When to Worry and When to Wait with Preschool Development

Preschool Development  ·  Ages 3 to 5

When to Worry and When to Wait with Preschool Development

A parent's guide to understanding what is typical, what warrants attention, and when to talk to your pediatrician

By Dr. Erica Buchholz, PhD  ·  Becoming Playful

Key Points

• The range of typical development is wider than most parents realize, and individual variation is significant.
• Most preschool behaviors that concern parents are within the range of typical development for this age.
• Knowing the specific signs that warrant professional attention helps parents distinguish normal variation from genuine concern.
• Your pediatrician is always the right first stop when you have a developmental concern. There is no such thing as a concern that is too small to ask about.
• Trusting your instincts about your own child is valuable and worth acting on.

Every Parent Has a List

The thing they noticed last Tuesday. The behavior that the internet says is concerning. The comment from a well-meaning relative. The comparison to another child who seems to be doing something differently. The quiet background worry that has been running for weeks without quite crystallizing into anything specific.

Parenting a preschooler means living with a certain amount of uncertainty about what is typical and what is not, because the range of typical development is genuinely wide and because children at this age are changing rapidly enough that yesterday's concern is sometimes gone by next week.

This article is a guide to distinguishing between the worries worth sitting with and the ones worth acting on.

The Width of Typical Development

Developmental milestones are described in terms of ranges rather than precise ages precisely because individual variation is so significant. The child who walks at ten months and the child who walks at sixteen months are both within the range of typical. The child who has a hundred words at eighteen months and the child who has thirty words at eighteen months may both be within typical range depending on other factors. The child who is intensely social at three and the child who is intensely solitary at three are both showing developmentally typical variation in temperament and social style.

What the Research Tells Us About Normal RangesThe CDC's developmental milestones, released in updated form in 2022, reflect the range within which most children accomplish particular skills, not the median age. Missing a milestone by the listed age does not automatically indicate a concern but is a useful prompt to discuss with your pediatrician. The AAP recommends developmental surveillance at every well-child visit and specific screening at eighteen months, twenty-four months, and thirty months, with additional autism screening at eighteen and twenty-four months (CDC Developmental Milestones, 2022).

The behaviors that most often concern parents of preschoolers, intense tantrums, defiance, difficulty sharing, imaginary friends, fears, aggressive play, strong preferences, all fall within the range of typical development for this age the vast majority of the time. The presence of any of these behaviors is not, on its own, a red flag.

The question is never whether a behavior exists. Almost every preschool behavior exists in typically developing children. The question is whether it is affecting your child's functioning in a way that warrants attention.

Signs That Are Worth Discussing with Your Pediatrician

While most preschool behaviors are within typical range, certain patterns are worth bringing to your pediatrician rather than waiting to see if they resolve. The following are not diagnoses. They are prompts for a conversation with the right professional.

Language concerns worth discussing include: not speaking in phrases by age two, not speaking in sentences by age three, significant loss of language skills that were previously present at any age, speech that is very difficult for familiar people to understand past age four, or a child who does not seem to understand what is said to them.

Social-communication concerns worth discussing include: limited or absent eye contact, limited or absent pointing or showing by twelve months, not engaging in pretend play by age two or three, significant difficulty in peer interactions that is not improving over time, or a child who seems unaware of or uninterested in other people.

Behavioral Patterns Worth DiscussingThe following behavioral patterns, particularly when they are persistent, escalating, or significantly affecting daily functioning, are worth a conversation with your pediatrician: tantrums that are very frequent and very intense past age four, self-injurious behavior, aggression that causes significant harm and is not decreasing, significant anxiety that is interfering with daily activities, very restricted eating that is limiting nutrition, and sleep difficulties that are significantly affecting the child's or family's functioning. Any sudden and unexplained behavioral change in a previously well-regulated child is also worth noting.

The Role of Your Instincts

You know your child better than any professional who has seen them for thirty minutes in a clinic. Your instincts about your child, even when they are difficult to articulate specifically, are worth taking seriously. The parent who says "something feels off, I cannot quite say what" is often right. Advocating for a developmental evaluation, a speech therapy assessment, or an occupational therapy referral when your instincts are telling you to is not being an anxious parent. It is being an informed and attentive one.

Early intervention, where it is warranted, produces meaningfully better outcomes than a wait-and-see approach for many developmental differences. The cost of seeking an evaluation that turns out to be unnecessary is low. The cost of waiting when intervention would have helped is potentially significant.

A Framework for Deciding What to Do

1Ask whether the behavior is affecting functioning.

A behavior that exists but does not significantly affect the child's daily life, relationships, learning, or your family's functioning is usually within the wait-and-see category. A behavior that is significantly affecting any of these is worth discussing.

2Ask whether it is improving, stable, or escalating.

Most typical developmental behaviors improve gradually over time. Behaviors that are escalating rather than improving, or that have not shifted at all over months despite a consistent supportive approach, are more worth discussing than those that are slowly resolving.

3Trust your instincts and ask anyway.

There is no such thing as a concern too small to bring to your pediatrician. If something is worrying you, bringing it up at the next well-child visit costs nothing and can either reassure you or set something useful in motion.

4Document what you are observing.

A brief written record of what you are seeing, when it happens, how often, and in what contexts, is far more useful to a pediatrician or specialist than a general description of concern. Specificity helps professionals know what to look for.

5Know that early support, where warranted, makes a significant difference.

The preschool years are a time of extraordinary neurological plasticity. Where intervention is helpful, earlier is meaningfully better than later. Waiting to see if something resolves on its own is sometimes the right call. It is not always the right call.

Summary

The range of typical development is wide, individual variation is significant, and most behaviors that concern parents of preschoolers are within the range of normal for this age. The most useful questions are whether a behavior is affecting daily functioning, whether it is improving or escalating, and whether your instincts are telling you something worth listening to. Your pediatrician is always the right first stop for developmental concerns, and there is no such thing as a worry too small to raise. Where early support is warranted, earlier is better. Trust your knowledge of your own child, ask the questions you have, and advocate for what you observe.

Frequently Asked Questions

How do I know if my child needs speech therapy?

Common signs that a speech therapy evaluation may be helpful include: speech that is very difficult for familiar people to understand past age four, sentence structure that seems significantly behind peers, very limited vocabulary for age, or a child who has lost language skills they previously had. Your pediatrician can make a referral.

My child has a lot of sensory sensitivities. Should I be concerned?

Sensory sensitivities, strong reactions to sounds, textures, lights, or other sensory input, are common in preschoolers and are within the range of typical variation. When sensory sensitivities are extreme, are significantly affecting daily functioning, or are accompanied by other developmental concerns, an occupational therapy evaluation may be helpful.

What is the difference between typical preschool behavior and ADHD?

ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity that affect functioning across multiple settings. All preschoolers show some level of these behaviors. ADHD is typically not diagnosed before age four and requires a comprehensive evaluation. If you have concerns, bring them to your pediatrician.

My child is behind on developmental milestones. What should I do?

Bring it to your pediatrician at your next visit or sooner if you are concerned. Your pediatrician can help determine whether a referral for developmental evaluation, speech therapy, occupational therapy, or early intervention services is appropriate.

I feel like I am overreacting to everything. How do I know when my concern is legitimate?

Trust the combination of your observations and your instincts. If something is consistently on your mind, it is worth mentioning to your pediatrician regardless of whether you can fully articulate why. Pediatricians are trained to help parents sort through exactly this and will not judge you for raising a concern that turns out to be within typical range.

Sources

Centers for Disease Control and Prevention. (2022). CDC's developmental milestones. cdc.gov/ncbddd/actearly/milestones

American Academy of Pediatrics. Developmental surveillance and screening. healthychildren.org

Zero to Three. Developmental milestones: Three to five year olds. zerotothree.org

If you have a specific developmental concern about your preschooler and want a knowledgeable, warm perspective on what you are observing, Dr. Erica works with parents of preschoolers one-on-one. She can help you think through what you are seeing and whether and how to pursue further support. Visit becomingplayful.com.

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