How To Get More Out of Your Pediatrician Visits - Feel Heard & Validated

Today’s discussion sheds light on the genuine concerns mothers face and how these often go unaddressed or overlooked in routine pediatric consultations.

These concerns, sometimes dismissed or brushed aside, create an undercurrent of anxiety for new moms navigating the uncertainties of parenthood.

One specific area of concern is the use and understanding of the screening Modified Checklist for Autism in Toddlers - Revised/Follow-Up  (M-CHAT-R/F) during the 18 and 24 month well-child checkups. 

Erin pulls back the curtain and shares details of this important tool and how you can guide your pediatrician through it better.  

Erin acknowledges the common worries new mothers have and the complexities of addressing them within the confines of short medical appointments. She emphasizes the significance of open, honest dialogue between mothers and pediatricians, encouraging a supportive environment where concerns are respectfully heard and thoroughly addressed. 

This episode stives to empower mothers to advocate for their children's needs and highlights the importance of seeking second opinions or further assessments if their worries persist.

Listeners gain practical tips on how to effectively communicate their concerns to pediatricians, fostering a collaborative partnership that prioritizes the child's well-being. 


There are options at the end so listen all the way through.

You won’t want to miss this one!

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Links I mention in this episode:

Modified Checklist for Autism in Toddlers - Revised/Follow-Up (M-CHAT-R/F) 

https://www.mchatscreen.com/

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Transcript

Erin 0:00

we often use in early child development or a neuroscience that neurons that fire together wire together. And what that means is that we're building deep automaticity. And so if you see your 16, 18, 20 month old. And they're having some of these symptoms, then we could, think of it as writing the ship early on is going to take less effort, less work. And we don't just wait and see. Hello, and welcome to Talking Toddlers, where I share more than just tips and tricks on how to reduce tantrums or build your toddler's vocabulary. We're going to cover all of that, but here, our goal is to develop clarity. Because in this modern world, it's truly overwhelming. This podcast is about empowering moms to know the difference between fact and fiction, to never give up, to tap into everyday activities so your child stays on track. He's not falling behind. He's thriving through your guidance. We know that true learning starts at home. So let's get started. This week let's delve into the topic that's near and dear to every new mom's heart. It's about the unending worries that you hold regarding your baby's health and wellbeing. According to a recent survey, mothers spend a staggering 1400 hours of their baby's first year consumed with concern and worry about your little one's health and wellbeing. That's over eight weeks dedicated, solely to fretting or worrying. So throughout this first intense year, if you haven't already experienced it or you're in the middle of it. The average mom, that's you will conduct around 330 Google searches, seeking reassurance and guidance on various aspects of your baby's health and your parenting skills. But here's the catcher. It doesn't end there. The survey also uncovered that you new mama, make an average of 337 calls or texts to your own mother. Uh, to discuss different symptoms or seeking advice just from everyday experiences. So you're probably wondering. Oh, my gosh, maybe I'm not alone. Maybe I'm not crazy. Right. Let's talk about what some of those worries, those common, typical. Expecting worries. You worry about sleep patterns. Firstly, then you look at developmental milestones and the third big worry is dietary concerns. So believe me, I get it. There's a plethora of anxiety going around in those first 12, 14, 16 months. And they're all weighing you down. I know that. I feel it. And in my practice, I used to see it day after day after day. in today's episode, I am going to be incredibly direct with you because at the end of the day, I want you to be able to stand up, embrace your parenthood and acknowledge your uncertainty. Really face it go toe to toe. Like I talked about in the last episode. it's okay. And expected to feel ignorant. Of course, you're going to do searches. Of course. You're going to reach out to your mom. That's what we're supposed to do. Even when I became a mom. And I was almost 40 with 13, 14 years of private practice specializing in early child development. I had all of that in my pocket. And yet, that first year was hell It was overwhelming and. A lot of it for me was. I never felt so vulnerable because. After caring for this baby in my womb, as you have for nine months. And then all of a sudden. She, or he is really dependent on us to quote unquote, do the right thing. And the truth is I had a slew of mentors. I had friends who had already done it way before me. So I'm reaching out and saying hi to my best friend, Cindy, you know me, you love me. Thank you for those first couple of years of guidance, I had colleagues who actually worked right in my private practice with me, Susan, the wonderful occupational therapist and the two child psychologists that I worked with for Umpteen years, Curt and Robin. I even had a developmental optometrist. In my back pocket. Thank you, John. So my point here is yes, it is natural. And I think it's healthy to reach out and look, but the problem is, I'm sure you're feeling overwhelmed with the amount of information that you get. So you do your Google searches. You ask your mom who, you know, raised kids 30. Plus years ago, the world is a little bit different. Expectations are a little bit different, even though our babies and toddlers and children haven't technically changed. But my point here is I don't want you to ever be afraid to ask questions or to seek guidance. I want you to be able to be open to brainstorming the possibilities. And if you disagree, then go out and seek a second opinion. I've shared that over and over again. One-to-one in my private setting. Like, if you don't agree with me, fine, go get another opinion. And quite often I would be that second opinion after they talk with a doctor or a developmental pediatrician. And we'll talk about what those are, but. I think it's really, really prudent. And vigilant. To do that. And in your parental right. before I go on I need to make it a disclaimer here. Because I think it's really important that we're all on the same page. Please note that the material and the opinions that I share on this channel is just for informational purposes only and is general in nature. And I'm giving you my personal experience, my professional experience, but I'm just one person. Right. And I'm encouraging you to go out and seek your own research, not sit back and just wait and see, but to take what I'm sharing with you and then explore it to the next level. So, whatever I share on here, it's not intended nor should it be relied upon or construed as medical advice. And so if you do have specific questions about the health or wellbeing for you or your child, please pick up the phone and call your own personal healthcare provider. Or a state agency. Now with that, disclaimer, we are going to talk about what the pediatrician's role is and how you can work together to really support and benefit your child, right. And so I, I just need to make sure that we all understand that I'm not giving you quote, unquote medical advice. I'm giving you my personal experience. And what I've learned in my 35 years of practice. So I, I will outline what. Pediatricians are what their role is and what they can do for you. And I think sometimes families, mostly moms, because we're kind of leading the charge in those first three, four. Eight years, but it's important to understand what the pediatrician role is an, is not. So pediatricians are encouraged and that's just encouraged, not mandated, not forced or any of that. To screen your toddler using a standardized screening form. Both at 18 months and 24 months for autism. And although today we're going to talk about this one specific tool that most of the pediatricians have at their disposal now whether they use them or not, but that's part of this discussion. But typically they will administer this at your 18 and 24 month well-baby checkup. Now it is designed to be administered from a 16 month old, all the way up to 30 month so they can give this at any time. It doesn't have to be on their 18 month marker or their 24th. Or a two year old birthday. And it is. Questioning the risks of autism, but many of the symptoms or questions will also be applicable to other developmental issues. So keep that in mind as we walk through this. Now there are three or four different, types of screeners that your pediatrician could choose from the vast majority of practices will use a tool called the M chat dash R. And then there's a slash after it. AF And it stands for the M stands for modified. And then the chat stands for checklist for autism in toddlers. The R means revised it's a revised version. And then there's a followup to it. So all of those. Title is very, very important. I'm going to explain what all of that means to you and how you can use it more purposefully at your pediatrics office. So the M chat was first introduced or developed. Around 2009, I believe. And it was revised. In 2012 and then computerized. So when it first came out, it was just paper form. And very few pediatricians really followed up on it. Sometimes the, the front office, staff or a nurse would implement it, but it would often get lost in the shuffle, but now it's all computerized, so pediatricians are expected to do this, and yet you'll be surprised at how many don't. what it basically is if you haven't already experienced it or if you have, and you have some questions, I hope to answer those. So it said 20 questions. Yes. No questions for the parents. Mostly the moms fill it out and they needs to be done they're in the office on the computer because you can get immediate scoring and that's key here because one, it takes any interpretation. off the doctor shoulders, right. He or she can simply say, okay, here's what the outcome stipulates. What's the next step. Now do keep in mind that a screening is just that it's just a baseline measure. It's not a fully valuation. It doesn't diagnose. It's really designed to get a baseline. And ideally what I've always thought it should be used for is to start that conversation with you to open up that door. And really talk about early child development and what these milestones mean. But the problem is pediatricians are kind of stuck between a rock and a hard place. And I'll explain what that means. The goal behind it back in. You know, the early two thousands, when it was first developed in research and then became, widely used, there was a high level of what we call false positives. And so that's why they revised it back in 2012 and it became better, right. The validity and the reliability uh, is better now. but the goal is to really help the pediatrician. assess with the mother, Or the primary caretaker, right. Dad. where your child is early, early on to look at that 16, 18. 20 month old child and say there are really subtle nuances that could help us determine if they're on track or not. And the idea is to catch a child or to be able to identify them at a much earlier age, because then we could intervene or be much more purposeful with all of our supports. Right. And, and it's not to say that a four or five or six year old child couldn't or would benefit less from therapies it's just, we know that working with a 16 month or an 18 month, a 20 month old they've had less life experience. And so a lot of the neuro pathways aren't really solidified. They haven't, and I've shared with you a phrase that we often use in early child development or a neuroscience that neurons that fire together wire together. And what that means is that we're building deep automaticity. And so if you see your 16, 18, 20 month old. And they're having some of these symptoms, then we could, think of it as writing the ship early on is going to take less effort, less work. And we don't just wait and see. the idea is to catch them earlier. And to not let a lot of these subtle kids fall through the cracks or become overlooked. And, we can always go back to the big discussion. Why are the numbers so exorbitant again, I have my philosophies and my professional experience. I've also done some deep dives and talked to a lot of people and, and that's for another entire different episode. Today is to explain to you what this m chat is and how you all can really use it purposefully with great success. And so I tell you this because unfortunately, The truth is that most pediatricians. Or at least the ones that I've worked side by side with, and that's 20 plus years in California and another 15 years in Vermont. They are very uncomfortable talking about development. And I'll tell you why, or at least my impression. I think primarily they feel like they're undereducated and it's true. They have perhaps, a couple of chapters. Or, a couple of lectures on overall development. And what the developmental milestones are on that checklist. They also feel incredibly crunched for time. And you know this, and I know this one. They have a lot of sick kids or they just have a high back-to-back patient count because that's how our system works these days, you know physicians get about 15 minutes tops from beginning to end with any patient. And truthfully, I think pediatricians are of the mindset that they want you to lead that question or to lead the charge. Because what do they often say? They say. Well, Do you have any concerns and that's just this kind of open-ended. But you as a new mom, a new parent You're overwhelmed. you're spending 1400 hours that first year, which I think is equivalent to eight weeks of your first babies year on this planet, earth questioning and doubting. And you're going to this pediatrician, hoping that they'll give you guidance. And they kind of put the ball back in your. In your court and it's, it's a hard predicament. So they know that spending just a few minutes and literally, like I said, 10 to 15 minutes with you and your little one doesn't really put them in a comfortable position. It's not relaxing. It's not like let's get down and play. A lot of them will have decent bedside manners because, they must like children. They went into pediatrics. But I think you were experienced enough to know that the conditions for that visit. Can be stressful. because you're only in the office for one of two reasons. One it's a well-baby checkup, which means there are shots just right around the corner, which makes you nervous. Makes the whole energy in the room, nervous. The baby picks up on that. Right. So you certainly can't talk to them about, developmental. milestones after the shots. And they only really have a few minutes and they have to get some very specific tasks done in that window. Or you're there because your baby sick. And so that's another stressful situation. Again, not a lot of time to spend and quote, get to know each other. So. I think one, they feel like they don't have a full understanding of the intricacies of these developmental milestones. And they're pressed for time, right? And they figure, huh? If mom is worried, chill had asked me right. So now with all of that in mind, let's take a deeper look into what the M chat is. And like I said, pediatricians are encouraged to use this formal screener. They all don't. But it would be incredibly helpful if they did at the 18 and the 24 month. Checkup and sat down with you and discuss what the results were. We know that. Kids are still being missed. We also know that. Only about 73% of the pediatricians who report that they use this screener on a regular basis. And of those 73%, only 31%. Share the results with you. The parent. The one who has to take the baby home. And continue his growth and development. And so it was my organization, American speech and hearing association that did this study back in 2019, because we realized that. Even with a computerized version of the M chat. The parents were being informed of what the results meant. Good, bad or indifferent. And yes, it's just a screening. It's not a diagnosis. But it's important piece of information that can really help you. The family guide the next step. And so we're still kind of scratching our heads with why don't pediatricians use this properly. And with that. I just want to give you an example. I want to read and share an email with you that I received a couple of months ago. with a new mom regarding this M chat, she says. I normally get an eight or 11, depending on how hard I'm grading my 20 month old son. Either way it's always high risk. Our pediatrician tells us not to worry yet that all children learn at their own pace. But my husband and I both worry that our son seems so far behind. He doesn't speak in single words or even babble. He doesn't wave. He doesn't point he doesn't do imaginative play and he hardly ever responds to his name. And does not follow simple directions. On the positive side, he has a great temperament. He never throws a FET. He makes good eye contact and seems to eat whatever I serve him. And he does enjoy playing with his cars. And she continues with. I don't want to make a problem where there is none, but I also know that early intervention can really help. I'm hoping to get some direction and that you could give me that. I'm also curious if other moms have similar experiences, what do they do with a score? Maybe I'm just overreacting. So I'd like to say that I was able to walk through what the scores meant with this mom. She was not overreacting. And the truth is. I initially didn't understand when she said, well, I usually get an 11 or above. And I'm like, how many times has the pediatrician given you this? With no support. And with that, I want to explain to you all you moms out there, what the scores really mean. And what the pediatrician should be doing now, I get that they haven't had a lot of training. That is, it's just a tutorial online. And because they don't have a lot of educational experience or even clinical experience on child development than, This tool is actually designed to give them the script to help guide you to the next best step. So here it is. there are 20 questions, like I said, yes, no questions. And then you get an automatic score. If you score zero. One or two you're at low risk for falling in. the autism spectrum, If your child's score is three to seven, you're at medium risk. And that we need to take a closer look ASAP. If your child's score seven or above, right. We have seven to 20. Then you're at high risk and you need to do something. Immediately But here's, here's the catch. That this particular screener has a part two. and we're going to go through, I'm going to share with you what those 20 questions are. Just so you know, if you haven't done it already, I'm going to give you a little insight of what they're really targeting. say you get a 10, like this mom. And you fall into, the high risk. Part two should be administered right then and there, because everything is done on the computer and it's immediate, right? Because the"F" part of this title of this, of the screener, That M chat. R which means revived and then there's a slash F on it means to follow up. So the pediatrician needs to ask follow up questions right away. And the questions are right there on the computer. So say for example, you missed question number five, he would. pull up question number five. And probe to extract more specific information with you. Again, it should be a dialogue. and then he determined whether you pass or fail again. Right? Because sometimes like this mom, she's like, well, it depends on how hard I want to score my 20 month old son. you don't sit down and do a screener like that. You try your damnedest to take your emotion and kind of tuck it deep inside your heart someplace and say, okay, I'm going to be honest. I'm going to think about this. And this is why. I want to walk through these questions with you. So you all can be well aware and thoughtful when you answer these questions, but the part to the followup should be done right then. And there, if you score at a medium risk or a high risk, if you miss quote-unquote or your score is three or above, then your pediatrician needs to follow. Up. It's important. And if he or she can't do it right then and there, then. schedule an ASAP or see if the nurse practitioner can help or something. But that's how it's designed to be implemented. to rescore it. And if you then get a two, You monitoring or what they call surveillance. Right. And if you score three or above 7, 10, 12, plus then you need to referral. I want you all. Now, as you're sitting there, ask yourself where do you all fall with your pediatrician? Did they administer this screening, this M chat at 18 and then again at 24 months and they can do it again any time. some tests we shouldn't teach to the test. But, this is developed where you can take it every month, if you need to. I mean, it's not designed to do that, but if you Answer it at 18 months and 24 months and 30 months. That's totally fine. you're going to answer the same questions. And so for me, reading through them with you right now, Doesn't Invalidate the outcomes or break any rules. You will know, the, questions each time it's administered through the, office., the whole idea behind this screener. Is to conduct further inquiry. And then get a referral to a specialist as needed. Pediatricians are not necessarily developmental specialists. And I know you're all maybe sitting there scratching your head saying, yeah, but he's a pediatrician or she's a pediatrician. There are four categories under pediatrics, one, they could specialize newborns. Right? They only seen newborns. Or they could be newborn intensive care at the NICU. Those pediatricians. I had a friend and a colleague back in Vermont and that's what she specialized in. Just the NICU. And then there are mostly general pediatrics, right? So they, they have to study the medicine, right? The physical biology of the body from birth all the way to 18 or 21, actually. And then the fourth subgroup. Is called the developmental behavior specialist and they have additional training in the developmental milestones and how they all relate to one another. But here's the kicker. There's a serious shortage of developmental behavior specialist here in the United States. And there has been for a number of years, so will, according to the American academy of pediatrics. There are only 758 board certified developmental behavioral pediatricians in the United States. As of 2022. And yet. We. Have 19 million children with a developmental or learning problem. Learning disorder and that runs a whole gamut. Autism is part of that. But there's all other kinds of developmental and learning disabilities. So we only have. 758 developmental pediatricians who have specialized in that area. And yet 19 million kids. Are struggling. So, what do we do, right. And where do we go? Who do we talk to? That's why I'm here trying to give you guys tools, information, strategies, knowledge. So you can be your child's best advocate. And what research suggests is that over the next 10 years, one third of the existing developmental behavioral Pediatricians.. Are expected to retire. And we have significantly fewer replacements. In other words, The medical students are not necessarily going into pediatrics, nor are they getting a specialization in the developmental areas. So. They're scrambling to try to figure out. As these doctors retire and leave. How the heck are we going to take care of these kids? And the numbers are escalating. We have 19 million today. What's it going to be 10 years from now. And part of my impression, this is just my opinion. Is that the reason why doctors aren't going into this area? Because it's really freaking hard. The health care system in general, again, in my opinion is pretty dysfunctional. And then you're looking at these poor children where you know, 54% of children in America have a chronic disease. That's one out of two. And so I've heard in recent years that not only do general physicians feel like they've become quote unquote legal drug pushers. Because let's be honest. There's a lot of incentivized. Action going on to write those prescriptions. That's reality. I'm here. To, to be honest with you all. You can look that up. But it also seems that the role of the pediatrician over at least my career span, the last 30, 35 years has become to act like a funnel. And what that means. Is that they can look at some basic wellness, do they have a cold, is there an ear infection? Does he need stitches? Did he break his arm? beyond the basic medicine. They refer out to specialists, including a developmental specialist. So your pediatrician technically can't diagnose autism or speech and language disability, or an occupational weakness or any of those developmental areas. And the four primary developmental, think of them as pillars would be social, emotional. So they would refer out to a child psychologist. Language and communication, they would refer out to a speech language pathologist. Cognition, which also would be either myself or a clinical psychologist who specializes in intellectual diversity. And then movement or physical areas and that would be a a physical therapist or an occupational therapist. And so your pediatrician I doesn't have the expertise to really understand those areas. So my point here. Mom. And dad and grandma, all of you together because there's power in numbers, right? You are your baby's number one advocate. And my role here is to empower you, to give you more knowledge and to even spark some questions. So you can scratch your head and say, wait a second. What else can I do? Because you guys direct the conversation, you make the inquiries and monitor his health and wellbeing. Right. But I know that you guys have been short changed with understanding what the importance of this screener at your well baby checkups. And whether your pediatrician is really following through with what their role should be. Because at the end of the day, I believe it's necessary for each and every one of us to really embrace our independence and take our own health, growth, wellbeing, development, all of that in our own hands. even for us adults in the room here, Just because we've physically stopped growing, right? We're not going to get any taller. We stop in our teens or we stop in our twenties. We as human beings will never lose the potential to expand or enhance or reshape any of our abilities through our mind or our brain, our bodies, our spirits. So, let me walk through these 20 questions and give you some quick highlights because I really do. I do want you to understand what they're intended for. So number one. If you point to something across the room, does your child look at it? For example, if you point to a toy or an animal, does your child look at that toy or animal? And that measures joint attention. And it's really. Really really important because it starts joint attention starts to emerge. And I use that word a lot here, but it starts to emerge around six months of age. So by the time your child is 16 months, 18 months, 20 months. That should be pretty well-established joint attention is really, really important. And you're going to see out of these 20 questions, 10 of them. Is about joint attention. That's interesting. Right. All right. So number two, have you ever wondered if your child might be deaf? And that too is about awareness, but it's also about auditory processing and is your child coding language in that first year, year and a half? Well enough that they're responding to your voice in all of this noise. Right. Number three. Does your child play pretend and make believe for example. Does he pretend to drink from an empty cup? Pretend to talk on a phone or pretend to feed a doll or a stuffed animal. And pretend play typically in kind of a natural growth pattern. Starts to emerge around 18 months of age. And so it doesn't mean that, if you said no to that, then that would be this big, huge red flag. What it does mean is are they beginning to do it? And so by the time they hit that 24th month, they're pretty well into pretend, play. And so at 18 months of age, you should be seeing it beginning to emerge simply, right? Like pretending to eat or drink or to talk on the phone. Number four. Does your child like climbing on things for example, furniture, playground, equipment, or stairs? again, this is looking at neurological health and growth and development, looking at bilateral integration. especially walking up the stairs or on an uneven surface. Then they're able to adjust their upper motor neurons, their lower motor neurons, the right and left hemisphere, looking at balance and coordination. Again, he doesn't have to be a perfect climber or Walker, but that gait and body awareness really starts to solidify around 14 months of age. Does your child make unusual finger movements near his or her eyes. And for example, do they wiggle their fingers close to their eyes? And that's what we would call a visual self-stimulation. It's it is for the most part, pretty atypical every once in a while, you're going to see a kid jump up and down and shake his hands and do those kinds of things. But putting the fingers and wiggling them in front of their own eyes is a way of self soothing. And that's what self stimming is. And you and I, or any human will do some self stimming or self-soothing. Like shaking your legs when you're trying to concentrate or clicking your pen or smacking your gum or twirling your hair, all of those kinds of things are appropriate occasional behaviors. But the wiggling of the fingertips in front of the eyes is fairly atypical. Number six. Does your child point with one finger to ask for something or to get help? For example, pointing to a snack or a toy that's out of their reach. This is really looking at the gestures and that's a very mature thing to do by pointing. Mature meaning that it should be emerging around 12 months and 14 months. And by 16 months it should be used frequently, right. And gestures, and I've shared in previous episodes about 16 gestures by 16 months. And I will have a link below, but pointing is very, very important because it's part of that joint attention. It's part Of a gestural cue that really, really means. Join me in this. This is important. So does your child point with one finger to show you something interesting? So there's a slight difference between asking for something like pointing up on the cupboard says, I want my Teddy. or getting help, like, pointing to the boot, like the boot is stuck in the drawer or something. but also then pointing with one finger to show you something of interest. And that goes back to that joint engagement and shared experience. The next one is, does your child, or is your child interested in other children? And this we have to be sensitive about, for example, does your child watch other children? Smile at them. And go up to them. But those are the examples. we're not expecting an 18 month old or even a 24 month old to share and play with other children. They can four spurts here and there, but for the most part They're showing interest of their peer group. Right. But it's not really sharing yet because they don't have that sophistication, that social communication yet, but they're interested. And so they will often go up to somebody like if the cousin is going to come and play, but they don't really know how to sustain that conversational flow or engagement or play. They don't have really strong, reliable turn-taking skills yet. But we want them to be come aware to look at them. And with interest, watch them. Right. And so there's a subtle difference. And so th the whole, sharing and playing together, doesn't really start until two and a half or closer to the third birthday. And that is uh, myth out there. And I think it's really, really important. a lot of parents will say, especially during, the whole lockdown thing. Is that, oh, they didn't have any socialization. And the truth is. A two year old or a one-year-old really doesn't need a lot of socialization. I think they need exposure. Like if you went to a playground and there are kids running all around they will follow older kids. And want to engage with them. They can't because they don't have that social skills yet. But, an older kid is almost an adult to them, if you have a two and a half year old compared to an eight year old, that's a significant difference there. But it's important that your 18 month old and your two year old. Is aware of those other kids and they look at them almost wantingly, but they don't have that sophistication yet. So does your, the next question, does your child show you things by bringing them to you and holding them up for you to see. Not to get help, but just to share, for example, showing you a flower. Or a stuffed animal or a toy truck. And kids will often do this. And maybe you notice this during the holidays. Because if you have aunts and uncles and cousins coming and going. And they would just bring things to show you again. They didn't really know how to talk about it too much. Now some kids are chatty Cathy's at two and two and a half. But this is their nonverbal way of starting a conversation. And it's a very important precursor. Two. Conversational flow into turn-taking to asking questions. Oh, how are you? Oh, look what I did. And, and really engaging with that object and the other person. But it's a very important, important precursor. Number 10. Does your child respond when you call his or her name? And this is a big one. So does he or she look up. Or talk or. Say, huh? or start to babble, right? Or do they stop what they're doing? And they'll at least look toward whoever's calling their name. And that's the important part here is that they're developing a maturation of themselves and others, but they're also processing and filtering the auditory noise in whatever room you're at. And able to pull out something that's important, such as their name. Right. and they're doing it in real time. In a future episode, I'll talk at length about what is auditory processing. And that's a little bit different than just this catch all phrase of language processing, but auditory is just the perception and the interpretation of the spoken word. one of the most important things in that first year, 18 months is that your baby learns his or her name. And that that's their identity. and so for them to be attuned to that and to be able to perceive it in everyday activity is critical. When you smile at your child, does he or she smiled back at you? Again, this is part of that social connection. Right. and that's a nonverbal gesture. saying hi. I see you. I acknowledge you. Or, sometimes I wink and other kids will try to wink. Right. Number 12. Does your child get upset by everyday noises? And this is an auditory sensitivity, I hear a lot of parents nowadays. Talk about my child is sensitive", right. And I think we need to respect different gradations of sensitivity, but it's not healthy to be overly sensitive with this three dimensional world. we have to really gauge what's happening neurologically and developmentally to make this happen. So that is, an auditory sensitivity, like to aloud vacuum cleaner or loud music. Right. And if that happens once in a while, if he's sick or if he's tired or if he's had a long day, that's all understandable. But if something is chronic. does your child walk and that physical development? Again, a lot of pediatricians, a lot of parents, a lot of school teachers will push that developmental marker out further and further, and by 18 months they should be walking. I mean, the outside of development, motorically that would be 16 months. If your child isn't really walking independently by 16 months, you should pick up the phone and call a PT or an OT. Yes. First, you can talk to your pediatrician. But they might say, wait and see. I say every month accounts. So number 14, does your child look you in the eye when you are taking care of him or her? I like playing with them or dressing them. And again, that's falls under this pillar of connection attunement. Purpose sustained attention. And it's not a fleeting lock or just a look and a smile, but you want them to. You really feel, or you want to feel connected with them? And we have to put a little asterisk on this one, because like that example that I read that email from the mom, she said that he has good eye contact and I have met, Hundreds and hundreds of children who. did end up being on the autism spectrum and many of them will learn appropriate eye contact. I mean, they are well loved. They are well taken care of. They do build a loving relationship with their, their mother most of the time or where their primary caretaker. And they learned that by connecting with the eyes that makes them feel good. And it gets them stuff. Right. So there's a positive reinforcement there. so just keep that in the back of your mind. I know it's, that's often a parent's first response, they have great eye contact. They give me lots of hugs. Yeah, because that's only one possible symptom. All right. Number 15. Does your child try to copy what you do? For example, wave by, by clap. Or make a funny noise when you do it. So this supports gestures, like I talked about 16 gestures by 16 months, but also imitation and gestures and imitation have to be pretty solid before your child is ready to speak and use words with purpose and intention. They have to understand that. Gestures represent communication, just like words. Represent your thoughts and your feelings and your desires, communication, right? And so it's part of this developmental hierarchy. That's, that's really important. So if the next one 16, if you turn your head to look at something, does your child look around? To see what you're looking at. So say you're playing a game or you're changing him and you turn and look, is he aware, connected in tune with you? But he also, you know, is very. Sponge-like right. He wants to know what you're doing or thinking and wants to be in it with you. So that is part of that. Engagement. that's pretty. important. And number 18. Does your child understand when you tell him or her to do something again? Some basic following directions that can be a hit or mess? But. Here's the key. If you don't give them any gestural cues, if you don't point, if you don't look toward whatever you're asking, if you just put your hands on your lap and ask. Put the book on the chair. Or bring me the blanket. They can start to process these types of questions, also give them directives, like where does your cup go? In the sink, right? Where's the doggies food. In the cupboard. Those kinds of questions. Number 19, if something new happens, does your child look at your face to see how you feel about it? For example, if he or she hears a strange or a funny noise. or if they see a new toy, something novel, right. Will they look at you to see how to respond, That's part of that human connection, that attention and awareness. It's also seeking confirmation. Like, is this good? Should I be scared? Should I be happy? Should I go and touch this new thing? Right, but it's a nonverbal visual connection. About you in the environment and that's a really important skill to have to tell us that they're consciously aware of what's going on and they're connected with you to understand to get feedback right. And then the last question, does your child like movement activities? And again, this can be one of those asterick ones, right? Because it's looking at your child's vestibular system. Movement and connection. Lots of kids, like to move a lot, lots of kids can over seek movement, right. They spin around, they jump, jump, jump. They roll all those kinds of things, because that's a way to regulate themselves. And sometimes kids are not very physical or active, If you don't feel like your son or daughter fits the parameters that we're looking for, then your pediatrician should. Probe and dive deeper into those questions and figure that out. I shared in the very beginning that the scoring. From zero to two, like if you have one or two of these. Ah, you're at low risk let's monitor that maybe with a conversation with your pediatrician, then you take a look and say, oh, I'm going to really look at. His sensitivity to loud noises, you know, a lot of kids. Don't like vacuum cleaners. And maybe it's just because they haven't heard it on a regular basis. Right. Or is there a certain pitch or frequency that really drives them crazy? that wouldn't be a big problem, but I would encourage all of you to then assess what does he do with auditory stimulation in other contexts, right? You bring it to the next level. This is information that is really powerful. And so I wanted to kind of walk through this because I have seen a lot of dialogue online. and parents are getting some I think bad information bad. direction from their pediatrician and I want you all to feel. Much more empowered. knowledgeable. Capable. And I have often heard parents say you know, I didn't want to go there because I, scares the pants off of me. This is serious stuff. I get that. But at the same time, In this day and age with the way that our systems are kind of bogged down, right? our pediatric offices are over-scheduled. if you do need to go and get a second opinion or to get an evaluation, there's going to be a wait list three months, six months, some places a whole year. And so. Use what you have at your disposal. Try to get as much as you can from your pediatrician. Um, and if you still don't then, call friends and family, But I want you to ask yourself these questions. Did your pediatrician administer the M chat? Did they follow up? Right? Did he, or she explained what the results were. Did you, and this is a big one. And a hard one. Did you answer questions honestly, and with an open heart, Cause it's, it's hard. But now that I've kind of walked you through each question and down below, I will have the link where you can go online. I did a dummy. an untrue case, right And I got results, But I will give you the links and you can look at them and I want you guys to be the evaluators, right? You determine where is my son or daughter for real? You know, can you discuss your concerns or your questions with your pediatrician? Do you think a second opinion is warranted? Can you call friends and family to get a referral to another pediatrician? And then as a wrap up, I just want to give you other options. And this is important too, because like I said, pediatricians are medical doctors who kind of focus on the younger population. They don't necessarily, they're just medical doctors. They're don't necessarily understand the subtle nuances of these developmental pillars that we talk about, right. Have you ever considered, or have you looked up a D oh, a doctor of osteopathic medicine? they have the same education as a medical doctor, an MD, right. Um, MDs generally focus on treating specific conditions and they usually use medication. And if it's beyond their scope, then the pediatrician, like I said, we'll refer out to a specialist on the other hand, dos doctors of osteopathic medicine tend to focus on. On the whole body healing. With or without some traditional medication so they can write scripts and all of that too. But they look at the system working together. what they say is that it began as a small profession with distinctive philosophy. Which now has grown to become a critical component of the nation's healthcare system. And in 2023, the total number of osteopathic physicians in the us reached almost 150,000. Like, remember I told you that they were just over 700 developmental pediatricians. And so here's 150,000. And so that. means a 30% increase over the past five years. So DEOs, can treat the whole family too. And they will often, Welcome the. Opportunity to really see a child. Throughout his whole childhood. The other option would be functional medicine and, functional medicine practitioners really studies the systems of our biological body, That focuses on identifying and addressing the root cause of a disease or an illness or a problem. So each symptoms or differential diagnosis may be one of many little pieces to the puzzle. and in the United States, the use of functional medicine has grown significantly in recent years as well. So I think it's interesting, that we, as, The adults. are exploring different options. So according to the survey conducted by the functional medicine practitioner research network, the number of functional medicine practitioners in the us has increased. From just over 5,000 in 2010 to nearly 40,000 in 2020. So that was, that's a big jump and another great option for you guys to explore. And I've I've shared this before. you know, you don't have to just because you have children, see a pediatrician, you can. find a healthcare practitioner that really serves you and your family and your desire. Of creating a healthy home life and wellness and thriving children. There are choices. It's not always easy. I get that. And we do have to do the legwork. And we have to be uncomfortable sometimes saying, I'm sorry, I can't work with you I don't feel comfortable. It's okay. sometimes it's just a personality thing, right. I remember. letting my dentist go once And he wrote me a letter, like he was really personally insulted and I thought, maybe that's why we couldn't really get along. Um, but be honest with yourself. Hoping something will resolve Or just go away is pretty. The risky business, especially when we're talking about 18 month or a 24 month or a three year old. Right. If you're unsure. Do some more legwork, do some more research? I will recommend a book, by Patricia Lehmer, L E M E R called Outsmarting Autism. my goal here for this episode is really empowering. You have, what is the M chat What are pediatricians encouraged to do? And can you encourage them to do the right thing with you and help you filter through all of this. So I do have links below. to get an expanded version of the developmental milestones for 18 to 24 month old. Because if you just Google it. You know, developmental milestones, the CDC pops up. Or your state organization and they're very, very cursory, right it a couple little check marks under each domain. Mine are pretty extensive. I look at all of them across the board. I look at speech and language and communication articulation, of course, but I look at the social-emotional and cognition cause they all develop together synergistically. And then I look at the physical aspect too. Now to say that I would quote unquote ever treat that, but then that's when I would refer out. And quite often I would say. We can't address these early speech and language issues or communication, or even attention issues. If they have other physical problems that are interfering or blocking him or her from learning social communication or spoken language, or even, sitting in the high chair and learning how to explore with food and all of that. And so some times we have to put things. Speech and language and that on the back burner, because perhaps there is a sensory integration deficit or weakness that's interfering and really causing problems with him being able to. Engage with his daily life. And so that's a different episode too, but I think it's really important the more information you all have at the tips of your fingers, then the, better questions you can ask, the more refer referrals, you can seek out and the better you guys can do at home. Right. So if you know that, 10 of these 20 questions fall under the umbrella of looking at joint attention, Then you're going to want to go back to playing a lot of social games and playing a lot of nursery rhymes and getting them to engage through play and gestures. And, uh, hold off on speech and language. I hope this all makes sense to you. And please feel free to reach out. you can email me or DM me. email contact@HyerLearning.com HYER my last name H Y E R. I would love, to help in any way I can. So take care. Thanks for spending time with me. Thanks for investing in your child's future. And showing the possibility. So God bless. See you next week. Bye.