I feel a twinge of anxiety every time I take my son to the pediatrician. And it’s not just over the shots or the probably germ-infested waiting-room toy he’s pawing. The stress kicks in once the receptionist hands me the developmental questionnaire, which includes a list of physical, cognitive, and social developmental milestones to tick off.
Does your child respond to their name? (I call my son’s name a few times to see. That’s a nope.)
Does your child roll? (He’s done it, but it didn’t seem to be intentional. I consult my husband before checking the “sometimes” box.)
Does your child smile? (Phew. A clear yes.)
Each time I hand the sheet over to my doctor, she’s quick to reassure me that this is not, in fact, a test and that there is a big range of what’s typical. Still, I have to admit, in the absence of concrete feedback about my parenting, I find myself using these milestones to assess not just how my son is doing, but also how I’m doing as a parent. And when it’s unclear whether or not my son is “on track,” I worry.
A recent survey has confirmed I’m not alone. The results, collected by OnePoll on behalf of Mead Johnson Nutrition, revealed that 54 percent of moms are worried about their babies reaching milestones at the right age.
“In my practice, I get a lot of referrals for evaluating a child’s development, and I see such high levels of anxiety among parents,” says Mona Delahooke, PhD, child psychologist and author of Beyond Behaviors: Using Brain Science and Compassion to Change Children’s Behavioral Challenges. “When you get feedback that your child is delayed in hitting a milestone or is missing a milestone, it can be so anxiety-provoking, but it’s really needless because a child’s development is always changing.”
When you’re hunched over that list at the doctor’s office, it might be difficult not to see milestones as anything but black-and-white, but experts stress that it’s important to read between the lines. Development is dynamic, milestones are variable, and they’re unreliable predictors of future success or failure.
Milestones are variable
Developmental milestones are intended to be guidelines interpreted with the understanding that kids develop at variable rates, says Damon Korb, MD, developmental and behavioral pediatrician, author of Raising an Organized Child, and director and founder of The Center of Developing Minds. “They don’t predict what will happen later,” he says. “They’re just an indicator of where we’re at now, and that we’re moving through the stages and aren’t stuck.”
The ages associated with milestones merely reflect an average. Take walking, for example. When you hear that a child is “supposed to” take their first steps by a year old, what that milestone really says is: This is the age by which most children take steps. If you pan out, you’ll see that “normal” variation ranges anywhere from about 8 to 18 months.
And parents of premature babies should give their children additional leeway. “If your child was born prematurely, apply milestones to the baby’s due date, and not the birth date,” Korb says. “It would be unfair to hold a 3-months premature baby to the same standard as someone who had an extra 3 months in the womb.”
Progress isn’t always linear
Typical development also isn’t a straight line. While the word “milestone” implies a step-by-step progression with a neat path connecting point A to point B, experts have found that’s simply not how the brain works.
“Developmental theory is moving toward seeing development as happening in cycles rather than in a straight line,” Delahook says. “ I don’t even use the word milestone anymore because I feel that they are so dynamic and shifting. I call them processes.”
As children make leaps, they’ll simultaneously experience small regressions. “You may see children who have a burst of language development and get clumsy for a month or two. Or the opposite,” Korb says. “Uneven growth in one area of the brain can overwhelm growth in the other temporarily.”
Learning to walk is a microcosm of this back-and-forth process. “When toddlers learn to walk, they don’t learn all at once,” Delahooke says. “You walk, then you fall. Over time those motor skills develop through a few steps forward, and a few steps backward. It doesn’t happen all at once.”
Likewise, it’s not uncommon to see a child who is early to walk, but late to talk, or vice-versa. “While kids can do a whole bunch of things at one time, sometimes they can only truly advance their milestones one at a time while the others lag,” says Katherine Williamson, MD, FAAP, a California-based pediatrician and media spokesperson for the American Academy of Pediatrics.
Step away from the milestone to view the big picture
Developmental questionnaires aren’t pass/fail tests — there’s only so much a single milestone can tell us. Your doctor collects this information so they can evaluate milestones in the context of a child’s overall development.
“If I have a patient who was hitting all their milestones until 6 or 9 months and then slows down, I’m looking for something new,” Williamson says. “If I have a kid who is always a little late to roll, crawl, and walk, but they get there, I sort of know their pattern. That’s a kid who might be putting their focus more on social cues than physical development.”
Look at each milestone as one piece of the puzzle. Without considering your child’s development as a whole, examining one tiny part won’t tell you much about where they stand. And myopic focus on each small piece can prevent you from seeing what’s really important.
For instance, rather than tallying up each word your toddler says, consider the many ways your child communicates. Even if a child doesn’t talk at all, ask yourself whether or not they’re communicating through gestures, pointing, or facial expressions. “Step back to see if your kid is engaging, if they understand a lot of what you’re saying, and if they’re starting to learn new words — even if the kid next door is the same age and is speaking full sentences, because that doesn’t necessarily mean anything,” Williamson says.
Early developmental achievements ≠ future success
We’ve all probably heard stories of the babies who rattle off whole paragraphs before they turn one or break into a full sprint at 8 months. It can be tempting to look at a child who’s ahead on milestones (especially if they’re your own) and wonder if they might be destined to become the next Steve Jobs or Serena Williams.
While it’s entirely possible you have a budding brainiac or a future Olympian on your hands, the age at which your child hits milestones won’t necessarily predict it. “It’s a misconception that if your kid talks at 10 months, they’re a genius,” Korb says. “It just means his development was more uneven.”
As with developmental lags, it’s best to look at leaps in the context of the child’s overall development. “The fact that someone reads early is not predictive,” Korb says. “But if they read well and have good communication skills and are good at figuring out puzzles, you can say that this guy is an effective thinker.”
Some milestone delays do require intervention
Though milestones may be unreliable markers of future genius, doctors do rely on them to help identify developmental challenges. In some cases, significant ongoing developmental delays will require an intervention or additional diagnosis, as they can be symptomatic of a learning or developmental disability.
If your child is not reaching milestones within the suggested range, don’t worry, but do check in with your pediatrician, Williamson urges. “It’s good to have them take into the context to see if intervention is necessary,” she explains. “This is where we want parents to want to rely on their pediatrician and not put it on them to self-diagnose their children.”
The good news for parents is that there are many ways to support developmental delays. “We can support a child if they happen to have areas of challenge. We know how to do that,” Delahooke says. “It’s super hopeful. It’s not fixed.”
Instead of thinking about milestones as scrawled in permanent ink, try thinking of them as sketched in pencil, as alterable markings that provide guidance, rather than a definitive letter grade assessing your child — or your parenting.
“We have enough to worry about as parents,” Delahooke says. “If we recognize how dynamic development is, we’ll have more compassion for not only for our kids, but also for ourselves.”