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There seem to be a lot of milestones we need to keep track of: smiling, rolling, sitting, lifting their head, crawling, etc. But a lot of it feels like it’ll happen eventually or isn’t that big of a deal anymore, so which milestones actually matter to a pediatrician? I’d rather keep our focus on those.
—Hesitant Milestone Tracker
The focus on milestones can add a lot of unnecessary anxiety for parents. While it can be satisfying to check the accomplishments off the list, especially when your child is on target or ahead of schedule, anything that’s not adhering to the plan can cause concern when taken out of context. This is the reason the milestone schedule is supposed to correlate with the timing of your appointments with your pediatrician. Ideally, your pediatrician is helping assuage your concerns and is there to answer any questions you may have.
Milestones are based on normative data and bell curves. For most milestones, there is a wide range between the most “advanced” baby and the baby who is slower to reach a target skill. This range is often almost three months when looking at milestones under age 1, and often even longer after. Other factors, such as head size and body weight, also impact when kids achieve their milestones because it takes more strength to hold up a 90th percentile head than a 10th percentile head. Kids often are asynchronous in their development — progressing faster in some areas than others — with speech, motor, and social and emotional skills all unfolding at different times.
All of this said, there are a couple of milestones that, as a pediatrician, I always pay attention to: sitting without support and saying three to five words. I pick these not necessarily because of the significance neurologically or developmentally, but because of the meaningful impact they can make both when children achieve them or when they are delayed. Sitting with minimal support is important for the safe introduction of solid foods and occurs at 6 months. We know that by introducing allergens early, all babies (and high-risk babies in particular) benefit from even earlier introduction between 4-6 months. However, many babies aren’t ready developmentally to eat yet at 4 months: they tongue thrust, pushing the food out, and don’t have great control of their head, which enables proper swallowing. Sitting is a sign of readiness to eat.
Additionally, when babies miss this, I often find there are identifiable root causes, such as spending excessive time in a stroller, car seat, or bouncer instead of on the floor. We know that a minimum amount of floor time, at least 15-30 minutes a day, helps prevent positional plagiocephaly or having a flat head. Beyond head shape, infants continue to benefit from free floor play, though specific guidelines don’t exist; common sense implies it continues to be important. Identifying babies who need assistance sitting is important because those same interventions will allow them to focus on developmentally appropriate play, cruising, rolling, and walking.
Similarly, I like to hear babies making a lot of different noises at age 1 and having their first three to five words by around 15 months. I pay close attention to this one because social and emotional communication is essential for regulation and secure attachment. Often, when babies are behind schedule here, I consider checking their hearing as well.
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