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Measuring Up

Shannon Caldwell, with Harper (left) and Bruno: “Parents are ultimately the best judge of when there is a problem.”

Connie McDevitt and Kyra (left), Sinead and Ailish: In one case, “I was an over-concerned mom.”

Michael Davis Photos


Michele Stadder and her husband Ian thought they had beaten the rap. For the majority of Michele’s pregnancy—her first—they had resisted the urge to obsess over every little thing that could go wrong. The Syracuse couple listened to the obstetrician and followed his advice, but they decided to stay away from parenting blogs, forums, and the array of guides that seem to do little more than foster anxiety in new mothers and fathers.

All that changed once their baby, Matthew, arrived 10 months ago.

“We couldn’t seem to stop wondering if things were going well,” says Michele. “Matthew was wonderful, but I found myself wondering if he was progressing the way he should, especially language.”

Family members thought it was silly for Michele to worry—Matthew was so young after all. But Michele and Ian were concerned about the pediatrician’s chats regarding autism spectrum disorders and developmental delays.

“When Matthew was about 3 months old, he wasn’t really babbling that much and I was panicked,” Michele admits. “I was constantly trying to get him to respond in certain ways. It was really stressful.”

Many new parents are also beset by anxiety. Advances in and publicity about diagnosis of developmental delays have made parents hyper-aware of the warning signs, and more fearful about what it means if their children do not hit certain milestones “on time.”

Pediatricians in the United States typically follow the guidelines issued by the American Academy of Pediatrics on markers for social and emotional development, movement, vision, hearing and speech. (These guidelines are also listed by the Department of Health and Human Services, and can be found at www.cdc.gov/actearly.)

Shannon Caldwell of Syracuse, mother to Harper, 4 years, and Bruno, 20 months, says she looked at the milestones more as a gauge of her own parenting skills. She attributes this to the fact that she was committed to her work as a public relations professional before her children were born, and the milestones gave her a way to evaluate her new role as mom.

“I really like looking at the milestones because they were a way of marking progress,” Caldwell, a New Zealand native, says.

Caldwell’s first child was born in New Zealand, and parents in that country are given a book that includes examples and bullet points on developmental milestones, and a log so parents can write things down that they may want to discuss at the next doctor visit.

“That log was great because sometimes, in the doctor’s office, you are nervous, and the doctors are in a hurry,” Caldwell says. “So, writing things down can be good for judging where your child might be.”

Caldwell was thrilled when Harper began to talk at an early age—according to the guidelines. But Bruno seemed much less verbal when he reached the same age. “I was worried,” she admits, adding that her pediatrician at the time was also concerned.

Caldwell says a child’s early speech can be an especially emotional subject for parents because it eases the guessing game of understanding what a child wants and needs.

Caldwell is confident that Bruno is right where he should be developmentally. And she has become more relaxed about her children reaching other milestones as they get older.

“Milestones are great and I think they can be a useful tool, but you can’t get hung up or focused on them,” she says. “I’m definitely more relaxed now. It’s less about obsessively checking a list and more about how each child develops in their own way. ”

Alice Sterling Honig, professor emerita of child development at Syracuse University, says despite increased awareness about developmental delays, and the increasing number of proactive, informed parents, she still meets many parents and pediatricians who don’t know enough about how developmental progress should be assessed.

“I worry so much that too many parents do not know the developmental milestones,” says Honig, a licensed psychologist who specializes in developmental psychology and has worked with parents and childcare providers for more than 40 years. “I don’t think pediatricians promote them enough. It’s not their fault; they are trained to address medical issues. During a well-child visit, there is so much that needs to be addressed. Doctors focus on the physical.”

Honig has an encyclopedic knowledge of even the most subtle physical, emotional and social milestones. She advises parents to observe their children’s “receptive language development”—that is, comprehension of others’ speech—and, by 15 months, fine motor development such as their ability to coordinate use of the thumb and forefinger.

While the progress of social skills is more subtle, problems that could indicate an autism spectrum disorder are typically “so clear by the age of 2,” and can be marked by a noticeable decrease in language skills.

While doctors often do not want to alarm parents about potential gaps in their child’s development, Honig says, it is the parent’s responsibility to provide their children with an environment that maximizes their potential. “Those first three years are so important,” she says. “The brain is growing enormously.”

Parents spend too much time encouraging what Honig calls “wide-window” milestones, such as toilet training, and too little on the subtle—but just as important “narrow-window” ones—such as maintaining attention with a parent or caregiver and thumb-forefinger dexterity. Honig also puts a lot of emphasis on the understanding of language by the end of the first year.

“Receptive language (comprehension) has to be in before a child can move toward expressive language,” Honig says. “Most people don’t know how important it is to interact with your baby. It’s those first three years that give (babies) a depthless enthusiasm for learning.”

Steven Nicolais, a pediatrician with Pediatric Associates in Camillus and Liverpool, says his practice begins addressing specific milestones during well-child checks from the age of 2 months on. At 18 months, young patients are screened with a 20-question autism spectrum disorder questionnaire known as the Modified Checklist for Autism in Toddlers, or M-CHAT.

The goal is to pick up on language disorders and delays as early as possible. “We’re diagnosing (autism spectrum disorders) much, much more often,” he says. “I think it is better that we are able to make those diagnoses now. There was no such thing as Asperger’s when I was training 20 years ago. Many high functioning children were not given the treatment they would have benefited from. ”

Even in babies’ earliest months, screening for sensory issues can be beneficial, Nicolais says. By 18 months, children should be pointing to indicate interest in objects. Social interactions become more apparent during this time, and Nicolais asks parents to be aware of the less obvious aspects of social and emotional interactions—because they know their children far better than the doctors do.

To enhance the ability to track developmental milestones in patients, Pediatric Associates as often as possible schedules well-child visits with the same doctor.

Nicolais agrees with Honig that detailed monitoring of these milestones often goes beyond the training of pediatric medicine. But he and his colleagues have made a commitment to staying on top of new research on developmental issues. “We are happy to keep up on these things,” he says. “We consider it to be our responsibility as pediatricians.”

Syracuse mother Caldwell says a good relationship with your child’s pediatrician makes it easier for parents to address concerns about development. In New Zealand, her family had wonderful support from the government; mothers and babies are offered at-home care in the months after birth. After giving birth to Bruno in the United States, Caldwell found the rapid-fire pace of well-child visits a bit unsettling. “We weren’t able to establish a dialogue,” she says, adding that she is very happy with her children’s current physician.

Most parents eventually learn how much importance to give to particular milestones, Caldwell says. “Parents are ultimately the best judge of when there is a problem. When it comes to some of the developmental milestones, you can only fool yourself for so long. A mother knows when something is wrong.”

Connie McDevitt, mother of three girls, Ailish, 10, Kyra, 7, and Sinead, 2, says she has become less concerned with making sure every milestone is hit at a specific time. But even the most experienced parents find it helpful to keep talking about them with their children’s doctors.

“(We discuss them) in our well-baby checkups,” McDevitt, of Jamesville, says. “Our doctor asks if Sinead is doing things or tells me what to look for.”

Because Sinead has a rare skin disease, McDevitt and her husband, Gerard, have been particularly concerned. “That (condition) puts us on hyper-awareness for all things—including milestones.”

About a year ago, McDevitt thought her experience—and maternal instincts—had picked up on a delay with Sinead. “Ailish and Kyra were early talkers. They had words at 1,” McDevitt recalls. “Sinead babbled and didn’t have words as we approached and passed 2 years. I was concerned and had her speech evaluated. It turns out she was right where she needed to be developmentally. So, I was an over-concerned mom.”

But as her youngest moves further into toddlerhood and toward preschool, McDevitt has found that there are new milestones to worry about. “At this age I am more aware of the physical milestones,” she says. “She frequently ‘W’ sits and I will ask her to ‘put your feet together.’ Depending on her mood, she will listen or I reposition her. She also doesn’t hold her crayon, pencil or marker the right way. Her teacher is working with her to correct that, but whenever I ask her to hold it with three fingers, she says ‘NO!’”

Michele Stadder says she hopes her early preoccupation with checking Matthew’s progress has peaked. Thanks to reassurances from her pediatrician, she is happily focusing on the less dramatic day-to-day joys of new parenthood. “There are still days that I worry,” she acknowledges. “But most of the time, being a new mom is just awesome.”

Caldwell offers the following advice to new parents: Try to be mindful but not frantic. “I think it is sad if (tracking) milestones—or parenting in general—becomes like work,” she says. “I think it is a shame when parents don’t let kids be kids.”

Honig, who has coordinated a seminar for infant and toddler caregivers at SU each summer for 34 years, says the key is shifting the focus from what could potentially be wrong to what is actually going well for your child. She finds this difficult for modern parents.

“Every parent wants their kid to be perfect nowadays, but there is no perfect child,” she says. “If you are too ferocious with your child in encouraging them to accomplish, it will be a negative. You have to be an authoritative parent, but look at the child for who he or she is. Celebrate them; look for ways to celebrate their gifts.”

Award-winning writer Tammy DiDomenico lives in DeWitt with her husband and two sons.

© Family Times: The Parenting Guide of Central New York