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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

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.

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.

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