Watching your child develop new skills during the first months and years can be exciting. However, it is natural to worry about whether something could be wrong, if your child is not doing something as quickly or as well as a sibling or neighbor's child. As you watch your child grow, remember that each child is unique and the range of typical developmental progression is broad. Differences among children do not necessarily indicate a problem. However, it is important to watch for signs of delays in development and to get help early if you suspect a problem.

Development occurs across various areas: gross motor (sitting, crawling, walking), fine motor (grasping objects), communication/language (waving, babbling, following directions), social/emotional (eye contact, playing with others) and self-help (dressing, toileting). The term developmental delay is used when a child fails to reach milestones within the broad range of what is considered typical. The delay may be in one or more of these areas. Several warning signs should alert you that your child may be experiencing a problem. If you notice any of these, you may want to consult your pediatrician.

By 4-5 months

• Not smiling in response to your smile

• Not reaching for or grasping objects

By 7 months

• Not rolling in either direction

By 1 year

• Not sitting up or crawling

• Not engaging in games such as peek-a-boo

• Not pointing to objects or pictures

• Not babbling with consonants

By 18 months

• Not walking

• Not using at least one word other than "mama" or "dada"

By 2 years

• Not using 15 or more words or two-word phrases

• Not using words to communicate — only imitating

• Not following simple instructions ('sit in the chair")

3-5 years

• Little or no pretend play

• Little interest in social interaction

At any time, no matter the age

• Using one side of the body more than the other

• Losing skills that were once present

• Not startling to loud sounds

• Showing continual violent or aggressive behaviors

If you notice one or more of these warning signs, you should consult your child's physician. Developmental screening procedures can potentially be done in a physician's office and may show that the child's development is actually within the range of what is typical. If a problem exists, your physician can refer your child for a formal developmental assessment. Early intervention and therapy is available for children with all types of developmental delays and is most effective the earlier it is put into effect.

You are the person who knows your child best. If you have concerns, act early.

Dr. Gretchen Meyer is a neurodevelopmental pediatrician with Mercy Children's Hospital. For more information about Mercy Children's Hospital, visit www.mercy.net/stlchild.