Dr. Bob: I am worried that my 16-month-old grandson is behind in his development. He has barely started walking and falls frequently. Plus, he only says a few words. What should we do?
Answer: It is appropriate for you to be concerned as we want our children to be on target and assessed if they are not. There are some basics that should be considered—
- Well child checkups are imperative in the first two years of life. In addition to the potentially life-saving immunizations, your pediatrician will be making developmental assessments. Screening assessment tools will often be used. Their expertise is critical to the ability to interpret what is happening and what needs to be done. Their experience along with a skillful examination can help provide information about the nerve and muscle status of the child, about the visual status, about hearing and other critical factors in child development. An awful lot can be determined by a skilled physician.
- You can get a good idea of what might be expected with a quick peek at a CDC website that is specifically for parents and family members to see what is expected developmentally (https://www.cdc.gov/ncbddd/actearly/).
- Not all children are the same so the specific times that infants and toddlers acquire certain skills can vary.
Now, let me address some of your specific concerns.
- Most children will start walking around 12 months of age but there is significant variability. I have seen children start to walk before 12 months and some not start until 18 months. But more important than the specific skill of walking is the assessment of the child’s bones, joints, muscles and nerves. The muscle tone and strength might signal an abnormality before children do or do not achieve a particular milestone.
- Vision and hearing issues might affect motor development. It is so important to check those factors early so potential interventions can occur.
- Toddlers do fall frequently and often walk with an unsteady gait that improves with age. To toddle means to walk with short, unsteady steps, so “toddlers” is a great description for children this age.
- Saying only a few words at 16 months of age is not out of the ordinary, but again each child needs their own assessment. In addition to hearing concerns, language expression is a combination of receptive language and expressive language. Your pediatrician is skilled in the assessment of those, usually in conjunction with therapists and specialists.
- It takes a team to assess and follow children to assure their development.
In all of my years of experience, I welcomed any concerns about development. I wanted to be sure that the family felt comfortable with their child’s development. It was important for me to listen intently and make sure that we were addressing all of issues regarding development. It is perfectly acceptable to question everything about your child. Why? Because if problems are identified, early interventions can often minimize detrimental effects. Problems that are not identified or adequately addressed might lead to problems that could have been minimized or even corrected. Sometimes, a simple course of close follow-up might provide the reassurance that both the family and the doctor need. But we do not want to miss something. Don’t be embarrassed to ask your pediatrician about a child’s development. They are on your side.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.