Developmental milestones -- What to expect during the first year of your child's life

Babies grow everyday, each day there is a new development, a new skill they learn. However, as parents we are always worried -- 'If my child is growing right?' Well, not all babies are the same and each grows at its own pace catching up on their developmental milestones with time. Developmental milestones imply the certain set of skills and functions that are age-specific and which most babies master within a certain age range. Development of your baby during the first year of life depends on various parameters like physical development, acquiring language skills, cognitive behaviour, social skills, emotional and behavioural changes. Here is a rundown to your baby's first year of development: PHYSICAL DEVELOPMENT  There are certain signs that would say your child is growing and developing at a certain pace in terms of physical development -- the movements, the gestures, these are the first signs of development. A child develops control and use of her body in a certain order, here is how:

• head control
• trunk control (sitting and balance)
• leg control (standing and walking)

Apart from these, there are other movements that ensure your child's physical development is on track, like,

• Shedding of tears: This begins anywhere between three to 12 weeks. Newborns are incapable of shedding tears because their tear ducts haven't yet fully formed.

• Eyeballs following objects: Between six to 16 weeks of age your child's eyes can follow the route of a pen, pencil or any colourful object when shown.

• Holding the head steadily on her own: This is a milestone your baby achieves from anywhere between six weeks to four and half months.

• Recognising loved ones -- This is also called visual recognition. This development happens in between two to three months of age. Babies might not recognise mother’s facial features immediately, but may recognise shape of face, colour of eyes, hair, etc.

• Turning head to the sound of bell or rattle -- Auditory senses develop somewhere between four to seven months.

• Rolls from back to stomach – This happens between three to seven months. After babies develop the strength to hold their head up, they will learn to roll over, i.e. flip from lying on back to being on tummy and vice versa, most commonly at about four months.

• Passes objects from one hand to the other -- This is when playing becomes more fun. From five to 14 months your child can hold toys and transfer them to you too.

• Teething - This happens by the age of three months and the process completes by the end of the year. However, the first teeth comes out only after six months. The lower front teeth are the first to erupt followed by the upper front teeth.

• Sitting - Between seven to 13 months your baby tries to get up and sit on her own after gaining strength in the torso.

• Crawls - Between six to nine months as your baby starts to crawl it will keep you and your little one busy and merry. However, some babies never crawl and move directly to pulling up and standing.

• Stands with support -- Once your child has mastered the art of crawling then she takes the next step ahead, tries to stand albeit with support by eight to 13 months.

• Tries to walk -- By 10 months your baby might try to be independent and walk on her own. If she doesn't don't worry, some babies don't do it till 18 months of age.

• Finally takes baby steps all on her own - By 12 months your baby would be able to walk on her own and keep you on your toes. For some babies this doesn't happen by end of the first year and might happen.

Warning signs: When should you worry Not being able to focus on objects close at hand, inability to focus on moving objects even after four months of age, tilting the head and looking at objects from an angle, frequent tearing and redness in the eye. These signs can indicate any problem ranging from delayed eye development to childhood cataract so beware. If your baby is struggling to lift head up even slightly at three months or is unable to hold head steady by 20 weeks this could mean a developmental delay and could mean a problem with the nervous system. No reaction to loud sounds by 12 months could be a sign of hearing disorder. Unable to sit on her own, doesn’t crawl or get mobile, drags one side of body while crawling this can indicate a host of problems manifesting as physical symptoms. So get checked at the earliest. LANGUAGE DEVELOPMENT Of course you little one won't be talking any time soon. But there are signs that say she is ready to communicate with your and the whole world out there. Here are signs that say she is developing her language skills with time, Babbling and cooing -- This stage is termed as the pre-linguistic stage that starts between three to nine months. Babies begin with vowel sounds  like aaa, ooo, etc., and later on add consonant sounds like mama, dada, papa, etc. Saying single words:  This is also known as the holophase stage. Babies enter this stage anywhere between 10 to 13 months of age. During this stage they start babbling and cooing a lot more using single words  in an effort to increase their vocabulary and pick up more words. Warning signs: When should you worry If your child doesn't babble or coo by the end of the first year and use sign language to express her feelings talk to your pediatrician to nib the problem early. COGNITIVE DEVELOPMENT There isn't a single development that speaks about your child's cognitive development but a range of skills and actions that she performs to ensure proper cognitive development. Here are few signs and skill you should watch for during the first year of your child's life: Identifying loved ones by smell -- Babies can recognise their mother's by her smell. Of course you won't know that, bu the fact that your baby feels comfortable and calms down in the mother's lap shows that she knows her primary caregiver well. Starts to breastfeed – Even though it is thought that babies start to suckle on the mother's breast for nourishment instinctively, remember, your little one might need help over here too. However from birth to the first month most babies learn to be  pro in it. Crying becomes a mode of communication - By one month of age your baby will be crying out more often than you imagined and it's not always a SOS message. They might cry when they are wet, hungry or just need warmth. Developing grasping reflex - Between one to two months your baby will be able to grasps things place on her palms like your little finger, the rattle, etc. Explore everything with her mouth - By three to four months of age your child will probably try to taste everything with her mouth -- from her own fingers to your hair, toys, etc. This is a vary cautious period for you to avoid fatal accidents. Explores her own body - By three to four months of age, no matter how many toys she has her favorite playthings will be her fingers, toes and her own skin. Sounds and lights excite her -- By four to five months of age she will develop a  keen interest in toys that make sounds or emit lights. However, to be on the safer side invest in BPA free toys as those toys will find a way to her mouth for sure. Thinks she can talk - Expect to hear more sounds by five to six months of age as she tries to express even more to gain attention and communicate. Plays with simple objects -- By five to six months of age as her grasping power develops she can hold and play with toys like her rattle. Understands the meaning of 'NO' - By age six to nine months your little one would know what is a 'no' and will respond to it. Even nod her head to a no. Explores different tastes -- By six months to nine months she would be ready to explore the various textures and tastes of food other than breastmilk or formula. However, go slow and try one taste at a time with other liquids like fruit juices or vegetable soups. Pinching reflex develops -- This is an important reflex that your child develops called fine prehensions between eight to 12 months. Develops memory recall -- Remembers few details of a particular experience or action for a short duration of time between three to nine months. Eye movements develops -- By nine months your baby will be looking at objects and toys that fall out of site along with the head turning to the same direction. Eating adventures -- Between nine to 12 months your child would love to feed herself and probably the entire family. It would invite a lot of mess but guarantee good reflexes. Takes orders -- By end of her first year she would be able to take small order from you, like, 'Come here,' 'Go there,' 'Say bye,' etc. Spends more time exploring things -- By now your child would start playing more with her toys on her own, spend more time exploring the various textures and colours. Warning sign: When you should worry If your child finds it difficult to understand simple verbal commands by end of her first year it is an alarming sign of developmental delay. Inability to grasp objects is another sign you should watch out for. SOCIAL DEVELOPMENT If you think that babies aren't able to socialise then you are wrong, they are the most adorable social creatures. Here is how she develops her social skills during her first year, Smiles often– By the second week to 14 week you would notice your little one break into cute and adorable toothless grins Responds to smiles when smiled at – By two months of age she will be smiling at people who greet her with a grin (well, almost everyone who smiles at her, some people might be an exception) Recognises people – By five to six months of age your child will be able to recognise immediate family members and others who she sees frequently. Begins to enjoy peek-a-boo – By nine months this will be her favorite social game Imitates and copies people – By 12 months your child will pick up actions and gestures that you perform. Warning sign: When to worry If your baby refuses to smile at anyone after nine or 10 months. Lack of interest in relating to others; doesn’t use gestures, such as pointing or waving bye-bye, by 12 months EMOTIONAL & BEHAVIOURAL DEVELOPMENT It is tricky to keep a tab on your child's emotional and behavourial development with every passing day, but it is essential for you to look for the right signs. Here are the ones you should watch out for during the first year,

• Crying as a mode of communication from birth to four months of age.
• Expressing emotions through smiles, body movements, frowns
• Coos when comfortable, consoled by being cuddled
• Able to laugh and make happy sounds
• Begins to show fear around unknown people
• Comforted with familiar face or voice
• Strong attachment to caretakers. Babies play games with caregiver, fuss or cry if caregiver looks or behaves differently and become upset when caregiver leaves (separation anxiety).
• Senses and expresses emotions like happiness, fear and unhappiness
• Resists to things not happy about
• Soothes self with thumb sucking or familiar toy
• Enjoys attention

Warning signs: When to worry  If your child lacks in emotions and refuses to cuddle up to your arm or remains indifferent to your touch, it speaks volumes of her delay in emotional development. Delayed Milestones The developmental milestones are reached around the expected age most of the time. And most babies catch up soon even if there is a delay. Babies are said to have developmental delay – in one or more fields - when they don’t reach developmental milestones within the broad normal range. But it is important to note that each child develops in different ways and at different rates. Development delays are diagnosed by tracking the baby’s forward progress in all fields. It is also important to diagnose vision and hearing problems as they may affect development in other fields. Mistakes to Avoid

• Never offer water to your baby below six months of age. It can lead to dilution of sodium concentration in the body, unsettling the electrolyte balance and causing tissues to swell.
• Do not allow sleeping with the bottle. Breastfeeding the baby to sleep is no different either. Allowing baby to sleep with a bottle could lead to milk pooling and erode the enamel of the newly formed teeth, leading to nursing caries.
• Never make your baby sleep on her tummy or sides as it increases the baby’s chances of SIDS (sudden infant death syndrome) due to compressed airways.
• Pillows are dangerous for your baby. It could be a prime cause of suffocation in infants, leads to flat head syndrome or a sprain in the neck.
• Do not wake your baby up to breastfeed. Babies can get through the night without feeding.
• Do not shake and rock in a rigorous manner to soothe a crying baby. This action would only lead to trauma and can also cause damage to their delicate brain.
• Do not try to wean before time: The WHO strongly recommends exclusive breastfeeding for the first six months of life.
• Separation anxiety can be frustrating for the babies. In India, unlike in western countries, infants are rarely separated from their mother in the first year of life. But you may have to leave your child when you need to run an errand and join back work. Get your baby to gradually get used to the idea.
• Never force your baby to walk with supporting aids like the walker. This is dangerous as it can lead to hip bone damage.
• Pulling your little one’s arm while helping to walk can lead to dislocation of the ball-and-socket joint. Instead, hold your baby from the sides of the tummy to give support while taking baby steps.

This article has been verified by Dr Mona P Gajre, Professor of Paediatrics & Head - Learning Disability Clinic, Lokmanya Tilak General Hospital, Mumbai.   You may also like to read:  Developmental milestone: Has your baby started walking? Developmental milestones: Should you worry about your child’s delayed speech?

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