Monday, July 20, 2015

what's the deal with developmental milestones?

I've heard a bit of hating on the concept of developmental milestones lately. Many parents seem sort of derisive and indignant about the idea, insisting that "each child is an individual," "they all develop at their own pace," and "the doctor is just trying to scare you." Well, the first two are true, but I doubt the third one is (unless your doctor is a terrible person, and that's a whole other issue).

I think people misunderstand what developmental milestones are and what they aren't.

They aren't hard-and-fast deadlines that every child must reach at the exact age specified OR ELSE. For instance, rolling over is a "four month milestone." But some babies roll over at 3 months, and some at 6 months. That's generally okay. It's an estimate, an average.

They aren't a judgement on your child or your parenting. If your doctor expresses concern that your 15-month-old doesn't say any words yet, they're not saying that your child is dumb, or that you're a bad parent. They're not even saying-- and this is key-- that anything is necessarily wrong at all... which leads to my next point.

Developmental milestones aren't meant to be taken in isolation. If an 8-month-old baby isn't sitting up yet (typically a "six month milestone"), but everything else is totally fine-- he's babbling, putting things in his mouth, grabbing toys, scooting across the floor-- it's probably no big deal. It's just something to keep watching for and encouraging. But if he's not doing any of those things yet? That could be a sign that something's wrong.

And that leads to what developmental milestones actually are.

Developmental milestones are a group of guidelines, meant to be taken as a group, illustrating the rate at which the average child develops. The AVERAGE child-- which means that kids may hit some milestones earlier and some later. The milestones are meant to give parents and doctors and other caregivers an overall picture about how a child is doing in several areas of development (usually categorized as fine motor, gross motor, communication, problem solving, and personal/social).

So why do we need these specific milestone markers that stress parents out, if the individual markers don't matter and they're just meant to give an overall picture? Several reasons:

  •    Parents may not realize their child is behind in a certain area, especially if they don't have a lot of prior experience with kids, because their child is their "normal."
  •    Doctors only see the child briefly, intermittently, and under strange and sometimes scary (to the child) circumstances, so they're unlikely to really see the whole child as he/she is.
  •    Studies have demonstrated over and over that kids who do have true delays are identified much earlier when objective milestone questionnaires/evaluations are used, rather than the parent/teacher/doctor/etc relying on their general impression.

It's also important to note that even if a child does have a true delay in some area, it doesn't necessarily mean there is some terrible scary underlying problem that will make their life super difficult. They would probably be fine eventually anyway. My oldest daughter, Faith, had speech delay as a toddler; at 17 months old she really didn't say any words at all. She didn't have any other delays. We got speech therapy through Early Intervention and by the time she was 2, her speech was normal for her age. Would it have normalized if we didn't get therapy? Probably, yeah-- though it probably would've happened later (and it was frustrating to her to be unable to communicate well). But we also know that, on average, outcomes are better if kids get treatment for whatever delay they have earlier rather than later. There's no benefit to waiting.

"Missing" a true delay, on the other hand, can be downright harmful. So if doctors express concern about a certain milestone, they're not trying to scare you. It's just one piece of evidence that they don't want to miss, because while one piece may not mean anything, enough pieces of evidence put together can. Imagine one of those old-fashioned balance scales, with one side being "concerning," and the other side "not concerning." If you have thirty pebbles in the "not concerning" side and move one to the "concerning" side... well, who cares. But if you move ten to the "concerning" side, well then the scale starts to tilt. And if you paid no attention to each individual pebble, you would never realize they were adding up.

I also see a lot of fear when it comes to diagnoses like developmental delay-- not just among parents, but among doctors too. Everyone is so hesitant to "label" a child with a diagnosis, and would prefer to just call him/her a "late bloomer" and "keep an eye on things." But what everyone forgets is that the label doesn't change the child. Whether or not Faith was given the diagnosis of "speech delay," she still wasn't talking. What the label does do is make the child eligible for services that can help. Even if the diagnosis is later found to be inaccurate, the only concrete thing that has changed is that the child was given the opportunity to have occupational therapy or classroom modifications or whatever. (Maybe parents are worried that the "label" will cause others to treat their child differently... but here's the kicker:  you don't have to tell anyone if you don't want to.)

So basically:

1- If you're concerned, don't let your doctor blow you off. (Really.)
2- If your doctor is concerned, don't blow him/her off either. It can't hurt to look into it.
3- Even if everything turns out to be fine-- and in most cases it will!-- it doesn't mean either one of you was wrong to be concerned.


  1. So, I just realized that I've been reading your blog for a while but because I read through Feedly I didn't see your profile picture. Which means that when we met at Edel I didn't connect you with your blog! What a delight to have met you. I love that on the developmental milestone sheets our doctor uses the last option reads "not yet". That simple change in terminology calmed my crazy mama brain right down when I saw it!

    1. Tara, how funny! I'm sure I did the same thing multiple times.

      I agree, the "not yet" gives a totally different perspective than just saying "no." (Ages & Stages Questionnaires, yes?)