What Does It All Mean: Why Do We Track Milestones Anyway?

Raising his hand, photo courtesy Nett Family, Preemie Power 2010

Photo credit: Nett Family

Early childhood is measured in milestones. First smile. First step. First word. Parents are encouraged to track what their baby can do compared to their typical peers. This can bring both anxiety and frustration when you are worried that your baby is not “on track.” But what can you do? While it’s tempting to throw the milestone charts out entirely, there is a better option. Remind yourself why we track milestones in the first place. Tracking milestones is all about recognizing how one skill builds upon the next. We watch to make sure that our babies are following a progression that will give them the tools they need to thrive. While your child will follow their own unique path, there are certain benchmarks they will need to visit along the way.

But what do you do if your child doesn’t follow the typical progression? That doesn’t necessarily mean the typical milestones won’t apply. It just means they need to be adapted for your child. You might consider breaking your child’s early development down into a new, broader set of categories. This will help remind you what you’re really working towards. Ask yourself: What are the things your child really needs to be healthy and happy? Thinking about milestones in this new light will help you create unique, personalized goals for your child based on the things you really want them to achieve – like being healthy and learning to communicate, move and play.


Jada at two weeks old

Photo credit: Alter Family

Your child’s developmental journey began early in the womb. As their bodies and brains developed they progressed along a path unique to them and their environment. When babies are born early that development must continue outside of the womb. While we used to think that most babies were prepared to enter the world after 35 weeks, we now understand just how much development happens in the final month of pregnancy.

Your baby’s NICU team will do everything they can to create an environment where your baby can grow and develop in a way that is most like the womb. This is called developmental care, and it has come a long way in recent years. Developmental care not only includes monitoring the noise volume, light level and activity in the NICU but also includes being thoughtful about how your baby is positioned and how much sleep they get.

Read more about Sleep and Brain Development.

All of this is done to help your baby achieve physiological stability. Without that it’s hard to make progress. Think back to when you talked to your doctors and nurses about when your baby would come home. You probably learned that progress was not measured in days, but in accomplishments. Your baby had to reach certain goals before being considered for discharge. Before your baby could come home they had to learn to regulate their body temperature, remember to breathe, be able to take all their feedings, and gain weight. While, as a general guideline, many babies are able to do this by their original due date, age is not an indicator of when your baby will graduate from the NICU.


Preemie in the NICU - Preemie Power 2011

Photo credit: Raymer Family

Once your baby’s brain and body have developed enough to be physiologically stable, you will begin to focus on building the broader skills your child needs. First and foremost is communication. In the NICU you begin to learn how to read your baby’s cues. This is their first, most basic way for babies to communicate what they need. This conversation with your baby will continue once you go home. Even the youngest, tiniest babies are able to express their mood. A grimace, a hand over the eyes, or a tight posture lets you know your baby is distressed. Conversely, a relaxed, symmetrical, organized posture and steady gaze tell you your baby is ready to talk to you.

When they are ready, talk to your baby. Touch them. Carry them with you. Babies love the sound of your voice and the rhythm of your movements. Beginning at just a few months of age infants will mimic your expressions and coo in response to your voice. Even if your baby is quiet, their eyes and gaze will do the talking.

As your baby grows their ability to communicate with you will grow, too. But no matter how your baby develops, remember that the larger goal is communication – the give and take of information between you and your child. There is more than one way to accomplish this. Babies who can’t yet speak can often sign. Children with limited motor skills can use eye gaze. It doesn’t matter what the mode is. What matters is that you’re communicating.


Crawling at Physical Therapy, photo courtesy Farish Family

Photo credit: Farish Family

Eventually your baby is going to express the desire to get around on their own. What begins as holding their head up during tummy time often progresses to rolling, scooting, sitting and crawling. But the sort of muscle control, strength, coordination and gross motor skills it takes to walk are incredibly complicated. Even in typically developing children, there is a very broad range of ages at which it is considered normal to start walking. Don’t get too hung up on one mode of getting around. There are lots of ways to accomplish this goal. If your child is having a difficult time putting all the skills together to walk, there are lots of  tools to support mobility. Using walkers, gait-trainers, orthotics and wheelchairs are all great ways of getting around.  And most children can benefit from occupational and physical therapy as well. Talk to you pediatrician and care team about what might benefit your child.

Problem Solving

When you’re just beginning to learn about the world around you, life is a series of puzzles to be solved. Babies learn how to make sense of things through exploration, trial and error. And they use whatever tools are available to them. (This includes putting nearly everything in their mouths!)  Give your little one safe opportunities to explore and learn. Help them see the connection between cause and effect. Show them that their actions will be met with a predictable response. Once they understand this they have tremendous power. Most babies quickly discover ways to get what they need – and what they want. For example, young babies understand the connection between crying and getting picked up. Soon they will even make sense of more complicated things like object permanence. (Where did you go during that game of peek-a-boo!)

Social Skills

Babies have certain advantages in life, like being adorable. They enter the social arena ready to be loved and cared for. As they develop, their social skills grow, too. They smile readily and giggle when they are happy. They protest and complain when they’re upset. You seldom have to wonder what they are thinking.

toothy grin, Photo courtesy Deal Family, Preemie Power 2010

Photo credit: Deal Family

One of the most amazing transformations you will experience is when your baby begins to share and enjoy things with you. Early on babies start to point. Then they’re ready to request things. But “joint attention” to an object or game is a sign that your baby really sees themselves as part of a larger social world. It is one of the first hallmarks of social understanding. Soon they will transition from playing side-by-side with others to joining in activities together. Your little one will start to seek out other children and be excited to be around them. Coincidentally, this is the time developmentally when we also start to see the first signs of independence and defiance. (But when you think about it, even those are desirable qualities!)

No matter what your child’s developmental journey is, keep the “big picture” in mind. Once you start to see your child for all the amazing things they can do, you’ll be less likely to focus on what they can’t. Try to remember that children are incredibly inventive and resilient. They will find ways to meet their communication, mobility and social needs. Follow their lead and put as many supports in place as possible. Give them every opportunity to succeed  and you will be amazed by what they accomplish!

Erika Goyer is hand to Hold’s Education Director. She is also the mother of three boys and the parent of a child with special developmental needs.

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