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Sunday, 09 November 2008

Stepping In to Help: I Am Concerned About My Child's Physical Development - What Should I Do?

Written by  Esther Boylan Wolfson

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This article was written in consultation with

Ziva Schapiro, OTR


Take the Early Childhood Physical Development Checklist.

The results of the checklist should give you some indication of how your child is doing compared to other children his age. His ability to do well on this checklist does not guarantee that he does not have a problem, but it does let you know if he is developing age appropriate skills.

* Don't Worry - Remember the checklist is a tool to help you decide if you should have your child evaluated. Even if he has trouble with some or most of the tasks, this does not mean that there is a problem.

* Speak To Your Pediatrician.

Your pediatrician is not just there for illness and broken bones. Tell your pediatrician that you are concerned about your child's physical development. You can show him the checklist and point out areas in which your child is having difficulty.

While I definitely recommend going to the pediatrician as a first step, I must also point out that not every pediatrician is an expert in child development. Some doctors are excellent at diagnosing every rare form of childhood disease, but do not jump to deal with possible developmental delays in the hope that the child just "needs time." I worked for many years as a pre-school special education teacher. I cannot count the number of parents who told me they did not seek treatment for their child because their pediatrician told them "not to worry."

Some pediatricians are developmental experts. If your pediatrician is, then consider yourself lucky and follow his instructions. If you are not certain if your pediatrician is also an expert in the field of developmental delay, then I would suggest consulting with the following professionals.

* Consider a Vision Evaluation

Discuss with your pediatrician if any of your child's difficulties may warrant a vision check up. While some problems are clearly not related to vision, many areas of physical development can be affected by a child's inability to see properly. If a child cannot see clearly, then she may be more likely to fall while walking or running and will have more difficulty building a tower or putting together a puzzle. Keep in mind that not all ophthalmologists have the appropriate skills or equipment to test young children. Make sure that the one you choose is used to evaluating children of your child's age.

Often, developmental optometrists are best suited for these evaluations. Ask your pediatrician for a recommendation.

* Speak To Your Child's Teacher Or Day Care Provider

If your child is enrolled in a formal pre-school program, then your child's teacher is one of the best first stops for getting information and relieving possible concerns. If you feel confidant that your child's teacher is experienced and has a good feel of your child, then ask her how she feels about your child's fine or gross motor development. Do not assume that because your child's teacher has not approached you about a problem, that she does not feel any problem exists. Some teachers are very hesitant to approach parents about potential problems unless the problem reaches significant proportions. If your child has an experienced teacher and she is not concerned, then likely as not, there is nothing to worry about.

* Have Your Child Evaluated by An Occupational or Physical Therapist

The bottom line for making sure that your child is not having difficulty with either gross or fine motor development, is to take him for an evaluation with the appropriate therapist.

Consider the areas in which your child is having difficulty. Are they primarily gross motor difficulties or fine motor difficulties? Do you find that most of the tasks he has difficulty with are the ones involving his hands or do they more often have to do with movements involving his entire body?

* If you find that your child is having the most difficulty with gross motor skills, then the best person to evaluate your child is a Physical Therapist. A physical therapist is the professional whose primary role is to work with children who have gross motor difficulties.

* If you find that your child is having the most difficulty with fine motor skills, then the best person to evaluate your child is an Occupational Therapist. An occupational therapist is the professional whose primary role is to work with children who have fine motor difficulties. If you are concerned that your child's skills are affected by attention problems or sensory integration then the Occupational Therapist is also your best choice. While these factors can also affect gross motor skills, they primarily cause difficulty with fine motor skills are most often treated by an Occupational Therapist.

Choose a therapist that specializes in children your child's age. Just as most people take their children to see a pediatrician and not a general practitioner (although there are G.P.'s who are great with children), you need a therapist who specializes in young children.

* No Child Is Too Young To See an Occupational or Physical Therapist.

There are therapists whose specialty is working with children in neo-natal intensive care units and other newborns. Try and get recommendations from your pediatrician or from other parents. If you are uncertain whether to take your child to a physical or an occupational therapist, check with your physician. If your doctor is not recommending an evaluation and you would still like to get one, just let him or her know that you will be going anyway and ask which therapist he feels would be the best first step. In any case, both physical and occupational therapists are familiar with the skills usually treated by the other, and will let you know if you should consult with another therapist.

Both a Physical Therapist and an Occupational Therapist will evaluate your child skills in his or her area of expertise. You can help the therapist by providing her with as much information as possible about your child. Bring the results of your child's vision test (if your child has had one) and even feel free to show the therapist the results of the Early Childhood Physical Development Checklist.

The therapist will evaluate your child in all areas of physical development, with an emphasis on her area of expertise (fine or gross motor skills). After this evaluation, she will tell you if your child's skills are appropriate for a child of his age. Often this evaluation can put a parent's fears to rest by re-assuring the parent that his child is doing just fine. Alternatively, if the therapist finds some difficulties, she may feel it is sufficient to give the parents some exercises or activities to do with the child to work on problematic skills. Another possibility is that she may feel that the child needs to see a therapist in order to work on his physical difficulties.

If the therapist feels that your child requires therapy, then she will design a program of therapy that is specifically suited to work on your child's problems. A good therapist is always happy to talk to parents and explain what this program is and usually can also give the parents suggestions for additional activities to work on specific problems at home. She will also be regularly available to speak to parents (at reasonable hours and lengths of course) about any concerns relating to their child's difficulties and progress.

Another common recommendation is that you should bring your child back for a re-evaluation in six months time. This usually means that the child's skills may be somewhat behind those of his peers, but there is every reason to believe that the child will catch up on his own and will not need any therapy to deal with his difficulty. Take this recommendation as an assurance that your child, despite any difficulties, is doing well and there is no reason to be overly concerned. Do, however, make sure to bring your child back for that re-evaluation, to make sure that he is catching up, as expected.

* The most important thing that you should do if you are concerned about your child's development is to take action.

Young children usually respond quicker to therapy, so the earlier you start dealing with a problem, the easier it will be for your child to progress. If you take your child for an evaluation and it turns out there is no difficulty, well then you can sit back, relax and cross the issue off your list of worries. Do not continue to worry if you have gone through all the channels, checked out all the possibilities and the professionals feel your child is doing just fine. Remember that all children develop skills at different paces and feel re-assured that your child is doing just fine for a child of his age. If after six months, you are still concerned about his development, then you may want to check back with a therapist on your own initiative "just to make sure."

As parents we must be as vigilant as possible to make sure that our children are developing the skills they need to succeed. But if all is going well, then sit back, relax and enjoy watching your child flourish.

If you are interested in working with your child to help him progress in his fine and gross motor skills, then make sure to come back soon to read:

Developmental Fun:
Activities to help strengthen your child's physical development

Last modified on Thursday, 04 April 2013 14:24
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Esther Boylan Wolfson

Esther Boylan Wolfson

Esther Wolfson , director of our Early Childhood Development Center is an Early Childhood Specialist, who received her BA in English Communications from Stern College for Women, Yeshiva University and an MA in Early Childhood Special Education from Teachers College, Columbia University, both in New York City. Esther worked as a pre-school special education teacher for seven years. Three of those years were spent working in a school for language delayed pre-schoolers, which is her area of specialty. Another special love of hers is cooking with young children. One of her most enjoyable projects was developing a program for cooking with pre-school children for three special education programs. Esther and her husband Myles have three boys aged eight, five and two-years-old. While her three lively boys and her work at WholeFamily, keep her quite busy, in her spare time (if she ever has any!) she is an avid reader who also enjoys creative writing, exercising and swimming.

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