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Why Isn't My Child Reaching His Milestones?

Baby in Jacket Running Outside

When my daughter Rachel was 13 months old, I decided to enroll her in a movement class. I reluctantly placed her in the "crawlers" group; at her age, I was positive she'd start walking any day. Four months later, she was still happily crawling on the foam mats, and I was in a panic: Seventeen months and still not walking? What was wrong?

A mere month later, Rachel sprang up on her feet, and today -- seven years later -- she ice-skates and dances ballet with skill and grace. When it came to walking, she was a typical late bloomer, a child who is developing normally, but achieves a milestone or two at the later end of the spectrum. Experts say that developmental leaps, such as learning to walk, take place only after numerous supporting skills have come together, and the rate at which those pieces assemble varies among children.

Of course, sometimes slow development indicates a condition that requires treatment. Here's how to tell if your baby is merely a late bloomer or if he needs some outside help.

Getting Around

Crawling and walking are two eagerly anticipated milestones; there's nothing like the thrill of watching your baby zoom across the room to claim his favorite toy -- or your cell phone. Experts say that babies usually begin crawling at 7 to 8 months, walk with support at 9 to 11 months, and begin to walk on their own just before their first birthday.

More complicated large motor skills, such as walking up stairs and jumping, occur at 16 months and two years respectively. But here's the rub: These "typical" ages don't reflect the wide variation that occurs among perfectly normal children. In fact, according to research from the University of Missouri-Columbia, 90 percent of babies crawl between the ages of 5 and 11 months, walk alone between 9 and 17 months, and jump with two feet between 17 and 30 months.

Why such variation? One reason is muscle tone. Babies whose muscles are a little weaker than average may be slower to walk, as may chubbier babies. "Weight distribution also plays a role," says Joseph Campos, PhD, professor of psychology at the University of California, Berkeley. "A top-heavy baby needs to develop extra strength to keep his balance."

Practice time can affect motor development as well. For example, a study by British researchers at the University of Bristol in the 1990s found that 6-month-olds who were put to sleep on their back had lower gross motor scores than 6-month-olds who slept on their front. (The difference disappeared by the time the babies reached 18 months.) The reason seems to be that the back-sleepers didn't have as much opportunity to strengthen their neck and shoulder muscles as the front-sleepers did.

While the American Academy of Pediatrics strongly advises parents to put their babies to sleep on their back as a way of minimizing the risk for sudden infant death syndrome (SIDS), many pediatricians are urging parents to place their baby on their tummy periodically during playtime to help them build their upper body.

Finally, temperament can influence motor development. According to a study by Campos and his colleagues, babies who were prone to frustration began walking two to four weeks earlier than other babies. "Temperamentally, these babies were inclined to find a faster and more efficient way than crawling to get to where they wanted to be," says Campos.

When motor delays fall outside the normal ranges, children can often be helped with some type of treatment. If the delay is caused by low muscle tone, for example, a course of physical therapy can help build strength and fine-tune coordination. "Sometimes we give the child a walker to help him take steps. Over time, we take it away as he is able to bear more weight on his feet," says Lori Freedman, an early-childhood developmental specialist in private practice in Edgemont, New York.

Rebecca Luckenbach, a Cincinnati mom, recalls that her son, Gavin, was diagnosed with low muscle tone as an infant because he wasn't meeting his large motor skill milestones. "The therapist would show us exercises for him," she recalls. "For instance, we would press our hands against his hands and feet to encourage him to push back."

Sometimes motor delays are a sign of more serious genetic or neurological disorders, such as cerebral palsy (a brain disorder that can be characterized by spastic movements). If your child's motor development seems extremely delayed, consult your pediatrician.

It's amazing what a baby can learn to do with her chubby little fingers and hands. Babies typically can move objects from one hand to another at about 5 months and play patty-cake at about 9 months. The "pincer grasp" -- the movement of the thumb and forefinger to pick up a small object -- usually kicks in at around 11 months to 1 year. By about 13 months, a baby can stack two blocks, and by 14 months, scribble his first masterpiece with a crayon.

Again, the parameters for these milestones can vary widely. According to the University of Missouri-Columbia report, 90 percent of babies begin to play patty-cake between 7 and 15 months; stack two building blocks between 10 and 19 months; and scribble with crayons between 10 and 21 months.

The first sign of a fine motor delay is often the absence of that pincer grasp. A child who is older than 1 year and still using his fingers to "rake" small objects toward him may have a problem that requires treatment. Many times, however, fine motor delays are picked up by preschool teachers, who notice if a child isn't able to manipulate crayons or has trouble using a cup.

But experts caution that a little one's awkwardness with preschool implements may not signal a true fine motor problem. Instead, they may just indicate that he hasn't spent time acquiring strength and dexterity in his fingers. "A kid who only wants to run around the playground may be less skilled with crayons because he hasn't had as much practice as one who loves making crafts," Freedman says.

Connie Gross, a Long Valley, New Jersey, mom, confirms that practice can make perfect. "When my twins were around 3, they would often tell me they needed help with skills such as brushing their teeth. I encouraged them to do it themselves. Soon enough, they were doing it on their own."

Sometimes, though, fine motor delays are caused by a treatable disorder, such as low muscle tone in the fingers. Occupational therapy, which helps a child build finger strength through tasks like puzzles, is often helpful.

The cheerful babble of a baby learning to use his voice is music to a parent's ear. But it turns out that the ability to understand words (receptive language) and produce speech (expressive language) are two different concepts requiring a variety of skills. In order to speak, a child must coordinate cognitive, hearing, listening, and motor abilities. Expressive skills typically kick in at about 4 to 6 months, when babies begin to make one-syllable sounds, such as "ba."

Between 7 and 12 months, babies will babble strings of syllables ("ba-ba-da"). Most children say their first words around their first birthday; by 18 months, babies should say at least 10 words, and may understand 50 or more. "Eighteen months also marks the beginning of a 'language explosion,'" says Lydia Soifer, PhD, a speech pathologist in White Plains, New York. "They may acquire as many as eight words daily."

As for receptive language, from around 9 months to 1 year, babies start to follow simple commands (such as "Sit down") and begin to show that they understand the word "No," particularly when it's accompanied by a stern tone. Between 1 and 2 years, babies can point to their body parts when somebody names them.

Because language is so complex, there is a wide range of issues that can put the brakes on its development. Muscle coordination is one of them. According to Jan Turner, PhD, director of the Speech-Language and Assistive Technology Department at the Kennedy Krieger Institute, a Baltimore-based facility that helps children with developmental disabilities, talking involves several muscular tasks: making sounds and moving the lips, tongue, and jaw.

A child who's having difficulty controlling and coordinating these actions may have trouble sounding out intelligible words. And because speaking involves controlling the release of air from the lungs, kids with breathing troubles, such as asthma, may have speech problems. It's also true that severe ear infections can impair hearing and slow both expressive and receptive language skills.

Some speech and language delays require no treatment. For example, according to the American Speech-Language-Hearing Association, studies show that 18- to 30-month-old children who are late to speak but who understand language and make steady progress don't need intervention.

Other times, a course of speech therapy can help. For expressive language problems, therapists use games and exercises to strengthen muscles; for receptive language problems, they may speak commands ("Put the doll on the table") and model a response, until the child gradually learns connections between words and actions. Speech and language delays can also signal serious problems, such as mental retardation or autism. If your child isn't making steady language progress, consult your doctor.

Though delays in reaching milestones may seem like insurmountable obstacles at first, rest assured, the majority of kids walk, talk, and do just about everything else you can think of eventually -- just on their own timetable.

Can a child lag behind in social development? The answer is complex. Children vary widely in when and how they exhibit social skills, such as smiling broadly when a parent enters the room. But it's predominantly temperament -- not physical or developmental issues -- that dictates a child's social climb.

"As many as 20 percent of developmentally normal babies under the age of 1 year are not very sociable. They may be more interested in their toys than in interacting with others," says Michael Lewis, PhD, professor of pediatric psychiatry at Robert Wood Johnson Medical School in New Brunswick, New Jersey. "Similarly, some kids cry in the presence of a stranger, and some simply pause for a moment and go back to playing. Both are responding -- they're just responding at different levels of intensity."

Temperamental variability aside, a lack of social abilities could signal a medical or developmental problem. A baby who doesn't have a social smile or won't make eye contact may need help.

Originally published in American Baby magazine, September 2004.