Child Development refers to the complete set of changes that occur in the human brain from the time of birth to adulthood. It is this process which transforms a helpless new born who cries and sucks into a walking talking adult. In the usual sequence, it is a one way process and happens by and large on its own in every child, provided the brain and body are adequately supported, protected and given a good environment.

The challenge of adoption lies therefore in providing that right support and environment and then waiting for the natural process to unfold. Intrauterine and the immediate birth and early developmental periods may not have been ideal environments in the case of adopted children; of course they need not have been ideal in biological children too. But the brain has this remarkable ability to change, to repair and rewire itself as long as it is given the time and space to do so at all points of life. This “neuroplasticity” is the key to developmental success. And harnessing this ability is something that all parents learn as they go along; an adoptive parent is no exception.

What differences can we anticipate and prepare for when we bring a child home? A commonly seen difference is physical – the size, weight and height of a child. Nutrition may have been inadequate and may result in a child who is underweight and/or stunted in height. Iron, calcium and vitamin deficiencies also tend to be common. Fortunately, nutrition is one thing that is very easily remedied and can be made up for in a fairly short period of time. Even months and years of malnutrition recover with adequate care in a matter of weeks to months.

The next difference is in the attainment of child developmental milestones. Development requires the presence of a supportive environment in order for the brain to reach full potential. Both intrauterine and extra uterine environments have important roles to play here. And both these may have been inadequate in an adopted child thereby manifesting as a delay in developmental milestones. Commonly these are seen as delays in the gross motor milestones of rolling over, head control, sitting, standing and walking. The other big delay seen may be in the area of language – both in understanding (receptive) and speaking (expressive). More than any other domain of development, language is dependent on the presence of a primary caregiver who interacts with the child on a continuous basis. A child in a group care setting misses out on this and as a result may show a lag in the acquisition of meaningful words and understanding others speech. Add to this the fact that in a country like India, the child may have been spoken to in more than one language in the initial phases and then a completely different language after adoption (depending on location), and the possibilities of a language delay become higher.

The good news is that most of these delays can be rectified even at later stages. The majority of adopted children do catch up with their age peers in a few months to years and in the long run do just as well in terms of developmental potential as anyone else. What they require, for this to happen, are two things – opportunity and time. And both of them lie in the hands of the parent. Opportunities may involve restructuring the home environment to foster particular skills or milestones or may even require seeking outside professional help like a therapist. Time is sometimes more difficult because it needs patience and persistence on the part of the parent – something most of us are not very good at. But we can learn as they grow and as we learn to understand our and recognise their strengths, weaknesses, quirks and uniqueness, we grow too.

Development in an adopted child proceeds along the same natural path as in biological children albeit with a higher possibility of initial delays. Parents can however provide time and space and thereby enable any delays to be made up for and thus ensure that every child, whatever their start in life, grows to and attains full developmental potential.

Let’s take a look now at the major milestones that children reach at various ages and what the important “red flags” to watch out for are:

0-3 months:

Smiles at faces (social smile)
Vocalisation (saying ooo, aaah, nggg)

Red Flag:
No smile by 20 weeks

3-6 months:

Head control – holds head up well by himself
Rolling over
Able to reach for and hold an object (both hands reaching equally often)
Mouthing of objects
Sounds like ma, da, ba (no meaning)
Recognising mother (or primary caregiver)

Red flags:
Poor head control by 6 months
Preferring one hand always while holding/reaching for objects
No sounds

6-9 months:

Sitting alone
Crawling/moving around
Transferring objects from one hand to the other
Playing peekaboo
Laughing
Crying or fear when seeing a stranger (Stranger anxiety)

Red flags:
No attempt at sitting with support by 9 months
No attempts to crawl or move
No single syllables by 9 months

9-12 months:

Pulls herself upto standing position
Moves by taking steps holding onto furniture
Can hold small objects between thumb and finger
Talks words of 2 syllables – mama, papa, thatha etc but not meaningfully
Can wave bye bye,clap on being asked to

Red flags:
No sitting by 10 months
No pulling to stand by 1st birthday
Does not wave or understand any instructions
No stranger anxiety/recognition

12 – 18 months:
Walks alone
Can scribble with a pencil
Starts saying a few meaningful words
Can understand many words and simple directions

Red flags:
Not walking by 18 months
Not able to poiint to common objects when asked
Still mouthing objects
Poor eye contact
No words with meaning by 18 months

18-24 months:

Runs; jumps with both feet
Can go up stairs but has trouble coming down
Throws a ball
Can draw some lines with a pencil
Can name 3-5 body parts
By 2nd birthday can speak 50 words with meaning and is starting to join 2 words together

Red flags:
Less than 50 words by 2nd birthday
Does not understand single step directions and/or point to all common objects/body parts
Unable to scribble
Toe walking after 2nd birthday

2-3 years:

Can go up and down stairs holding on to rail
Can throw a ball well and attempts to catch
Draws a circle by 3rd birthday
Can name all body parts
Talks in sentences; can say 200+ words by 3rd birthday
Feeds herself with some spilling
Removes clothes
Starts indicating need to use toilet

Red flags:
Less than 100 words by 3rd birthday
Does not follow 2 step directions
No attempt at bowel control

3-5 years:

Rides tricycle
Can go up and down stairs
Can play on slide,swing etc
Can kick, throw and catch a large ball
Attempts to imitate shapes like square,cross,triangle with a pencil
Attempts to dress himself and wears shoes (may need help)
Can eat by himself
Daytime bladder and bowel control achieved by 5th birthday
Can narrate a simple story(with prompting)
Recognises a few colours

Red flags:
Not talking in sentences by 4th birthday
Unable to draw lines/shapes
Clumsiness/tremors/unsteadiness
Poor pronounciation by 5th birthday
No bladder/bowel control
Cannot perform self care tasks like eating,dressing
Not interested in playing with other children
Unable to sit in a classroom for 30 minutes by 5th birthday

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