Children's developmental milestones

Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, April 26, for an hour-long chat about how parents can help their children reach critical developmental milestones, and discuss techniques that do not work. Chicago Tribune health reporter Deborah L. Shelton will moderate the chat, and questions will be answered by panelists Dr. Michael Pitt and Dr. Penny Glass.

Developmental milestones refer to functional skills that children develop within a certain age range, including cognitive, gross and fine motor, language and communication, and social and emotional skills. Pediatricians evaluate how children are developing based on when they reach certain milestones.

Dr. Michael Pitt is a pediatrician at Children's Memorial Hospital in Chicago and an instructor of pediatrics at Northwestern University Feinberg School of Medicine. Pitt works with a wide range of patients and their families, and instructs parents on various stages of development.

Dr. Penny Glass is the Director of the Child Development Program at the Children’s National Medical Center.

If you are unable to make the chat, or would like to send your question in advance, e-mail Deborah Shelton at

 Health chat: Child developmental milestones(04/26/2011) 
Deborah L. Shelton: 
Welcome to this chat on childhood developmental milestones. We will get started in a few minutes. Please stand by.
Tuesday April 26, 2011 11:49 Deborah L. Shelton
Deborah L. Shelton: 
Welcome to this Chicago Tribune web chat on childhood developmental milestones. I’m Deborah Shelton, a Tribune health reporter and your chat moderator.

During this hour-long chat, we will talk about how parents can help their children reach critical developmental milestones and techniques that do not work.

Developmental milestones refer to functional skills that children develop within a certain age range, including cognitive, gross and fine motor, language and communication, and social and emotional skills. Pediatricians evaluate children on how they are progressing based, in part, on when they reach certain milestones.
Tuesday April 26, 2011 11:59 Deborah L. Shelton
Deborah L. Shelton: 
Our guest experts today are Dr. Michael Pitt, a pediatrician at Children's Memorial Hospital in Chicago and an instructor of pediatrics at Northwestern University Feinberg School of Medicine. Dr. Penny Glass is director of the Child Development Program at the Children¿s National Medical Center in Washington.

Welcome to the chat!

Tuesday April 26, 2011 12:00 Deborah L. Shelton
Michael Pitt, MD: 
Hi. Thank you for having me. I'm looking forward to participating.
Tuesday April 26, 2011 12:00 Michael Pitt, MD
Penny Glass, PhD: 
I'm looking forward to this discussion. Thanks for having me.
Tuesday April 26, 2011 12:02 Penny Glass, PhD
Deborah L. Shelton: 
We are now taking your questions for the experts.

As we await questions, let¿s start the conversation by talking about what babies understand about their world and how they interact with it.
Tuesday April 26, 2011 12:03 Deborah L. Shelton
Penny Glass, PhD: 
At birth, babies are first “listeners,” rather than ¿lookers.¿

At first, a human face should be the most interesting thing for a baby! Visually intense toys and videos are not appropriate.

Tuesday April 26, 2011 12:05 Penny Glass, PhD
[Comment From KatieKatie: ] 
What are the best techniques for getting my baby to put herself to sleep by herself
Tuesday April 26, 2011 12:05 Katie
Deborah L. Shelton: 
Thank you for your question Katie.
Tuesday April 26, 2011 12:06 Deborah L. Shelton
Michael Pitt, MD: 
Katie, you've asked a very popular question that I'm sure many other parents in this forum have. The short answer is that there is no single right answer, but we can certainly discuss some tips. It is most important that you and your caretakers are committed to the plan to allow your infant to sleep by herself. When that decision is made, many parents choose to make a date of the first night's try. It is important to stay united as it can be difficult to not walk in the room if your daughter starts crying, but part of the exercise is to allow her to self soothe. By developing a bedtime routine, she will start to be conditioned to learn it is time for bed.
Tuesday April 26, 2011 12:08 Michael Pitt, MD
Michael Pitt, MD: 
One important point, is that infants in the first two months of life will need to be feeding on demand, and therefore should not sleep through the night.
Tuesday April 26, 2011 12:08 Michael Pitt, MD
[Comment From TonyTony: ] 
My son Aidan is just 6 weeks old, is it too soon to introduce developmental toys and music to his routine? If not, do you have any reccomendations? thank you
Tuesday April 26, 2011 12:09 Tony
Penny Glass, PhD: 
What ever toy is available, it should be no more interesting than your face. Some music is nice, but your baby should be hearing the sounds of your own voice more than music...

For example, toys should generally be pastel, rather than brightly colored, so that they don't compete with your face.
Tuesday April 26, 2011 12:09 Penny Glass, PhD
Deborah L. Shelton: 
That's interesting. People are drawn to the super bright toys!
Tuesday April 26, 2011 12:10 Deborah L. Shelton
Penny Glass, PhD: 
Bright, intense toys are misleading. Babies may be attracted to them, but that doesn't make it "good" for them. These toys produce a higher arousal level, rather than a "thinking, problem-solving" response.
Tuesday April 26, 2011 12:11 Penny Glass, PhD
[Comment From JenniferJennifer: ] 
Hi! My son is almost 9 months, very tall (90th percentile) and strong for his age, yet still cannot crawl, cruise, or pull up from sitting. At what point should I become concerned, and do you have any suggestions>
Tuesday April 26, 2011 12:12 Jennifer
Michael Pitt, MD: 
Jennifer, believe it or not, some children never do crawl. In fact, it is not even considered a true milestone. We are seeing less crawling because children spend less time on their tummies due to the safe sleeping recommendations. Many children use other types of movement to bridge before standing such as scooting on their bottoms or slithering on their stomachs. As long as your son is learning to coordinate each side of his body and is using each arm and leg equally, there¿s no cause for concern. The important thing is that he's able to explore her surroundings on her own and is strengthening her body in preparation for walking. Your pediatrician can assess your son's tone and strength and advise to if there should be concer, but certainly what you are describing is normal in lots of healthy nine month olds.
Tuesday April 26, 2011 12:12 Michael Pitt, MD
[Comment From ClydeClyde: ] 
I have an almost 21 month old daughter who we are trying to potty train (sort of.) She will occasionally tell us she needs to potty and does on toilet but most times doesn't. What methods tend to work best for potty training?
Tuesday April 26, 2011 12:13 Clyde
Penny Glass, PhD: 
21 months is generally too early for consistent success and then parents are disappointed that it doesn't work. Many babies show this early interest and then just are not really ready.
There are good precursors to toilet training:
First, always change your baby in the bathroom, rather than where ever it's convenient.
Second, make sure your child always sits to eat or drink.
Third, consider how long your child can sit and listen to a story.

If your child is interested in using the potty, always take them to the potty and praise their success.
This is good practice for the real thing.
Tuesday April 26, 2011 12:17 Penny Glass, PhD
Deborah L. Shelton: 
Have a question about child development? Our experts are taking your questions live.
Tuesday April 26, 2011 12:18 Deborah L. Shelton
[Comment From RossRoss: ] 
Roughly how many words should my 16 month old be using?
Tuesday April 26, 2011 12:18 Ross
Michael Pitt, MD: 
Ross, there is a wide range of what is considered normal language development, but what we know is more important than the absolute numbers of words children have at a specific month is that they are showing strides and improvements in both expressive and receptive language. Expressive language means what the child is saying or communicating via gestures or shared interest to indicate a want or need. Receptive language means the child's understanding of what is said to him or her. For example, a child who is able to get his toy when asked is showing good receptive language.

As to quantities of words, again a steady improvement is more important than an absolute number. Most 16 month olds should have a handful of words. The average is 1-3 words by 12 months, and 20 or more by 20 months, but again, adding to the handful is more important than a particular number.
Tuesday April 26, 2011 12:19 Michael Pitt, MD
[Comment From MeganMegan: ] 
My 32 month old son is still in diapers and shows no interest in potty training. He also doesn't mind if he has a dirty diaper and will sleep through the night with one. Any tips for getting him interested in the potty? I really don't want a 3 year old in diapers!
Tuesday April 26, 2011 12:21 Megan
Penny Glass, PhD: 
As I mentioned above, there is an indirect approach which helps prepare the child. If those steps are already in place I might add the following:
--Diapers are terrible, children can't even feel that they are wet. Try adding a little discomfort by placing a non-absorbent cloth inside the diaper...
--Peer pressure helps...You can subtly admire when his friend uses the potty.
--Sticker chart helps, if he shows any interest...One of my favorite ways is for the parents to have a sticker chart and award themselves a sticker when they "go", without any comment to the child. Just have a place on the chart with the child's name.,.. see what happens...
Tuesday April 26, 2011 12:25 Penny Glass, PhD
[Comment From GuestGuest: ] 
My husband and I have a disagreement. I've been working with her on identifying colors and the first letters of the alphabet. He thinks she's too young. What cognitive and overall developmental milestones should I expect from my 17-month-old daughter?
Tuesday April 26, 2011 12:25 Guest
Deborah L. Shelton: 
Lots of questions coming in! Thank you. We will try to get to all of them.
Tuesday April 26, 2011 12:27 Deborah L. Shelton
Michael Pitt, MD: 
Chidren learn at different paces. While it is never too early to try to teach things to our children, we do know that kids learn as the play. As they practice making decisions, play with imagination, and take leadership in a play environment, they absorb many of the lessons much faster than if we tried to formally teach them. So while it is not too early to start working on adding to knowledge, the way in which we do it can make a big difference.

As to what to expect from a seventeen month old cognitively, expect a curious, active child interested in the world around them. Children this age should have an understanding of cause and effect (if I press this button, the toy makes this noise) and a good sense of object permanence (If dad hides this toy under the towel, I remember it's under there and will look for it). Games that play off this type of understanding are very effective ways for your child to learn.
Tuesday April 26, 2011 12:28 Michael Pitt, MD
[Comment From KellyKelly: ] 
In addition, my 20 month old nephew is just saying what sounds like "dee" for everything. What do you think that could infer?
Tuesday April 26, 2011 12:28 Kelly
[Comment From AmyAmy: ] 
My 18 month-old has quite a few words, but while I can understand him perfectly, his words are not clear to others. At what age can I expect for his words to become more clear and sound more closely to what they "should" sound like?
Tuesday April 26, 2011 12:28 Amy
Penny Glass, PhD: 
The most important thing about a 20 month old who is saying "dee" for everything is whether he's trying to tell you something, such as looking at you while pointing to something that he wants. In addition, children this age should have a large vocabulary of words that they understand.

Language and communication are more important than pronounciation (speech). There is a lot of normal variability in speech. It's best not to attempt to correct a young child's speech by trying to get them to say it differently, but to just repeat the correct pronounciation (once or twice) so they hear it.
It may also be important to assure that they have normal hearing.
Tuesday April 26, 2011 12:33 Penny Glass, PhD
[Comment From JessicaJessica: ] 
Can you point me in the direction of some guidelines I can use to see where my child should be developmentally?
Tuesday April 26, 2011 12:33 Jessica
Michael Pitt, MD: 
Jessica, the American Academy of Pediatrics has developped a fantastic user-friendly website for parents at This site has answers to many common questions about development and parenting.

One thing I like about this website is that they avoid lists of milestones. It is becoming more and more clear as we gain new evidence, that the age of vigorous checklists of milestones (how many blocks can a 9 month old stack, when can they hop on one foot) are becmoing antiquated and replaced by a more global understanding of the broad range of normal development. While tempting, it is best to avoid stressing over such lists that focus on a theoretical child and not the living breathing real thing.
Tuesday April 26, 2011 12:34 Michael Pitt, MD
Deborah L. Shelton: 
We have a couple of allergy-related questions.
Tuesday April 26, 2011 12:35 Deborah L. Shelton
[Comment From AmyAmy: ] 
I gave my son a scrambled egg at 9 months old and he developed a rash (red dots) the next day (he also had a cold at the time). Is this allergy to the egg? I have not given him egg since. Should I have him tested before giving him egg again?
Tuesday April 26, 2011 12:35 Amy
[Comment From GuestGuest: ] 
Is it possible for a newborn to be allergic to breastmilk?
Tuesday April 26, 2011 12:35 Guest
Michael Pitt, MD: 
Food allergies are certainly on the rise and there are many theories as to why this is the case. Allergic reactions can range from mild such as flushing or diarrhea to life-threatening reactions affecting the airway.

Amy, it is difficult to tell if your son had a reaction to the egg. I can say, that it is uncommon to have an allergic reaction one day after exposure. However, because egg is one of the most common allergic triggers, it is a good idea to talk to your pediatrician in detail about what the rash looked like and he or she can advise further.

To the parent with the question about breastmilk, the answer is yes and no. It is possible to have allergic reactions to breastmilk, but it is not typically the milk itself causing the problem, but a reaction to something the mother has eaten. For example, mothers of children who have a milk protein allergy but wish to breastfeed, can opt to remove dairy from their own diet and safely feed. This can often be teased out with the pediatrician.
Tuesday April 26, 2011 12:39 Michael Pitt, MD
Deborah L. Shelton: 
Some of you are asking about TV time, which is something that many parents worry about how to handle. Thanks for the great questions.
Tuesday April 26, 2011 12:39 Deborah L. Shelton
[Comment From johnjohn: ] 
What are your thoughts on the impacts of early exposure to television on a child's development?
Tuesday April 26, 2011 12:40 john
[Comment From SaraSara: ] 
T.V time-Should i allow my 20 month daughter to watch kids programs in T.v I see my friends kids who watch those programs regularly do better in learning alphabets , Numbers and rhymes. We don't turn on T.v much in our home. So my daughter doesn't want to sit in front of t.v. She wants to run around and play
Tuesday April 26, 2011 12:40 Sara
Penny Glass, PhD: 
The official position is no screen time for children under 2, but many videos and products are being marketing for toddlers and even infants. I recommend NO TV ¿ and especially not videos ¿ until children have sufficient language skills. What does that mean? They have the ability to ask questions and reply to answer, which is a conversation. This usually occurs around age 3.

The only things early TV time are associated with are delays in early vocabulary and attention problems in school. To that I would add behavior problems, especially tantrums.

Many parents say that their babies like watching videos, but that doesn¿t make it necessarily good for him. I like to eat cookies, but that doesn¿t make it good for me, right?

My suggestion is to put the videos away. Not only can they cause tantrums, but they can also hinder language development and communication skills.

Language development is not just how many words a child has, but also how the child uses them to communicate with others. There is no two-way communication (someone on TV doesn¿t care if your child is really listening).

Toddlers love repetition. When they watch the same movie over and over, there¿s no variation. When you read them a book, there is always some slight variation in your tone, pitch, voice, etc.

Young children often narrate play, which is thought to precede inner talking. Recent research suggests that this ¿self-talk¿ is absent in children when the TV is on, so it affects the nature of their play ¿ and their language development.

Tuesday April 26, 2011 12:41 Penny Glass, PhD
Michael Pitt, MD: 
Like Dr. Glass has said, the American Academy of Pediatrics recommends zero screen time until the age of two and then only 1-2 hours of quality programming per day.

Piggybacking of what Dr. Glass said, there is an interesting study out of The University of Washington on the effects of popular videos such as the "Baby Einstein" and "Brainy Baby" series, where researchers found that these products may be doing more harm than good. And they may actually delay language development in toddlers. The research team found that with every hour per day spent watching baby DVDs and videos, infants learned six to eight fewer new vocabulary words than babies who never watched the videos.

The bottom line is we know babies need face to face interaction to learn.
Tuesday April 26, 2011 12:43 Michael Pitt, MD
[Comment From ErinErin: ] 
My 5 year-old son is relatively high functioning Pervasive Developmental Disorder with hypotonia, requiring Occupational and Physical Therapy. He speaks well and is progressing. Will the hypotonia persist indefinitely? He is physically weak, such as unable to stand on tippy toes for long. He is light weight and lacks muscle tone. Do I continue with a pediatric neurologist, or a developmental pediatrician? The neurological M.D.'s pushing off to the other developmental pediatricians.
Tuesday April 26, 2011 12:43 Erin
Michael Pitt, MD: 
Erin, let me start by reminding our other readers that Pervasive Developmental Disorder is a spectrum of disorders that affect social interaction and include Asperger's Disorder and Autism. It is great to hear your son's language is improving as this can often be a difficult aspect in the therapy. As for which type of doctor should follow your son, the answer is that the best approach to Pervasive Developmental Disorder is a multi-disciplinary one including pediatric neurologits AND developmental pediatricians, not one or the other. Each brings a useful skill set to the child. Other members to his medical team should include the various therapists such as speech, occupational and physical therapy.
Tuesday April 26, 2011 12:47 Michael Pitt, MD
[Comment From Matthew TMatthew T: ] 
Are there any downsides to advanced development in a young child? Our 10 month old is walking on his own, understands cause and effect, is actively pushing boundaries and disobeying us, etc. Compared to most of his peers in the classes he seems ahead of the curve, but that causes my wife and I a bit of worry. Is there anything we should look out for?
Tuesday April 26, 2011 12:47 Matthew T
Penny Glass, PhD: 
He sounds like his gross motor skills are advanced and challenging for a parent. Listening skills are usually not as advanced in early walkers, because they are too busy. You may want to encourage listening skills. The "disobeying" might suggest that he has too many choices?
Tuesday April 26, 2011 12:48 Penny Glass, PhD
[Comment From SteveSteve: ] 
My son is 5. He and my wife got into a terrible habit of going to sleep together - in our bed! It's so bad now, I just sleep in the spare room. How do we break him/them of this habit??? :)
Tuesday April 26, 2011 12:49 Steve
Penny Glass, PhD: 
A good place to begin is for mom to express how much she enjoys cuddling in the morning, but it's difficult for her to get her rest when he's sleeping with her.
Then, mom can start a gradual separation by at first sleeping with him in his own room. She can progress by sitting on his bed until he goes to sleep, then sitting in a chair beside his bed, if he's needy. Provide him an alarm that goes off in the morning so that he can come back into the bedroom and snuggle with you both.
Tuesday April 26, 2011 12:52 Penny Glass, PhD
[Comment From StevenSteven: ] 
My son just recently brook out in hives but we really don't know what caused it. Is there a way to check to see without going through the dreaded allergy testing on him?
Tuesday April 26, 2011 12:52 Steven
Michael Pitt, MD: 
Steven, hives can be caused by several things in childhood and most the time in isolated hives like you descibe in your son, the trigger is not found. In fact, even though we often think of an allergic reaction as the probable trigger, hives are more commonly seen in pediatrics as part of common viral syndromes. That being said, seeing hives should make you look for other warning signs for allergic reactions such as difficulty breathing, vomiting, or swollen tongue or lips. If any of these symptoms are seen, you should call 911 immediately.

In answer to your question about allergy testing, one isolated episode of hives with no trigger is not in and of itself a reason for testing. Be sure to talk to your pediatrician about the episode for more specific advice.
Tuesday April 26, 2011 12:54 Michael Pitt, MD
Deborah L. Shelton: 
What do you think about infant walkers? Are they helpful?
Tuesday April 26, 2011 12:54 Deborah L. Shelton
Michael Pitt, MD: 
I'm glad you asked that question, Deborah, as this is a very important issue. Many parents think walkers will help their children learn to walk. Contrary to what the name suggests, however, these devices do not help the process of learning to walk and can actually delay when a child starts walking.

Most important, though, is that walkers can also be quite dangerous ¿ so much so that the American Academy of Pediatrics has called for a ban on the manufacture or sale of them.

Try something just as enjoyable but safer, like stationary activity centers as they look like walkers but have no wheels. They usually have seats that rotate, tip, and bounce. Play yards or playpens are also great safety zones for children as they learn to sit, crawl, or walk.
Tuesday April 26, 2011 12:56 Michael Pitt, MD
[Comment From ScottScott: ] 
With TV, my 15 month old son reacts to series such as Little Einstein'
Tuesday April 26, 2011 12:58 Scott
Penny Glass, PhD: 
Videos are particularly inappropriate. They are mesmerizing and very repetitive. Everytime a parent reads the same book, their words sound different so that the baby's brain is learning to make sense of these slight variations having the same meaning. The mechanical nature of DVD's or the same TV show is not the nature of normal brain development. That's why talking to your child and reading together is so important.
Tuesday April 26, 2011 12:59 Penny Glass, PhD
Deborah L. Shelton: 
The hour flew by! Thanks to our chatters for the excellent questions. Sorry we did not get to all of them. Please check the archive to make sure your question wasn't answered.

Thank you also to both of our experts for taking time out of your busy practices to join our chat .
Tuesday April 26, 2011 1:00 Deborah L. Shelton
Michael Pitt, MD: 
Thank you to all of the Health Chat partipants for your great questions. Sorry we weren't able to get to all of them. Be sure to ask your pediatricain if you still have unanswered questions.

I am encouraged by the fact that each of the children addressed in the questions has a loving parent who has their child's best interest in mind. That, believe it or not, is the biggest key to a healthy normal childhood. Keep up the good work.
Tuesday April 26, 2011 1:01 Michael Pitt, MD
Penny Glass, PhD: 
Thanks for having me. One note about "stationary walkers", or exersaucers. They have too many things immediately available for babies to hit and swat. They need to learn to direct their reach, coordinate their grasp, and retain/pass toys. Toys on these devices never fall to the floor. Babies don't get this important lesson.
Tuesday April 26, 2011 1:02 Penny Glass, PhD
Deborah L. Shelton: 
Thank you!

Next week¿s chat will be hosted by Tribune health reporter Judith Graham, who will tackle the topic of older men's sexual health. Her guest experts will be Dr. Laurence A. Levine, director of the Male Sexual Function and Fertility Program at Rush University Medical Center in Chicago, and Dr. Andrew McCullough, director of andrology at Albany Medical College in New York.

The chat will take place Tuesday, May 3, at noon CDT/1 pm EDT.

Have a great day everybody!

Tuesday April 26, 2011 1:02 Deborah L. Shelton