AskMeDoctor! S2 Ep16 Part 1: Children's Development Milestone

Skills such as taking the first step, smiling, rolling over, crawling, walking and more are all considered milestones. There is a normal range in which these milestones are different for each age group. In this episode of AskMeDoctor! we have Dr. Foo Chee Hoe, a paediatrician from Dr. Foo Child Specialist Clinic to share with us about a child’s development milestone. Q1: What is the healthy development of a child? Image Credit: chickyolive.com Dr. Foo: A child will be developing healthily when they are consistently and gradually acquire all the developmental skills from the state of a tiny vulnerable newborn baby to a bigger, older child. So, if you observe a baby, from newborn time all the way to five years old, we can see a very remarkable progressive acquisition of developmental skills. We identified four (4) key areas whenever we talk about the developmental ability of the child that he/she should be consistently, gradually and steadily acquire: Gross motor function Fine motor and vision Speech, hearing and language skills Socio-emotional behavioural skills Q2: What is a developmental milestone? Dr. Foo: A milestone is like a flagship developmental skill that we put in place, at a specific age range. So that, it is easy for us to assess and identify whether there is any reason to be concerned about the development. If a certain milestone developmental skills are not achieved by a certain age, then it could raise a red flag to us that make us very concerned whether there is a developmental delay in the child. Q3: Can you elaborate about the developmental milestone at a glance? Dr. Foo: A child will progressively acquire skills from a tiny baby all the way to a bigger child. So, in these four (4) key areas, let's start with gross motor. Gross Motor Milestones In the area of gross motor function, they should have a good neck strength with no head lagging between 3 to 5 five months. They will sit up by 6 to 8 months. Usually, they will sit up very well, straight back between 8 to 9 months. They usually crawl by 9 months and they are able to pull themselves up to stand up at 10 to 12 months. They can walk by holding on to the furniture at around 12 months. They should walk independently by 18 months and then progress into running, climbing, jumping, ball kicking as they move on all the way. By after 2 years old, they should be very actively running, confidently acquire more and more motor skills. Fine Motor Skills When talking about fine motor skills, fine motor coordination is very much linked up with their visions. So, we assess their visions first. By 6 weeks to 2 months old, their eyes should be tracking a moving object very well—usually your face or a very bright, interesting coloured object—so their eyes will follow a moving object, from left to right. And then by 4 months of age, they should be able to try to reach out for a toy and then by 6 months they can use their palm to grasp the toy. And by 10 months they should able to have a pincer grip, means not just using a palm to grasp, they can actually use two fingers like a chopstick like that, usually the thumb and the index finger to pince, to grasp, to grip on a tiny object by 10 months of age usually. And of course, after 1 year old, they will progress to hold writing utensils to scribble, to draw, and then from scribbling they will be able to draw pictures they can write as they progress to 2 to 3 years beyond. And they should be able to also stack cubes after 1 year old, from a tower of 2 cubes becomes a tower of 3 cubes and 6 cubes as they grow older and older. Speech & Hearing In terms of speech and hearing, they will be able to make sounds and laughs by 4 months of age, usually around that. They can call papa, mama between 10 to 12 months, usually they will call papa first, papa seems to be easier. At around 12 months, they should also have 2 to 3 words besides papa and mama and they should be able to understand when they are called and they can understand simple instructions by 12 months, can understand ‘no’, they can understand ‘come here’. By 1 and a half years old, they should be able to point to their body parts when named, such as ‘show me where is your eye’, they should be able to point to their eye, ‘where is your nose, where is your ear’, something like that. At least 3 body parts by 18 months. This shows that they are able to receive the audio message, be able to process in their brain and execute it out. Comprehensive language is very important. For the children between the age of 1 to 2 years old, they should demonstrate a very good level of comprehensive language. As for expressive language, how many words they can talk. It can be more subjective and has a broad variation between children to children. But, you must have a comprehensive language before you are able to speak up to express. So, from the simple 2 words, 3 words at 1 year old, you will then progress into able to make 2 words short phrases by the age of 2 years old. Socio-emotional Behavioural Skills Then comes to the socio-emotional behavioural skills, just as when their vision is developing to be able to look at a face, so, they should be able to smile responsively by 6 weeks old and then they will learn to put food in their mouth by 6 months, they have mouthing. And then they can wave bye-bye, they can maybe even do high five and flying kiss between 10 to 12 months. They can feed themselves, use a spoon, maybe very clumsily, it doesn’t matter. They can use a spoon to have a concept of putting food into the mouth with a spoon by 18 months. And then they can have imaginative play by 2 years old, they will be toilet trained at least the day time, they are dry by day, they do not need to wear diapers anymore they can indicate they need to go to the toilet between 2 to 3 years old depending on how soon they are willing to be trained. And 3 years plus, they will have more advanced kinds of play – imaginative play, interactive kind of play, taking turns to play, pretending, imagining and etc. So, all these 4 key areas, at the glance, of course, it could be like a lot of information overload, but, like you, each parent can have a checklist and also the doctor will also have a checklist to check on them whenever they have a chance to see them. Q4: What are the factors contributing to their development? Dr. Foo: In short, there are two factors – medical organic factors and environmental factors. Environmental factors So, let’s start with environmental factors first. The environment means where the child grows up. So, there will be physical needs and there are psychological needs. The physical needs factors would be the child should have a safe place to grow up, a healthy place with good nutrition, and good healthcare. So, all these will ensure the child is able to grow up healthily and therefore, develop properly. And also psychological needs, we cannot just give food and shelter and that’s it, leave the child behind. I think parental love, affectionate love, love and care give the child a sense of confidence security and also to provide leadership by example be a good role model for your child especially when they go into tantrums, you know, how you teach them. These are important factors, these are the environmental factors and these are under the control of the parents, usually. The things that are out of control would be the medical reasons. Medical Reasons Sometimes, unfortunately, the child may have genetic abnormalities, neuromuscular development problems, hormonal problems or they are going through a chronic infection. All these will restrain and hinder the child's development. All these could factor into the child’s development. https://www.youtube.com/watch?vn0mtTJicwCA Wait! That's not all. This is only the first part of the video. Stay tuned for Part 2 of the Children's Development Milestone and for more AskMeDoctors! videos at Motherhood Story.

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