Milestones: Thirteen to Eighteen Months

Remember to use your child's corrected age when comparing her accomplishments to a developmental chart! If your baby has been generally healthy since nursery discharge you can expect she will:

• be able to scribble with a large crayon (if she can keep from putting it in her mouth).

• walk alone with heels flat on the floor.

• feed herself finger foods and begin to try to use a spoon.

• walk up stairs with one hand held.

• use a vocabulary of four to ten words.

• follow simple verbal directions to perform a single task. For example, "Give me the ball."

• coordinate the use of both hands well. For example, hold a container in one hand while putting something into it with the other.

• respond to her name.

• "talk" in long, jabbering sentences as if holding an understandable conversation with you.

• point to at least two pictures on request.

• use her thumb and first finger easily to pick up a very small object.

• throw a ball easily.

If your infant has required lengthy or frequent hospitalizations since discharge from the NICU, or your infant is still on supplemental oxygen, feeding tubes, and/or a large number of medications, she may not be able to put forth much effort to accomplish developmental milestones at this time (just like you would be unlikely to get up and learn a new dance step if you were home in bed with the flu or just recovering from surgery). If your child is still in the NICU at this time her developmental progress will definitely be affected by her health status.

If your child has Cerebral Palsy (CP) her motor problems will have an impact on her learning. It is important to work with qualified therapists to help maintain and hopefully improve your child's mobility. However, do not neglect play and learning through play. Children learn best through play. A child's need for play is not different because she has CP, though she may need help in getting this need met adequately. Encourage your child's therapists to help you figure out ways to support your child in expanding her ability to play.

When someone physically needs help to do many things it is hard to be independent. Whenever possible let your child choose between two acceptable choices. You want to find ways to encourage your child's autonomy. It can sometimes be difficult to be sure what a significantly motor impaired child knows and what she is learning. It is wise to assume any young child can learn if we figure out a way to support their learning. As the child gets older it will be easier to understand what her level of cognitive functioning for school will be. It may be helpful to become involved in a program that can help children and their families find adaptive toys and ways to play. One such program is Lekotek, a toy-lending library for children with disabilities (1-800-366-PLAY).

If your child is having significant problems developing a communication system and learning to talk, there are several things you should be doing. A thorough hearing evaluation needs to be done by a pediatric audiologist. Once hearing has been ruled out as a cause for a child's language delay a speech evaluation should be done. If a hearing loss has been documented it would be appropriate to contact Georgia PINES for assistance both with securing hearing aids, if required, and for help providing appropriate stimulation for your child. Your child will automatically be eligible for the Babies Can't Wait Program if the hearing problem is severe. It will be helpful for your child to work with a speech therapist experienced in working with hearing impaired children. In the meantime it is important to develop a communication system for your child. See ideas outlined under 10-12 month exceptions above.

If your child has feeding difficulties and is not growing appropriately, an oral motor evaluation may be needed. It is important to determine the cause of a feeding problem. This allows for appropriate medical intervention and referral for therapies. If feeding problems persistent, working with a nutritionist to increase caloric intake, or possibly consideration of a gastrostomy tube may need to be explored. Children who are undernourished risk impaired brain growth. Also, without proper nutrition a child may be very tired, irritable, and lack the muscle mass to get around, explore and learn. This is an area that should be under close supervision by your primary health care provider.

Visually impaired children will need to be followed by a Pediatric Ophthalmologist. In addition, there are several programs that can provide vision therapists to work with families and help you understand how best to stimulate your child's development. Begin and Georgia PINES are two such programs available in Georgia. If your child's visual impairment is severe she will automatically be eligible for the Babies Can't Wait Program. 

It is not generally possible to determine what significance delays at this age will have for later development. However, by noting problems early and providing appropriate services the impact of delays may be minimized, skills may be enhanced, and the level of skills may be maintained. It is important to remember that an infant’s medical history can be critical in determining whether or not a further evaluation or referral for service is necessary. A particular delay in development may require different responses depending on the infant’s previous medical and developmental course. While for children who have no history of health problems, a "wait and see" approach may be appropriate for some delays. However, developmental delays in high-risk infants generally warrant more immediate attention.

If you notice any of the behaviors listed below speak to your child’s primary care provider about your concerns. Your child’s primary care provider can help decide if your baby needs an evaluation by a pediatric audiologist, pediatric ophthalmologist, developmental psychologist, physical/ occupational/ speech therapists, or other specialists.

It may be of concern if by eighteen months corrected age an infant:

• is not walking independently.

• is continuing to walk on her toes.

• is not responding to verbal requests. For example, "Show me your shoe," or "Give me the ball."

• is not developing a language system. She is not using words and/or holding "conversations" using long strings of jabbering.

• does not point or try to indicate what she wants.

• does not have a vocabulary of at least three words that are used in a clear, purposeful way.

• neglects one hand; uses one hand exclusively.

• as a rule seems to give up quickly when an age appropriate task is difficult.

• uses her whole hand in a racking motion to pick up small objects.

• is unable to throw a ball. She goes through a throwing motion but does not let go of the ball.

• usually chokes or gages when eating, or has not transitioned to table foods.