Hit or Miss: Tracking Milestones

By Richard McConkie, FNP-C

Experiencing your baby’s growth from their first sounds and the first time they look at you to the first steps and the first words is one of the best parts of parenting.  As much as parents anticipate the next stage, understanding and noting your child’s growth through the typical milestones gives important insight into their development, helps identify potential issues early on and supports their overall health and well-being.

Guideposts to Development

Childhood milestones are distinct skills or abilities that children typically acquire by a specific age, based on decades of research and observation of human development.  These fall into four main categories that your provider will check at your well-child visits: 

Social/Emotional: Is there anything cuter than when your baby first recognizes a face in the mirror?  Smiling at a caregiver or laughing in response to stimuli are some examples of these milestones.  Engaging with the people around them is a hallmark of the Social/Emotional milestones: playing games, clapping with excitement and giving kisses are other infant and parent favorites. 

For the first several months of life, social/emotional milestones are noticed in turning their head to the sounds of your voice and “tracking”, which means following the movement of someone or something in their field of vision. Around age 5-6 months, their vision starts to get a lot more clear and they start to interact in ways that bring a lot of joy to parent’s lives. They start playing a lot of interactive games like “peek a boo” and “patty cake”. They smile a lot and you will likely even get your first “belly laugh” around these ages. 

Motor/Physical: When parents think of milestones, this is the category they are most likely focused: sitting independently, crawling and first steps fall into this category.  These are essential developments in your child’s brain and body communication.  Monitoring milestones allows parents, caregivers and your child’s provider to identify potential developmental delays or disabilities early on. That being said, many children develop their motor skills on their own timeline. One baby may crawl, while a different child goes from scooting straight to pulling up and first steps.  Discussing and tracking these with your child’s provider can give you peace of mind that your child is still following the pattern of development that is typical for your baby’s age. 

Some big milestones to look forward to include rolling over around 3-4 months of age (usually starting with front to back followed by back to front), sitting up independently by 6-7 months of age, getting up to all 4’s and starting to crawl by 9-12 months of age, and walking by 12-15 months of age. It is really important to know that there is a wide range of what is normal in an infant’s development, especially regarding timing of these milestones. Not every baby will be doing all of these exactly at these times, but your provider will look for these developments as your baby grows and work with you and with them if they need help meeting these milestones.

Communication: Development of language and speech starts at day one with your baby.   Milestones in infant communication include making vocalizations other than crying, mimicry of facial expressions and reacting to external sounds.  Achieving these milestones often involves interaction between the child and their caregiver.  Engaging in activities that support communication and development includes talking to your child and even reading to your child (even if they aren’t old enough to understand it yet).  Studies show that language acquisition and comprehension is directly related to the number of novel words your child hears from birth to age 5.  Promote reaching communication milestones for your child by regularly reading, making eye contact and interacting directly with your child. 

First words can start as early as 9-12 months. The first time a baby says “mama” or “dada” is something that every parent looks forward to from the day their baby is born. It is amazing to see how, after starting to say a few words, an infant’s grasp of language seems to multiply exponentially. Once they get started, there is no stopping them. 

One of the most fun and most incredible moments in a parent’s life is when bedtime is nearing and your busy little toddler is able to calm down for a few minutes in order to sit on your lap and have you read them their favorite story for the 20th time this week. These are the moments that mean everything to them, and that you will look back on in future years with happiness. 

Sometimes infants and toddlers don’t meet these milestones exactly as expected. When this happens, you can work with your provider to discuss treatment options including speech therapy, where trained therapists will help get your child up to meeting expected milestones in speech and pronunciation. 

Cognitive: Thinking, learning, problem solving are the bedrock of the cognitive milestones category.  Most babies begin to exceed in these milestones when they are toddlers, even though they’ve likely been practicing them since birth: Your child drops something off their highchair and onto the floor.  The dog comes over to investigate and the baby looks over the tray.  Your baby drops another morsel down and giggles.  A new pattern is noticed and a game begins.  

Babies love to throw things. Once they learn that you will bring it back, they will throw it again and again and again and again and again. They love repetitive games. It helps them make those connections in their brains that helps develop their cognitive thinking. From playing these interactive games with your child, they will learn how to problem solve and think on their own. 

As they become toddlers, they may feel like they have it all figured out and will start not wanting so much help. They may want to put their shoes on by themselves (if you can get them to keep their shoes on in the first place), or they will want to start dressing themselves. An infant and a toddler are always learning and always searching for new ways to figure things out. Making sure your child is hitting these milestones is a bit more subtle than the obvious developments, but bringing up any concerns with your provider can aid in early detection and intervention and start your baby on a path to success.

Missed Milestones?

Child development experts say it’s not possible to hurry your child into a new stage of development before he or she is ready.  Progress through the milestones can vary even month to month.  As long as your child progresses and develops new skills as time goes on, then he or she is on track, even if they miss a step here and there. For example, your infant might begin rolling over from front to back around age 3-4 months, but then skip rolling from back to front because they get enough core strength and head and neck strength to sit up on their own around 6 months of age. Then it’s on to crawling. They may not go back and start rolling over from back to front. These skips are ok as long as your baby continues to develop and grow.  

Indicators your child might be on the cusp of a burst: sleep disruptions from normal schedule, fussiness or regression back to old habits.  All of these can be signs your baby’s brain and body are going through internal changes that will soon be apparent on the outside. These can happen at any time, but are generally very common around 4 months of age, 9 months of age, and again around 18-20 months. This usually leads a lot of parents to have questions about whether their child is not developing appropriately, and get concerned because of the “regression” that is happening. Please reach out to your child’s provider with any of these concerns and we can help you understand what is going on as well as intervene if necessary to help your child get back on track. 

The important thing to note is if your child is consistently missing milestones over time or in more than one area.  Because milestones provide insight into a child’s overall health and well-being, it is important to speak to your healthcare provider about your concerns.

Check out our free downloadable milestone guide and tracker for parents to use and bring to their well child visits with their provider.  The CDC also has a free milestone tracker app available for download.