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UPMC Pediatrician: Should You Be Concerned About Missed Milestones?

The first time your child laughs, walks, and talks, are all exciting moments to look forward to – in addition to being important developmental milestones. To help determine how well your child is developing and growing compared to other kids the same age, these developmental milestones are measured at every doctor’s visit. The physical, cognitive, social, language, and sensory/motor development of your child will help tell you what you should expect at certain ages.

When your child meets the expected level for their age group for any of the developmental categories, their progress is on track. If they happen to miss a milestone or lose a certain ability expected for a milestone, it’s considered a developmental delay.

Developmental delays can occur for many reasons. Common medical reasons for developmental delays include prematurity, chronic illness, malnourishment, anemia, lead poisoning, or trauma, to name a few. Developmental delays may also be indicative of a disorder such as autism spectrum disorder (ASD). As of 2020, one in 36 children are identified with ASD, according to the Centers for Disease Control and Prevention (CDC). If ASD is suspected, early diagnosis and intervention are essential to improving long-term outcomes on symptoms and development of skills.

Early Signs of ASD

Signs of ASD often appear in the early stages of a child’s life and may continue into adulthood. It is key to intervene as soon as a diagnosis is suspected. The earlier an individual is evaluated and diagnosed, the sooner treatment services and resource support can be incorporated into developmental care. A few of the early significant signs to look for include:
• Six Months – No big smiles, little to no squealing, little to no single syllable sounds (Ex. ma, ba, ga, da)
• Nine Months – No back-and-forth sharing of smiles or sounds like “raspberries”
• 12 Months – Little to no babbling, decreased interest in sharing attention like pointing, showing, or bringing objects of interest to a caregiver
• 15 Months – No single words (Ex. mama, dada, no)
• 24 Months – No two-word phrases, showing minimal affection (Ex. does not initiate hugs or kisses)
• Any loss of speech, babbling, or social skills at any age

Other signs may be a lack of eye contact, not responding to their name, and repetitively stiffening their arms, hands, and legs. They may also engage in repetitive behaviors, such as lining up cars or other toys, get upset when toys are disturbed, or become deeply agitated when their routine is disrupted.

Older children and adults with ASD may also:
• Have a functional language impairment
• Have difficulty forming social connections and understanding common social cues
• Lack meaningful relationship and friendships
• Have a preoccupation with facts, details, and collections
• Be viewed as “odd” or “eccentric” by peers
• Difficulty taking the perspective of others or the appearance of lacking empathy

Seeking Support

Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently. People with ASD have unique strengths and challenges and, as such, have different needs when it comes to services and treatments. Treatment plans usually involve multiple professionals and are tailored to the individual.

If you suspect your child may have ASD, refer to your pediatrician immediately. The need for support may continue as autistic children transition to adulthood. Educational, behavioral, medical, and vocational services are just a few kinds of support that are available in your community and your pediatrician can help connect you with local resources.

by Santisree Tanikella, M.D., F.A.A.P
UPMC Primary Care

Santisree Tanikella, M.D., is a pediatrician and Integrative Medicine practitioner with UPMC Primary Care. She sees patients at 900 Plaza Drive, Montoursville, PA 17754. To schedule an appointment with Dr. Tanikella, call 570-123-4567. For more information, visit