- The Washington Times - Sunday, December 8, 2002

Parents should keep in mind there is a wide range for children's developmental milestones, but there are red flags that could signal a developmental delay and warrant further investigation."Development varies for each and every child," says Dr. Nathaniel Beers, assistant professor of pediatrics at Georgetown University. "If parents are concerned in any way, they should tell their pediatrician. A doctor can tell them whether their child is within normal range."
Often, meeting a milestone late means nothing at all. It is, however, worth investigating in case of a real problem that could benefit from early intervention.
Dr. Beers says a child should be able to walk unsupported by 15 months.
"If not, we need to look further to see if there is evidence of a brain or motor or muscular problem," he says.
Language is another developmental milestone with great variability.
"A child should have one word, other than 'mama' by 13 or 14 months," he says. "He should be able to combine words into two-word phrases by age 2."
Language is an important predictor of future school success or difficulties. Lack of language or difficulty in understanding what others are saying also can be indicative of a developmental delay such as autism.
Dr. Elisabeth Guthrie, a New York neurodevelopmental pediatrician and psychiatrist, says she generally tells parents to relax and not get caught up in whose child is the first to walk or talk. She says, however, language is the one area where parents should be a little more tuned in.
"You don't want a child to not talk until age 2," she says. "It could mean he or she is not hearing properly or may have autism, two things that could benefit from early intervention."
Laura Colnes, a Springfield mother of a 5-year-old daughter and a 3-year-old-son, says she was concerned when her daughter, Rebecca, didn't start talking until age 2. Because Rebecca could understand directions and other people's speech, Mrs. Colnes' doctor told her not to worry. Eventually, Rebecca caught up and is now thriving in kindergarten.
Mrs. Colnes' son, Sammy, also didn't speak at age 2. But because he didn't seem to understand directions, Mrs. Colnes and her husband, Bob, sought further answers. Sammy is now being evaluated for a developmental delay.
"I knew it was crazy to get stressed out," she says. "But at the same time, you need to voice concerns.
Parents also should pay attention to a child's hand preference, Dr. Beers says. A child should not be right-handed or left-handed until between age 2 and 3, he says. If a child is only using one hand at a much earlier age, it might be a sign of a neurological or muscular problem, he says.
Toilet training is another milestone with a broad spectrum, Dr. Beers says.
"Toilet training is a hard one because of huge ethnic and cultural variations in expectations," he says. "It is perfectly normal for some children to not be trained until age 4. After that, we worry about behavior or other developmental problems.
"We have all heard some parents claim to have trained their children at 12 or 18 months of age," Dr. Beers says. "It is not that the child is trained, it is that the parents know the child's signals and put him on the potty every half hour. Really, at 12 months old, a child is not developed to indicate his needs well enough or to have enough muscle control to be able to hold it. Most children are not really ready to be trained until age 2 or 2."
If a child is not trained at night until he is much older, that is normal, too, he says. Twenty-five percent of 6-year-olds still wet the bed at night, he says.
Parents also should keep in mind that boys and girls are different developmentally.
"Girls will often develop faster in language areas," he says. "Boys tend to be faster in motor skills."

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