Expert Q&A: Baby Development

An interview with Jeremy F. Shapiro, MD.

Reviewed by Louise Chang, MD on July 08, 2010
From the WebMD Archives

Should my baby be walking by now? Why isn’t my baby talking yet? From day one, thinking about these and other milestones in baby development seems to be part of a parent’s job description. Fortunately, it’s part of a pediatrician’s job description to provide reassurance and answers.

WebMD talked to Jeremy F. Shapiro, MD, MPH, FAAP, a pediatrician and father of three, about some of the most common questions new parents ask and how he answers them.

What’s the best way for parents to know if their baby is developing on time?

Keeping an eye on a baby’s development is a very important part of the well-child visits children have during the first few years of their life. It’s so important for parents to follow up at these routine visits, so that close monitoring of a baby’s developmental milestones can be followed and appropriate intervention can occur, if needed.

From day one, I tell parents that we’ll be watching the developmental milestones during the first few years very closely. And I assure them that there are never any silly questions. Parents need to feel comfortable with their own instincts.

Also, I recommend having parents fill out a developmental questionnaire when their child comes in for their 15- and 18-month well-child visits. If your pediatrician hasn’t brought the questionnaire to your attention at these visits, please bring it up with him or her.

What are the most common questions parents ask about developmental stages?

Questions about autism spectrum disorders (ASD) -- including autism, pervasive developmental disorders, and Asperger’s syndrome -- top the list. And although it’s difficult to make a diagnosis of an ASD in that first year of life, there are still developmental milestones we can look for during that year that indicate something may be going on.

Gross motor issues are also a very common concern -- specifically, “Why isn’t my child walking?” First, it helps to know children walk at quite a wide age range -- from nine to 15 months. But I may not begin a large work-up even with a 15-month old who hasn’t walked yet, depending on other gross motor milestones.

And usually I tell parents there is no rush to walk. Once children start walking, they never stop! So if your child walks a little later, but is still within the normal age range, there really should be no worries. And maybe you should consider yourself blessed.

Language is another concern. As with walking, there are certain milestones and age ranges, but there also are the occasional 1-year-old who has 10 or 15 words and the 16-month-old who just says “mama” and “dada.”

Again, it really is important to watch all the developmental milestones just to get an overall sense of how the child is doing. But some verbal milestones I look for are a minimum of six to 10 words by 18 months of age, and by 24 months a few two-word phrases and too many words to count.

What are some of the first personality developments in babies?

The first year of a child’s life is truly a magical time, something I try to remind parents of every chance I get. And although you may be losing sleep those first two months, I tell parents that just around the corner is that first social smile, when the baby smiles in response to your smile. About that same time, your baby will begin to coo and watch your movements very closely.

At four months of age, the cooing turns into more vocalization, almost harmonizing, and the smiles expand to laughter. It takes a lot to make babies upset at this stage -- if they’re crying, there’s usually a very good reason.

It’s such a fun time. I tell parents to really enjoy it to its fullest and to make the most of it. Having three children of my own, I know so well how fun this time can be.

What exciting baby milestones can parents look for during the second half of the year?

At about six months of age, infants may start rolling around, trying to sitting up, as they want to see the world more clearly. When you’re sitting upright you can see so much more, so they wonder, “Why should I be lying on my back?”

At about nine months, separation or stranger anxiety may set in, and babies will look to their parents for reassurance. Usually about this time, they’ll also be uttering their first consonants, usually “da-da-da.” But don’t worry, moms, that’s only because it’s easier to say than “ma-ma-ma.” Your baby knows who you are!

Also at around nine months, babies start picking things up with a modified pincer grasp. Now’s the time to be sure things are baby-proofed because what they pick up usually goes in their mouth.

What baby developments can parents look forward to around their child’s first birthday?

At about a year, maybe some babies will be walking and maybe others will be feeding themselves. The first sense of independence starts to come -- and before too long, you realize they’re ready to move on and head off to college!

They’re all special years, but a baby’s first year is truly magical because of all the developmental milestones he’ll reach. It really is such an incredible time.

What can parents do to help stimulate their baby’s development?

I recommend talking and singing to your baby as much as possible from day one, as it helps stimulate the brain and neurological development. Encourage the laughter when your baby starts laughing and always, always, interact with your child. When your baby is awake, it’s time to bond and play. It’s rewarding for you and helps his development as well.

That first year is the time when you want to get down on the carpet and lay next to your baby and create that eye contact that only parents can. Let them really see you and get close to you, because there’s nothing better to give reassurance to the baby and to help stimulate overall development.

Also, as they get a bit older, speak directly and simply to babies. Talk as if you’re actually hoping to convey something in your words. Even if your baby doesn’t know the words, she’ll understand the tone and melody in your speech, which will help her translate what is being said as she gets older.

Can toys, DVDs and flashcards really help a baby’s development?

I don’t think there’s any real research proving that they do much of anything for your baby’s development, either beneficial or harmful.

That said, I don’t necessarily have an issue with some of these so-called developmental toys and DVDs. I really think it’s more important how you use them. If you’re going to use flashcards, get down on the floor with your child and really make it a fun experience. The DVDs are not meant to be on two hours at a time, three times a day. But for a 20-minute stretch, there’s certainly no harm. Just remember to involve yourself in the experience, too.

What words of wisdom do you have for parents who are concerned about their baby’s development?

Always be in contact with your pediatrician. Also, trust and follow your instincts.

I never want to see a puzzled look on the face of a parent when they leave my office. If you’re not comfortable with something your pediatrician has said, ask the question again. Make sure the pediatrician understands your concerns and answers them in a way you find satisfactory.

If your pediatrician doesn’t answer your questions, definitely find someone who will. I am a parent, too, and I want to make sure I understand everything that involves my child. That’s why I want the same for the parents of the children I care for.