A general paediatrician looks after children from birth until they are anywhere between 16-18 years of age generally. We look after medical issues such as asthma, constipation and headaches; but a large part of our practice is monitoring children and supporting their parents in ensuring normal development.
When we are trying to assess how a child is going developmentally, we divide up skills into different domains – this helps us to more clearly demonstrate if children are meeting the milestones they are supposed to
Domains of Development
= areas of development that are relatively distinct
- Gross motor – balance, coordination
- Fine motor – hand skills
- Speech & Language
- Social Interaction & Self Cares
For example, one of the most well known GROSS MOTOR milestones is that babies usually begin to walk independently at around 12 months of age. Of course as with everything developmental, there is a wide range of normal and this can be anywhere from 10 months, to 18 months for walking.
Why should we bother to look for developmental problems?
- Disorders are common
- Disorders are chronic (ie they generally last a long time)
- To find treatable cause (only occasionally with current knowledge)
- Early intervention means better overall outcomes for children because of early brain “plasticity”
- Maximize parental understanding of child
- Prevent/ ameliorate secondary complications (low self esteem, mental health problems (eg anxiety), substance abuse etc)
Developmental paediatrics is a complex part of looking after children so we obviously can’t cover it all in one small blog post. Today we are going to focus on language development.
We recognise that children will make vocalisations/noises as soon as they are born. Gradually, like all skills, these noises become more refined and intelligible as meaningful words as they get older. Then comes the formation of short phrases, then sentences, and then the ability to converse and so on. Below are some rough guidelines to the language milestones of babies and children of various ages:
- Vocalisation (making noises) from birth
- Squealing / laughing – 2 months
- Single syllables – 6 months (eg “ba”)
- Multi-syllabic babble – 6-9 months (eg “Bababababa”)
- Mama/ dada (non-specific) – 9 months (that is, saying “Mama” but not necessarily directed at their mother)
- Mama/ dada (specific) – 12 months (that is, saying “Mama” or “Dada” with meaning – directed at a parent)
- 4 -20 words – 15 months
- Combining words 2 words together – 2 years
- >20 word vocabulary – 2 years
- Body parts – a few by 2 years
- Object names – a few by 2 years
- Actions/uses (ie which one flies?) – a few by 3 years
- Prepositions (on, under, in front, behind) – 3-4 years
- Adjectives (cold,tired,hungry) – 4 years
- Opposites (eg fire is hot, ice is…?) – 4–5 years
Intelligibility is the ability of the child to be understood. Usually the child’s mother or father are able to understand what they are trying say before other people. Listed below are the general milestones for intelligibility at certain ages:
– A child should be 50% intelligible (that is, HALF of what they say should be understood by a stranger) at 2 yearrs
– A child should be 75% intelligible at 3 years
– A child should be 100% at 4 years (that is, everything they say should be clear and understood by a stranger)
If you are worried about your child’s speech development then you should first seek the advice of your General Practitioner, AND get a HEARING ASSESSMENT and then a referral to a Paediatric Speech Pathologist if necessary and/or a Paediatrician to look at your child’s developmental profile.
Developmental RED FLAGS – When should you seek developmental intervention and/or assessment for your child?
ANY AGE if there are:
- Strong parent (or teacher) concerns
- Significant delay in milestones in one or more domains
- Regression (significant loss of skills)
- Stuttering that impairs child’s intelligibility or peer interaction
- Unusual behaviours (eg – repetitive/ obsessive; self injury)
- Not rolling/ sitting/ holding head & shoulders up
- Hands persistently clenched
- Doesn’t smile laugh or squeal responsively
- Not crawling / standing holding on
- No multi-syllable babbling
- No back and forth gestures (pointing, showing, waving)
- No back and forth sharing of enjoyment (eye contact, facial expression, interactive games eg peekaboo)…esp parent-initiated
18 months to 2 years
- Not walking
- No words
- No understanding of crayon/ pencil usage
- Not running well
- Limited word combinations/ phrases
- Not interested in pretend play or other children
- No interest in self-care skills (feeding, dressing)
- Can’t walk up & down stairs easily or pedal a tricycle
- Speech difficult to understand
- Not drawing simple pictures
- Unwilling/ unable to play cooperatively
- Not toilet trained by day
- Poor balance / very clumsy
- Can’t copy simple shapes
- Can’t follow instructions
- Poor grammar/ reduced intelligibility
- Not independent with self cares (dressing, eating, toileting)
REMEMBER developmental milestones are a spectrum and as with many things there is a wide range of normal.
Just because your someone else’s child can do something and your child can’t – is not a cause for panic.
However, if you have concerns, seek the advice of your GP with a referral to a paediatrician if necessary +/- therapy if needed. We have guidelines to help us to piece together a picture of each individual child and their skills, and to help us to decide if they need developmental support or assistance.
Will do some more posts on developmental milestones soon,
Till next time – keep talking to your kids!
xx Dr Megs