Child Developmental Milestones
The developing child’s annoying charecteristics
Each day is fascinating, and new developments take place in your baby. However adorable your little baby is, he can at times be exasperating because of his behaviour, questions and annoying ways. It can, at times, be too much for the mother because she lives with it all the time and has no respite from it.
After the first few months, the baby is learning to feed himself. After 9 months of age he can be able to move around. After the age of 1, he will be involved in doing some naughty things. At this age, he has enormous energy and is on the go the whole day and he loves to make noise too. Once he learns to talk he never stops, and wants her to talk back to him all the time.
By the age of 2, he does the opposite of what he is asked to do. Between 2 and 3 he constantly asks questions until the mother is exhausted with answering. One answer leads to another question, and of course we cannot answer many of them.
Crawling, standing, and walking
The baby can have more control over his legs and back and begins to creep or crawl by the end of 8 to 9 months. Some babies move around very fast on their buttocks, giving themselves a push with their legs. Others crawl on all fours and can go all over.
Now is the time to be careful that he does not get into trouble or fall. Around his first birthday be will learn quickly to take a few steps without support. Between 1 year and 18 months most babies are walking about fairly well. A baby-walker is a good innovation and the baby can use it once he has learnt to sit.
Speech has its beginnings in some unknown language of the baby from the third month onwards. He vocalizes more and more, making all sorts of noises which mean nothing, and yet his speech is developing all the time. By 6 months he is constantly babbling and one can respond to some sounds. From 9 months to a year, the sounds become more in number and the baby may use one stund for his mother, another for milk and yet another for water, and so on. Between 1and 2 years the vocabulary increases gradually, and the child is able to express himself and talk fairly clearly. Some children speak baby-talk longer than others, which is quite normal. It is important to talk to your baby while you feed, bathe, care for and play with him.
Speech and Language
If the baby fails to speak by 1 years, many parents get worried. It is important to recall by which time the baby attained the other milestones like sitting, crawling, standing, playing with toys and so on. If all the other things have been done at the right time there is nothing to worry, as your baby may just be a late talker. If you have any doubt, consult your doctor. The often held belief that delayed speech is due to a tongue tie, is not true.
Language is defined as a symbolic system for the storage and exchange of information.
Language consists of auditory expressive ability (speech), receptive ability (listening comprehension), and visual communication (gestures).
I. Normal speech and language development
A. Auditory expressive language development
1. In the first 4 to 6 weeks, the earliest sounds consist of cooing.
2. In the first few months, bilabial sounds begin, consisting of blowing bubbles.
3. By 5 months, laughing and monosyllables appear, such as “da,” “ba,” or “ga.”
4. Between 6 and 8 months,infants begin polysyllabic babbling, consisting of the same syllable repeated, such as “mamama,” “dadadada.”
5. By 9 months, infants sporadically say “mama” or “dada” without knowing the meaning of these sounds.
6. By 10 months of age, infants use “mama” and “dada” consistently to label the appropriate parent.
7. By 12 months, infants acquire one or two words other than “mama,” or “dada.”
8. During the second year of life, vocabulary growth velocity accelerates, starting at one new word per week at 12 months of age and increasing to one or more new words per day by 24 months of age.
9. By 18 to 20 months, a toddler should be using a minimum of 20 words; the 24-month-old should have a vocabulary of at least 50 words.
10. Early during the second year of life toddlers produce jargon, consisting of strings of different sounds, with rising and falling, speech-like inflection. These speech inflection patterns of are referred to as prosody.
11. By 24 months of age, toddlers are producing two-word phrases, such as “want milk!”
12. In the second year of life, pronouns appear (“me” and “you”).
13. Thirdyear.Vocabularygrowth velocityreaches a rateofseveral newwords per day.A30-month-old's vocabulary should be too large for the parent to count (>150 words).
14. By24 to 30 months, childrendevelop “telegraphic” speech, which consists of three- to five-word sentences.
15. By 2 years, the child's speech should be one-half intelligible; by 3 years, it should be three-fourths intelligible, and it should be completely intelligible by age 4 years.
B. Auditory receptive language development
1. Newborn infants respond to vocal stimuli by eye widening or changes in sucking rate.
2. The 2- or 3-month-old infant watches and listens intently to adults and may vocalize back.
3. By 4 months of age the normal infant will turn his head to locate the source ofa voice; turning to inanimate stimuli, such as a bell, occurs 1 month later.
4. By 7 to 9 months of age, an infant will attend selectively to his own name.
5. By 9 months of age, infants comprehend the word “no.”
6. By 1 year of age, infants respond to one-step commands such as “Give it to me.”
7. By 2 years of age, toddlers can follow novel two-step commands. (eg, “Put away your shoes, then go sit down”).
8. By 2 years, children will point to objects on command and name simple objects on command.
9. By 36 months, a child's receptive vocabulary includes 800 words, expanding to 1500-2000 words by age 5.
10. By 5 years, children are able to follow three and four-step commands.
C. Visual language development
1. During the first few weeks, the infant will display alert visual fixation.
2. By 4 to 6 weeks, a social smile appears.
3. By age 4 to 5 months, the infant will turn towards a voice.
4. By 6 to 7 months, infants play gesture games, such as patty cake and peek-a-boo.
5. Between 8 and 9 months, infants reciprocate and eventually initiate gesture games.
6. By 9 months, infants appropriately wave bye-bye on command.
7. Between 9 and 12 months, infants express their desire for an object by reaching and crying.
8. By 12 months, infants indicate desired objects by pointing with the index finger.
II. Classification of speech and language disorders
A. Hearing loss
1. One infant per thousand is born with bilateral, severe-to-profound hearing loss. Two children per thousand are deafened during the first 3 years of life.
2. One-third of congenital deafness is genetic in origin, one-third is nongenetic, and one-third is of unknown etiology. The most common nongenetic cause of deafness is fetal CMV infection.
B. Mental retardation
1. Three percent of children are mentally retarded, and all children who are mentally retarded are language-delayed. Mental retardation (MR) is defined as significantly subaverage general intellectual function plus delayed adaptive skills in the first 5 years of life.
2. Intelligence that is “significantly subaverage” is defined as more than 2 standard deviations (SD) below the mean. “Mild” MR is defined as -2 to -3 SD. Intelligence tests are standardized to a mean score of 100,and mild MR is equivalent to an intelligence quotient (IQ) of 69 to 55. Moderate MR = -3 to -4 SD (IQ 54 to 40), severe MR = -4 to -5 SD (IQ 39 to 25), and below -5 SD is profound MR (IQ lessthan 25).
C. Developmental language disorders (DLD)
1. DLD are disorders characterized by selective impairment of speechand/orlanguage development. General intelligence is normal. DLD affects 5-10% of preschool children, and affected boys outnumber affected girls by 3:1.
2. In the majority of cases, the etiology of DLD remains unknown; however, DLD can be caused bysexchromosome aneuploidy,fragileXsyndrome, neonatal intracranial hemorrhage, fetal alcohol effects, head trauma, or human immunodeficiency virus encephalopathy.
3. Autism manifests as delayed and deviant language development, impaired affective
development, monotonouslyrepetitious behaviors withan insistence on routines, and an onset before 30 months of age. The prevalence is 0.2%. Autism can be caused by most of the same etiologies that cause MR.
a. Physiologic dysfluency is characterized by a transient loss of normal rate and rhythm of speech, and it is normal in children between 2 and 4 years of age. Physiologic disfluency involves repetition of whole words (“I want . . . I want . . . I want to go home”).
b. Stuttering involves repetition of shorter speech segments (“I wu . . . wu . . .wwwwant to go home”) or a complete inability to initiate a word, referred to as “blockage.” The prevalence peaks at 4% between 2 and 4 years of age and declines to 1% among older children and adults.
5. Dysarthria is caused by a physical impairment of the muscles of speech production. Dysarthria in children usually is caused by cerebral palsy.
III. Clinical evaluation of speech and language disorders
A. Infants with hearing-impairment. Deaf infants coo and babble normally until 6 months of age. Thereafter, vocal output graduallydiminishes.
B. Mentally retarded children manifest delay in all language areas. Cooing and babbling may be reduced and delayed.
C. Developmental language delay presents with expressive and receptive impairment, such as impaired intelligibility and delayed emergence of sentence structure. Speech may be effortful and reduced in amount.
D. Autistic children manifest delayed and deviant language, impaired affective development, and repetitious behaviors with an insistence on routines. Autistic type language disorder is marked by impaired pragmatics--failure to use language as a medium of social interaction.
IV. Diagnostic evaluation of speech and language disorders
A. Developmental testing by a speech/language pathologist should be undertaken once speech or language delay has been detected.
B. Audiologic testing is indicated for all children with a sign of a speech or language disorder.
C. Karyotype and DNA probe studies for fragile X are indicated in children who have mental retardation, autism, or developmental language disorder.
D. Human immunodeficiencyvirus (HIV) serology is recommended in higher risk speech-delayed children to exclude HIV encephalopathy.
E. Creatine kinase measurement to exclude Duchenne muscular dystrophy is indicated for boys who have speech delay plus gross motor delay but who do not have increased deep tendon reflexes.
F. Cranial MRI is indicated in the presence of focal neurologic abnormalities or dysmorphic features suggestive of a structural brain abnormality (eg, hypertelorism, midfacial hypoplasia, aberrant hair patterning).
V. Management of speech and language disorders.
The child who has DLD should be referred for speech therapy. Stuttering requires referral to a speech pathologist. Hearing loss is treated with amplification. Therapyfor autism isdirected atenhancing communication and social skills.
Some babies are walking by their first birthday, while others do not walk for another 2 months. These are all normal variations. As long as the child is crawling about vigorously, he cannot have any weakness of his legs, and so there is nothing to worry. If you saw any slow in sitting and crawling also, you must discuss it with your doctor.
Control of the baby
As you know, the newborn could not control his head at all, and you had to support his head with your hand or elbow while carrying him. By the end of 4-6 weeks, the head control begins and gradually becomes more and more developed.
Between 3 and 4 months of age he can hold his head up and does not need any support from you. If he is lying on his abdomen, he can lift his head and shoulders and look around. Newborn babies have a grasp reflex. As soon as anything is put into the palm, say your finger, the baby takes a firm grip of it. Gradually, around 3-4 months, this takes the form of deliberately holding an object. He will use only his palm and the 4 fingers (like monkeys). The thumb is not used at this stage. By the age of 6 months, the baby wants to hold the anything and tries to take it to his mouth. Of course his coordination is not good. By 8-9 months he begins to make use of his thumb and fingers. By 1 year the grasp is mature.
Once the head control is good the baby tries to roll over, first from his stomach to his back and later from his back to his stomach. The next is the sitting up position. This is a major development and baby’s horizon suddenly becomes much wider. This too is not achieved in a day. Remember, you cannot hasten his development. It will have to wait till the particular part of his brain responsible for that function matures. At first he is a bit wobbly on his bottom and rolls over every now and then. Then he can sit supporting himself on his two hands. Later, he feels confident enough to support himself with one hand and holds a toy in the other. By 6-8 months he can pivot around his bottom and still remain steady.
A newborn baby, while very well developed in certain aspects, is completely dependent and cannot do a thing for himself. He can draw your attention to him only by crying. Every now and then he seems to smile as if in a dream, because it is not a smile in response to you, however much you would like to believe it is. When a week old, he seems to take interest in bright objects, and appears to be looking at them. By 3-4 weeks he seems to look at you as if trying to recognize you. You can feel this first contact with your baby, and it sends a thrill through you. Soon he can move his eyes and follow you around the room with his eyes. When he is about 6 weeks old, he actually obliges you with a smile.