Some parents are blessed with an infant who sleeps, eats, meets his/her developmental milestones, coos, and rarely cries. Other children are more challenging. Friends, relatives, and passers-by often offer conflicting advice. Parents may feel very confused: which advice should they trust and where should they go for help?
Does Your Young Child Need Help?
The purpose of this article is to provide parents with some concrete information about developmental milestones and “red flags”. If a child displays some of the “red flags” listed here, it may be appropriate to have the child evaluated by a child study team or by a specialist in the area of concern. Either the parents’ concerns will be alleviated through the evaluation or the evaluator(s) will recommend intervention. When treated early, many problems may be eased helping the child and his/her family to a happier and more successful future.
The information in this article was collected through interviews with occupational therapists in our community. In addition, we drew on the experiences of parents who have raised special needs children.
Developmental Milestones and Red Flags for Babies
Children develop at different rates. Some children are significantly delayed in a specific area and catch up without intervention. The information provided below is meant to familiarize parents with the standard pattern of development and significant red flags. Parents should use their own judgment about intervening when their child is behind in developmental milestones. The red flags, however, are more serious indicators that the child needs help.
Social and Verbal Milestones
At around six weeks, a baby is usually smiling and interacting socially. Over the next few months, a variety of non-verbal signs of social engagement should appear, including imitation, cooing, and eye contact.
Babies begin babbling by age six months. Communicative words such as “mama” or “dada” usually emerge before eleven months and two word sentences by eighteen months. Two year olds typically use multi-word phrases and constantly add to their vocabulary.
Gross and Fine Motor Milestones
Infants are expected to begin rolling over at five months. By eight months, a baby should be able to assume a sitting position. Usually, crawling begins at eight months and walking at twelve months. By one year, babies should also be using the first finger and the thumb (a pincer grasp) when reaching for small objects like cheerios.
Note: In order to achieve these milestones on schedule, babies need “tummy time,” in which they are left on their stomachs. Placing infants on their stomachs encourages them to push up with their arms. This helps build strength and coordination in the trunk, the arms and the shoulders.
Visual Tracking
Newborns are programmed to gaze at their mother’s face when nursing. By two months, infants are usually swatting at objects nearby. Visual tracking should be firmly established, both vertically and horizontally by three to four months. There are a variety of causes when the infant does not focus, including lack of interest, poor vision or visual processing, and difficulty coordinating the eye muscles.
Behavior
When a baby is unusually fussy or unusually passive, it may be symptomatic of an underlying problem. Babies who have trouble regulating their arousal level are hard to calm once they are aroused.
Sensory Processing Problems
Some children have trouble processing the information that comes through their senses. These children may also be deficient in body awareness, the ability to “feel their body”. Often, children with these problems have weak muscles (low muscle tone). In some children, the symptoms may display themselves through delays in achieving standard developmental milestones, such as walking or coloring. Other children meet their developmental milestones, but show differences in their behavior. Whether the child is delayed or the child exhibits unusual behavior, he/she may need the intervention of an occupational therapist (OT).
A child with untreated sensory disorders may have problems with social interaction, attention, and/or physical coordination. Such children may suffer in school from loneliness, bullying, and academic failure. Depending on the severity of the symptoms, the child may experience difficulty functioning in a yeshiva or in any mainstream setting.
Hypersensitivity
Children with sensory processing disorders may display extreme reactions to stimuli: they under- or over-react to input from their senses. For example, they might want their bath water very hot or very cold. They may restrict themselves to very few foods, refusing to eat anything that tastes or feels even slightly different. Sensory defensiveness may lead the child to reject being touched, even by their parents. Clothing may be a problem; the child may refuse to have certain materials touch the skin. Such children may also find it impossible to tolerate noises, such as a vacuum cleaner or other household appliances. Handling crowds may also be exceptionally challenging.
Speech and Oral Stimulation
Speech delays may occur when a child cannot feel his/her tongue or lips. Low muscle tone in the jaw and lips may lead to open mouths and drooling. A need for oral stimulation may cause children to feel a constant need to chew on their toys.
Gross and Fine Motor Skills
Sensory disorders often prevent preschoolers from achieving fine and gross motor milestones at the appropriate age. The child may be clumsy, often bumping into things. He/she may be viewed as aggressive, since he/she pushes or squeezes too hard. The crayon may be fisted rather than grasped between the thumb and the fingers. The child may also have difficulty playing with blocks, assembling puzzles, or coloring within shapes.
Establishing a Dominance
Normally, children establish a dominant hand that they use eighty percent of the time, by about age three. It is still normal at that age to switch hands from time to time for convenience or when the dominant hand tires. However, by age six, children are expected to be using the dominant hand consistently from the beginning to the end of a task. When children are still using both hands equally, it may be a sign of problems such as low muscle tone in the hands. “Ambidextrous” children may experience delays in acquiring fine motor skills, including writing.
Attention Disorders
By age three, a child should be able to sit and listen to a book or a story. He/she should be able to attend a playgroup for a few hours a day. Sensory processing difficulties can interfere with this. They may lead to anxiety, unpredictable behavior, and extreme emotional reactions. The child may be developmentally on track, but unable to function in an age-appropriate manner because he/she is distracted by outside stimuli and/or is uncomfortable with his/her own body. In short, the child may be exceptionally bright and talented, but he/she may be unable to attain the calm, alert state that is essential for learning. This may be misinterpreted as ADD (Attention Deficit Disorder) even when the child does not suffer from attention disorders. However, it should be noted that children with sensory processing issues often suffer from ADD/ADHD as well.
Behavior
Maintaining appropriate behavior may be a tremendous challenge for children with sensory disorders. As they are often hypersensitive to many different stimuli, they are constantly being aroused by sounds, smells, touches, or textures that barely register with other people. Moreover, they have special problems in self-regulation: they cannot calm themselves easily, they have trouble dealing with disappointment, they have low tolerance for frustration, and they do not adjust easily to new situations. This may lead to frequent and severe tantrums.
Social Issues
When children suffer from sensory disorders, they are likely to suffer social rejection. Speech and language delays hinder children from being able to express themselves well verbally. This slows social integration. Since they are more emotionally unpredictable and extreme, they are more likely to fight with their peers.
Moreover, since these children often cannot handle their own bodies properly, they are more likely to inadvertently invade other children’s space. On the other hand, they cannot tolerate it when other children are too close to them, such as when standing on line. In general, they are more likely to overreact to sensory input from a normal classroom setting. This may lead to inappropriate conduct and negative interactions with classmates, teachers and other authority figures.
Summing It Up
Significant Red Flags for Infants
At this early age, it is difficult to determine the cause of a child’s developmental delays or his/her unusual behavior. However, the most striking red flags for babies include lack of social engagement, severe delays in developmental milestones, and absence of visual tracking.
Older Children
If your child displays many of the red flags, behavioral issues and/or delays described above, it may be appropriate to seek help.
Early intervention desensitizes a child’s nervous system, allowing him/her to tolerate more stimuli and behave in a more appropriate manner. Intervention also helps a child “catch up” and makes it easier for the child to fit in socially and academically.
Getting Help
Speaking to the Pediatrician
While many pediatricians are well versed in the developmental milestones and sensory processing, others may not have been trained to detect social or motor delays. Developmental pediatricians specialize in these areas and may be helpful to parents who are not sure whether their child is just a little late or needs help.
Tapping into the Public School System
Parents who suspect that their child needs help can request a free evaluation depending on which city or state they live in. It may be necessary to contact the local public school or board of education to find out which services are available. There are organizations devoted to helping children with special needs; it may be helpful to tap into them.
If the parents cannot obtain a free evaluation from their local school system, they should look into going the private route to have their child evaluated by a speech, physical, or occupational therapist. For more complicated situations, it may be necessary to bring in a neurologist. Insurance may be able to help defray the costs. While the cost of evaluation and therapy may be large, later interventions are likely to be more costly, financially and emotionally.