As a parent, it seems that “worry” is a new badge of honor that comes with the title of “Mom or Dad”. We worry about all the things- sleeping, eating, milestones, social interactions, behavior. Some of this just is part of being in charge of a little human and us wanting them to be the best version of themselves. But other times, there are valid concerns. So when this occurs, how do you address developmental concerns in your child in order to get the help you might need?

Before we get into ways to address a concern you have, let’s talk about how to know if you even have a concern. It is important to recognize a variety of ways that you or the providers in a child’s life can monitor development over time.

Developmental Milestones

Many people use milestone markers across many developmental domains to watch a child progress across skills. Recently, the CDC updated the milestones and put out new information for families to access. Full disclosure, there have been some variable reactions to this change from the community of therapists in particular. If you want to hear more about the updated milestones, check out my post on it.

Know that if your child is slightly behind in one milestone, I do not believe that is reason to panic. You could certainly keep this in mind, take note of it, and discuss with your pediatrician or family doctor at your next well child visit. If your child is behind in or not meeting multiple milestones, that can be a reason to seek out intervention.

Developmental Screenings

A screening tool can be a way to take a closer look and deeper dive into development. In the United States, children are typically screened through a medical provider or a childcare center. It is recommended that children be screened at 9, 18, and 30 months of age with specific autism screenings completed at 18 and 24 months of age. Commonly, the Ages and Stages Questionnaire (ASQ) is used in healthcare settings. This is a brief questionnaire that asks the caregiver to comment on the child’s participation in each developmental domain. If there are concerns, a referral could be placed for the child to have a formal evaluation completed by a specialist.

Parent Concerns

I think it is incredibly important to understand that a child does not have to show delays in milestones or a low score on screeners in order to warrant a need for a referral to a specialist. Oftentimes, a parent may have a concern that might not be identified on a formal tool such as a screener. This could include the child’s difficulty tolerating or participating in any daily activity including mealtimes, sleep, car rides, bath time, meeting people, being out in the public, play. A child may approach a task with variable coordination or endurance as well. So maybe they CAN complete a task or have reached a milestone, but it isn’t easy for them. A parent tends to know when something is out of the ordinary and challenging. If you’re a parent, know this and take this reminder as a confidence boost if you’re wondering if something is wrong or different with your child. If you are a provider, listen to the parent.

What’s Next?

So, maybe you have identified a concern. How do you express this and to whom?

Express Concerns to a Doctor

When your child has a well child visit, you are welcome to express any and all concerns to them. If you do not have a well child visit coming up in the near future, go ahead and ask for an appointment. If you have a good relationship, you could even consider calling or sending a message laying out your concerns and requesting advice for next steps. Sometimes, you know what you want: “At our last visit, we discussed my concerns about my daughter’s speech. We talked about waiting a little to see if she progressed soon. She is not vocalizing and has very few words. This worries me and I would like to seek out a speech therapy evaluation. Can you place a referral to [local clinic] and notify me when this is complete?” This lays out the concern, what you are requesting, and really leaves no room for discussion.

But What if the Provider Disagrees?

There is a mindset that suggests a “wait and see” approach. It is likely that some providers suggest this since there can be such a wide range of abilities within normal development. Some children walk at 9 months, some not until 15. Some kids don’t crawl. Some children are silent until 2 years old, then have so much to say. This likely depends on your child as well as your relationship with your provider. I would encourage you to ask questions about this and have a thoughtful discussion. I have created some phrases you can use, if needed.

• “Can you tell me more about the benefits of ‘waiting and seeing’?”
• “I understand that he might reach this skill, but I would rather just get an evaluation to make sure we’re not missing anything.”
• “I would like some help. I believe a skilled provider could evaluate her and give me ideas for home.”
• “Early intervention can be critical for developmental gains. I don’t want to miss a window and I would like to jump on this.”
• “I understand that he is showing skills in normal ranges. But the way that he is totally intolerant of certain activities is a red flag to me. I would like to investigate that further.”

I believe that if your provider pushes back against your request for a referral to an evaluation, AND they do not allow for a thoughtful conversation, I would seek out a second opinion.

Request a School Evaluation

If your child is 3 years or older, he may qualify for an Individualized Education Program and receive school supports including, but not limited to: specialized education, early childhood support, psychology, therapies, adaptations to his or her day. You, as the parent or teacher or provider, can request that a school evaluate the child to see if he qualifies for special education. Find the steps to do that here. Legally, a school must consider the request and act on it. The process certainly varies by state, so I would check out your state’s Department of Human Services or Department of Public Instruction websites for more resources

Self-Refer

If your child is under 3, you can refer yourself to Birth to Three or Early Intervention services in your county. Check out your county’s Birth-3 page and find a referral form. When in doubt, give a call. This might be helpful if you are unable to get into your provider in order to get a referral. It could also be helpful to simply get another set of eyes on your child. Tip: Birth to Three teams are excellent and helpful when transitioning to school teams.

While you Wait

Ok, so any of these routes do require some time of waiting. Even if you self-refer or your doctor places an order that day, you will have to wait for an appointment and availability. Then, if your child qualifies for intervention, it will take time to make and attend follow up appointments. So what can you do NOW? Well, my best advice is to continue to love up on that child (obvious, right? but worth stating). Secondly, check out CDC’s resources and free materials. Other good websites are Healthy Children, which is the American Academy of Pediatrics website, and Zero to Three which is a solid website that offers realistic suggestions. I hesitate to tell you to follow a random account on social media. Let’s face it, it’s hard to know who to trust. However, there are some great accounts that provide tips on ways to work on certain developmental milestones. If you find one that is helpful, send a message to them and ask more questions. If it makes you feel icky, unfollow ;).

Benefits of Seeking an Evaluation

What’s the rush? Why can’t I wait.
You totally can. But also, know this information.

Early intervention has been shown to positively improve outcomes for children with developmental delays. A whole lot of research has shown that a child’s earliest experiences have a very big impact on their brain development. This is due to neuroplasticity in the brain; this is a fancy word for the brain being the most pliable and moldable at it’s youngest age. The brain is strengthened by positive, early experiences. If a child’s brain is learning a new skill, early intervention and repetition of that learning is best. From a logistical standpoint, starting early allows for a child to be at the most even playing field as possible. Compare this to a child who enters school without any intervention that might have been necessary. There is a lot of ground to make up at that point, which may or may not be reached.

Ultimately, the outcomes of seeking out an evaluation could result in you hearing your child is doing great. Maybe, you receive some extra ideas to strengthen skills at home. Or, it could lead to your child receiving an intervention that can positively impact his or her development. To me, there is no reason to not ask the questions and seek the help when needed.

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Developmental Delay: When and How to Screen
Screening for Developmental Delay
The Importance of Early Intervention for Infants andToddlers with Disabilities and their Families