Hi Emily! I am curious about how exact babies need to be in hitting milestones. Our pediatrician is intelligent, lovely, and very thorough. But she just finished her residency two years ago and seems very anxious about hitting milestones exactly “by the book.” As a first-time mom and admittedly anxious myself, it’s hard to know what to think. The example that is coming to mind is around tummy time. My daughter is 10 weeks and loves tummy time on my chest and the boppy, and holds and turns her head at a 45-degree angle for minutes at a time without dropping. She’ll bob up and down like this for about 10 minutes, and we practice almost every wake window. She holds and turns her head very well in carrier wraps and when being held vertically. We also do a lot of side-lying play that she loves. But when we put her directly on the floor, she just licks the mat or coos at us or her toys.
At our two-month appointment, our pediatrician said if she doesn’t consistently lift her head on the floor by three months, we need to explore physical therapy. This feels aggressive to me as I look at her neck and core strength in all of the other scenarios, but I don’t want to be neglectful to my daughter’s development either. So is there wiggle room on milestones? If so, how do I know when to be patient with my daughter developing at her own pace? And even more, how do I have this conversation with my pediatrician without seeming like I am blowing off her expertise?
Oof, I hear you on this. Milestones are all fun and games until they are not. Sometimes they seem designed to make us feel like we (or our kids) are failing before they even get started. My daughter wasn’t walking at 15 months, and they told us if we came back at 18 months and she still wasn’t walking, she would need PT. I basically wanted to take three weeks off work to focus on baby-walking boot camp. Luckily, my husband talked me out of it.
Two things to say to start. First: There is a range in when kids hit different milestones, and how. The milestones the CDC puts out (see details here) are designed to pick up situations in which a baby or child is behind expectations. But for most milestones, the range of normal is wide — for walking, it’s 7 months to 18 months, which is huge. Similarly, kids do things differently; crawling doesn’t look the same for all kids.
Second: PT is great. Your frame here is very understandable — basically, PT as a threat or failure. But PT can really help; it’s an opportunity to step in if necessary, not a punishment. If that does end up being necessary, I’d urge you to try to see it as lucky it’s accessible, as hard as that might be.
The real question to me is the last one — how to navigate this with your doctor. A useful starting point may be to consider that you and your doctor come with different types of expertise. Your doctor is an expert on babies, and there are some aspects of physical strength that they are looking for that are hard to describe and quantify. You, on the other hand, are an expert on your baby, and what she can do. You see a lot more of her than the doctor does. The challenge is to combine those types of expertise.
The best way to do this as you head into the next appointment is to plan out the conversation. Think about what you’re seeing with your child. Write down your questions. Come prepared to engage as much as possible without judgment. It’s completely fine to ask why — in this case, to ask your doctor how she sees the other evidence of head strength, for example.
A final note: Three months and two months are pretty far apart. It may make sense to wait before borrowing trouble on this.