OPINION: Children come in all shapes and sizes, but not with a manual. Childhood achievements such as walking and talking are often celebrated signs that things are going well in a child’s life. However, once these achievements start being compared between children (at the park, on Facebook) they can become the cause of anxiety.
Why isn’t he crawling yet? Is her language normal? Is there something wrong?
It’s often difficult for parents to know whether they should be waiting or worrying. Asking for advice is natural but lots of opinions can be confusing.
Doctors, health professionals or early childhood teachers may give differing opinions about childhood development as they often look at it from different perspectives. Family and friends may give alarmist advice or be falsely reassuring.
Parental knowledge and instincts about their children are very powerful but parents often lack objective reference points to compare their children to. Anxiety, hope, denial and competing priorities can complicate matters.
Understanding the key underlying principles of child development will help clarify these issues and outline what needs action, and what action to take.
What is ‘normal’ development?
The age that children attain certain skills is variable. While many children achieve skills at a similar age, the range of what is considered “normal development” is in fact far broader than what is considered “common”.
For example, it’s common to walk at around 12 months but it can be perfectly normal to not walk until 16 months. Normal development relies on an underlying foundation of elements: a child’s body, brain, well-being and practice. If all these elements are healthy, then it can be normal to be slower in a certain milestone.
But if any of these elements are impaired then a child’s development might be problematic, even if their milestones appear at a common age. Two children who appear to have the same difficulty walking might, in fact, have very different underlying issues and require different interventions.
Foundations of child development
Body, brain, well-being and practice is one way to group together the vast and expanding body of research about the foundations of childhood development.
Body refers to a child’s physical health. Eyesight, hearing, nutrition, muscles and internal organs all need to be in good shape. A child’s metabolic systems, iron and thyroid hormone levels are also important.
Brain refers to neural pathways and regions of the brain that are specific for certain skills. For example, there are specific brain centres for motor co-ordination, language and social reciprocity. Genetic code anomalies are important underlying causes of problems. The health of pregnant women, for example having sufficient folate and avoiding alcohol, is also well recognised as important.
Well-being refers to social and emotional health that is related to a child’s temperament and nurturing. It presents as a sense of self, resilience and determination. Children need safety, security and reciprocal engagement from their carers’ and community to thrive.
Practice refers to having access to the right environmental opportunities to practice developing skills. A child needs exposure to key experiences and activities for the brain to develop optimally. Children then build future skills based on this.
What do I need to know about milestones?
Child development is a continuous process of acquiring skills, or milestones, which emerge from the foundations described above. Professionals cluster developmental skills into groups or domains. These are commonly called motor, communication, cognition and social-emotional domains.
Motor: gross motor skills refers to the control of the body and limbs. These are most easily recognised in infancy, and include skills such as head control, sitting and walking. Fine motor skills refers to the use of hands and fingers, such as when manipulating objects and drawing with precision. The quality of motor skills also depends on muscle tone and co-ordination, which may be smooth, clumsy or imprecise.
Communication is one of the best recognised domains and is divided into three components: expressive language (production of words and sentences), receptive language(understanding of sentences) and non-verbal communication or pre-linguistic skills.
Pre-linguistic skills are essential for healthy language development. They are the way we communicate in the absence of words and include eye contact, gestures and reciprocal responses.
Cognition or intelligence is often signified by problem-solving skills, memory, and identifying key concepts. As children’s cognition develops, they mature in their co-operation, application to new tasks and they broaden their play skills. Every parent marvels at their child’s ability to learn new things, but assessing intelligence objectively requires a formal test.
Social and emotional: babies have an inherent interest in human voice and movement, and our brains involuntarily mirror the movements we see. Toddlers watch other children and soon want to spend more time with enjoyable people than toys.
They are programmed to “copy and paste” what others do. Toddlers observe, mimic and extend on things they see, then look for a response and re-evaluate their actions. Children who have limited “copy and paste” or reduced interest in the perspectives of others tend to learn on their own agenda, and this leads to the slower acquisition of skills.
Emotional development manifests as a balance between confidence and seeking reassurance, developing a sound sense of self and others. Instability in early emotional development can result in dysregulation of emotions, unsettled behaviour, or sometimes guarded social responses.
Helping my child’s development
Milestones can be useful markers of a child’s progress, but alone they are not good tools for diagnosis. The context, pattern and foundations that underpin childhood development are central to interpreting milestones.
A practical way for parents to bring together all of the aspects of child development into everyday experiences can be summarised as Love Talk Sing Read Play. This is a resource for parents containing helpful information on what to expect from your child, how to stimulate them and when to seek further advice.
Milestones are measurable evidence of a child’s development but are not always the best way to understand what children need. If you find yourself worrying about your child’s milestones, see your GP or early childhood nurse and start a conversation about your child’s development and what to do next.
Milestones are visible and well known. Supporting children’s needs, and understanding their developmental foundations, is much more important than simply measuring when they walked or talked.
Chris Elliot is Consultant Paediatrician and Conjoint Associate Lecturer at UNSW.
Con Papadopoulos is a specialist in developmental and general paediatrics at UNSW.
This opinion piece was first published in The Conversation.