OBSERVING AND RECORDING BABY’S DEVELOPMENTAL MILESTONES EMPOWERS PARENTS TO BE MORE INFORMED AND SERVES AS A GUIDE FOR EARLY INTERVENTION

Meeting developmental milestones in the early years is the most critical. The term developmental milestone is often used to denote the acquisition of control and coordination of specific voluntary movements during infancy and childhood.

These early motor achievements are important components in developmental scales (e.g. Bayley Scales of Development).

2, 3

2. Bayley, N. (1969). Manual for the Bayley Scales of Infant Development. San Antonio, TX: The Psychological Corporation.

3. Bayley, N. (1993). Bayley Scales of Infant Development, Second Edition: Manual. San Antonio, TX: The Psychological Corporation.

Such scales are used to evaluate the integration of the developing central nervous system in infants and young children. Most importantly, it functions as a screening device to identify children with developmental problems, or who might be at risk for developing such problems. Emphasis on early identification and diagnosis so that early intervention can be initiated if necessary.

Monitoring functional movement skills of infants and toddlers frequently (three-week intervals) and quickly (minutes) produces information on whether development is on track or in need of intervention. Researchers presented the development of the Early Movement Monitoring Assessment (EMMA).

42 children (5 to 36 months at start) were assessed at three-week intervals using coded observations with standardised toys in a two-minute session. A model was employed to investigate the sensitivity of the tool to developmental change in frequency of total movements across seven assessment sessions. Findings showed that across developmental time, each cohort “grew in movement skill”. Within each cohort, the movement skills increased as the children aged, and the sessions progressed.

Parents, especially first-time parents, tend to be excited and look forward to their babies’ motor development milestones as they progress month by month. Parents are encouraged to observe and record their child’s developmental milestones to provide the most appropriate environment and toys. The AIMS home video method which requires parents to record their children’s motor skills using video is a form of active parental involvement. This leads to a better understanding of infants’ motor development.

Parents with infants at risk for delay will benefit from this knowledge. It might help them to become "their child’s expert" even more and as such improve equality in shared decision making between parents and professionals.

The level of motor age as determined from voluntary motor activities relate to reflex behaviour by elaboration and description. Pediatricians have reported that assigning children a motor age is not an easy task, since very few children could be placed at an exact level. Instead, assigning a functional motor range might be more useful and appropriate, for example, a child who is credited with some of the activities at the 6, 7, and 8-month levels would be said to be performing at a 6 to 8-month level. Such approximate statements seem more accurate since the motor behaviours appearing on the chart are only a small sample of the full spectrum of learned motor activities.

There are also developmental differences in children from different countries and origins. The ages at which developmental milestones are met, can also be widely distributed and across ethnicity or culture. A study found developmental differences in children of European and Asian origins.

Pediatricians should consider using a different scale for assessing developmental milestones with a normative sample representing ethnic diversity. Otherwise, differences may be erroneously interpreted as delays when they are within the typical variation for that infant’s ethnic origin.

A motor milestone study was set up to review the methods for generating windows of achievement for six gross motor developmental milestones. The study also aimed to compare the actual windows with commonly used motor development scales.

Trained fieldworkers assessed 816 children aged 4 to 24 months at scheduled visits (monthly in year 1 and bi-monthly in year 2) in Ghana, India, Norway, Oman and the USA. Longitudinal data were collected to describe the attainment of six gross motor milestones – sitting without support, standing with assistance, hands and knees crawling, walking with assistance, standing alone and walking alone. Results showed that about 90 per cent of the children achieved five of the milestones following a common sequence and 4.5 per cent did not exhibit hands-and-knees crawling. The six windows have age overlaps but vary in width; the narrowest is sitting without support (5.4 months), and the widest are walking alone (9.4 months) and standing alone (10.0 months).

It is noteworthy that infants under the "at risk" category should be monitored and well-supported during this critical window of achievement. A longitudinal study involved a large, population-based sample of 1,555 infants recruited from well-baby clinics in five municipalities in southeast Norway.

Using the Ages and Stages Questionnaire, they conducted latent class analyses to identify common pathways within the five developmental areas – communication, gross motor, fine motor, problem-solving and social-emotional skills. Findings revealed that male infants with low gestational age, low Apgar score and mothers with depression symptoms or non-Scandinavian ethnicity may be at risk of developing less beneficial developmental pathways, especially within the communication area.

Nevertheless, parents should express concern only if the child has not performed one or more milestones that he or she should have and, ideally, the assessment should be based on repeated evaluations over time. For example, the acquisition of independent walking constitutes a major challenge for infants and might be acquired within a wide age range from 8-18 months of age.

The study is more of a review of methods for generating windows of milestone achievement and a comparison to commonly used motor development instruments. Most importantly, observing and following the child’s lead in gross motor development is the key to a healthy and happy baby.