By Trenna Sutcliffe, M.D.

Whether it’s crawling, walking, talking or learning to read and write, there are many important and exciting developmental milestones in a child’s life. Parenting books and Web sites abounding with lists of developmental time frames and comparisons with other children can make parents anxious about their own child’s progress. How can you tell what’s normal and when you should be concerned about your child’s development?

I’m having my first baby in a couple of months. How can the pediatrician help me make sure my child is reaching all the important developmental milestones at the right time?

During early childhood, especially during the first two years of your child’s life, your child will have many, regular well-child examinations with his or her pediatrician. These visits are an excellent time to ask your pediatrician any questions you have about your child’s development or bring up any concerns.

At each visit your pediatrician will talk to you about what developmental milestones are appropriate for the current age of your child and what milestones are coming up next. An important component of each of these well-child visits, as recommended by the American Academy of Pediatrics (AAP), is mental and physical developmental surveillance and screening of your child to ensure early detection of any developmental issues.

My daughter is almost 12 months old and still not walking. Should I be concerned?

Much as each child has his or her own very unique personality, each child also has his or her own pace for reaching developmental stages. It’s important for parents to know that developmental targets listed in parenting books or on Web sites represent when 50 percent of all children will be reaching a certain stage. This means that the other 50 percent of children will be attaining these milestones later than the guideline. Rather than an exact time, there is a normal range for each stage of a child’s development. For example, the normal range for walking is between 11 and 16 months. If your daughter has no signs of developmental delay in other areas and is healthy, the fact that she is not yet walking by 12 months should not be a concern.

My two-year old son is in therapy for speech and language delays, but I’ve read that this can be one of the signs of autism. Could he be autistic?

There are many reasons a child may have delayed speech and language development. If your son is doing well in other respects, it is unlikely that he is autistic. A child with autism will demonstrate many other problems in addition to delayed speech.

Some of the signs of autism include:

• Problems with social interaction, including difficulty using non-verbal gestures such as pointing and eye-contact
  
• Difficulty sharing enjoyment with others
  
• Inability to engage in back-and-forth conversations or activities
  
• Difficulty with pretend play or imitation
  
• Restrictive and repetitive behaviors and interests
  
• Parents find it hard to engage the child

Unlike the autistic child, young children with speech and language delays due to other causes are often excellent non-verbal communicators. For example, by pointing, gesturing and using facial expressions they can hold clear “conversations” with their parents and peers without using a single word.

At the last parent-teacher conference, my 7-year old daughter’s teacher told me that my child is having a hard time paying attention in class, and as a result, her school work is suffering. Could she have Attention Deficit Hyperactivity Disorder (ADHD)?

Before considering whether your daughter might have ADHD, it’s important not to miss other reasons why she might be inattentive and having difficulty at school. For example, she might have a learning disability or be struggling with a social issue such as bullying. Although rare, underlying medical issues may also be the reason for her inattention, so a visit to your pediatrician would be helpful.

Features of ADHD include inattention, impulsivity and hyperactivity. These symptoms must be present in other settings besides school, such as at home or on the sports field, for a possible diagnosis of ADHD. Some children may only show one of these symptoms. For example, girls may be inattentive but otherwise quiet and not disruptive. This is known as Attention Deficit Disorder (ADD). However, if your daughter only shows symptoms at school and does well in other settings, look for other reasons for her inattention.

Dr. Sutcliffe is a board-certified pediatrician in developmental pediatrics at PAMF's Los Alto Center.