Green Lights & Red Flags

When it comes to developmental milestones, little kids are like good architecture: Form follows function.

The important milestones of childhood exist on a continuum, providing the skills essential for independence – from feeding themselves to dressing themselves, from walking to riding a bike. 

“All those motor tasks allow them to gain function and participate in the world,” says Dr. Neal Rojas, a behavioral and developmental pediatrician who sees patients at the Center for Developing Minds in Los Gatos and teaches pediatric residents at the University of California San Francisco.

But, those much-watched milestone charts are intended to be approximate. Children develop at their own pace, and parents shouldn’t worry if their baby isn’t performing exactly on schedule.

“It’s a plus or minus of a couple months either way,” says Dr. Manisha Panchal, pediatrician at the Palo Alto Medical Foundation’s Santa Clara office. “Some kids talk early, some talk late. If they’re not babbling by nine months, we’re not going to send them for therapy – even though it says they do it in the book. We look at the overall development.”

If parents are worried, they should never hesitate to pass on their concern to their child’s doctor. Studies consistently show that most parents recognize a problem with their child’s development before it’s detected in a screening test. 

Yet many doctors say that parents often resist seeking help when it’s still early enough to make a difference.

“I don’t know why parents are so opposed to speech therapy,” Panchal says. “I see it all the time. Often, by 2 ½ – if the child isn’t using enough words – I’ll bring it up and say they need to go.

“‘Let’s wait,’ they tell me. `It’s going to be okay.’ For some reason, speech therapy has a negative connotation.”

Let’s Play Pretend

Though reaching specific childhood milestones is somewhat hard-wired, parents can do many activities that encourage their kids’ development. Most of these involve imaginative, back-and-forth play – the kind of games that Dr. Damon Korb, director of Developing Minds and a specialist in autism treatment, calls “the bread-and-butter” of parenting.

“So much language is conceptual, and pretend play is how we get at it,” says Korb. “Starting at 15 months, I look to see whether a child is showing imagination. Can they pick up a phone and pretend to talk? By 18 months, can they pick up a shoe and pretend it’s a phone? 

“It shocks me how often I ask parents about whether their kids can play like this, and their response is, `We don’t know, we don’t really do that.’ That’s something every parent needs to do with their child.”

The linear thinking that takes place on a computer is hardly a replacement for the kind of rich pretend play that young minds require to thrive and grow.

“We don’t need battery-operated toys,” Korb says. “We need tea sets and dolls, blocks and construction sets” – things that encourage imaginative play.

“So much of the conversation starts with back-and-forth,” he says. 

“Certainly, we’re concerned about whether children make eye contact. Whether they want to make me (the parent) happy. Do they want to show me things? Do they look at what I look at? If I throw a ball to them, do they try to catch it or do they just walk away?”

Red flags for developmental delay include (but are not restricted to) the following: 

  • not giving big smiles at 7 months

  • not responding to his or her own name at 12 months

  • not speaking single words by 12 months

  • not using two-word phrases or showing interest in other children by 2 years old

  • not interacting with other children or engaging in pretend play by 3.

There are free screening tools online, among them the Modified Checklist for Autism in Toddlers. Intended for physician use, it is often referred to by concerned parents.

“I was just speaking with a parent who talked about going on the Internet to find out if her child has autism,” recalls Rojas. “I said, ‘Gosh, if you were worried about diabetes, would you go to the Internet or go to your doctor?’

“The idea that the complexity of child development is something that a lay person ought to be … handling by themselves, that ought to be dispelled.”

Preschool Power

Rojas is a strong endorser of preschool to encourage development, since “it provides a platform and structure” for finger painting, mud pies and other activities that busy parents often avoid, he says. 

“The kids are grabbing the paints, the glue, the glitter. They’re getting their hands dirty – and that’s one thing I see a lot of parents afraid of.”

Parents need to offer their kids plenty of chance to “push their boundaries and gain social skills,” he adds.

“That’s the thing about the jungle gym. It’s not just gross motor skills, but social skills. How do we wait our turn? How do we deal with a child who’s in our space? All of a sudden, the jungle gym becomes a pirate ship – so think about all the imaginative play that happens. That’s when language develops.”

While it’s understandable to become anxious, just remember that all growth – be it physical, linguistic or cognitive – has bumps in the road.

“When a child is working on one thing very hard – like learning to climb stairs – they might put something else on pause,” explains Rojas. 

“For a few weeks, they don’t learn any more new words, because they’re really focusing on stairs. They have to put something on the back burner for something else that’s more important to them. It’s not necessarily a stagnation or regression of growth. It’s just a pause.”

Sara Solovitch is an associate editor at Bay Area Parent.


Resources Online
  • American Academy of Pediatrics –

  • Ages and Stages: A Parent’s Guide to Normal Childhood Development, by Charles E. Schaefer and Theresa Foy DiGeronimo (Wiley, 2000)

  • Your Child’s Growing Mind: Brain Development and Learning From Birth to Adolescence, by Jane Healy (Three Rivers Press, 2004)
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