Observing developmental milestones may reveal anomalies in early childhood
10 May 2021
bySaras Ramiya
Parents should be advised to pay close attention to their child’s behaviour, actions, and habits, and seek early medical help if they notice any abnormalities. Early childhood is a crucial developmental stage therefore parents should observe key milestones involving gross motor, fine motor and vision, behaviour and social development, and speech and hearing.
Milestones, influenced by genetic, neurological, physical, environmental, and emotional factors, are defined as the progressive and orderly acquisition of skills and abilities as a child grows. While there are specific objectives to attain, it is essential to highlight to parents that the rate of development differs from one child to another, said Dr Hasmawati Hassan, a consultant neonatologist.
“The first years of life are so important for a child’s growth. Early experiences make a difference in how young children’s brain cells develop and can influence lifelong learning and health. Thus, it is important to spend time with young children and observe how they are growing. Developmental monitoring means observing and noting specific ways a child plays, learns, speaks, acts, and moves every day, in an ongoing way,” she said.
Consultant paediatrician Dr Melanie Majaham emphasized on the importance of paediatrician visits depending on the child’s age or if they have any underlying medical conditions.
“During each visit, babies are monitored for growth and to detect any issues such as poor weight gain or obesity. The doctors will also discuss details such as feeding frequency, weaning plans and milestones with the parents. Typical appointments will usually link up with the vaccination schedule, but visits will be more frequent if it involves any medical problems or other tests such as blood or urine tests,” she said.
Signs indicating developmental anomalies
According to Hasmawati, each child shows diverse stages of growth at different ages, but parents need to be aware of some early warning signs as follows:
Gross motor
The primary objective is for children to be able to walk and this begins with head control. At 6 months, they should be able to sit without support momentarily, shift from sitting to standing position by holding on to support at 9–10 months, and be able to walk at 12–14 months.
Early warning signs
· Child is unable to attain head control or has gross head lag at 4–6 weeks of age.
· Child is unable to roll over by 5 months, sit by 8 months, stand with support by 10 months or walk by 15 months.
Fine motor
The primary objective is for children to develop the two-finger pincer grasp. A newborn’s hand will remain fisted until the third month, and they should develop the pincer grasp at 9–12 months old.
Early warning signs
· Persistent fisting after 3 months.
· Persistent thumb abduction and flexion after 3 months.
· Not reaching out for objects after 5 months.
· Persistent spread of fingers when attempting to take objects after 5 months.
· Persistent palmar grasp after 9 months.
· Failure to develop a good pincer grasp after 1 year.
Behaviour and social development
This is to assess children’s ability to interact with and respond to their environment. This can range from displaying stranger anxiety at 7 months, to being able to drink from a cup at 12 months.
Early warning signs
· At 6–9 months old: very quiet, not smiling or laughing, not responding to their name or no stranger anxiety.
· At 9–12 months old: continue to have stranger anxiety or do not understand waving their hands to wish goodbye.
Speech and hearing
The primary objective is for children to speak, beginning with cooing, respond to sounds and the ability to verbalize simple words such as ‘mama’ or ‘dada.’ Their vocabulary should improve as they grow older.
Early warning signs
· No smile at 3 months.
· No attempt to laugh at 6 months.
· No babbling and not responding to their name at 6–9 months.
· Still babbling or quiet at 9–12 months.
If parents present with their child who has any of the early warning signs, indicating possible developmental delay, they should be referred to a neonatologist or paediatrician for further investigation and management.
Specialist care involves various technological advancements, including screenings, tests and treatments which can assist parents in providing a better future for their child. Melanie said these tests include the Denver Developmental Screening Test (DDST), used as a reference to monitor the milestones, as well as the Modified Checklist for Autism in Toddlers (M-CHAT) score to detect early signs of autism spectrum disorder (ASD). These tests are commonly administered between 16 and 30 months of age.
“Any concerns need to be addressed and discussed with the child’s parents. Occasionally, the child may need to be assessed further by an expert multidisciplinary team that includes a child psychologist, developmental paediatrician, occupational therapist, physiotherapist, feeding and speech therapist so that the child can benefit from an early intervention programme to enable the child to achieve their full potential,” Melanie added.
Hasmawati said parents can conduct many different development-promoting activities with their children to keep them stimulated and curious about exploring the environment around them.
“For example, parents can try singing and talking to their child using exaggerated tones of voice and observe the baby’s facial expressions to see how they react to different pitches—this will help with language development. For visual, social, and emotional development, they can try showing their baby their reflection in a baby-safe mirror and asking them ‘who is that?’ and repeating the gesture with their own or something recognizable such as a stuffed animal or sibling,” she said.
Milestones, influenced by genetic, neurological, physical, environmental, and emotional factors, are defined as the progressive and orderly acquisition of skills and abilities as a child grows. While there are specific objectives to attain, it is essential to highlight to parents that the rate of development differs from one child to another, said Dr Hasmawati Hassan, a consultant neonatologist.
“The first years of life are so important for a child’s growth. Early experiences make a difference in how young children’s brain cells develop and can influence lifelong learning and health. Thus, it is important to spend time with young children and observe how they are growing. Developmental monitoring means observing and noting specific ways a child plays, learns, speaks, acts, and moves every day, in an ongoing way,” she said.
Consultant paediatrician Dr Melanie Majaham emphasized on the importance of paediatrician visits depending on the child’s age or if they have any underlying medical conditions.
“During each visit, babies are monitored for growth and to detect any issues such as poor weight gain or obesity. The doctors will also discuss details such as feeding frequency, weaning plans and milestones with the parents. Typical appointments will usually link up with the vaccination schedule, but visits will be more frequent if it involves any medical problems or other tests such as blood or urine tests,” she said.
Signs indicating developmental anomalies
According to Hasmawati, each child shows diverse stages of growth at different ages, but parents need to be aware of some early warning signs as follows:
Gross motor
The primary objective is for children to be able to walk and this begins with head control. At 6 months, they should be able to sit without support momentarily, shift from sitting to standing position by holding on to support at 9–10 months, and be able to walk at 12–14 months.
Early warning signs
· Child is unable to attain head control or has gross head lag at 4–6 weeks of age.
· Child is unable to roll over by 5 months, sit by 8 months, stand with support by 10 months or walk by 15 months.
Fine motor
The primary objective is for children to develop the two-finger pincer grasp. A newborn’s hand will remain fisted until the third month, and they should develop the pincer grasp at 9–12 months old.
Early warning signs
· Persistent fisting after 3 months.
· Persistent thumb abduction and flexion after 3 months.
· Not reaching out for objects after 5 months.
· Persistent spread of fingers when attempting to take objects after 5 months.
· Persistent palmar grasp after 9 months.
· Failure to develop a good pincer grasp after 1 year.
Behaviour and social development
This is to assess children’s ability to interact with and respond to their environment. This can range from displaying stranger anxiety at 7 months, to being able to drink from a cup at 12 months.
Early warning signs
· At 6–9 months old: very quiet, not smiling or laughing, not responding to their name or no stranger anxiety.
· At 9–12 months old: continue to have stranger anxiety or do not understand waving their hands to wish goodbye.
Speech and hearing
The primary objective is for children to speak, beginning with cooing, respond to sounds and the ability to verbalize simple words such as ‘mama’ or ‘dada.’ Their vocabulary should improve as they grow older.
Early warning signs
· No smile at 3 months.
· No attempt to laugh at 6 months.
· No babbling and not responding to their name at 6–9 months.
· Still babbling or quiet at 9–12 months.
If parents present with their child who has any of the early warning signs, indicating possible developmental delay, they should be referred to a neonatologist or paediatrician for further investigation and management.
Specialist care involves various technological advancements, including screenings, tests and treatments which can assist parents in providing a better future for their child. Melanie said these tests include the Denver Developmental Screening Test (DDST), used as a reference to monitor the milestones, as well as the Modified Checklist for Autism in Toddlers (M-CHAT) score to detect early signs of autism spectrum disorder (ASD). These tests are commonly administered between 16 and 30 months of age.
“Any concerns need to be addressed and discussed with the child’s parents. Occasionally, the child may need to be assessed further by an expert multidisciplinary team that includes a child psychologist, developmental paediatrician, occupational therapist, physiotherapist, feeding and speech therapist so that the child can benefit from an early intervention programme to enable the child to achieve their full potential,” Melanie added.
Hasmawati said parents can conduct many different development-promoting activities with their children to keep them stimulated and curious about exploring the environment around them.
“For example, parents can try singing and talking to their child using exaggerated tones of voice and observe the baby’s facial expressions to see how they react to different pitches—this will help with language development. For visual, social, and emotional development, they can try showing their baby their reflection in a baby-safe mirror and asking them ‘who is that?’ and repeating the gesture with their own or something recognizable such as a stuffed animal or sibling,” she said.