Step By Step: Stages of Baby Development
Developmental assessment is one of the services provided at well-baby clinics (Tipat Halav). We have made a parents’ guide regarding babies’ development, developmental delays, and steps to take if concerns arise.
Parents of babies discussing their children often mention concerns and questions like: Why isn't he crawling yet? Why did she stand before sitting? But a few years later, their conversations might be a bit different.
Developmental assessment is among the services offered at Tipat Halav clinics - so we recently spoke with the head of Maccabi's Tipat Halav program to delve into what developmental milestones parents should anticipate at each age, and whether concerns arise when children appear to be lagging behind.
So what is a child’s typical developmental process from birth to 6 years of age?
Let's start with the fact that babies are born different. Many factors influence their development, personality and future outlook. Influences include genetics and environment, such as biology, family, the child's home environment, personal temperament, parent-child relationships, parental responses to the child's needs, opportunities for learning and exploration, and the child's reactions to their environment.
One of the nurses' responsibilities is to identify children whose development differs from that of their peers. However, as previously mentioned, each child develops at their own pace - how do those realities balance?
Indeed, each child progresses at their own pace, yet there is a general timeframe for reaching developmental milestones. So it is essential to identify children whose development falls outside the typical range. The aim is to identify children whose development differs from their peers as early as possible. This allows us to provide support, guidance, and referrals for early diagnosis and intervention, as well as address parental concerns.
How is the assessment carried out?
At every appointment, a developmental assessment is performed, evaluating progress across fine motor, gross motor, language, and social skills. The assessment will be conducted as close as possible to the standard age for skill acquisition. It takes place at the clinic, primarily by observing the child and parent. If observation is not feasible for any reason, questions and parental input are used.
What conditions are required for an objective assessment?
It's important to ensure that the child is feeling well, not hungry or tired, and that the room is comfortable and at an appropriate temperature.. The test location depends on the child's age but usually occurs in the nurse's room. It can be conducted on a mattress, the floor, the parent's lap, or around a low table. It's important to consider how the child responds, so the observations can be in the waiting room or elsewhere at the Tipat Halav clinic.
Why are assessments conducted in the waiting room?
Sometimes, when a two-year-old enters a nurse's room, they may feel stressed, shy, and less cooperative, limiting the nurse's ability to form an accurate impression. In such cases, the evaluation can be conducted in an alternate setting.
Are there additional factors considered during the evaluation?
Certainly, additional considerations include the child's home environment, cultural background, and language.
What elicits concern and when is further examination warranted?
When withdrawal signs are observed or when parents report fears of developmental delays. Withdrawal is primarily identified based on developmental milestones typical for each age. The nurses may request further investigation if they detect a delay based on their experience and intuition, even if it's not immediately apparent.
How does further testing proceed?
The nurse will contact the attending physician, who may then refer the child for further assessments such as hearing or vision tests, or evaluation at the Child Development Institute based on the findings. Treatments such as physiotherapy, speech therapy, and occupational therapy are provided at the institute.
What do you mean when you say the assessment also involves the parent-child relationship?
This is a good question and important point. Remember that we mentioned genetic and environmental factors? So the environmental component is the parent-child relationship. For example:
How does the parent respond to the child's success or failure? How much physical affection, such as touching, hugging, or kissing, and comfort does the parent provide? Is there consistent eye contact between them? Does the child seek frequent feedback from the parent by looking at them?
How do you respond to stressed parents who have exceedingly high expectations for their child?
Each test starts with the nurse asking the parent about their feelings regarding the child's development, their expectations, concerns, and reasons behind those concerns.
We try to understand the source of any fears and manage it effectively. At this point, we provide parents with factual information and emphasize that each developmental stage has an age range.
But didn’t we already mention that parental intuition is important?
Of course it is, but it depends on the situation. If the test results indicate healthy progress, we will explain and demonstrate that the child is developing normally. I always discuss and provide guidance on what to expect from the child going forward, outlining what I anticipate for the next visit. And I do likewise in the following visits. Having clear expectations helps reassure parents while also empowering them to actively support their child's development.
How is the assessment delivered to the parents?
We always start by highlighting the child's strengths and then address any developmental milestones that may require attention and support.
In general, it is important for parents to know Tipat Halav nurses are excellent sources of information, as they are specialists with extensive knowledge, training, and experience. It’s equally important to convey that the objective isn't to scrutinize children and parents for problems, but rather to identify any developmental delays that could impact future growth, ensuring timely intervention when necessary. Because unaddressed issues become more difficult later. The nurses at Tipat Halav always prioritize the child and parents.
The article is provided by Mira Kola, head of Maccabi’s Tipat Halav program.