaluation tests are used to create a profile of child’s strengths and weaknesses in all developmental areas.

Treatment

The treatment aims at correcting the developmental delay through early interventional services. The results of a developmental evaluation are used to determine if the child is in a need of early intervention services and/or a treatment plan. Early intervention services include a variety of different resources and programmes that provide support to families to enhance the child’s development. These services are specifically tailored to meet a child’s individual needs. These services include:

  • Assistive technology
  • Audiology or hearing services
  • Counselling and training for a family
  • Educational programmes
  • Medical services
  • Nursing services
  • Nutritional services
  • Occupational therapy
  • Physical therapy
  • Psychological services
  • Respite services
  • Speech/Language

These services are provided by public agencies and private organizations for children who are found to be eligible for these services after a developmental evaluation.

References

  1. Rudolph Abraham M et al. Rudolph’s Pediatrics. 21st United States: McGraw-Hill Medical Publishing Division.
  2. Internet: Behavior and Developmental Delays.

 

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