Expert opinion

Normal is boring

NORMAL IS BORING

As a neonatal therapist, I encounter one word from parents about their child – “normal”, as in “will my child be normal?” On this International Day of Person with Disabilities, I would like to answer that complicated question with a simple “Yes”.  Let me try to explain the complexity of this simple answer.

Normal or typical is when there is conformity to a pre-established, sometimes arbitrary, set of behaviors. In this discussion of typical, we tend to forget that behaviors are not static. There is a spectrum of behavior and for most of the population with intact functioning systems, we mostly fluctuate within an acceptable or tolerable range of this spectrum. For example, getting frustrated driving in slow-moving traffic is acceptable but remaining frustrated throughout the day would indicate a concern. If we all have fluctuations through our day and lives, what is “normal”?

Amidst the fear and worry about normalcy, we lose track of functional capacities of humans. We are all capable of reaching a certain place mentally and physically given our environments and who we are. Not all of us with so-called ‘intact’ bodies are physically or mentally fit and not all of us with impaired physique or mind will have a doomed life. Skills, related to life or vocational ones, are learned over time with the right guidance, feedback and repeated practice. How much of guidance, feedback and practice, is specific to each person. I don’t cook well, so I don’t cook for fancy dinner parties. I don’t do Math fast, so I use a calculator before I write checks. I don’t walk well, so I use a cane or a wheelchair to get around. I don’t hear well, so I lip read, use sign language or read written materials. Life is what we make of it, irrespective of and in spite of.

What does this mean for a parent who has spent many weeks at the bedside of their very tiny preterm infant in the NICU in a constant state of anxiety and stress? All parents want the very best for their child and will try to give the best they can. An important aspect of this is also parent well-being. Parent’s mental state has a huge impact on brain development of our babies. (Co-regulation) Evidence has shown a clear connection between parental engagement, self-efficacy and confidence on developmental outcomes from the first moments of life.

Just like in the airplane, during an emergency, they always ask you to wear your oxygen mask first before helping others, caregivers cannot provide the best possible care if they are unwell. It’s best to seek support from family members, friends or peers. Seeking professional help to talk about what the facts vs myths of developmental milestones are and understanding how parent role impacts will go a long way. Giving birth does not automatically make you knowledgeable about child development. However, you as a parent can bring in insight into the child’s strengths as no one else can. Work as a team with professionals instead of struggling on your own till it is late. Therapy works best if done while the brain is already molding and making functional connections.

As hard as it is, seeing the glass half full, will help not only you but also this young child who is seeing the world through your eyes. If the discussion revolves around strengths and functional independence and the attitude is of resilience, we are all normal.

 

Puja

12/3/2022

Expert opinion, Preterm Infants

Advocate for your baby in the NICU

ADVOCATE FOR YOUR BABY IN THE NICU

The NICU is one of the most intimidating places for a new parent. It is filled with beeping technology, wires and multiple professionals all of whom seem to be using words you do not understand, not to mention the heartbreaking and scary experience of having a child in NICU.
An NICU is a very controlled environment, a lot of the time parents don’t feel like they can voice an opinion or ask a question. The professionals around them seem to be too busy and seem to know what baby needs better than the parent! However a parent is the best advocate for any child, no one can do that job better than you. Here are some tips on communicating with professionals in the NICU:

  1. Do not be afraid of asking questions during daily counseling sessions. If the professional on the team uses a term/jargon you do not understand ask them to elaborate and explain what it means.
  2. Make lists, you will come up with questions or have doubts when the doctor is not around. It helps to write things down so that you don’t forget to ask them when you do get the opportunity. It also helps to prioritize concerns, so that you can bring up these concerns in the beginning of the appointment.
  3. Make notes during the appointment, so that you can convey accurate information to your partner if he/she is not present during the conversation. These notes will also help you keep track of what the medical professional thinks should be the outcome of an intervention, that way if a intervention is not working as it should you can quickly advocate for your baby.
  4. If you feel your concerns have not been addressed, state this clearly. You can go over the details again or ask for more information from your doctor. If necessary ask for a second opinion
  5. Ask your doctor if your baby is stable enough to do kangaroo care (skin to skin contact between parent and child), kangaroo care has been shown to have a lot of benefits for low birth-weight and premature babies including improved cardiorespiratory and temperature stability and better sleep, in addition to being beneficial to the breastfeeding relationship.
  6. Ask for help with breastfeeding, try to find a lactation consultant who can help you latch baby or pump for baby. Breast milk will help your baby’s tummy mature and help fight infections. Breastfeeding is also automatic skin to skin! In situations where the mother is unable to breastfeed or pump for baby ask if the hospital has a milk bank.
  7. Premature babies develop differently than full term babies. It is important that parents advocate for their children and ensure that regular developmental screens are conducted so that any delay can be caught early. Ask your doctor for referrals when it is time to take baby home from the hospital.

Parents of preemies share your tips here: What questions did you ask? What questions did you wish you had asked? Did you take a list of questions with you? What to expect on the first visit? What to do if the professional is using too much medical jargon?

 

Happy Parenting

Lalitha Acharya

11/25/2015

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We would like to thank Lalitha Acharya for writing this post. Lalitha is mother to a 2 year old and a psychologist with a M.S in Clinical Psychology from the US. She has experience working with traumatized children and their families and running groups for individuals diagnosed with severe mental illnesses in both inpatient and out patient setting.

Expert opinion, Preterm Infants

My experience as an early intervention therapist for preterm babies

Having worked with preemies babies straight out of the NICU, I can endorse the facts that there is so much more complexity to preemie development than any other. In many countries around the world, preemie babies are given special status, which means that they are automatically eligible for monitoring of development till they are at least 2 years old.

As an early intervention therapist and service coordinator in the US, I have followed many babies as soon as they come home from the NICU. Support for families include discussing how to take care of the baby within the home and family environment, how to inform other family members about the many do’s and don’ts associated with a preemie baby, how to create a development friendly environment and what to expect from preemie babies.

All families were followed by a service coordinator once a month and all five areas are tracked using parent questionnaires. As soon as a concern is noted or observed, simple environment changes are suggested to see if the baby will respond differently. If there is further need for intensive hands-on strategies, then services are provided accordingly. This system is put in place so we can monitor and track all at-risk babies and prevent any long term delays.

Families who are diligent from the beginning had higher chances of not needing any additional support after 3 years.  A lovely family I worked with had twin preemie boys. As usual, both babies were regularly screened and we picked up a delay in one of twins at the 3 months screen. There was a distinct lag in head control and we started with regular therapy sessions. At the 9 month check, this baby was at par with his peers. In fact, I remember that he walked 2 weeks before his brother did!

On the other end of the spectrum, I distinctly remember a child we were following right from the time she came home from the NICU. The family, for various reasons, decided not to pursue regular services after 6 months. At 2 years, when the child needed help with speech and problem solving skills, they came back to the program. If they would have remained within the regular monitoring system, there is a good chance that we would have picked this up sooner and the child would have shown some progress.

There are many possible outcomes of development in a preemie baby and it is impossible to make a guess of what will happen unless development is tracked closely. There could be multiple outcomes ranging from all perfectly okay to a diagnosable condition in a few years.  Since there is no way of predicting it, all we can do is keep a close watch and try prevention.

If there is one thing parents can take away from all of this, please remember to track your preemies development, not only growth. Growth is measured by height and weight while development is measured using milestones and skills.

While there is a general lack of awareness to track development in India, families with premature babies are hit the hardest! During NICU stay, families are overwhelmed by the medical aspects and bringing your preemie baby home in itself feels like a huge victory.

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Please do remember that this is just the beginning to their beautiful lives. Track their milestones based on adjusted age and know that premature birth come with certain developmental risks that are visible later in life. Be aware and educated so IF there is need, you know what to do and where to go.

Happy Parenting

Puja

11/20/2015

Expert opinion

Milestones: Rules or Guidelines?

Heard this before?

“My child walked at 10 months, isn’t it amazing?”, “Oh no! My child is 14 months and taking a few wobbly steps. I am so concerned!”

Often, our concern about our child’s development is overwhelming. At such times, having something to measure against is reassuring. A developmental checklist provides parents a good way of keeping track of their child’s development. Typically this checklist is made of certain skills that should be visible at each age. These are called milestones. Lets understand why these are important for parents.

Development has been intricately linked with milestones from centuries.  A quick Google search revealed that the first formal assessments were used in the western world to test larger number of school kids at the same time after schooling became compulsory. However the first formal standardized test developed was the Stanford-Binet IQ test in 1905. The earliest developmental tests were developed by Giselle in 1911, based on observations of infants.  As standardization become more common, developmental milestones were observed in larger cohorts to formalize these ranges as well.

Development of skill is extremely individualistic. Just like two individuals following the same recipe will not be able to replicate the exact taste, no two children can grow in the same exact manner. Several studies, with twins and siblings, have shown that growing up with the same set of parents and environment does not mean the rate of development or even the qualities within the children would be the same. Holistic development of a child is a delicate balancing act of parent personality, child personality and the environment around them.

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So exactly what are milestones?

1) Milestones are skills laid down at certain intervals along the path of development. But development is not linear and two dimensional like a roadway. Therefore, developmental milestones cannot be thought as one fixed point on this continuum.

2) Milestones are categorized in five distinct areas.

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All these five areas are development simultaneously and are inter-linked with each other. For example: skill in the adaptive area like brushing teeth requires motor skill of upright balance and hand movements to have developed beforehand. A skill in the speech area like responding to a question requires cognitive and social skills to be in place as well.

3) Milestones are ordered in sequence from easy to complex. In the initial months, milestones in the five areas seem easy and obvious. These early skills are the foundation for later skills. Simplest example is learning the alphabet around 2 years builds to reading and language skills in pre-school years.

 4) Milestones are points fixed as the average age for that skill. So basically a large sample of children was observed and the age of achievement of a skill was noted. Then the average age was taken to be the fixed point for that skill milestone. So if there were 100 infants who were observed for sitting milestone and the earliest age was 6 months while the latest was 10 months, on the milestone checklist, sitting would be placed at 8 months.  Parents should be aware of this aspect

 5) Milestones should not be used in isolation while tracking your child’s development.  As we have discussed above, developmental areas are not independently demarcated. Skills are inter-linked. There is a cause for concern when you see a whole bunch of skills missing or lagging on one or more areas.

Why are milestones important?

1) Reassurance: Parents, especially first timers, are always concerned about raising a healthy, happy child. Following a developmental milestone checklist is the easiest and simplest way to get that reassurance.

2) Early detection:  Following the milestone checklist also gives parents an early inclination of any red flags in developmental pathways. Early detection is the key to getting the right help to prevent and intervention in case of any delays.

3) Holistic development: Tracking with milestones will allow parents to focus on holistic development of their children rather than focus only on certain socially or culturally acceptable skills.

Where can you find a good milestone checklist?

Pathways.org is an organization dedicated to creating free resources for parents to understand their child’s development. Their resources are evidence based and renowned world wide for easy of use for parents.

Here is the link to their developmental checklist.

We hope that parents are able to look at milestones with a slightly more open perspective rather than focusing on them as a rigid entity. The most important aspect of development is progress- adding something new in learning various skills by exploring their environment and limits of their movements.

Till then,

Happy Parenting!

Puja

4/12/2014