The first few steps or words that a parent witnesses their child taking can be precious moments. However for some children, they may not come on time.

Surveillance and screening during routine pediatric visits are essential in being able to catch developmental delays early and act on them quickly by referral to educational programs that can help. The typical screening months for developmental delay are during the 9, 18, and the 24 or 30 month visits for general developmental screening. The 18 and 24 month visits are recommended for autism specific screening. The Ages and Stages Questionnaire, as well as the Child Development Inventory are two of the recommended screening tools by the American Academy of Pediatrics to be used for developmental assessment. These questionnaires are simple and effective surveillance tools that you and your pediatrician can go through together.

Just as it is important to not miss your child’s vaccination scheduling, it is also vitally important to not miss opportunities for developmental screening. Your pediatrician as well as early childhood educators are important resources in identifying delays when they are present.

If you are concerned about your child’s development, I recommend scheduling a pediatric visit solely for the purposes of focusing on your child’s growth and milestones.  Your doctor will be able to spend more time with you tuning in on your child’s development.

The relationship that children have with their caregivers from an early age, as well as the stimuli that surround them, are integral to their overall developmental success and have been shown to have positive effects on mental health and wellbeing as they age. Research has shown that educational achievement and productivity in adulthood is impacted by early childhood experiences.

Children are constantly absorbing information from their experiences, and interpreting them. Whether it is observing their parents cope with adversity in a positive fashion or watching them eat nutritiously and exercise regularly, these experiences will help to engrain these behaviors so that when the child is faced with similar circumstances they are more likely to emulate these actions.  It is also important for you to have regularly scheduled visits with your own physician to ensure that your health, including your emotional wellbeing, are being supported. Seeking help for yourself is a contribution to your child’s successful development.

Executive Functioning is the brain’s ability to filter, prioritize, and focus one’s thinking. According to the Center for the Developing Child at Harvard University the experiences and interactions that children have during a crucial window of development help shape their executive functioning for the rest of their lives. The “Serve and Return Interaction”, described by the Center, is one of the primary ways that children’s brains become molded and shaped to activate and develop neuronal connections that will become continual. For example, young children “serve” by gazing and focusing on a specific object, and adults “return” this attentive behavior by saying and repeating the name of the object. In due time the child will make connections in her brain which will enable her to instantaneously recall the name of the object.

It is important to engage your child in stimulating activities during the early stages of their development.  The simple act of reading to your child, even as early as two months of age, can have enduring effects on a baby’s mind. Not only does the physical act of reading to your child bring you closer together, but the action helps to solidify and strengthen the emotional parent-child bond. For example, the playful sing-song voice of a mother reciting the words and allowing her 6 month old child to grasp the pages of a hard paperbound book, feel them underneath her fingers and flip the pages, engage the child and allow connections in her brain to ignite.

The relationships that children have with their parents and caretakers are vital in enabling them to reach their full developmental potential. While our genes may lay down the foundation, it is the experiences that children have that are the true building blocks and the mortar for them to be able to establish important connections within the brain and grow. The stimuli that a child is exposed to during their early development helps to form lifelong connections in the brain that shape the way they process, associate and prioritize information.

Delays in development can be subtle and are sometimes difficult to detect by parents.  Quite strikingly, in our population an estimated 12-16% of children have developmental disorders.

Children who may be developmentally delayed can be significantly helped by important state-regulated programs that can target areas of need and maximize important skills during a vital period of brain development and growth. It is important that developmental delays are identified during this important window of time, where the most success can be achieved through multidisciplinary therapy.

One of the most dynamic and important resources is a state funded program called Early Intervention, which provides family centered plans geared to help children with developmental delays. In addition to the integral speech, occupational, and physical therapy, there are also social workers, nutritional therapists, and both nurses and physicians who provide their services to this fantastic program. Moreover, these services are provided at no cost to the family. Ensure that your child is being regularly followed by their pediatrician and early educators so that they can pick up any early signs of developmental delays if they are present.  If you have concerns about your child’s development be sure to raise them with your child’s healthcare provider. If you continue to have concerns or are unable to follow with your physician, you can contact early intervention directly.

Even before our babies are born, we are teaching them about the world around us. We communicate our choices, our values, even without thinking about it. They hear our voices, smell our aromas, and they taste, remember, and prefer the foods we feed to their mother.

After they are born, they will continue to learn, day and night, from what we say and do. Within just a couple of years they will learn to speak and understand our language, just from listening to us speak and trying to imitate what we say. This is quite an accomplishment! (When was the last time you fluently learned a language? Imagine tackling another in the next two years.) Meanwhile, babies will also be learning the figurative language of our habits, our relationships, our emotions.

Over the years our children will be shaped by the decisions we make: how we spend money, how we eat, the ways we spend leisure time, the ways we respond when they are struggling, the ways we celebrate their accomplishments, the ways we handle stress and personal disappointment. What we do will shape their lives.

I know, because my father has shaped my life.

As a child I watched my father work hard. And yet he seemed to find time for me whenever I needed it. He was involved in major family decisions and day-to-day decisions. He was not only there for annual vacations to visit extended family, but was involved in planning the trips. He is an example of healthy eating and a preventative lifestyle.

His parenting didn’t end when I grew up. And we didn’t stop going through adventures together. The adventures just changed.

Last week I was driving across the Delaware Memorial Bridge in the middle of the night, retracing my old route from college to my childhood home for the first time in many years. The memory of the night my little orange car broke down on the bridge came flooding back. I called my Dad that night well after midnight, and he drove a couple of hours to pick me up and help me navigate getting my car repaired. He gave me both freedom and support, taught me acceptance and responsibility. What I learned from my father, I try to model for my own kids.

We teach, we provide, we protect. We are dads. And the chain continues …

A new study has shown that brief exposures to bisphenol A (BPA) early in life can have a long lasting effect on reproductive hormones. BPA is a common ingredient in some plastics and resins that has been shown to act like an estrogen hormone. In this study, otherwise matched female newborn animals were exposed to zero, 50 micrograms, or 500 micrograms of bisphenol A (BPA) every day for ten days. Everything else about how the animals were raised was identical as they grew to adulthood. Infant exposures to even the low dose of BPA were enough to cause earlier puberty than in the controls. Exposures to the high dose caused even earlier puberty as well unusual monthly cycles throughout adulthood.

The US National Toxicology Program at the NIH, responsible for coordinating studies of unhealthy effects of chemicals, warns that BPA exposure in infancy and pregnancy may alter normal development and increase the odds of breast cancer or prostate cancer later in life. The CDC found BPA in 93 percent of Americans tested, from age 6 to 85, at levels similar to those that cause the health effects in animal studies. Canada has moved to ban BPA in baby bottles. Nevertheless, more than 2.3 billion pounds of BPA are manufactured in the US each year. The chemical industry maintains that BPA poses no danger to adults and that it is safe as used in kids. The FDA agrees with them. I don’t. For my own family, I choose BPA-free products.

BPA is big business, and the few industry-sponsored safety-studies have grabbed the attention of the FDA. I’ve partnered with BornFree to help get the word out about the many independent academic studies.

Fernandez M, Bianchi M, Lux-Lantos V, Libertun C. Neonatal Exposure to Bisphenol A Alters Reproductive Parameters and Gonadotropin Releasing Hormone Signaling in Female Rats. Environ Health Perspect 2009; doi:10.1289/ehp.0800267.Biello D. Consumer Alert: Plastics in Baby Bottles May Pose Health Risk. Scientific American. April 21, 2008.

Biello D. Like a Guest That Won’t Leave , BPA Lingers in the Human Body. Scientific American. January 28, 2009.

This study features the largest number of chemicals ever tested for in the same group of people – 210 chemicals were tested. The results were staggering – each participant tested positive for an average of 53 known human carcinogens, 55 chemicals known to cause birth defects or developmental delays, and a host of other chemicals. Each participant tested positive for chemicals that damage the brain or nervous system, that weaken the immune system, and chemicals that cause reproductive abnormalities. Perhaps most disturbing: these 210 chemicals tested represent only a small fraction of people’s exposure. More than 500 chemicals are used in the U.S. as active ingredients in pesticides alone. More than 3,200 chemicals are regularly added to foods. More than 2000 new chemicals are registered for use in the U.S. each year – most with no safety testing.

Combinations of chemicals can be far more damaging than individual exposures. We do know that just as drug-drug interactions can cause serious side effects, chemical-chemical interactions can multiply the risks. For example:

This Body Burden Report shows PCBs and dioxin in the same people. These often appear together – even in breast milk. Researchers looked at liver damage caused by the two. By themselves, the PCBs caused no liver damage. Dioxin did cause some. But mixed together, the two chemicals produced 400 times the damage of the dioxin alone. (Van Birgelen, A.P.J.M., et al. Environmental Health Perspectives (1996) 104:550-557.)

Some pesticides in common use can act like the female sex hormone estrogen. Researchers at Tufts University School of Medicine measured the effects of 10 such pesticides. Taken one at a time, they had no measurable effect on human tissue. But when different combinations were tested, these same low levels of pesticides now showed a strong estrogen effect. (Soto, A. et al. Environmental Health Perspectives (1994) 102: 380-383.)

Two commonly used pesticides, aldicarb and atrazine, are found in our food and our drinking water – and in our bodies. When tested individually at levels found in the groundwater in the U.S., they showed no adverse effects. But when combined – the way they are in the water – the combination produced immune system impairment. (Porter, W.P., et al. Toxicology and Industrial Health (1999) 15: 133-150.)

In short, the Body Burden study reminds me of a smoke detector or a carbon monoxide alarm – alerting us to a silent but serious danger, hopefully in time to wake us from our sleep. This study leaves no doubt about the pervasive pollution of our bodies with large numbers of toxic chemicals in combination, most of which didn’t even exist when my parents were born.

Notes

• Work was done by the Environmental Working Group in partnership with the Mt. Sinai School of Medicine and with Commonweal.
• Published January 2003.
• Work was published in Public Health Reports and online at www.ewg.org/reports/bodyburden/

Major Recent Studies

• Organophosphorus pesticide exposure of urban and suburban pre-school children with organic and conventional diets. October 2002.
• Loss of neuropathy target esterase in mice links organophosphate exposure to hyperactivity. March 2003.
• Second National Report on Human Exposure to Environmental Chemicals. January 2003.
• America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. February 2003.
• Related Tidbits

Dr. Greene’s Answer:

Some. I take information from those evaluations as one piece of a much larger puzzle, and ask myself if there’s anything I can learn from it–but I don’t just take it at face value outright. Still, I am grateful for any extra perspective I can get on kids.

The first widely used developmental assessment tool was the Denver Developmental Assessment. It looks at four areas of development: gross motor (or bi muscles), fine motor (or coordination), speech and language, and social/emotional. With each milestone there is a broad range. The range was decided on by testing a bunch of average kids (sort of like the growth charts) and determining the age when 50, 75, or 95 percent of kids have attained a milestone.

The Ages and Stages Questionnaires (ASQ) used to be called the Infant Monitoring System. ASQ is often used to screen development in children from 4 to 60 months of age. It assesses development in four general categories: cognitive, motor, self-help, and language.

A recent study showed that the ASQ was able to identify children in need of special services when they would not have been referred on the basis of a pediatrician’s assessment alone (Pediatrics, August 2007). This is one reason why the American Academy of Pediatrics recommends standardized developmental screening for all children at 9, 18, and 24 or 30 months of age or whenever a parent or provider has concerns about a child’s development.

It is important to remember, however, that these screening tests are not meant to decide whether or not a child is developing well, but as screening tools to identify which kids should be looked at more carefully. (Sort of like kids at less than the fifth percentile on weight–5 percent of healthy, normal kids are less than the fifth percentile, but those kids should be checked to be sure that their weight is best for them.)

Play therapy in groups is often recommended for a child who is developing much more slowly than his or her peers, and it can be very effective. Also, it can be good to identify the next expected milestones so parents can encourage (gently and playfully) activities that support those milestones.

Dr. Greene`s Answer:

Some self-exploration is normal and healthy for girls and boys alike. Usually it is the pleasurable sensation they are enjoying, not some sexual fantasy. We get concerned if kids are doing it in public or if it becomes something that seems to consume them–if it gets in the way of other healthy activities.

Usually the best way to handle it is to explain that this is a private thing–like going to the bathroom. Usually bribing isn’t necessary or best. Discouraging them from doing it at all usually makes it more desirable and it’s not something you can control. The best way to lessen the habit is to distract them or substitute a fun activity without even mentioning it. If it seems to be increasing, it is worth considering whether she might be under extra stress from something and she is using self-exploration as a form of relaxation. It can be a self-comforting behavior, much like thumb sucking. Many parents feel that their kids are the only ones doing this, but most kids do it.

Dr. Greene’s Answer:

An average weight for a 30-month-old boy is about 30 pounds. But anywhere from 25 to 35 pounds does not provoke concern, since 5 percent of healthy 30-month-old boys do weigh less than 25 pounds.

However, this is still the level where you should look into possible causes for your child’s low weight. There are many problems that can cause this. When children don’t gain weight, it could mean they are not taking in enough calories, they are not absorbing enough of what they are taking in, they are burning too many calories, or they are not able to use the calories they do have for growth.

You can try boosting your son’s caloric intake by giving him high-calorie nutritional drinks such as Pediasure. You can also make delicious, high-calorie drinks at home with whole milk, ice-cream or yogurt, and fruit. Additional calories can be obtained by adding, high-fat foods such as peanut butter and cheese to his diet. I also recommend starting a daily children’s multivitamin.

There are many causes of failure to gain weight, and your pediatrician would be the best person to determine what type of evaluation would be needed in your child, if any. Keep a food diary for a week and bring it to your appointment with the doctor.

Your doctor may determine that your child is at the perfect weight for his height and doesn’t need any extra food. It’s possible that he’s following his genetically programmed size and decreasing his appetite to hit his ideal weight. If he is at a good weight for him, then you can relax while sorting out the feeding issues.

Dr. Greene’s Answer:

The best way to determine whether or not he has a diction problem would be for a doctor or speech therapist to hear him talk. But if he will not talk at the office, perhaps a videotape would work, so they could get an idea how his mouth moves when he speaks.

They can get some idea from a physical exam (where the tongue-tie connects on the tongue and on the gum line–right on the tip of both is more likely to need surgery), but most kids with tongue-tie do not need treatment. But if there is a question about speech development, it makes sense to have that aspect looked at.