Wednesday, May 12, 2010

The developmental milestones parents obsess over are meaningless.

Can Your Baby Wield a Machete?
By Nicholas Day

This article appeared on the Slate website. Click here to see original article.

Photo of Arnold Gesell, a psychologist and pediatrician who was a pioneer in the field of child development.

My son Isaiah sat up late. He crawled late, too, according to all the books, and he agreed to walk only when he was pretty sure he wouldn't fall. With the exception of his remarkable ability to name dump trucks, garbage trucks, and every single apple in the produce section, he shows every sign of talking late, too.

Late, early, on time: In our what-to-expect era, when baby websites offer weekly, birthdate-timed developmental newsletters, parents can hardly avoid knowing where their child falls on the developmental spectrum. As Isaiah has stumbled through his first years, he's been accompanied, via child-rearing guides and websites, by the phantom presence of a typical child, whose textbook development sometimes has made Isaiah seem like Leo the Late Bloomer.

But when parents today worry about their child not meeting developmental norms, especially for motor skills, they're too often worrying needlessly. The typical child, it turns out, is a myth. But someone forgot to tell the parents.

Arnold Gesell, a pioneering developmental scientist at Yale, came up with the theory of developmental norms—the idea that there is a normal way for humans to develop—a little less than a century ago. Gesell believed that motor development was a question of neuromuscular maturation: Motor skills developed as the brain matured. It followed that all infants had to pass through the same series of developmental steps, in the same order, at the same times. Gesell just had to map what those steps were and when exactly they occurred.

He did so in astonishing, migraine-inducing detail. Using cameras to record the tiniest details of infant behavior, Gesell described the appearance of 40 different motor skills and the developmental stages of each of those skills: 23 stages of crawling, 58 stages of grasping, 53 stages of rattling. His work was rigorous, seemingly authoritative, and the basis for the first charts depicting how infants should develop. These showed babies as they moved in a strict, perfectly timed procession from lying to rolling over to sitting to crawling, and so on. Gesell's work was hugely influential: It cemented the concept of developmental norms, and the separation of normal and abnormal, into the popular consciousness. Gesell's books and the movies of infants produced by his laboratory made him famous, an early child-rearing expert. This video offers a sense of his patient, painstaking style and the quiet grandeur of his pursuit.

Yet Gesell himself knew that his norms weren't set in stone. As Ann Hulbert writes in Raising America, her magisterial history of modern American child-rearing advice, he warned that norms " are readily misused if too much absolutist status is ascribed to them,' as he knew from having arrived at them by observing countless deviations."

But the idea of developmental norms was too seductive to be rejected. It provided parents and pediatricians with guidelines and expectations. For almost a half-century after Gesell, the proper sequence and timing of development were treated by developmental psychologists as sacred; any deviation was dangerous. For example, the theory of "neurological organization," devised by the psychologist Carl Delacato, held that if an infant failed to take the expert-marked path for motor skills, her reading and language skills would veer off ! course, too. New research was largely limited to creating more precise norms—to making norms yet more normative.

The problem with all of this is that the theory of neuromuscular maturation turned out to be fundamentally wrong. Even during Gesell's ascendancy, there was ample evidence of the amazing plasticity of human development. Beginning in the 1960s, developmental psychologists conducting ethnographic research in different cultures discovered that infants around the world skip various developmental stages or develop key skills more quickly (or slowly) than American children. As a classic paper showed, for example, infants in a farming village in Kenya sat up and walked far sooner than their Western counterparts, but only when raised in traditional ways, which encouraged these skills. Moreover, different cultures have their own internal sense of what's normal. In one wonderful study, English, Jamaican, and Indian mothers living in the same city were asked to predict when their newborns would reach certain motor milestones. Remarkably, each group's expectations turned out to be accurate—even though they frequently varied by several months. As the (epically cute) new Babies documentary makes clear, culture matters.

All this reflects how infants actually develop: Babies take different routes to the same destination. There's no right way to learn to walk, for example, and there's scarcely even a right time: The accurate range for when babies should start extends from 8 months to almost 20 months—an amazingly, almost meaninglessly broad stretch of time. The most interesting research on motor development in recent years treats it as the product of many different systems: the infant's environment, personality, nervous system, and! personal physical limitations. When all these variables interact, you get a lot of different results, as countless studies have made clear. You don't get a chart that looks like something out of The Ascent of Man.

But the idea of the typical child is ever with us, never mind the volumes of research disproving it. As several prominent developmental psychologists have written, somewhat despairingly, "Ages and stages so thoroughly pervade our conception of motor development that every pediatrician's office and developmental textbook sports a requisite table of developmental norms." These charts and tables make us anxious and shrink our sense of the possibilities of infancy. There's no chart that can make sense of this photo of an 11-month-old Efe infant, in a rain forest in the Democratic Republic of Congo, carefully cutting a fruit in a half with a machete.

Of course, parents want some sense of what their children should be doing, and knowing that their baby girls technically might be able to use a machete won't help much. But false milestones and misleading developmental narratives aren't helping, either. It's a sorry state of affairs: Even as developmental psychologists have discarded the idea of universal developmental milestones, those milestones are the only things many parents know about developmental psychology.

We should start by erasing the word normal from the developmental ! vocabulary: What's typical in infancy is variation. Rather than a multitude of milestones, parents would sleep better with fewer but more relevant guidelines, an acknowledgement of how unstructured infancy actually is. At our pediatrician's office, I recently discovered a rare such example: a CDC flyer with the heading, "It's time to change how we view a child's growth." It lists a few key achievements for the end of each year, helping parents sift out actual problems. If a baby doesn't respond to "no" at the age of 1, for example—even if "responding to" just means ignoring—that's probably worth mentioning to the pediatrician.

I can report that Isaiah, who has always lagged behind his mythical normal counterpart, has met all the milestones on the CDC's short list. As a proud parent, though, I'm a little aggrieved it fails to recognize his deep talent for apple taxonomy: He's clearly way ahead of his peers.

Have you ever cared for a child with developmental delays? Do you think parents place too much meaning on children's developmental milestones?


Fiona Littleton said...

I tend to disagree with the author. Parents and nannies aren't exactly experts on the topic so having the list of developmental norms is helpful for us. Sure a few months here or there doesn't matter for a school aged child. But for infants turning into toddlers it's a big deal. It may mean a child doesn't go to Kindergarten or first grade for a year to catch up and give them an advantage. Teachers and doctors see more kids and know instinctively more than we nannies and parents typically do. So, I personally like developmental charts to help me figure out what to discuss with the parents and doctors.

Lisa said...

I come from a large family of ECE type educators (and parents) who raised children who came in all ends of the spectrum from special needs to gifted and talented. Then I've worked in child care centers, with at risk kids, arts programs, etc. I've taken child development course work. There have been many times I have picked up on young child showing signs of a developmental delay or high potential earlier than the parents.

It does take a special skill to share observations/concerns etc. with parents. Involves non-labeling documentation and support articles, lists of specialists in the area, and possible back up opinion, etc. (But this is a whole other blog post.)

I have never worked for a family that didn't have big hopes and dreams for their kids future success. I have seen some compare their kids to other children they know in the same age range. Or, they have read milestone charts and get concerned about their child not hitting some categories. And, in a few cases I have seen them get worried when a peditrician asks them if their child can do something yet, the kid can't, and then they think their child must have some lag. (There was one case when the parents spoke of something they were asked and I'm thinking this is way before his developmental stage to be doing that. And I'm thinking why did that Dr. ask that and freak out this MB now?)

Yes, developmental charts can be there as a guide, and there are other important ones to be aware of like the lists that are the signs for autism. BUT, as I have learned in my ECE coursework, when these different development milestone charts are taught to teacher types there are "disclaimers" about each child bein unique and developing at their own pace.

I also think it depends in the community one lives in. If there is the Smith family that needs to keep pace with the Jones family. Some families will hire the tutors or enroll their kids in the special programs because they think this is required for their kid to hit the benchmarks or beyond. I'm sure I'm not alone in seeing all these infant and toddler programs that are marketed to parents in this regard. (I've participated with my charge in some of them and think, boy this is silly.)

Although, I also have been purposely chosen though for a position in the past because of my educator capacities, and abilities to get children well prepped for school in a non intense way. And it's a nice niche to have on a nanny resume.

Anonymous said...

The author is nuts. Especially don't worry about fine motor skills? You don't want your kid to learn to write? Fine motor skills are essential for writing, cutting with scissors, using untensils when eating!!!

I agree each child is an individual though and all we can do is make them the best them they can be.

But developmental norms are very important for example for speech development!!!

Reyna NY NY

Michelle said...

Developmental screening identifies children who should receive more intensive assessment or diagnosis, for potential developmental delays. It can allow for earlier detection of delays and improve child health and well-being for identified children.

Early intervention is essential for autism, speech delays, intellectual disabilities, ADHD, and the list continues.

Early detection and intervention is hugely important!

Tobago Nanny said...

We all need to support each child as an unique individual and we shouldn't compare siblings.

But, nannies work for affluent families whose parents have graduated from ivy league colleges. The parents I have worked for are all great but all emphasize academic acheivement very heavily. I doubt they would agree with the author. They want their children to follow in their academic and career footsteps.

Some parents don't push academic acheivement as heavily on their kids as others, but the people that have hired me over the past 10 yrs are constantly pushing their kids to do better (not average or like anyone else).

There is a HUGE difference between a late bloomer and a special needs child too.

I don't think you should send a kid to pre-K or kindergarten or first grade if they are going to fall behind others. It will ruin the child socially. Mainstreaming special needs just make them the kids that are bullied.

I don't think my employers would agree with the author.

Anonymous said...

The article says "Babies take different routes to the same destination."

I disagree. Babies pretty much follow the same steps. When has a kid walked before they crawled, chewed before they sucked, written letters before they scribbled, spoken before they cooed?

I don't think a late bloomer of a month or two is a concern at all. I don't think being a late bloomer means anything terrible. But if you notice the baby isn't doing what other 3 months olds are doing I'd bring it up with the doctor at the next regular visit!

Parents do their children harm by waiting or being in denial.

Professional Nanny
Maria Lopez
Miami FL

Anonymous said...

Developmental delays such as speech and gross motor skills and fine motors skills can indicate a child on the Autistic Specturm Disorder contimuum. 1 in 100 children today are born or discovered to be on the spectrum so I would say vigilance is key.
Nanny Jan
San Diego CA

Anonymous said...

Ignore milestones? I wouldn't agree.

But I agree that developmental charts are simply guidelines to reference, not to diagnose.

Tonya R
Houston TX