Transcription:
Developmental Milestones for Your Child

Melanie Cole (Host): If you’re a parent, you know the amazing feeling when your child waves bye-bye for the first time or smiles or their little eyes follow you around the room. It’s such a great feeling. But what if your child isn’t doing those things when you heard they were supposed to be doing them and what options are available? My guest today is Dr. Shahnaz Ann Kazi. She’s a Family Medicine physician at BayCare Health. Dr. Kazi preventive health is important for helping children grow and develop and meet those developmental milestones. Let’s start with some of the most important things that you think parents need to do that can help their children grow and be the best they can be.

Shahnaz Ann Kazi, MD (Guest): Sure, so that’s a great question. So, it’s really important for everyone to take an active role in the health and wellness of children and it starts with setting a good example for your children by taking care of yourself, eating healthy, exercising, spending time with your children and teaching them what they need to know. That’s usually the best place to start and then we can talk about some more specifics as we go along.

Host: That’s great advice. It really is. Because we have to role model as well. So, let’s get into the milestones. I know that not all kids are the same. So, these milestones you’re going to give us, some kids are going to hit on time, and some are not. But let’s start with the little guys, the two months and the four month olds. What do you feel is really important that they are hitting?

Dr. Kazi: Sure. So, let’s talk about just some principles of developmental screening in general and then I’ll give you some specific examples. So, the CDC recommends regular developmental screening starting at two months of age and continuing throughout childhood. And this is usually done through well-child checks with your family medicine doctor or with your pediatrician. And developmental screening starts at two months of age and it does decrease over the frequency of childhood, but there is a lot of developmental screening. There are a lot of milestones to hit. So, all of those are probably more that what we’ll get to today.

So, let’s pick a few key time points to focus on. So, the most important time points for developmental screening are at nine months of age, 18 months which is a year and a half and 24 months of age. Those are really the key time points that we focus on to really make sure that kids are hitting certain milestones at that age. Like you said, there is huge variation in how children develop but these are some really important time points.

So, let’s start with nine months of age. So, at nine months old, children should be able to make sounds like mama and baba. They should be able to track so you mentioned that in your intro. Children should be able to follow the path of something of interest with their eyes as it moves around the room. For example, a favorite toy or a person as it moves from one position to another. A nine month old infant should be able to pick up small objects between the thumb and the index finger, cereal is the classic example. The should be able to sit unsupported. They should be able to stand with some assistance, so not on their own but meaning their legs should be able to support their body weight. Again, like with you putting your hands around their waist. They wont have the balance to stand unsupported; but they should be able to support their body weight.

So, those are some key milestone markers for nine months of age. Should I go onto the 18 month?

Host: Sure.

Dr. Kazi: Okay. So, at 18 months of age which is about a year and a half; a toddler should be able to walk, possibly with lots of falling but without constant handholding. They should have about six words and you might be the only person who can understand them; but they should have about six words. An 18 month old should be able to drink from a cup and eat with a spoon. Again, probably making a lot of mess; but at least understands what they are supposed to do with those objects.

And then at 24 months of age which is two years of age, a toddler should have two word phrases such as my ball, should be able to copy you in your actions for example doing the motions of teeth brushing, probably not very effective with an actual tooth brush, but at least doing the motions. A two year old should be able to walk fully unsupported and should be able to follow simple instructions such as putting a toy away or bringing your phone to you. So, those are just some key examples of milestones at nine months, 18 months and two years of age which are some of the most important milestones to make sure that we address if there are any concerns or issues.

Host: So, then Dr. Kazi as we said, not all kids grow the same, but some of these milestones like being able to stand and support their own weight, not unassisted, but just be able to support their own weight. If they are not hitting these at that particular mark, nine, 18, two years; maybe they hit them a month or two later, that’s fine, right? But when is the red flag? When do we as parents say to our pediatrician, they are not doing this or and then what do we do about it?

Dr. Kazi: Sure, yeah. So, like you said, all children are different, and some will hit their milestones later than predicted and some will also hit milestones earlier than others. And some kids go out of order according to our charts. There are a lot of factors involved including like age at birth, so children who are born earlier in pregnancy especially before their due date; they probably achieve their milestones a bit later than others versus children with older siblings may achieve their milestones earlier than predicted because they can copy their siblings.

But if a child is not meeting their milestones; it’s really important to see the doctor and have a complete evaluation to figure out what’s going on. So, in that exam, the doctor can determine if there is concern that it’s a sign of an underlying medical problem or if it is just a variation of normal. And most of the time, we give kids time to see if they can catch up especially if there is just one delayed milestone. But consistently not meeting milestones or not meeting multiple milestones; that’s when we get concerned that it could be a sign of an underlying medical problem for example.

Host: What do we do about it? My daughter didn’t speak when she was supposed to, now of course, we can’t shut her up. But at the time, she’s 16 now, but at the time, we were pretty concerned, and we did early intervention. So, what’s involved in some of the occupational therapy, speech therapy, feeding and swallowing issues. Any of these things where the kids really aren’t hitting those milestones; what types of therapies are available?

Dr. Kazi: Sure so, again we start with trying to figure out if there is an underlying medical problem so the doctor might order some testing like bloodwork or imaging to see if there’s an actual medical condition that needs to be treated. Because if a child is not meeting their milestones because of a medical condition, then that’s where you really have to start. But then beyond that, like you said, there’s lots of other services, all kinds of different therapy, different experts who can help us address a particular skill or a particular problem depending on what is going on.

And sometimes it’s just a matter of teaching caregivers how to work with their child to learn a skill that they haven’t learned. So, it really depends on the nature of the problem and so the most important thing to figure out is to see your doctor and make sure that your child has a medical evaluation to get a recommendation.

Host: Well I think that’s every parent’s biggest confusion Dr. Kazi is do we wait and just assume that they are like every other kid and they’ll come around, they’ll start feeding themselves and they’ll walk, maybe not at one, maybe not at one and a half. Do we wait? Or do we jump on these things right away?

Dr. Kazi: Well so it depends on the nature of the delay and everything else that’s going on. That’s a really important discussion to have with your child’s doctor and to figure out if it’s something that needs intervention right away or if it’s something that you can wait. And it really is different for each situation, each child and it depends on the milestone. So, your doctor is the best person to give you that recommendation about watch and wait and see or do a more aggressive intervention.

Host: That’s great information and parents do need to really relay those fears to their pediatrician so that they can get the proper screening and if needed, the therapies that are available. So, what can primary caregivers, parents, everyone in the community do to help support the health of our children? Speak about some of the most important things as we wrap up, that you feel we should be doing for our children?

Dr. Kazi: Sure, so it’s important for everyone to take an active role. Again, that starts with taking care of yourself and setting a good example. Healthy children start at conception. So, a healthy pregnancy sets the stage for a healthy life later. Early in life, breastfeeding and immunizations are very important to help support a strong immune system, to keep kids healthy. Because illness can – is one of the things that can contribute to milestone delays.

And then as children grow, they learn by observation. So, you eating healthy, exercising and demonstrating good self-care is really important for children to learn. And the most important thing is to spend time with your children, spend time teaching them what they need to know. So, the CDC has a website with checklists for developmental milestones at different ages. They even have an app called the Milestone Marker and you can use that as a resource to try to get some ideas of what you should be teaching your children at each age. But in order to know if they’re meeting their milestones or not; you need to be spending time with them.

You can start working with them. Most infants can start doing tummy time in the first few weeks of life. It does need to be supervised and in a safe environment, but the only way a baby is going to develop upper body head control and strength is with doses of tummy time and that’s one of the early milestones that you can start working on almost as soon as you get home from the hospital.

You can read to your child. So, again starting in pregnancy. Children develop language skills by hearing language. You can read them your papers from work, your Instagram feed, whatever you’re reading until they are old enough to tell you what they do and don’t want you to read to them. But just hearing the words is super important for language development later in life.

And then when they start school, make sure that you are talking to them and listening to them if they are having trouble. It’s important to know if your child can’s see or hear the teacher at the front of the classroom. And when you identify concerns or if you think that your child is developing differently than other children their age; then it’s important to bring that to your doctor’s attention at their well-child checks.

Host: Great information. Dr. Kazi thank you so much for coming on and telling parents what they can expect and what to do if things don’t always happen exactly on the timeframe that they think that they will. But it’s really great information. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org. I’m Melanie Cole. Thanks for tuning in.