SAN DIEGO — Closely observing young children during an office visit provides subtle but important clues about whether a child's motor and behavioral skills are developing normally, Barry Zuckerman, M.D., said at a meeting sponsored by the Los Angeles Pediatric Society.
Telltale maneuvers by children aged 6 months to 1 year include how they reach for, grasp, and manipulate objects, and how they respond to adults in the room.
“As clinicians, our greatest skills are observation skills,” said Dr. Zuckerman, chief of pediatrics at Boston University's teaching hospital.
For example, a normal child younger than 6 months typically lunges for a pen offered to him. One or 2 months later, however, he rotates his hand just before clutching the pen so that both are in the same plane, indicating progressive visual and spatial development. At 9 months, he rotates his hand half way through the reach.
Another bellwether maneuver, Dr. Zuckerman said, is a child's pincher grasp. At age 5–6 months, she picks up small objects without much coordination. At 7–8 months, thumb and forefinger do the grasping, and she moves her other three fingers out of the way. At 9 months, she picks up objects from above rather than straight on. By this time, her movement is very efficient and mechanical—a first sign of fine motor skills.
Dr. Zuckerman said that he also watches how a child manipulates objects, like a small toy car.
He said a 6-month-old reaches for the car and puts it in his mouth; a 7- or 8-month-old bangs, drops, and throws it; a 9-month-old moves the car with his hand and explores it, demonstrating good coordination of visual and motor skills; and a 1-year-old moves the car as though it were being driven.
In addition, he said, children should be able to sit by 6 months and, by 1 year, to stand or walk and perhaps say one or more words.
Observe fine-motor and cognitive skills only when the child is healthy and relaxed, because sick or stressed children tend to regress, Dr. Zuckerman advised.
He cited several social and emotional indicators between the ages of 6 months and 1 year:
▸ If a child isn't curious about an object offered to him or isn't interested in exploring it, his development may be delayed.
▸ At about 1 year, a child signals who the primary caregiver is by crying when that person leaves the room or by turning to him or her when a stranger enters. Use such information to identify and provide surveillance feedback to the primary caregiver, who may not be the mother, Dr. Zuckerman said.
Children at this age can retain an image of the primary caregiver when the adult is absent and may cry as a result, he said. In contrast, children 6–7 months won't cry when that person leaves, because “object permanence” hasn't developed. For them, the adult is “out of sight, out of mind.”
▸ When a parent and child are together, body language says a lot about the closeness of their relationship, Dr. Zuckerman said, and offers an opportunity for parents to learn from the physician about their own child-rearing behavior. Signs of a good relationship include total engagement between parent and child, and the child's positive affect, such as joyful facial expressions.
Reading and other shared activities foster a high level of engagement, which is absolutely critical in early childhood, he said.
However, he cautioned that some parents are overloading and stressing their children with too much information.
“We all believe stimulation is important,” he said. “But parents are putting so much pressure on themselves to do the perfectly right thing every minute with their child. That's not what being a parent is about. It's the downtime—taking it easy and enjoying each other.”