Musings about Milestones
Please note this blog post was updated to include the changes to the CDC Milestones in 2022.
You take your baby in to the pediatrician’s office, or step out of your baby’s NICU room to join the medical team for rounds, and inevitably the topic arises: “Is your baby meeting his or her developmental milestones?”
You scratch your head, pull out your checklist—a bead of sweat dripping down your face as the doctors stare in anticipation—and you analyze and scrutinize every aspect of your baby’s development as it compares to the list in front of you:
Head control by 3 months? Check.
Rolling by 6 months? Ummmm, not consistently. And only from tummy to back!
Sitting independently by 9 months? Sometimes, but baby is still falling over and often uses their hands to balance—does this count??
Sound familiar? Keep reading.
The pressure, scrutiny, and weight assigned to meeting developmental milestones is real. And don’t get me wrong: monitoring and assessing your baby’s development can give us critical information needed for identifying delays or concerns. It is also important to guide intervention to help baby grow, move, and explore. HOWEVER:
Milestones are more variable than you might think!
Did you know that most milestone checklists you see online were created based on information from the 1960’s, and most have not been updated since? YIKES! Meanwhile, many aspects of child-rearing have changed since then, most notably the very important Back to Sleep Campaign initiated in the 90’s to combat the rise in Sudden Infant Death Syndrome (SIDS). These changes have been instrumental in reducing SIDS, and have also impacted how and when babies meet different milestones in general.
In addition, rates of torticollis (a tight neck condition) and plagiocephaly (flat head syndrome) have increased substantially since the Back to Sleep Campaign. These conditions have implications for many developmental milestones, including head control, rolling and sitting. With babies spending more time on their backs, and less time on their tummy, development is impacted. More on this to come!
Many babies continue to acquire new skills by following a typical developmental timeline, but some may achieve them later, and that can be normal! Keep in mind, though, this wider range is rarely reflected in your standard milestone checklist.
When it comes to milestone checklists, I often guide families to the CDC’s “Learn the Signs. Act Early” as a resource. It gives comprehensive info about many aspects of development and provides families with ideas about how to support development at each stage. In 2022 the CDC milestones were updated to reflect when the vast majority of babies meet certain milestones—most notably, walking was pushed back from a 12 month skill to an 18 month skill, and crawling was removed completely. I have many many thoughts about these changes, but i’ll just leave it with this: mobility matters, and intervening if your child isn’t showing signs of upright skills by 12 months is important.
Milestones are not inclusive
Another key aspect to keep in mind is that milestone expectations DO NOT take into consideration any medical conditions, diagnoses, or challenges a baby may encounter. If your baby has a prolonged NICU stay, a known medical diagnosis, or was born prematurely (for example) there may be an impact on development that the baby books don’t explain. Your baby may need extra help to achieve these milestones (Enter: your friendly, neighborhood neonatal PT!). It is important to work closely with your pediatrician, PT, medical team, or appropriate healthcare professional to ensure your baby gets the care and support they need to thrive.
Milestone checklists also typically don’t account for racial or cultural diversity either. Most of them are established with a population of typically developing, white, affluent children—more on health equity (and inequities) later.
I want to highlight that there are established motor milestone curves for babies and children with several common diagnoses, including cerebral palsy and Down syndrome.
From the National Down Syndrome Society’s website
Delighting in individual development
While using milestones as a general guideline to support developmental progress, identify delays, and areas requiring intervention, I think we need to reconsider the way we (collectively) look at milestones.
In my experience, every baby grows and develops at their own pace, and there are many factors that impact a baby’s milestone achievements. It can be beneficial to look at the developmental trajectory of each individual baby.
Instead of saying “how is my baby doing compared to all the other babies?” which can fuel milestone anxiety, let’s shift the focus to “how is my baby doing now compared to how (s)he was doing last month?” This allows us to delight in your baby’s unique developmental gains, celebrate their strength and progress, and identify where he or she may need individualized support.
Helping kids achieve their milestones brings me such joy!
Worried about your baby’s development? SAY SOMETHING!
If you have concerns about your baby’s development and/or milestones are significantly delayed, I cannot over-emphasize the importance of talking to your pediatrician, pediatric PT, or trusted healthcare professional. We know that the science of baby development isn’t perfect, but if there is one thing we DO know, it’s that EARLY INTERVENTION is key to promoting healthy outcomes for babies! You know your baby best, so if you are worried about their development, speak up!
TL;DR
Milestone anxiety is real!
Using milestones to identify delays or concerns early is crucial.
However, milestones are commonly outdated and vary depending on the baby—use them as a guide, not a checklist.
There are established milestone guides for common diagnoses such as cerebal palsy and Down syndrome, but most milestone checklists are not inclusive.
It’s important to delight in each baby’s individual development!
TALK TO YOUR DOCTOR, PT, or trusted healthcare professional if you have concerns about your baby’s development. Early intervention is key!