Infant/Toddler (0-3)

 

As a new parent, raising a child can bring about many questions. Here at SpecialNeedsPBC we want to help by providing you a place to find the resources in Palm Beach County to help you raise your beautiful child. After all, it takes a tribe to raise a child. Whether your child was diagnosed prenatally, there were complications during birth, or you suspect developmental delays, the question is the same. “What do I do now?” You may have a concern that your child may not be developing at the typical pace or your child has been diagnosed with a disability. You are in the right place! This section is to provide parents and caregivers with highlights of typical Infant - Toddler growth patterns or milestones and warning signs, tips and questions to ask yourself, and resources to find help.

Milestones are guidelines to help understand typical patterns of growth and development and when to expect skills to emerge. Children reach milestones in how they play, learn, speak, act, and move through their interactions with the people around them and their environment. Every child reaches these milestones at their own pace. There are many childhood milestones to watch for. The four main categories of milestones are:

  • Motor skills:
    • Gross motor, involves the whole body and large muscles. Skills include crawling, walking, jumping, catching, and balance.
    • Fine motor, involves intricate skills using fingers and hands which require a high degree of control and precision. Skills include picking up and holding things, such as utensils, crayons, or stacking blocks.
  • Language or Communication Skills:
    • Expressive Language is about how one expresses their wants, needs and thoughts. Babies do this through cries, coos, facial expressions and body language.
    • Receptive Language is how one responds to communication. Receptive language is the ability to receive and understand a message from another person. With a baby this is demonstrated by turning their head towards your voice and responding to a simple direction.
  • Cognitive or Thinking Skills:
    • Include skills that involve the progressive building of learning skills such as attention, memory and thinking. Examples of cognitive development in infants include paying attention to faces, copying gestures, showing curiosity about things and trying to get things out of reach.
  • Social or Social/Emotional Skills:
    • Includes understanding and recognizing thoughts and feelings in order to connect with others.

Babies develop at their own pace. A developmental delay is when a child does not reach a milestone by the upper age range of the specific skill. Don’t panic if your child isn’t keeping up with the timeline, but do mention your concerns to your pediatrician. Sometimes a child may just need more opportunities to practice the skills. For example, a baby who is held frequently may need more opportunities to sit alone in a playpen or mat on the floor. Babies that are born prematurely may have delays in motor skills due to rate of muscle strength development. Children who have had recurring ear infections may show delays in speech or comprehension. Often these delays may resolve with time with proper intervention.

NATURAL AGE RELATED MILESTONES AND WARNING SIGNS

Because many of the early signs of communication and learning disabilities are recognizable in children as young as 12 months old, it helps to know what behavior may actually indicate a problem. It is recommended parents become familiar with the developmental milestones. The following are highlights of major milestones.

Click on the age for the age of your child. 0-6 months, 6–12 months, 12-18 months, 18-24 months, 2-3 years

​Healthy Milestones:

0-6 Months

Social Skills
  • Looks at a face of caregiver
  • Shows anticipation of being picked up by caregiver
  • Shows affection towards familiar people
  • Plays with toy or object, alone or with others
  • Plays very simple interaction games with others
  • Responds playfully or smiles at mirror image
Cognitive Skills
  • Inspects own hands
  • Plays with rattles
  • Uses hands and mouth for sensory exploration
  • Turns head to sound
  • Eyes follow ball rolling across table
  • Approaches mirror image
Communication Skills
  • Cries when hungry and for attention
  • Makes pleasure sounds, coos
  • Turns head, searches for speaker
  • Startles and looks in response to loud noises
  • Turns toward speaker or ringing bell
  • Smiles in response to presence of caregiver
Motor Skills
  • Begins to manipulate a rattle
  • Attempts to roll on stomach
  • Extends arms and legs
  • Props self on elbows with head
  • Reaches for and grasps toys
  • Brings hands together
  • Carries toy to mouth

6 - 12 Months

Social Skills
  • Reaches for and holds a toy
  • Plays "peek-a-boo" or waves bye-bye after seeing caregiver do those actions
  • Pats toy in imitation
  • Engages in simple games with others (rolling ball)
Adaptive Skills
  • Opens mouth when food is presented
  • Removes food from spoon with mouth
  • Sucks or chews on crackers
  • Eats solid foods
Communication Skills
  • Says “mama” or “dada” meaningfully Imitates non-speech sounds (cough, sneeze)
  • Looks at objects and pictures when named
  • Understands and responds to name
  • Raises arms when caregiver says “come here” or “up”
  • Imitates sounds of adults immediately after hearing them
  • Demonstrates understanding of the meaning of at least 10 words
Motor Skills
  • Rolls from back to stomach and stomach to back
  • Sits with some support; trunk and head
  • Crawls
  • Transfers objects from one hand to another
  • Picks up small object with thumb and fingers
  • Stands
  • Stirs with a spoon
  • Opens doors that require only pushing or pulling
  • Lifts cup by handle
Cognitive Skills
  • Plays with things by banging them together
  • Imitates familiar actions (peek-a-boo)
  • Plays with a single toy for at least 2 minutes
  • Searches for missing objects
  • Reacts to “no”
  • Looks at pictures in book

12 - 18 Months

Social Skills
  • Engages in simple games with others (rolling ball)
  • Likes to look at books with caregiver
  • Starts to exhibit a temper when angry
  • Laughs at funny things
  • Communication Skills
  • Can follow one step commands
  • Saying a few words spontaneously
  • Asks to have needs met
  • Labels familiar objects
  • Follows instructions requiring an action and an object
  • Names at least 20 familiar objects without being asked
  • Indicates preference when offered a choice
Cognitive Skills
  • Stacks rings
  • Pulls strings to get toys
  • Turns pages in a book
  • Identifies at least one body part
  • Pushes toy car
Adaptive Skills
  • Drinks from cup independently using both hands
  • Uses spoon to scoop food
Motor Skills
  • Walks without assistance
  • Climbs stairs
  • Rolls a ball, flings a ball
  • Opens a box/container
  • Kicks a ball
  • Imitates scribbles
  • Scribbles spontaneously

18-24 Months

Social Skills
  • Imitates actions of another child
  • Smiles or laughs appropriately in response to a positive statement
  • Shows desire to please caregiver
  • Participates in at least one game or activity with others.
  • Imitates a relatively complex task several hours after it was performed by another
  • Engages in elaborate make-believe play (e.g., take dog for walk)
Communication Skills
  • Recognizes clothing and objects
  • Uses 1 word utterances frequently
  • Follows 2 step commands
  • Combines word and gestures
  • Says 8 different words
Uses pronoun(s)
Cognitive Skills
  • Attempts and succeeds to use simple toys
  • Explores cabinets and drawers
  • Imitates actions of adults
  • Begins to place large puzzle pieces in slots
  • Places approximately 4 pieces in puzzle
  • Identifies objects in a book or photograph
Adaptive Skills
  • Drink from cup independently with one hand
  • Removes socks and shoes
  • Feeds self with spoon
  • Demonstrates understanding that hot things are dangerous
  • Indicates wet or soiled pants or diaper by pointing, vocalizing, or pulling at diaper
  • Willingly allows caregiver to wipe nose
Motor Skills
  • Throws a ball
  • Runs
  • Builds a tower with small cubes/blocks
  • Turns pages of a book one at a time
  • Rolls ball while sitting
  • Climbs both in and out of bed or steady adult chair
  • Climbs on low play equipment

2 - 3 Years Old

Social Skills
  • Watches other children play and attempts to join briefly
  • Plays simple group game (e.g., Ring around the Rosie)
  • Use toys to act out a scene
  • Seems to understand another’s perspective
  • Shows a preference for some friends over others
  • Says “please” when asking for something
  • Identifies people by characteristics other than name when asked
  • Begins to take turns with prompting
Communication Skills
  • Recognizes names of friends and family members
  • Expresses needs verbally
  • Uses 3 word phrases
  • Uses simple sentences
  • Spontaneously relates experiences in simple terms
  • Asks questions beginning with “what”, “where”, “who”, “why”, and “when”
  • Answers yes/no questions
  • States full name
  • Relates experiences verbally
  • Uses pronouns (I, me, you, and mine)
  • Possessive s, is and regular past tense are used
  • Comprehends 3 prepositions (in, on, under)
Cognitive Skills
  • Uses objects/toys in symbolic play (e.g. picks up a shoe and pretends it is a phone)
  • Begins sorting objects by characteristics
  • Recognizes self in photos
  • Builds tower of 6 blocks
  • Listens to simple stories
  • Knows primary body parts
  • Understands “big/little”
  • Understands concept of one
  • Compares sizes of two objects
Adaptive Skills
  • Feeds self with fork
  • Removes shirt and pants
  • Unfasten front buttons
  • Washes and dries hands with assistance
  • Attempt to brush teeth with assistance
  • Puts on shoes
  • Dry hands independently
  • Urinates in toilet or potty-chair
  • Bathes self with assistance
  • Puts on “pull-up” garments with elastic waistbands
  • Puts possessions away when asked
Motor Skills
  • Stands on one foot with assistance
  • Walks backwards
  • Snips with scissors
  • Removes caps from bottles
  • Stands on one foot without assistance
  • Cuts paper
  • Walks upstairs, putting both feet on each step
  • Opens doors by turning and pulling doorknobs
  • Jumps over small objects
  • Screws and unscrews lid of jar
  • Imitates vertical and horizontal stroke

Warning Signs:

It is helpful to be aware of the warning signs of developmental delays in children. Delays are significant lags in one or more areas of emotional, mental, or physical growth. If your child experiences a delay, early intervention or treatment is important to help with progress or catching up on the skills.

Remember children develop at different paces. Many developmental delays in children may not be serious and children do catch up. Improvements can be made when interventions are started early.

Contact your child’s doctor if your child has any of the following signs at the age indicated so that the child’s development can be assessed.  By 4 months, By 7 months, By 1 year, By 2 years old will be hyperlinked

By 3 to 4 Months

  • Does not smile at people
  • Does not pay attention to new faces, or seems frightened by new faces
  • Does not respond to loud noises
  • Does not babble
  • Begins babbling but does not try to imitate sounds (by 4 months)
  • Does not follow moving object with eyes
  • Does not notice their hands (by 2 months)
  • Has trouble moving one or both eyes in all directions
  • Crosses eyes most of the time
  • Does not reach for, grasp, or hold objects
  • Unable to support their head very well
  • Does not bring objects to mouth (by 4 months)
  • Does not push down with legs when feet are placed on a firm surface (by 4 months)

By 6 - 7 Months

  • Refuses to cuddle
  • Shows no affection for parents or caregivers
  • Shows no enjoyment around people
  • Cannot be comforted at night (after 5 months)
  • Does not laugh or squeal (by 6 months)
  • Shows no interest in in peek-a-boo games (by 8 months)
  • Does not respond to sounds
  • Has one or both eyes turning in or out all the time
  • Experiences constant tearing or eye drainage
  • Does not follow near objects (1 foot away) or far objects (6 feet away) with both eyes
  • Has stiff and tight or very or floppy muscles
  • Flops head when pulled into sitting posture
  • Reaches with one hand only or does not actively reach for objects
  • Has trouble getting objects to mouth
  • Does not roll over in either direction (by 6 months)
  • Does not bear weight on legs when pulled up to a standing posture

By 1 Year Old

  • Shows no back-and-forth sharing of sounds, smiles, or facial expressions (at 9 months)
  • Shows no back-and-forth gestures, such as waving, reaching or pointing
  • Does not use any single words
  • Does not understand words like “bye-bye” or “no”
  • Does not crawl
  • Drags one side of body when crawling
  • Cannot stand when supported
  • Does not search for objects that are hidden while watching
  • Does not use gestures, such as waving
  • Does not point to object or pictures

By 2 Years Old

  • Cannot speak 15 words
  • Does not use two-word phrases without repetition. (Child can only imitate sounds)
  • Does not use speech to communicate more than immediate needs
  • Cannot walk (by 18 months)
  • Does not develop heel-to-toe walking pattern or only walks on toes
  • Cannot push a wheeled toy
  • Does not imitate actions or words
  • Does not follow simple instructions
  • Does not know the function of common objects (such as spoon, phone, brush)

TIPS FOR PARENTS/CAREGIVERS

Developmental Check-ups:

You take your child to the pediatrician on a regular basis for physical exams to ensure that they are gaining weight and growing... But what about the other developmental areas that make your child the unique, special being you have come to love and adore? For more information on Developmental Check-Ups Click Here

Parent Road Map:

The links below are meant for those individuals who are new to the entire process of getting their child evaluated and treated for a developmental delay, communication, learning, and/or social relating disorder.

All children benefit when their parents and caregivers are healthy and not stressed or depressed. The posters above provide practical tips and tools to help build positive relationships and help reduce stress. Click Here to view or download the posters.

Parenting:

When an infant or toddler is diagnosed with a disability, you may experience difficulty managing other aspects of life, such as employment, home responsibilities, and caring for other children and yourself. You may feel the need to be with your child at all times. It is important to remember that you can express your attachment or love for your child through concern, questions, and spending time. Your strength and love are critical support.

It takes a village. Accept support from others close to you and of professionals who are experts in the field of the specific disability. In Florida, each year there are over 20,000 families who find out their child has a disability. Many belong to support groups for specific disabilities; 211PBC, your pediatrician or Early Steps can connect you with these organizations.

“Remember that your baby needs a strong and well-functioning home. Taking care of yourself, your family, your partner, your children, your job, and your home is also building the nest for your infant. Maintaining a routine as much as you can will also help you feel more in control.”
Florida Developmental Disabilities Council First Steps: A Guide to Your Child’s Development

Parenting isn’t an easy job. Parenting is about helping a child learn, adapt, and develop self-determination to their highest ability. Self-determination is about having a sense of control over one’s life, setting goals and working to attain them. The goals should be obtainable. Goals can be choosing an outfit and dressing oneself rather than designing and sewing an outfit.

Key points to remember as a parent:

  • Set routines in your home
  • Maintain the health and safety for all in your family
  • Plan for your child’s experiences
  • Build a support system
  • Work to maintain the quality of relationships with family and friends
  • Seek the advice and assistance from other family members, positive sources in your life
  • Take one day at a time
  • Learn about your child’s disability, ask questions to understand the professional terminology
  • Organize a notebook with your child’s records that includes Medical,
  • Therapy, and Education records, plus a journal that you keep on your child’s progress and your concerns.
  • Employment Rights for Parents of Children with Disabilities

Employment Rights for Parents of Children with Disabilities:

There are some laws that help to protect a parent caring for a person with a disability against discrimination at work. WrightsLaw.com provides resources about Parental Protections from a review of the different laws to things you need to know if you feel your rights have been violated.

The Americans with Disabilities Act (ADA) prohibits most employers from firing a parent, or excluding a parent from a job opportunity or benefit, because the parent has a child with a disability. An employer may not treat an employee differently because his or her child has a disability.

The Employee Retirement Income Security Act, or ERISA, is a federal law governing certain employee benefit plans. ERISA contains an "anti-discrimination" provision that makes it unlawful for any person to be fired or otherwise discriminated against for exercising his or her rights under an ERISA-governed plan. An employer cannot legally fire you because of the high cost of providing health insurance to your child who is ill or who has a disability.

The Family and Medical Leave Act (FMLA) is a federal law which provides important job protections to parents who take time off from work to be with children receiving medical and psychiatric care or who are recuperating from serious health concerns. This includes taking FLMA to attend meetings pertaining to interventions (MTSS) or Individual Educational Plan meetings. FLMA also extends to care for a child with a disability who is 18 or older.

Questions to Ask Myself during the Infant/Toddler Stage:

  • Have you established a daily routine for your infant/toddler?
  • Are you sharing information with extended family members and close friends so they can feel comfortable spending time with me?
  • Are you playing with your infant/toddler and helping them to find ways to learn and explore their environment? Does the child have time to play with a playmate or independently?
  • Are you taking your child out to do typical social things as a family?
  • Does the child’s diet include a variety of healthy foods
  • Are you childproofing and making sure there are not things that could harm me in our home?
  • Are emergency numbers and poison control information posted in the house and easily accessible?
  • Have you arranged for someone to care for me in case something happens to you?
  • What is the plan to pay for services above what my health plan covers?
  • Have you checked to see if your child is eligible for government benefits?

Resources:

Help Is Available

Unicornchildrensfoundation.org: The Unicorn Children's Foundation has a child development specialist on-staff that is available for consultation.  Our specialist can help you with…

  • Concerns regarding your child's development
  • Questions about different treatment approaches
  • Provide objective evaluation of your child's current treatment plan
  • Connecting you to resources and service providers in the community

You can contact our Executive Director by phone at 561.620.9377 x 303 or by email at [email protected]

HealthyChildren.org: is a website developed by the American Academy of Pediatrics. This website provides families with a wealth of information. Topics cover ages and stages, healthy living, safety and prevention, family life, health issues, and tips and tools. Click Here for their website

HealthyChildren.org: Learn more about physical developmental delays for children ages 5 and under. Physical Developmental Delays are when a child is not doing activities that other children their age are doing, like rolling over, sitting without support or walking. Click Here for their website.

Zerotothree.org: Zero To Three Resources and Services Section. Click Here For their website, Click Here.

Cdc.gov: Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities (NCBDDD). Click Here for their website.

Cdc.gov: Centers for Disease Control and Prevention. Learn the Signs. Act Early. Click Here for their website.

Milestones Matter for families

Cdc.gov: Centers for Disease Control and Prevention Milestone Tracker App. Click Here for their website.

Cms-kids.com: Children’s Medical Services (CMS) is a collection of programs that serve children with special health care needs.  Each program provides family-centered care using statewide networks of specially qualified doctors, nurses, and other healthcare professionals. Click Here for their website.

Cms-kids.com: This webpage provides tips and tools for parents and caregivers. The available topics include information on child development, family relationships, keeping children safe, caring for your child’s health, child abuse, shaken baby syndrome, positive parenting, and sleep safe. Click Here for their website.

Cms-kids.com: Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers (birth to thirty-six months) with significant delays or a condition likely to result in a developmental delay. Early Intervention is provided to support families and caregivers in developing the competence and confidence to help their child learn and develop. Click Here for their website.

Cms-kids.com: This webpage provides information on the Florida Newborn Screening Program. Newborn screening is a set of tests done to see if your baby has certain disorders. Newborn Screening tests your baby's blood for different diseases and conditions. A hearing screening is also done to see if your baby may not be able to hear. Early detection and treatment of health issues can help your baby grow up healthier. Click Here for their website.

Fddc.org: Projects of the Florida Developmental Disabilities Council have produced an array of materials on topics ranging from inclusive early education to supported living and employment programs under the publications tab. To meet the needs of diverse audiences, these resources are available in a variety of formats and media, including pamphlets, newsletters, resource guides, handbooks, training manuals, research reports, public education materials, audiotapes, and videotapes. Many are available in Spanish and alternate formats. Click Here for their website.

Other Professional Organizations:
Unicornchildrensfoundation.org: Unicorn Children’s Foundation has provided a list with hyperlinks to professional organizations that are focused on disabilities. Click Here for the links.

References:

Centers for Disease Control and Prevention. Learn the signs. Act early. Milestones for children 2 months - 5 years of age.
cdc.gov/ncbddd/actearly/index.html

Department of Defense Virtual Lab School. Infant & toddlers cognitive development.
virtuallabschool.org/infant-toddler/cognitive/lesson-2

Florida Developmental Disabilities Council (2017). First steps a guide to your child’s development.

UMKC institute for human development. Missouri family to family.  Charting the life course experiences and questions booklet a guide for individuals, families and professionals.
cdd.tamu.edu/wp-content/uploads/sites/33/2019/11/LCEXPERIENCESBOOKLETupdated92016-1504896211363.pdf

Pathways.org. Communication.
pathways.org/topics-of-development/communication

Rauh, S (2008, May). Is your baby on track?
webmd.com/parenting/baby/features/is-your-baby-on-track#3

Unicorn Children’s Foundation. Learn the signs.
unicornchildrensfoundation.org/learnthesigns.html

Unicorn Children’s Foundation. Healthy milestones.
unicornchildrensfoundation.org/healthymilestones.html

WebMD 2018, December). Recognizing Developmental Delays in Children.
webmd.com/parenting/baby/recognizing-developmental-delays-birth-age-2#1

Wright, P. & Wright, P. Parental Protections.
wrightslaw.com/info/protections.index.htm.

Written By: Iris Neil, M.Ed. NBCT

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