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An Early Warning System for Possible Delays

An Early Warning System for Possible Delays

By Amy Landsman

The first smile. The first time a baby rolls over. Those sweet first babbles, eventually giving way to words.
Children should experience dozens of milestones in their first few years of life. Knowing what to expect and when can help parents track their baby’s development, and it is vital to spotting delays as early as possible.
“There is a lot of rapid development in the first two years of life,” says Ajoke Ajayi-Akintade, a developmental pediatrician at Mt. Washington Pediatric Hospital in Baltimore.
“At 7 or 8 months they do the ‘dada.’ Then by 9 or 10 months comes the ‘mama.’ And they say their real first word by 12 months,” she says.

“When a parent brings me a child and says, ‘My child isn’t babbling,’ that’s a red flag. That’s a major red flag,” says Ajayi-Akintade. “That child should be seen immediately to make sure that child can hear.”
As a developmental pediatrician, Ajayi-Akintade says she first looks for signs of non-verbal communication.
“Does the child gesture? Does the child look at you properly? Is the child aware of his or her environment?” questions Ajayi-Akintade. “I also look at motor skills and language, and I carefully look at a child’s abilities in regard to his [or her] chronological age.”

“Obviously, if I see a 1-year-old, and that child’s developmental quotient is 50 percent—or, is doing things at a 6-month age level—my job is to figure out what’s going on,” she continues. “Is there a need for brain imaging? Is there a need for blood testing? Genetics testing? Does the child look different from his or her siblings?”
In addition to walking and talking, families and physicians should also keep an eye on a child’s social and emotional development, such as whether a child is having difficulty interacting with other children at ages 2 and 2 1/2, even with adult facilitation.

“If a child can’t make eye contact, is showing sensitivity to things like textures, sound, and light, that’s going to cue me that this is a child who may have sensory processing difficulties,” says Harriette Wimms, director of Inpatient Pediatric Psychology at Mt. Washington Pediatric Hospital and director of Community Outreach at the Mariposa Child Success Programs, a Towson-based nonprofit group offering workshops and consultation to educators, parents, and caregivers on healthy child development. “I think, years ago, people weren’t paying attention to that.”

Times Have Changed

In the past, many parents complained that their doctors would dismiss their concerns about delays in their child’s development, telling them to simply, “Wait and see.”
Generally, that’s no longer true.
“If parents come to me and say, ‘My child is not doing things right,’ usually they are right,” says Ajayi-Akintade. “They might not be able to tell there’s a speech delay, they might not be able to tell there’s a motor delay, but they do know—especially parents who have other children—and, overall, pediatricians [now] take the concerns of parents seriously.”
“What I’ve found over the years is that parents want to know,” she continues. “I think parents appreciate when I tell them, ‘Look, your child is 10 months old, and he or she is two months behind.’ I think they appreciate that. I don’t think they feel alarmed.”

Most babies sit up at about 5 months. And, by 6 months, many of them can sit independently. Shortly after that, they’re probably crawling and they’re pulling (or trying to pull) themselves up to stand. By 9 or 10 months, many babies are strong and confident enough to begin wobbling around the room while clinging to the closest object for support, or to cruise along while holding onto furniture or whatever is stable that’s close at hand. At about 1 year of age, most children take their first steps.

But remember that these are simply guidelines, and that there may sometimes be reasons why they don’t match your expectations. For instance, says Ajayi-Akintade, if Mom has three other children at home and they all walked at 8 months old, and the fourth child does not, that’s worth a closer look at why.
Plus, a child’s development isn’t necessarily linear.

“There may be some back and forth as new skills come in,” says Barbara Willer, deputy executive director of the National Association for the Education of Young Children, described on its website as the world’s largest organization dedicated to improving the well-being of all young children, with particular focus on the quality of educational and developmental services for all children from birth through age 8. “Things don’t always come in neatly, step by step.”

If you suspect a delay in your baby’s development, bring that concern to the attention of your child’s pediatrician as soon as possible. You may also want to contact the Maryland Infants and Toddlers program, a state program providing therapy and support for children ages birth to 3 years with developmental delays. (See this month’s column, The Early Years, for an article on the Maryland Infants and Toddlers program.) Early intervention is the key to nullifying or mitigating the effects of a developmental delay. BC

On the Go with Healthy Beginnings

While numerous child development charts are available on the Internet, one that is particularly valuable is on the Healthy Beginnings website,, a resource developed by the Maryland State Department of Education (MSDE) in collaboration with the Johns Hopkins University Center for Technology in Education. The site provides child development guidelines as well as tips and suggestions for families and caregivers to interact with their little ones.
“It’s valuable for the child who may have a developmental delay in a particular area. You can see where his or her typically developing peers would be according to age,” says Liz Kelley, director of the Office of Child Care for MSDE. “Then, you can look back into the document to find out what kind of activities you can or do with the child, to help to develop the skills and hopefully get [him or her] caught up with typically developing peers?”
“Children develop at all kinds of rates,” she adds, reminding parents that the charts are based on averages. BC

Preschoolers, Specifically…

What are preschool ages anyway?
The National Association for the Education of Young Children (NAEYC) identifies preschoolers as children between the ages of 2 1/2 to 4 1/2, give or take a month. And, as with many aspects of child development, there’s room for a little leeway.
Preschoolers spend a lot of time exploring the world around them, says Barbara Willer, deputy executive director of NAEYC. You’ll often find them engaging in pretend play with their stuffed animals or dolls or wanting to play house. Or they like to play with action figures or building blocks.
“It’s really their effort to learn about the world around them and incorporate that learning through their play,” explains Willer.
She also says that the number and types of words young children hear have a well-documented impact on their language development.
For instance, says Willer, children whose “primary social language” consists mainly of simple commands such as “No,” “Don’t do that,” or, “Stop” can be at a disadvantage. Instead, Willer suggests engaging preschoolers with open-ended questions, such as “What do you think?” to help build their language and social skills.

Developing Skills for Ages 2 to 5

The average 2 year old usually:
Speaks about 50 words.
Begins to play make-believe.
Can scribble.
The average 3 year old usually:
Speaks 250 to 500 words or more.
Starts asking “why” questions.
Can copy a circle.
The average 4 year old usually:
Becomes involved in more complex imaginary play.
Can draw a person with two to four body parts.
The average 5 year old usually:
Uses his or her imagination to create stories.
Can copy a triangle and other geometric patterns.


© Baltimore’s Child Inc. June 2011

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