What’s Normal? What’s Not?
What is normal? Is my child growing up like other children?
This is one of the most commonly asked questions of parents and of other adults who may interact, work or play with children. It is also one of the most difficult questions to answer clearly. Here are some things to keep in mind.
Things to Remember
- Most children do grow-up without significant problems. Estimates are hard to come by, but a minority (up to 20%; CDC ) of children are diagnosed each year with mental health (psychiatric) issues or disabilities requiring special education services in the schools (approximately 13%; ies). These statistics vary by family income level, ethnicity and geographic location.
- There is great diversity in how children develop. Some are ahead of their peers in some areas, while behind their peers in other areas.
- The typical steps in how most children develop age-to-age are sometimes called “milestones”. For example, most (but not all) children crawl before they walk. And the common age at which walking or a child’s first steps occurs is around 9-12 months of age. However, this covers only 50% of babies—the other 50% start to walk later. See the “milestones” section below.
- Some children can display what are called “developmental delays” that are not necessarily disorders or do not necessarily lead to disorders. Statistics suggest that 8% or more young children will exhibit such delays. See the “developmental delays” section below.
- Remember: It is common for parents to worry about their child’s development. It is, in fact, a good thing to observe and think about these issues. Only by doing so, can potentially important issues in a child’s development be brought to the attention of a professional who can properly assess the child’s development.
Milestones In Development
The links below are various sources of information about typical patterns of child growth and development. Again, they represent only the most common patterns and average ages we see these milestones, and therefore they do not portray the equally normal and common diversity we see in children as they age. Note also that some milestones come at different times for boys or girls. See “things to remember” above.
If after exploring these milestones you have concerns, see the section below called “developmental delay” or other sections of our site dealing with specific disorders or where to get help.
A Developmental Delay is a “significant” lag in a child’s physical, cognitive, behavioral, emotional, or social development, when compared to norms or typical milestones. The term “significant” is hard to define simply. It can vary according to:
- The particular milestone being measured. For example, there is more variation in the age at which a typical child walks (9-17 months) versus displays a social interactive smile (1-3 months). Thus, saying what is a real delay for milestones with broader ranges of variation can be more difficult than for milestones with narrower age ranges.
- State laws that determine if a developmentally delayed child is eligible for services. Children with delays can qualify for services but what is needed for qualification can vary location-to-location.
- The experience and approach of the professional assessing the child. Some professionals will take a very statistical approach to defining a significant delay. For example, they may consider a child significantly delayed when he/she has failed to accomplish a milestone when some 70% of their peers have. Another professional, based on his/her experience, may not be so worried.
The important thing to remember is to watch your child develop. Explore the available information, talk to other parents, see what other children do, but bear in mind that children differ—a lot! And if you have a concern about your child’s development, seek the advice of a professional. See section below called “get help”.
- Having a Developmental Delay is not the Same as Having a Disorder
- The key thing about delays is that they are usually less severe than a disorder and that they will either go away on their own or with the help of a treatment.
- It is difficult to know ahead of time if a child will catch up on their own. Often they do. So in some cases a professional is completely correct to say “wait a while and don’t worry too much…”. However, if you feel that your concerns have been dismissed too quickly, go back and ask for a formal developmental assessment. At the very least this should include some sort of standard assessment instrument, family history and parental report.
- Delays do respond to treatments and the earlier treatments are initiated the better. Treatments may involve therapies performed by professionals outside the home. In some cases, treatments occur in the home as well. Treatments may be complex, such as physical therapies, or simple, such as advising parents to engage with the child differently or in a more stimulating way.
Remember that what appears to be a delay can be the precursor or early sign of a disorder but often it is not. Being a watchful parent and an advocate for proper assessments and services can be critical to your child’s health. If needed, the earlier treatments are started the better the outcome. Be patient, avoid anxieties, gain knowledge. See the “get help” section below.
Things That Can Cause Delays
- The culture, ethnicity and language background of the child. For instance, infants raised in multilingual homes may be behind their monolingual peers in some early aspects of language development. However, research suggests that these delays pretty much disappear by age 4 or so. See child development chart.
- The extent to which a child is raised in an impoverished environment. Studies show that delays are more common in economically depressed families and in families where in-the-home stimulation is minimal regardless of the economic standing of the household.
- Natural variation in genetics. Some children simply get the genetics predisposing them to be delayed in development although they can catch-up. The chance mixture of parental genes is a contributor in the differences we see across children making some children fast or slow developers. But just because there may be a genetic basis to the delays does not mean that the delays cannot be helped by proper treatments.
- Genetic risk factors. This type of genetics can be a bit different than natural variation mentioned above. It refers to specific genes that can put a child at risk for delays and eventual disorders. For example, there are genes that put children at risk for reading-related learning disabilities in the later years that may show their effects as delays in language when the child is quite young.
- Environmental factors. In addition to the environmental factors like economics, there are other more specific “environmental risk factors”, that like their genetic risk factor counterparts, can cause delays and perhaps yield more serious disorders later. These include things like physical and emotional abuse, toxins like lead, drugs the mother may have taken during pregnancy, and poor nutrition.
Remember that there are many causes of delays and that genetics and environment work together to produce delays as well as determining if and how a child will catch-up. For more information on this topic see child development chart.
Causes of a Child's Normal Development
Witnessing your child grow and change can be an amazing experience. Many people ask questions like: Why does a child grow as he or she does? What is the basis of milestones such that they tend to have average ages across children and often go in a certain sequence? What underlies these changes?
- The answers are complicated. But here are a few points about them:
- Child development is a reflection of muscle, bone, brain and physiology as it changes and matures.
- Many of these changes are governed by genetics which in turn interact with the environment.
- Therefore, differences we see in how children develop, some behind and some ahead of their peers, are because children experience different things in their environment and have different genes.
- Similarly, delays or disorders in some children are because they have the genes and/or environments that trigger these things.
- All humans are designed to walk, talk, and play in certain ways. They are programmed to acquire these abilities given normal environments. This is why all typically developing humans look quite similar.
- The way the nervous and other body systems develop requires that some things come before others. The brain must be able to store language information before it is able to use that information in speech. The muscular and skeletal systems must exercise and practice skills like holding the head up before the body can jump up and run. Thus, we necessarily see the common sequences in development that we call milestones.
There is a lot of interesting information on these mechanisms of development. The interested reader should see the child development chart.
- If you feel that your child may have a delay that concerns you may want to have your child formally assessed. After the assessment you can speak with the professional about next steps.
- These types of assessments are sometimes called “developmental screenings” or “developmental evaluations”.
- These two sites offer more information about these evaluations: Developmental Screening & Developmental Evaluations
- The resources in or near Merced County for screenings can be found here.
- You are also encouraged to speak with your child care provider, such as teachers at his or her preschools or their pediatrician. You might also speak with your own health care professional/physician for advice about how to proceed.
- Remember: Read the information in this section on delays and normal development, be a calm advocate for your needs, and know that early interventions, if needed, are usually best.
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