Should Your Child Be Evaluated?

CNC Parent & Baby Journal, September 2000

Is my child developing normally? It is every new parent’s main concern. At one time or another, all new parents ask themselves about their child’s development. Because development is such a complex and unique process in every child, it is no wonder we all have questions. Fortunately these days there is not just one Dr. Spock book out there for parents; there are scores of books, articles, and websites informing us about normal developmental stages and milestones. Many parents are better informed and savvier about childhood development than they realize. Our instincts regarding our children are often extremely accurate.

How does a parent know if everything is okay? The more we learn as a society about the importance of early intervention, the more crucial it is for parents to be certain that their child is developing normally, and that if they are not certain, to take the right steps.

Karen, a parent from Scituate, took action when her son was three. “Because [our son] was our first, we didn’t know that his development was not typical, although we had some inkling that something wasn’t right. I consulted my pediatrician, who said that his development was ‘uneven’ and would probably straighten out over time…” But Karen and her sister, a physical therapist, knew otherwise. Karen pushed for more testing despite her pediatrician’s hesitation, and finally learned that indeed, things were not developing typically and that her son needed some intervention. He was diagnosed with Pervasive Developmental Disorder Not Otherwise Specified, (PDD- NOS), on the autism spectrum. Karen turned to the school system for help and now, at the age of six, he is in a mainstream classroom, getting support services from the school, and is doing very well, due to his parents’ vigilance and persistence.

If we believe something is wrong with our child’s development, we should honor that instinct and follow through with it; so should our doctors. Susan Reuter, a pediatrician at Newton-Wellesley Hospital, agrees: “The bottom line is, if a parent comes in with a concern, you have to take them seriously.”

Of course, not every worry that a parent has turns out to be a real concern. How, then, should a parent move forward from worry and questions to getting some accurate answers and reassurance? What are some specific things parents can do to protect their child? What can you do to make your visit to the pediatrician be as fruitful and satisfying as possible? One of the first things you can do is get yourself a developmental checklist, or a book on child development (see sidebar at the end for suggestions). A developmental checklist will explain the general milestones a child achieves in the first few years of life and the ages for each skill. The checklist will serve to clarify just what it is that may be bothering you about your child’s development and give you a way to put it into words.

Once you’ve read through the milestones, you can make a list of the questions you may have about your child’s development. Observe your child with peers or even siblings to get the best information. Compare notes with friends, if that is helpful. Once you have an idea about your concerns, “Explain as clearly as you can what it is that is worrying you,” advises Dr. Margaret Bauman, Associate Professor of Neurology at Harvard Medical School, “Write it down…Parents [may] need to be insistent…” with the pediatrician that there is something that needs attending to.

You can make a specific appointment with the pediatrician to discuss your concerns, or bring up your questions at the next scheduled visit; but don’t wait too long. “Every bit of research shows that the earlier you intervene, the better,” says Dr. Janice Ware, Associate Director, Developmental Medicine Center of Boston Children’s Hospital. Be certain that at every checkup the pediatrician is monitoring the child’s development in speech, fine motor, gross motor, and social skills. There are milestones to be checked at each pediatric visit, even as soon as two months. As the baby develops over his first year, pediatricians should be observing social behavior, language development, gross and fine motor ability, and play skills, according to Dr. Reuter. Don’t be afraid to ask about these!

But parents should keep in mind that they have a certain degree of expertise about their own children that no one else has, and that doctors are not infallible. “Pediatric visits are short and [parents] cannot always rely on a visit to detect what a parent may be seeing,” cautions Dr. Ware. “If the pediatrician has not explained why there really is no problem here…call Early Intervention or Special Services at the local school.”

Early Intervention, a federally run program designed to assess children under the age of three and either refer them for treatment or work with them right at the local E.I. Center, is a great start for many parents with concerns about their child’s development. In Massachussetts you do not need a referral to use E.I.; parents can call on their own. Russ Hoyt, Director of Building Blocks Intensive Early Intervention, North Shore ARC, urges parents to “talk to [their]pediatricians or other professionals who may be involved” if there is any doubt about a child because early intervention “needs to happen before three if at all possible” because this is the age where there is such a large degree of brain development.

Keep trusting that instinct.

Massachusetts Resources