Family Medicine Vital Signs

By: Katherine Fortenberry, PhD

My daughter was a beautiful, happy, chubby baby – who couldn’t sit independently until 10 months. Or crawl until 11 months. And didn’t have any words yet at 12 months.

I’d taken enough child development classes to know that she wasn’t hitting the milestones. But when my daughter’s doctor encouraged me to contact Early Intervention services to have her evaluated, I was reluctant to reach out. After all, I rationalized, all kids develop at their own pace and there is a wide range of what can be normal. The actual problem, though, was that it is hard as a parent to admit something could be wrong with your child.

My sentiments of denial are echoed frequently in the parenting groups I’ve joined on social media, and even among friends. A common scenario – a concern mom posts: “My child is 18 months and only has two words. But I was a late talker too. Do you think I need to be worried?” Dozens of well-meaning moms jump in with reassurance. “My kid didn’t talk until two and now she won’t shut up!” “He’s probably just focusing on motor skills; language will follow.” And in most cases, these mothers are completely right. Most kids turn out to be just fine, and most kids do catch up on their own. But I throw in the opposite advice for my friends or internet strangers: “Just get the evaluation. There’s no downside.”

Why do I feel the need to make this recommendation, when just three years ago I was sure my daughter’s doctor had to be wrong when she gave me the same advice?

Reason 1:  Consistent with my above advice, there is no downside to getting an evaluation for a child’s development. With many Early Intervention programs, including here in Utah, the evaluator comes to your house and the initial assessment is free. Maybe your child really is on track and you get reassurance from a developmental specialist that your child is within the normal range. And if the evaluator finds that your child does qualify for services, then your child gets more support, typically in your home, for a nominal cost.

Reason 2: The time window for these services is limited. At three years old, children age out of Early Intervention services and their care is transferred to the school system. This can lead to a gap in services depending on the timing of your child’s birthday, which will mean your child needs to adjust to a new team of providers, and in my daughter’s case, an initial drop in the amount of therapy she received. The sooner children get connected with Early Intervention, the longer they will benefit from these services. Believe me, it becomes more challenging after the age of three.

Reason 3: Everything takes forever. Hopefully, more extensive services and evaluations won’t be needed, but in my daughter’s case, they were. And every step was a waiting game. Three months to see the developmental pediatrician. Another three months to see neurology. And nine months to consult with genetics! If my daughter’s doctor had waited until her 18-month or two year check up to get the ball rolling, every step would have been that much more delayed. At an age where intervening early is crucial, delaying the first step can have ripples effects across childhood.

Some friends have told me they feel guilty using limited state funds for their own child. If this is your objection, pay it back or pay it forward. Donate to your local Early Intervention center – it’s tax deductible and they need it – or call your state representative demanding that they prioritize early childhood services in the next year’s budget.

My tenacious, tutu-loving daughter is currently thriving with frequent speech and occupational therapy, but it’s a long road, with many steps and evaluations still to go. I’m grateful that I was pushed to get the evaluation as early as I did, and that I was able (with encouragement) to overcome my own anxiety and make the phone call. Getting started was harder than I would have expected before having to do it, but parenting is hard. And just like with parenting, the stress and the discomfort are worth it.

Katherine Fortenberry, PhD, is an Associate Professor (Clinical) in the Division of Family Medicine in the Department of Family and Preventive Medicine at the University of Utah in Salt Lake City, Utah. She sees patients at the Madsen and Sugarhouse Family Clinics.