Many parents remember their children’s first words or first steps—if you’re lucky, maybe you even caught the special moments on camera—but there are plenty of lesser-known milestones to watch out for when trying to understand your little one’s developmental progress.

Angela Orsino, a Toronto-based developmental pediatrician, says that when kids achieve certain milestones later than expected, it can be classified as a developmental delay. A delay is different from a disability, which is a lifelong diagnosis. According to the Canadian Pediatric Society (CPS), milestones are simply the various speech, social, cognitive and motor skills kids develop between birth and age four. “A delay is just a term meaning that they’re behind,” says Orsino.

What should you do if your baby, toddler or preschooler seems to be behind? Get an overview of the major milestones along with early intervention programs across the country.

What are the developmental milestones for children 0 to 5?

Every child develops at their own pace. “There are ranges of when milestones can be achieved,” said Orsino, who added that delays are only considered a red flag if they persist past that range. For example, there might be cause for concern if a baby is not sitting on their own at eight months, since most children master the skill around six months.

Gross motor milestones

According to the CPS, most children can roll over by four months old, control their upper body by eight months and crawl at 12 to 14 months.

If you are waiting for baby’s first steps, Orsino says to remember that the typical walking range is quite broad, between nine and 18 months. She also says that even early walkers can exhibit red flags, such as consistently putting more weight on one leg or only stepping on their toes.

Later on, at four years old, the CPS says that most preschoolers can kick a ball and stand on one foot for a few seconds. To explore a full list of mobility-related milestones, check out this chart.

Speech milestones

“Children start to use their first words between nine and 12 months,” said Orsino. “By 16 months, if parents are still not hearing any words, really, that is a sign to investigate more. Typically, children would need a hearing assessment if there’s any concern about delays in language development.”

Klaudia McDonald is a mom of two and the co-founder of Bobo, an app allowing families to track their baby’s milestones and receive notifications about out-of-the-ordinary progress, which might require attention. When her younger son experienced a speech delay, McDonald says that she worried about their ability communicate or make friends at school.

Social-emotional milestones

Orsino says that if a baby is not smiling or making much eye contact by six months, it could be a red flag. Parents can also monitor other forms of body language while tracking their little one’s milestones.

“Gestures are part of what we call social communication, and a really important one that develops early on is pointing,” said Orsino, adding that most children use pointing to ask for items they want by age one. Later, by 18 months, most toddlers will also point to direct your attention towards something they find interesting, like a plane in the sky or a bulldozer on the street.

According to the CPS, social progress at 24 months old involves playing alongside other kids and showing defiant behaviour in line with the dreaded terrible twos phase. Luckily, the association also says that at four years old, most preschoolers can negotiate solutions to conflicts.

Cognitive milestones

Orsino says that by 12 months, most children can understand a basic cause-and-effect relationship. Your little one might know that by pressing a button on their toy, they will hear a fun song, for example.

By age one, most kids also understand object permanence. “If they see an object but then you cover it up with a blanket, they’ll go looking for it,” said Orsino. “If something’s on their high chair and all of a sudden it falls down, they lean over.”

According to Orsino, if a child loses any of these cognitive, social-emotional, verbal or motor skills, parents should consider the loss a significant red flag. “Child development should always be moving forward, learning new skills and growing over time,” she said.

The early intervention process in Canada

Olaf Kraus de Camargo is a professor of pediatrics at McMaster University. If parents notice red flags and are concerned about a potential developmental delay, he says that a conversation with the child’s kindergarten teacher and family doctor is a worthwhile first step. 

“People who know the child well can help you understand what might be the main issues that should be addressed with certain types of therapy,” said Kraus de Camargo, who adds that a family doctor, pediatrician, psychologist or other provider may begin a screening process to clarify how the child is progressing, given their unique circumstances. 

If screening processes or public health assessments determine that your child is eligible, your family may be connected to targeted, family-centred services, according to early intervention program guidelines from the Government of New Brunswick. This process may include referrals from speech pathologists, occupational therapists or pediatricians. 

“There is variability per province,” explained Orsino. “A lot of these programs are government-funded at the provincial or local level.”

Still, childhood development experts and parents note that waitlists are often long for public early intervention programs. “For a consult with myself, there is a waitlist of three years now,” said Kraus de Camargo, who added that some parents seek private services in light of this challenge. “It is terrible for a family if they have a two-year-old and are worried about their development, and then have to wait until they turn five.”

How does early intervention work?

According to Orsino, many Canadian early intervention programs incorporate the words for Child Development, a framework encouraging folks to consider family, functioning, fitness, fun, friends and future while discussing children’s development.

“Basically, it’s an explanation of health and what contributes to wellbeing,” said Orsino. “The framework really takes a holistic view.” For instance, professionals might consider how children with speech delays function day-to-day, and note whether the child has enough exposure to books and songs which stimulate language development.

This family-centred approach might be displayed in a professional’s recommendations as well. “We need to provide activities that are meaningful to the child and that parents can offer in the home,” said Kraus de Camargo. “One hour of therapy in a week will not make a difference in the development of a child who lives 24 hours every day.”

Accordingly, parents play a vital role in supporting children experiencing developmental delays. For example, Kraus de Camargo says that pediatricians or therapists might tell parents to act less protective towards children experiencing motor delays.

“Of course, you want to ensure safety,” he said, explaining how restricting learning opportunities can hinder a child’s development. “But I think that nowadays, children are a bit bubble wrapped and don’t have the opportunities to climb a tree, explore things on their own, go on a scooter and have a fall and then get up again.”

Trust your instincts

Ultimately, if you are concerned about a missed milestone, experts say that seeking a professional opinion is worthwhile. A 2021 fact sheet from Hamilton Health Sciences and McMaster Children’s Hospital reminds parents that identifying and treating developmental delays early is key to a child’s success.

“When you know your child is sick, or you’re stressing about your child’s health, the easiest thing is to go on social media or ChatGPT,” said McDonald, who encourages parents to avoid researching developmental delays on social platforms. “The reality is, ChatGPT is not the best doctor.”

Experts

• Klaudia McDonald is the co-founder of Bobo, an app allowing families to track baby’s milestones and receive notifications when out-of-norm progress is identified.
• Olaf Kraus de Camargo is a professor at McMaster University’s department of pediatrics and the co-director of CanChild, a centre for childhood disability research.
• Angela Orsino is a developmental pediatrician at Holland Bloorview Kids Rehabilitation Hospital. She is also a director for the University of Toronto’s developmental pediatrics fellowship program.

Article Source: Today’s Parent

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Discovery Point is a daycare in Woodbridge, Ontario, Canada