The Areas of Development and the Limits of Normal

A child's development is like a structure that grows before your eyes but is made up of many different parts. While your child is learning to walk, run, and use their hands skillfully, they are at the same time learning to talk, to connect with others, to think, and to manage their emotions. All of these move forward together, feeding one another. In this chapter, we'll first briefly introduce these different areas of development; then we'll approach the question parents wonder about most: "Is this normal, or should I see a specialist?" Our aim is not to frighten you; it's to help you tell apart, with a calm eye, which situation calls for waiting and which calls for action.

The five main areas of development

Thinking of child development under five main headings makes things easier. Each of these areas will be covered in detail in later chapters; here we're just drawing the map of the road.

The first is motor development, meaning movement skills. This comes in two kinds. Gross motor skills are movements that use the large muscles, such as holding the head up, sitting, crawling, walking, and running. Fine motor skills are the hands' more precise tasks, such as picking up a small object between thumb and forefinger, using a spoon, and scribbling.

The second is language and communication development. This area covers a child's understanding of sounds and words, and expressing themselves through words or gestures. The first babbles, the first words, and the sentences that form over time are the steps of this road. But communication is not only speaking; pointing, making eye contact, and using hand and arm gestures are part of this area too.

The third is social and emotional development. This is a child's ability to connect with other people, to make eye contact, to smile, to build love and trust, and to recognize and eventually manage their emotions. A baby smiling when they see their mother and a child being able to play with peers both belong to this area.

The fourth is cognitive, or thinking, development. This area includes the skills of learning, being curious, solving problems, remembering, and being able to focus attention on a task. It's a wide world stretching from realizing that objects don't vanish when they disappear from view, to figuring out how a toy works.

The fifth is the area of behavior. Sleep patterns, appetite, coping with tantrums, following rules, and the rhythm of daily life are all thought of under this heading. Behavior is also a mirror of the other four areas; a change in a child's behavior can be a clue about development in another area.

Normal is not a line but a wide range

Perhaps one of the most important ideas to keep in mind from this book is this: developmental milestones (also called mileposts) are not a single "pass line"; they are a wide range. In other words, there's no strict rule that says "every child must walk at exactly this month." Each skill has an average age when most children reach it, and there's also an upper limit up to which the skill can still appear late in healthy children.

Let's give a concrete example. Independent walking begins around twelve months in most children. But in some completely healthy children it can appear as late as eighteen months. So if your thirteen-month-old is not walking yet, that alone is not a sign of a problem. Every child has their own pace; some talk first and walk later, some the other way around. Comparing one child with another child or with a "calendar" usually creates unnecessary worry.

So what should we look at? Not a single milestone, but the overall course of development and its trend over time. Is your child adding new things each month compared to the month before, are they moving forward? That's what truly reassures us.

Four keys to understanding a difference

When evaluating a child's development, it's very helpful to distinguish four different situations. Let's introduce them in simple terms.

• Delay: a skill not yet gained at the expected age, but in the right order. The good news is that delays often have a "catch-up" course; the child comes along a bit behind but can close the gap with appropriate support.
• A different order or quality: a skill gained in an unusual order or in an unusual way. For example, a baby who tries to stand before learning to sit and moves their legs stiffly, rubbing them together, may suggest the muscles could be more tense than they should be.
• Imbalance between areas: one area moving along very well while another clearly lags behind. For example, movement development being right for the child's age while language and social communication are clearly behind falls into this situation.
• Regression: the most important and most urgent of these. Regression is the loss of a skill a child had previously gained. Examples include a child who had started talking going quiet, a walking child starting to fall, or losing the eye contact they'd made.

Why is regression so important?

While a delay can often be made up for with patience and support, the loss of a skill already gained is a different matter. A child no longer being able to do something they used to do is a warning sign that must always be evaluated. It should be taken seriously until proven otherwise, and a pediatric neurologist should be consulted without losing time. Acting early here is very valuable; because in childhood, the brain has the power to reorganize itself with the right support given at the right time.

Please remember this: when you notice a regression, rather than trying to explain it to yourself, the best thing is to share it with a doctor. In this chapter we introduce what regression is; which signs to watch for especially at which ages, we'll cover in detail later, in the chapter devoted to red flags.

The "let's wait, they'll grow out of it" trap

There's a phrase often heard from older family members or those around you: "Don't worry, they'll grow out of it." This is usually said with good intentions and, in many cases, with a well-founded instinct; and indeed, many small differences do fall into place on their own over time. But this approach has a shadow side. If there is a regression or a clear warning sign, saying "let's wait" can cost you precious time that can't be reversed. In childhood, time is one of the most valuable resources.

So the healthy balance is this: don't panic over small differences in pace, and give your child room to develop at their own speed. But when you see a clear sign like the loss of a skill, don't wait; consult a specialist, even if only to put your mind at ease. Consulting is not admitting there's a problem; it's simply making sure the right eyes look at it at the right time. Most of the time you'll leave these visits with the news that "everything is fine"; and in the times you don't, the benefit of having acted early is priceless.

• There are five areas of development: movement, language and communication, social-emotional, thinking, and behavior; they all move forward together.
• Developmental milestones are not a single line but a wide range; every child has their own pace.
• A delay can often be caught up; what really matters is the overall course of development.
• The loss of a skill already gained, that is, regression, is the most urgent warning sign and must be evaluated without losing time.
• The phrase "they'll grow out of it" may hold true for small differences; but if there's a clear warning sign, consult rather than wait.