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Age-by-Age Growth: Milestone Madness

Milestone Madness
Sang An

On the sun-drenched playgrounds of Tucson, AZ, Kristi Thomas, who has a 3-year-old son and a baby daughter, reports that there's a certain other mom -- Thomas is too polite to name names -- who opens every conversation with the greeting, "Guess what David did today?" At an infant exercise class outside Chicago, first-time mother Amy Lowe recalls other parents' gasps of disbelief that her daughter, at 19 months, did not yet show dexterity on the balance beam. On the Web, at a bulletin board devoted to "advanced babies" -- we're too appalled to name the site -- one correspondent recently boasted about her 9-month-old son's mastery of "quite a few meaningful, multisyllabic words."

New parents have never been known to downplay their baby's unique genius. But today's proud moms and dads are taking it a few levels higher. "Some go crazy competing," as Lowe says. This preoccupation with developmental milestones cuts two ways: For every braggart celebrating her little Einstein's first wave bye-bye, there's another worrying that her Fiona or Oscar ought to be keeping up with the Davids.

Especially in a baby's first months, when there's not a lot of evidence to go by, parents like Kelly Marcus, a Philadelphian whose daughter is just over a year old, read and reread the relevant passages in their baby manuals -- Marcus has six -- for clues that their child is on track. "In the beginning, I read every chapter two or three times, over and over. I was waiting for things to happen," Marcus says. "I'm not as consumed now. Actually, that's a lie; I just read the chapter on walking."

Two recent trends are to blame, says Jerry Brodlie, Ph.D., a child psychologist and chair of the department of psychology at Connecticut's Greenwich Hospital. On one hand, he says, our accomplishment-oriented society is no longer satisfied to wait for grade-school report cards to quantify a child's achievements. "It's a downward trend, age-wise," he says. "If you have a 1-year-old, what measure of accomplishment can you use? If you say, 'Well, my child started to talk at 8 months,' you can one-up your neighbor."

Plus, he says, a torrent of news and debate about pervasive developmental disorders such as autism has parents seeking reassurance that their babies are growing and thriving on schedule. Says Dr. Brodlie: "I think people are looking for hard empirical data to prove that their kids are okay."

Smart parents are also aware that early interventions like speech evaluation and occupational or physical therapy can help a child with a developmental delay get on track with his peers, so they keep their eyes hyper-peeled for signs of trouble. "These programs are readily available, and people -- rightly so -- want to take advantage of them," says Richard Saphir, M.D., a pediatrician and clinical professor of pediatrics at New York City's Mount Sinai School of Medicine. But in medical terminology, intervening "early" usually means taking action when a child is a couple of years old, he says, not a couple of weeks.

Milestone Madness
Sang An

Today's new parents can easily check their babies' progress against development charts in dozens of books and Internet sites -- a good thing, in moderation. The problem is that parents risk taking too literally this wealth of literature, expecting their baby to crawl at precisely 8 months and to walk at 12 because the guidelines say those are the norms rather than the averages. Excessive chart-watching is not likely to harm an infant's well-being, according to Dr. Brodlie: "At that age, I think it's the parents who are actually harmed."

For mothers and fathers in the throes of milestone madness, the reassuring truth is that individual babies will show a tremendous range of normal development, says Stephen Boris, M.D., a pediatrician who's been in private practice for 30 years in Mamaroneck, NY. "It can be normal to walk at 9 months; it can also be normal to walk at 18 months." Variables like gender and birth order complicate the guidelines in parenting manuals, he says. "First-children girls tend to be very rapid talkers, for example. Second-children boys are often a little bit delayed."

Moreover, the developmental goalposts sometimes move. Until recently, for instance, it was expected that many children would roll over from their backs to their bellies by 4 months of age, but the successful "Back to Sleep" campaign against sudden infant death syndrome has produced many babies who are disinclined to do so until several months later. Barbara Howard, M.D., an assistant professor of pediatrics at Baltimore's Johns Hopkins University School of Medicine, says she no longer pays much attention to this particular milestone, although it persists in baby books. (She does, however, usually recommend 20 minutes of daily tummy time, starting in a baby's first week, to condition muscles for crawling, walking, and other motor skills.)

Pediatricians are largely blasé about height and weight percentiles and tend to be amused by their patients' stories about other parents who trot out these numbers as though they were infant SAT scores. On the whole, pediatricians concern themselves more with the rate of a baby's growth and development than they do with her individual percentile scores. In fact, because height and weight are largely determined by genetics, it's normal for a child to fall almost anywhere on the charts. What's not normal is for any child whose height or weight has registered consistently in one range to show a significant change, unless he's recently been sick.

Because many parents worry unnecessarily about even small fluctuations, some pediatricians, including Dr. Boris, don't address percentile scores unless specifically asked. There is no need, he says, as doctors are unlikely to overlook a baby who is way too big or way too small for his age. Indeed, real problems -- which may be nutritional or behavioral, among other causes -- tend to be obvious at a glance.

Milestone Madness
Sang An

The bottom line is that parents shouldn't ignore developmental milestones -- just keep them in perspective. "They're important," Dr. Saphir says, especially if a parent has a nagging sense that his or her child is somehow different -- a feeling you should always report and one that should be welcomed and respected by your child's physician. "But I think parents have to realize that there is variation," he says. "The more people get overly involved with reading guidelines and checking lists, the less they're going to enjoy their child."

Current findings in early childhood development should offer some relief to parents who worry that their baby is not keeping up with the Joneses' progeny. Dr. Howard points out that children move ahead in fits and starts, not on a smooth upward curve. "Development seems to happen in sudden reorganizations in functioning," she says. "Your baby may be behind your neighbor this month but ahead next month." As your child gets older, such spikes will even out: "When they're 3, whether they walked at 12 months or 15 months will not seem significant."

It's also useful to remember that a baby's temperament may influence her progress. "Sometimes a baby won't walk as early as another one because she's cautious," Dr. Howard says. "Or maybe he can run but really prefers sitting down and coloring. This is a good chance to practice how you're going to appreciate your baby's individual differences." Your child may have the same innate athletic ability as the varsity toddler next door, she says, but might achieve motor milestones later because of looser muscle or ligament structure.

Another factor to keep in mind is that a baby with highly intuitive parents may actually be delayed in meeting some developmental milestones. With his parents anticipating his every need, for example, such a child may feel no rush to talk. "Then, at 16 months, he'll come out with full sentences," says Dr. Brodlie.

Milestone Madness
Sang An

While today's playgroups are often the biggest breeding grounds for milestone madness, doctors say they can also be the best antidote to it. It all depends on parents' approach. When you're surrounded by people whose babies are about as old as yours, look at it as an opportunity to gain a better sense of the wide variety of normal temperaments and abilities.

Marcus and her daughter, Samantha, belong to a playgroup of nine babies, all born within three months of one another, at the Hall-Mercer Child and Parent Center at Pennsylvania Hospital in Philadelphia. The diversity in Samantha's peer group was particularly striking when the babies were between 8 and 11 months old, Marcus says, with the born athletes already standing or cruising while the less ambitious sat and watched. Although Samantha lagged in mobility, she proved to be the attention-span champion of the group. At one meeting, the facilitator asked parents to take turns reading from a book during circle time, and Samantha's eyes followed each reader in turn. "I thought, 'Oh, she's way ahead,'" Marcus laughs.

Keeping a sense of humor may be the best way to stay sane in the savage world of early childhood development. One busybody mom asked Lowe for a tally of Emma's vocabulary at 20 months. All she could think of in response was, "Emma can moo like a cow." "What can you say?" Lowe recalls with a smile. "As a parent, you obviously want to know if something is wrong with your child, but competition is absurd and completely unnecessary and just adds stress to your life." When she's with company, Lowe deliberately downplays Emma's achievements in order to avoid hurting anyone's feelings.

It's only human to rejoice in our children's triumphs, no matter how small they may be, according to Dr. Brodlie. He encourages moms and dads to celebrate these moments privately, but agrees with Lowe's approach of showing grace and humility in front of other parents.

For her part, Thomas encourages new parents who attend her weekly playgroup to take the long view. Her first child, Colter, missed the 8-month milestone for crawling, then ended up walking at 11 months. Her younger child, Tayler, a dynamo in motor skills, consistently misses every deadline in the books for feeding. "My mantra has been, 'She's not going to go to college eating out of a jar,'" Thomas says. "I know we're going to get there eventually. It just takes time. And I try to help other parents see that too."

Baby books tend to overemphasize the importance of gross-motor milestones like crawling and walking, says Barbara Howard, M.D., an assistant professor of pediatrics at the Johns Hopkins University School of Medicine in Baltimore. Pediatricians are more interested in whether a baby is achieving the precursors to language and social skills. "Being able to understand and interact with others is what it means to be human," she says. Your pediatrician will look for these signs that your baby is coming along nicely both intellectually and socially.

At about: 8 weeks
Your baby should: Smile Responsively

At about: 8 weeks to 3 months
Your baby should: Take turns in a cooing game

At about: 6 to 8 months
Your baby should: Babble

At about: 8 months
Your baby should: Attempt to get mobile

At about: 8 to 10 months
Your baby should: React differently to strangers

At about: 9 months
Your baby should: Sit up

At about: 10 to 12 months
Your baby should: Play pattycake and wave bye-bye

At an ideal infant check-up, the doctor will perform these steps:

  • A weigh-in, along with measurements of length and of head circumference. The doctor is more concerned with your child's overall rate of growth than with the baby's precise size at any one visit.
  • A whole-body exam. Among the parts regularly assessed are a baby's heart, lungs, abdomen, skin, eyes, ears, nose, throat, teeth, nerves, muscles, genitals, and bones (particularly hips, for displacement).
  • Vaccinations. The battery of inoculations that the American Academy of Pediatrics currently recommends is posted in the "You and Your Family" section at
  • A developmental assessment. Some doctors ask parents to fill out a checklist. Others ask open-ended questions like "What great things is your baby doing since his last visit?" Additional routine diagnostics include the doctor making eye contact with and talking to the baby, as well as handing over a small object for her to grasp.
  • A measure of family well-being. Some pediatricians observe the way Mom and Dad hold and comfort the infant as well as how they interact with each other. Some inquire outright. Barbara Howard, M.D., a developmental-behavioral pediatrician in Baltimore, likes to ask: "What's hardest about having (for example) a 6-month-old?"
  • A question-and-answer session with parents. Good pediatricians value parents' observations and concerns.

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Copyright © 2003. Reprinted with permission from the May 2003 issue of Child Magazine.