Missed Milestones? Advice from a Family Medicine Specialist

Nearly one in four parents express concern about their child not meeting developmental milestones. Michael A. Traub, MD, a primary care provider at Crystal Run Healthcare who is board certified in Family Medicine, knows how stressful it can be. However, a child’s doctor can help address missed milestones, whether parents are concerned about their child falling behind or showing significant developmental delays.

“While not technically a milestone, parents often put a lot of emphasis on their child's weight,” said Dr. Traub when asked about one of the top questions parents often ask for pediatric patients. “While it's easy to focus on the child's measured weight, we depend on the weight percentiles as well.  This often comes up when discussing how much and how often a child should be fed, or if the child is having issues with spitting up or being fussy while eating.”

The Centers for Disease Control and Prevention recommends that pediatricians and parents not rely only on growth charts to determine how healthy a child is. Child growth charts are percentile curves showing the distribution of selected body measurements in children. These charts are usually used by pediatricians, nurses and parents to track a child’s growth from infancy to teen years. While growth charts can show the percentile a child is in, it is not a grade level for a child to pass or fail in their development.

“If the child is tracking along his or her growth curve nicely, we don't need to drastically increase or change the feeding method,” said Dr. Traub. “Also, being at a higher percentile isn't always necessarily better, and being a little lower isn't always necessarily a bad thing either.”

When considering a child’s milestones, a doctor assesses many areas. How often a child eats, their exercise level, hand-eye coordination, socialization, and behavior are all a part of their development. One thing doctors don’t go over, however, is how a child compares to their siblings or neighbors of the same age.

“It’s tempting to compare one child to another,” said Dr. Traub. “For example, a parent may be worried as their first child was easily crawling or walking at a younger age than their second. This may be because of individual factors with either child or the first child may have been a little ahead in certain skills.”

It’s important to recognize that children can develop skills at different speeds and still reach their milestones for their individual development. There are many tools available to parents to track their child’s development.

The CDC Milestone Tracker provides a checklist for children from two months to five years old. These checklists help give parents a general idea of what to expect as their baby starts to grow, move and interact with the world. If a child has significantly missed a milestone or has regressed in a skill they once had, parents can also ask their child’s doctor for a developmental screening. A developmental screening is done by a licensed professional to assess a child in the skill parents are concerned with. These assessments can check for physical and mental delays.

“Parents will often worry when they hear that their child may be a little behind on any given milestone. The important thing to remember in this situation is that we also look at what degree, or how far behind, they are,” said Dr. Traub. “In many cases, if their development is within a certain range, we don't need to do anything except observe. The majority of children will catch up to that milestone. If that isn’t the case, we’re ready to help with the next steps in planning your child’s care.”

Michael A. Traub, MD is a primary care physician board certified in Family Medicine. He earned his medical degree at St. George's University in Grenada, West Indies. He completed both his internship and residency in Family Medicine at the Centra Medical Group, Lynchburg Family Medicine Residency, in Lynchburg, Virginia. His clinical interests include general practice, pediatrics, musculoskeletal/sports medicine, behavioral health, and medical education. Dr. Traub is currently seeing patients in Middletown, New York.