Child Not Meeting Milestones

Hi there,
I am a Pediatric Occupational Therapist and a mom of 3 kids... one of whom received EI for and expressive language delay. After reading this, red flags went up for me for several reasons. One, the child seems to have delays in many areas (social, oral motor/eating, speech/language, gross motor, and socialization). Though it is true that all children develop at different rates, generally they will develop faster in one area while working on another ie. some kids are early walkers/climbers, but talk later. However, when milestones in all major areas are slow to be met, there is definitely cause for concern. Also, the fact that mom and dad make excuses or lie to the Dr., means that they really do notice that their child is different and haven't come to terms with it yet, or they just don't realize *yet* that he is delayed (neither of which is advocating for the child- which is our job as parents or caretakers). As a mom and an OT I always wonder why some parents are so reluctant to get help... maybe it is the stigma... or denial? It's a tough situation. If I were you, I would just be blunt... it seems that the hints have not worked. Just tell them that you are genuinely concerned for his wellbeing and that you know Early Intervention can help. Maybe give them the number to your local EI Center and offer to be at the evaluation to help answer questions/support since you are with him everyday. It is a shame when parents could get help early. It can be so beneficial and certainly won't hurt the child. I am in no place to diagnose, but after working with well over 100 children on the Autism Spectrum/Sensory Integration Disorder, with all of the things you mention (lack of socialization, delayed motor skills, hand flapping, trouble eating etc.) he seems to fit the description. If this is the case, the earlier it is addressed, the better. The best thing you can do is gently but honestly tell the parents that you want to see their child be happy and healthy and that you would be glad to help them get their child evaluated to see if Speech Therapy or Occupational Therapy could help him be more functional and successful eating, socializing and interacting in his environment.

It's time for a real heart-to-heart with the parents. This conversation should happen as a "parent teacher conference", not at pick up or drop off.

Have the following things with you:
- APA Developmental Guidelines. I often use this one by the CDC because it is easily understood and there is a "printable checklist" that is a great conversation "starter" with parents. http://www.cdc.gov/ncbddd/actearly/milestones/index.html
- A written summary of your observations (I would be happy to look at it before you give it to them) and keep a (dated) copy for yourself
- Contact information for your local Early Intervention Center (county based services)

Be factual with them, not opinionated. Express your concern about their child as compared to the developmental guidelines. Talk with them about what typically developing children do and how skills build upon eachother. You cannot stress to them enough that Early Intervention can (and often does) remediate delays before children enter school. Give them the facts and give them the resources. Beyond that, there is very little that you can do. Make sure to let them know that you are welcoming to the idea of a therapist working with their child in your home, if needed.

Good luck. Eventually this will catch up to them, but denial is a really powerful state of being.

**DO NOT contact the pediatrician without written parental consent. The doctor won't even take your phone call. If you want to call your own pediatrician and ask him/her how to approach the situation, go for it but do NOT (as someone has suggested) call the doctor anonymously. It is illegal and unethical.

Yikes. I think you are right, they aren't doing him any favors. Maybe a printed list of milestones? A good website with video of milestones?

A day or half day of free daycare if they come and observe his behavior compared to the other ones? Call it something special you are doing with parents.

Otherwise, I don't know what you can do but document your conversations with his parents. people who would condone "white lies" to a doctor about their child are crazy. Crazy doesn't like truth.

I just want to add a few things. First thank you everyone for your input.
Over the past year of him being in my care, I have seen so many "red flags" going up for this poor kid. He sits and flapps his hands most of the day. I told his parents and their response is a laugh and "we know. He does it all the time at home. We guess he thinks he can fly." As for his not chewing, he doesn't know how. everything that goes in his mouth instantly kicks in his sucking reflex like a young infant. He doesn't even chew on hid fingers or toys like other kids do. At 15 months old he acts more like a 9 month old.

I am not trying to pick on the poor kid, I just want his parents to realize he might need some help. I know all kids hit milestones at different times, but my concern is that he just sort of hit a point at which he is not progressing. At his 1 year check up, the pediatrician told the parents that if there was no progress made by 15 months that the next step would be an Early Intervention Evaluation. that is when the parents told me that "Little white lies won't hurt".
No one wants to hear that there is something wrong with their kid, but I am a firm believer on getting help while they are young!!! My 10 year old was diagnosed with a learning disorder last year. When I questioned her lack of academic progress when she was six, I was told all kids are different. It took me three years of fight the public school system to evaluate and give her the help she needed. Unfortunately in my township, they do not honor outside evaluations, so I had to wait on the school. It was a long battle!!!
I think because of everything I went through with my daughter makes me want to push these parents more. There are so many little developmental delays that if caught early can be "fixed".

Parental denial is a difficult thing to deal with. All you can do is prepare information and talk to them. You can not call the ped. and I strongly disagree with contacting CPS, as one person advised.

I would schedule a private meeting with them after hours. Gather information about what is the "normal" range for a child his age. I would not compare him to the other kids in the daycare.

As far as the chewing goes... it could be something or nothing. Did he have acid reflux as an infant? Some kids just have an aversion to textures and they grow out of it. Most can be helped by "food therapy" or some other early intervention service. If he is given something like a soft breadstick, will he attempt to eat it or leave it alone? Those are good because they get soggy enough for him not to choke on, but encourage chewing. And rather than going completely back to baby food, you might consider pureeing things progressively thicker to see if it develops his chewing.

In addition to the information that you gather about development, I would also gather information about services. Sometimes families don't know about the services that they are eligible for and they don't know that they are free. And if they will at least have an evaluation, they may feel better about someone specializing in developmental delay talk to them. Some kids don't have a disability, they are just delayed an especially with early therapies, they can grow out of the problems they are having. However without early intervention they can develop other problems that are more difficult to address.

Chewing food also help develop muscles in the mouth that assist in speech development. So if he's not chewing, I'm not surprised his speech is delayed.

Assure the family that you are only talking to them out of concern for their son and you hope that they will consider getting an EI aval. If nothing is going on with him you will be relieved (and so will they), but it's better to know early and more chance to resolve issues. Depending on the personality of the family and your relationship with them, you may lose them as client in your daycare. For some people the denial is so strong and the possibility of anything being "wrong" with their child is so scary that they will simply avoid anyone who points it out.

Good luck~

After having four kids I have realized that no kid reaches a milestone at the same time and not in the same way.

Although it is strange that he swallows his food whole you have not said whether he can chew and chooses not to or can't at all.

I have seen my kids go about getting there in some strange ways but they are all pretty normal now. So if he is choosing to not chew I don't see this as the big deal you are making it out to be.

One thing that is obvious but that I haven't seen said explicitly is that you should take care to talk with them in a way that emphasizes there are resources to support them and you want to help find them, but NOT that they are not doing their jobs as parents. If they are in denial they may take your efforts at intervention as an accusation and dig in even further.

I think the best you can do is just keep talking to the parents. Sit them down for a formal meeting, rather than just telling them at dropoff or pickup time when they may be feeling more rushed.

It sounds like they do know there are problems, they just don't want to admit it and are scared to find out the truth.

As you well know, he's definitely not developing at the normal rate and clearly needs some kind of intervention. But, as long as the parents are not harming him, you can't report them anywhere and don't have the right to talk to the doctor yourself. I wish you could, but you can't.

Ask them to come in, that you need to have a meeting with them and then sit them down and be honest but firm and nice.

Tell them that in all your 25 years of watching kids you feel strongly about this.... and how early intervention can make a HUGE difference! Say it bluntly, so there is no way that they can misunderstand you. "I believe your child needs to be evaluated and you need to answer the questions about what your child can and can not do honestly"! Make sure to tell them that since you have been in his life since he was 4 months old you have come to love him and you are worried and want only the best for him.

This is all you can do.

I would have a meeting with them. Give them information on milestones for children his age and information for the early intervention program in your area. It is often free and all it will cost them is a few hours of their time. I had my own DD evaluated for her speech and it actually came out that she had some fine motor skills issues I had not noticed. So it was good. If he's within norms, no big deal. If he's not, then they know what to do next. I would be professional but say that you have strong concerns about his progress and further, you want to provide him the best care, but if you and they do not know if there are issues, you don't know how to resolve them in a way that's best for him. Tell them you are not saying they are bad parents (even if you think they are). Just that since you are with him so much you are pointing out things they may not have seen or thought about.

There's a wide range of normal. My DD didn't walk til well after 1 yr. But she was still within norms and interacted with people, ate her food, etc.

It is hard to hear your child may not be normal. But it is also hard to watch a child struggle when Mom and Dad are in denial. I hope having a meeting and providing official information (like from the APA) will help them realize you care very much for their son and they need to do something.

Little white lies to the pediatrician are going to hurt. I hope they stop thinking that way.

Baby food has no nutrition so please consider using a food chopper to make his food into smaller pieces. It takes less time than cutting it up your self and it's pretty uniform.

I would print off a list of milestones and check off the ages of which age he's supposed to do them. Write down the age you see him doing stuff. Do this for a couple of weeks and fill it in thoroughly.

Then give it to them. Let them know what he's supposed to be doing and that he's not doing them.