Moving the Markers for Child Development

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You’ve got to crawl before you can walk

A child’s development in the first few years of life can influence their development throughout life, and issues or delays in development should be identified and mitigated early. The title of this section is not just a truism, it has been used as a metaphor for many of life’s achievements. Skills and abilities are built upon previous development, like scaffolding. But how do we know when the necessary growth and learning have occurred? Physical and cognitive development was first tracked routinely in the 1920’s and 30’s due in part to two psychologists, Arnold Gessell in America, and a bit later, with much more press, Jean Piaget in Switzerland.

The practice of monitoring child growth and the emergence of development as a subdiscipline of psychology is still quite new relative to human history. While highly cited and still taught in many education and human service programs internationally, Piaget’s ‘ages and stages’ model has not been without criticism. Every child develops at their own pace, and not all developmental milestones missed result in some delay or shortcomings of the individual later in life. They are based on averages yet are still quite relevant. Ages and stages are a map, not the territory.

What is agreed upon is that patterns of human development are common across cultures, gender, socioeconomic categories, etc., although environmental and genetics factors play a part. In short, the stages of growth help determine norms, and can allow for early detection and sometimes the prevention of developing issues. In some contexts, small interventions make for small changes. In others, small interventions can create significant change.

It’s just a 100 Meters. What’s the Fuss?

The 100 meters, one of the original competitions of the Olympics, is still the centrepiece of the modern summer games. The event garners the most attention for its athletes, becoming global superstars for winning the event—ala, Usain Bolt, Gail Devers, Carl Lewis... To compete at this level requires a very high level of dedication, athleticism, and focus. Athletes need to train progressively to ‘peak’ at the Games to have any chance of Olympic glory.

The current world record for the 100 meters is 9.63 seconds in the men’s, set in 2012 by Usain Bolt.

The women’s record is 10.61 set by Elaine Thompson-Herah in 2021. Why am I talking about the 100-meter sprint while exploring child development? I am providing an analog of skill and abilities being developed over time, in this case from one’s natural progression through childhood into a formidable high-performance athlete. The necessary fundamental movement and cognitive skills needed to develop from crawling to walking, from infant to adolescent, are both requisite for everyone, including the future Olympic athlete. I am not suggesting any conflation between advancing records in high performance sports and the natural, mostly unguided, developments of an infant learning to crawl. I will argue however, that it is easy for adults to alter child developmental trajectories (versus adult) with what were, at the time, seemingly reasonable (although later seen as questionable) interventions. We do know that coaches, psychologists, nutritionists, exercise physiologists, and others can help athletes ‘move the needle’ with each of their efforts to achieve optimum performance. We also know mistakes can be made by those same professionals. This is where the two contexts of growth will intersect, when good intentions or ideas go wrong.

Bob Beamon cleared the high jump bar at 8.9 meters in 1968, a record only eclipsed by Mike Powell 56 years later. In 2002, the first motorcycle backflip was landed in a competition. 2006 saw double backflip, but not until 2022 did Australian freestyle motorcross rider Jayo Archer (RIP) pull off a third rotation and ride away. From impossible to possible, each rotation of rider and bike became the equivalent of an Everest ascent among the best riders in the world with now the quad seemingly the newest impossible. If you ride motorcycles like I do, this is worth watching, yet still makes me nervous.

So, with improved nutrition and training techniques, better equipment and clothing, and advanced biomechanics assessments, the record is now Bolt’s 9.63. Only 1.37 seconds have been trimmed off the record over the last 125 years! I may be criticized by sprinters here who would say this is a huge improvement. We must also remember though that life expectancy for males in America in 1900 was only ~45, whereas today its ~80. Clean water, improved sanitation systems, and knowledge about nutrition, health, and wellbeing have come along way. Point is, despite having many modern advantages in general, small incremental change in high-performance contexts is normal. Rapid and significant growth and development in children is however a very different scenario.

Babies Brains & Uninterrupted Normal Development

At birth a baby is ~6% of its future adult weight, but has ~25% of its full adult brain weight. By age 2 the brain reaches ~80% of its adult weight. This is extraordinary growth, where small interventions can lead to significant change. Grey matter (neural cells, dendrites, glial cells…forming brain structures) and white matter (myelinated axons…connecting the structures) grow simultaneously and dynamically throughout the lifespan, yet these critical first two years see a baby’s 100 Billion brain cells create up to 15 Trillion neural connections. This growth is driven by taking in information from the environment around them, exceptionally diverse and dynamic experiential learning.

Timing of many neurological and physical developments are sequential and unfold naturally in optimum settings. Again, not all children have optimal settings due to human and environmental factors; an older house with lead paint and pipes, for example, is going to hamper development. A home where violence or substance abuse is the norm will also interrupt, delay, or alter growth. The short story is, interference with natural processes will have an impact on such a defined series of natural events such as a baby learning to crawl, speak, and respond to others. These of course are only a few aspects of physical development. You must imagine hundreds if not thousands of insights, skills, and abilities developing concurrently.

Mask Mandates and Child Development Interrupted

The CDC and American Academy of Pediatrics (AAP) changed the developmental milestones for children February 8^th 2021. The changes did not suggest human’s evolving and developing more rapidly, in fact, they went in the other direction. Was this simply the state of slowing child development, or was there, as some have argued, an impact from the Covid Mandates such as social distancing/isolation, lockdowns, and especially related to communication skills, masking? What has the CDC and AAP changed? For starters, crawling was removed as a milestone altogether; walking was bumped from 12 to 18 months; and talking, usually having a grasp on about 50 words, was delayed as a milestone from 12 to 15 months. These changes might reflect children being less developed now at those stages than in the 20^th century.

We recognize that atypical development might fit well into a Piaget or other theorist’s models of how young people grow and that there are children who may not fit or follow the models. Again, these are just maps, and not the territory of human development, however, these long-established norms are being adjusted.

There are parallels here to the world of therapy in which clinical assessment often includes pre-determined measures such as questionaries about mental health, motivation, and specific to disorders like depression and anxiety…we can also help through intervention…but we also know that the scores calculated or the impression from one instrument is not equated to the person as-a-whole. They are not their score. Assessments are just tools to help us guide our work.

I’m Walking, yes indeed, I’m Talking

Crawling being removed as a milestone has come as a shock to child physical therapists who recognize crawling, creeping, and walking as natural and clear indicators of future motor control and effective physical functioning. From muscular development to coordination and fundamental movement skills, the checklist approach of developmental milestones in the physical realm are commonly used and highly relied upon. The CDC’s complete removal of crawling, and only having locomotion listed at 12 months as ‘walking with support’ has been rationalized, although not explicitly, because some kids don’t crawl, they just move to standing and walking without a crawling stage. Yes, and yet this ignores the majority of children, and the benefit of recognition of that majority’s crawling phase and its timing, seems negligent. This change suggests crawling in not an important marker?

Related to the milestone of talking, and the unprecedented masking mandate during the Pandemic, how can it be that in the most crucial time of a child’s development of speech and hearing, these milestones, while kept in checklists by the CDC/AAP, have been pushed back by 90 days from 12 months to 15 months. Physical, speech, and occupational therapists will wonder how many kids will now not be referred in a timely manner if these milestones are not being reached at the long-standing 12 months. What has changed children today that speech is delayed by three months? I mean, besides putting healthy children at a major disadvantage by hiding all faces around them for months at a critical time of development.

How then, in a culture where advancements and innovations in learning, childcare, and developmental processes, could children’s speech be later and not earlier? Some have argued coherently that these changes occurred due to the pandemic mandates of social distancing, lockdowns, and especially masking. Masks interfere with a child’s need to see parents and caregiver’s mouths, eyes, and facial expressions to learn emotions, word formation, and the relationship between non-verbal communications and human behaviors. Children were deprived of these affordances when masks were worn, they experienced less human contact and closeness due to the fear of viral infection, and spent less time with family and friends, most critically the oldest generation, their grandparents and other seniors.

Researcher Dr. Lewkowicz at Florida Atlantic University has shown through multiple studies that infants learn most from the lips and mouths of the adults caring for them. This body of research has extended previous thinking that babies learned to speak primarily through sound—language development is not just an auditory process, it is equally visual and experiential. Lewkowicz’s research also suggests that as the child grows, attention shifts from the eyes to the mouth, and then back to the eyes. Between 4 and 12 months, the baby focuses attention on the mouth and lips to build the skills of speech through imitation and observation while still picking up on other cues from body language, the eyes, and behaviors of the adult or older children.

An imposed masking of faces was experienced by many infants, children, and youth at a time of significant development. Further, contact and close connection was lost due to (we now know fabricated and lacking evidence) distancing rules. We do not yet know the full impacts of the intervention. I really hope researchers are busy trying to find out. We have already seen government and professional associations (CDC and AAP) moving the markers, and will they move them back as this generation grows up or will all children henceforth have their later milestones for development?

I teach young adults, and we have these conversations as they prepare to launch their careers as physical educators and recreation and health professionals. Many of them are former high-performance athletes, some still on student athletic scholarships. My current juniors and seniors, and most were in their last year of high school of freshman year at university during the pandemic lockdowns. Of this generation of young people, we witnessed declining rates in sport participation and overall physical activity. The story was worse than numbers suggested as fewer children and youth overall were active, but some kids took up multiple sports and increased activity level considerably, skewing the data a bit. Point being, the mandates drastically affected youth participation in youth physical activity and sport, period.

Of Olympians and Toddlers: Small Interventions with Big Consequences

Consider the months of deprivation for infants during the pandemic where mandates, in effect, removed adults’ facial expressions from their developmental opportunities. Masks, and sometimes face shields, significantly hampered their language skill development, distancing reduced physical contact in many care settings, and even in some family homes. The impact on adults, and high performance athletes was minimal, although had its own effects.

While there were many debates and much disagreement regarding the efficacy or negative effects of masks during the pandemic, you can imagine what it would have been like for Olympic sprinters to have to wear them during the 100 Meter Dash. One systematic review of masks suggested reduced oxygen saturation, reduced oxygen uptake, reduced ventilations, and slower respirations. Some studies suggest no difference, but that doesn’t seem to make sense when we know oxygen is reduced and CO2 gets trapped… It would be absurd to think Usain Bolt could train under these conditions, let alone improve. Overall, a mask may not impair a high-performance athlete’s effectiveness as only small changes are expected when at or near peak performance. An infant however is growing and building neural networks at a phenomenal pace and is quite dependent upon seeing faces for verbal skill development.

Were the masks the real reason for the change in delayed milestones listed by the CDC and AAP? Has the bar been lowered now for children who were in that developmental stage during the pandemic? More concerning though, is what happens when language development is delayed by months? Does this then impact learning in other domains? Does this lead to schools needing to lower the bar for academic expectations? Masking was a major intervention during a time of major development for many children.

My hope is that there are specialists and researchers addressing this now. My hope is that people are willing to ask these questions, to push for answers, and to not ignore the fact that it happened. My hope is that this research can be done objectively and without the outrage we witnessed over whether the mandates were even evidence-based in the first place. A healthy population of children and youth have been affected developmentally. Fractures, which I will follow up on in a future post, can have lasting impact. Child health and wellbeing should be the priority. Language and physical development does not end in childhood, and there may be far-reaching effects on learning and development for many young people.