How do we know if our child’s development is on track?

Posted on Apr 02, 2018

The fear of not having a “normal offspring is one of the most common worries that haunts almost every expectant parent or those who are already into rearing their very young.

How do we know that our child’s development is “on track,” and how do we ensure that our child’s development and behavior is optimal?

In settling that nagging worry, it is very important that parents monitor and recognize the state of their child’s physical, mental and behavioral progress through some standards.

When we speak of growth and development in children, we are specifically referring to how our child grows physically (e.g. anthropometric measurements like weight, length or height, head circumference), and how he achieves the expected developmental norms and milestones (e.g. the different domains of development like gross motor, fine motor, language, personal and social).

During the first two years of life, physical as well as brain growth is very much dependent on nutrition especially during the so-called ‘critical period’ which starts from in-utero or when the child is still in the womb up to the first two years of birth. For proper brain development, both the conceiving mother and her baby or toddler should be eating a healthy and well-balanced diet. Brain development is very important as it impacts on the future cognitive skills of a child.

Aside from proper nutrition, the child should also be given the appropriate environmental stimulation; which would stimulate the child’s different senses like hearing, sight, smell and touch, most especially during the first year of life.

Parents should also make sure that their child is healthy by providing him with the proper immunization to protect him from getting sick; bringing him regularly to a primary care physician for his well-baby and well-child care; and if their child gets sick, that he’s getting the proper treatment and management.

There are several principles of development that a parent or any healthcare professional who is looking after a child, must know.

First is that development is a continuous process, from conception to maturity. It simply means that development begins in utero, while the mother is still conceiving the baby or the baby is inside the womb and goes on until adulthood.

Another principle states that the sequence of development is the same in all children but the rate will vary from one child to another. For instance, when we speak of motor development, it should start from head control, to sitting, to standing, to walking and then to running. All children follow this sequence. However, the rate would vary some kids can walk as early as nine months while others can walk as late as seventeen months (still within the normal age range for independent walking which is from 9 to 17 months).

The next principle notes that motor development proceeds in a cephalocaudal direction (e.g. head to the foot). This is best explained with our example above regarding sequential motor development.

The next principle pertains to environmental stimuli whose course is from general to specific. A good example is when a baby would receive a painful stimulus when he would respond by crying and moving almost all the different parts of his body, but as he grows older, his response becomes more specific e.g. shoveling away the painful stimulus or withdrawing the part of his body exposed to hurting the stimulus.

Lastly, certain primitive reflexes have to be lost before a corresponding voluntary movement is acquired. One example of this is that newborns have a lot of what we call primitive reflexes, including palmar, planta, sucking, rooting, Moro, etc. Such reflexes should normally disappear at a certain age (e.g. palmar grasp at four months, to pave way for the voluntary grasping and/or reaching for objects.)

Parents also need to know the essential milestones of development across the different domains, in order to know whether their child’s development is on track or not.

For normal gross motor milestones, the child should have a good head control between 3 to 6 months, to sit alone at 8 – 9 months, and stand alone at one year. He should be walking at 9 to 17 months, with a mean age at 13 months, running well at 2 years old, riding a bike at 3, catching a ball at 4, going up and down a stair with alternate feet at 4-1/2 years old; skipping rope ad doing a backward heel-to-toe walk at 5 to 6 years old.

For fine motor skills, a child has visual tracking of around 90 degrees angle at one month and 180 degree angle at two months, grasping and reaching for objects at four to five months, holding a bottle at six months, throwing toys or holding a trainer’s cup at 12 months, scribbling at 15 to 18 months, copying a circle at 3 years, a cross at 4 years, a square at 5 years,; printing his name and all the letters of the alphabet in proper sequence as well as counting numbers 1 to 10 at five years.

For language milestones, a newborn normally startles at birth; turns to sound at 4 months,  responds to the word “no” or “bye-bye” at 8 to 9 months, follows a simple command without gesture at one year and a two-step command at 2years old. He should utter non-specific “dada” or “mama” at eight months, three words with meaning at one year, 10 words with meaning at 18 months, phrases at 2 years, and simple sentences at 3 years old. He should state his name age and gender at three years old. A child should be 100% intelligible in his speech to non-family members at 4 years old.

For personal social, the child should have a social smile at 2 months, wave “bye bye” at 8 to 9 months, attempt to use a spoon at one year. He should be toilet trained by day at 2 years, by night at 3 years; could button and unbutton at 4 years and dressed self completely at 5 to 6 years old.

For cognitive skills, a baby should have a good concept of object permanence by 9 to 12 months, build a tower of 3 cubes at 15 months; 3 shapes in a form board puzzles by 2 years old; recognize colors by 4 to four-and-a-half years old, a mastery of the alphabet by 5 years old, and read 2 to three-letter words as well as perform simple addition and subtraction by 6 years old.

Parents should always remember the key ingredients to ensure optimal growth development in their child including the following: proper nutrition, parental love and affection; keeping the child healthy and free from getting sick. If you have concerns about the course of your child’s growth and development, visit the St. Luke’s Medical Center’s Neurodevelopmental Center. This specialized center provides interdisciplinary evaluation and management of children and adolescents (up to 18 years old) who manifest developmental or behavioral problems in the cognitive, motor, communicative and/or academic realms. Its interdisciplinary team of professionals (child neurologists, neuropsychologists, speech-language pathologists, occupational therapists, educational specialists, social workers and nurses) evaluates each child’s needs and work together to develop a customized plan of treatment.