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Posted by Dr. Claire McCarthy May 28, 2013 07:45 AM
As a pediatrician, I always want to find developmental problems earlier rather than later. When I do, I can get children and families the help they need earlier, which can make a big difference--especially if the developmental problem is caused by something that needs medical treatment.
The problem that I--and all doctors--face is that it's not always as easy as you might think to pick up on problems. Babies and toddlers aren't always happy to come to the doctor, and don't necessarily, um, cooperate--or show me everything they can do. So sometimes I'm not sure if what I'm dealing with is a problem--or a scared or furious kid.
And while parents are the experts on their kids and usually do know when there is something going on, that doesn't always get communicated as well as it could. Sometimes parents, especially first-time parents, aren't sure about their concerns and decide not to say anything. Sometimes denial plays into it, sometimes parents get intimidated, sometimes doctors don't ask the right questions and sometimes we plain old run out of time at a visit.
This week, the American Academy of Pediatrics (AAP) published some guidelines to help pediatricians pick up on motor delays--that's when there's a problem with how children use their muscles, especially their arms, hands, legs and feet.
The clinical report, entitled "Motor Delays: Early Identification and Evaluation," lays out a whole process for doctors to use. The well child visits they want doctors to especially concentrate on are the 9 month, 18 month, 30 month and 48 month visits.
At the last two, the 30 month and 48 month visits, doctors are mostly supposed to be looking for anything they might have missed earlier--and assessing for school readiness at the latter visit. But at the 9 month and 18 month visits there are very specific things they are supposed to look for--and parents can look for them too.
At 9 months, babies should be able to:
- Roll to both sides
- Sit well without support
- Use both arms, hands and legs equally (without preferring one side)
- Grasp objects and transfer them from hand to hand
At 18 months, toddlers should be able to:
- Sit, stand and walk independently
- Grasp and manipulate (play with, pick up, move around, etc) small objects
If your child can't do any of these, talk to your doctor. Make sure that he or she listens, and that you have a plan for not only figuring out why (if you don't know already) but for getting your child help.
There are also four questions that doctors are encouraged to ask parents--and that parents can also ask themselves:
- Is there anything your child is not doing that you think he or she should be able to do?
- Is there anything your child is doing that you are concerned about?
- Is there anything your child used to be able to do that he or she can no longer do?
- Is there anything other children your child's age can do that are difficult for your child?
Think about these questions. If the answer to any of them is yes, talk to your doctor. Again, make sure that he or she listens--and that you have a plan for figuring out and helping if after talking about the questions there does seem to be a problem.
Children under the age of 3 years with developmental delays may qualify for services and support through a program called Early Intervention. What many people don't know is that parents can call Early Intervention themselves and ask for an evaluation; a doctor doesn't need to do it. You can find listings of programs here in Massachusetts at the Family Ties of Massachusetts website.
You can also find more information about developmental milestones at the website of the Centers for Disease Control and Prevention.
Get informed, and speak up. That's what I always want the families of my patients to do--because it helps me be a better doctor to them.
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About MD MamaClaire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »
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