From birth, your child is undergoing changes at a rapid pace and many factors may influence these changes, including your child’s genetic makeup, the environment in which you raise your child, nutrition, and medical care, to name a few. 

Though there are ranges in which kids attain developmental milestones, a delay in achieving certain skills does not necessarily mean that your child is ‘developmentally delayed.’ One should remember that "normal" is expressed in many different ways.

A child’s body systems can be categorized into motoric, sensory and cognitive components and can encompass a wide variety of changes, not to mention the defining personality and emotional changes that are occurring at the same time.

Typical development does occur in stages and can help you track your child’s progress, as listed below:

• Developmental milestones by age/dimension:
  • 3 months:
    • Physical development: Your baby is beginning to explore his/her environment and will start to push up on his/her arms and lift the head up against gravity for a short period of time.
    • Speech development: As you feed your baby, you will notice he/she will refine his/her ability to suck and swallow, will coo to the sound of your voice and smile, and turn his/her head in response to sound.
    • Play development: When playing with your baby, you will notice he/she will be able to follow toys with his/her eyes and reach for them. Your baby will also be able to position his/her head in the middle during interaction with people/environment.
  • 6 months:
    • Physical development: As your baby gets stronger, he/she will be able sit up with the use of his/her hands, will be able to explore his/her environment with rolling from back to stomach. When you hold your baby, notice that your baby can tolerate supported standing with full weight through his/her legs.
    • Speech development: What an exciting time for progress with your baby’s communication! Your baby will now start to babble in order to get your attention. Make sure to keep cereals and pureed foods handy, as your baby is now ready to eat these items.
    • Play development: ‘Tummy’ time is important during this stage of development and you will notice your baby reaching for objects when placed on his/her stomach, and will be able to hold onto his/her feet during play when placed on his/her back.
  • 9 months:
    • Physical development: Your baby is getting stronger during this age and should be able to sit up and reach for toys without a loss of balance, can transition from the floor to sitting, and can crawl using opposite hand/knee movement.
    • Speech development: During this time, your baby will be able to visually recognize familiar people and toys when named; and will now begin eating mashed table foods.
    • Play development: At this time, your baby will use both of his/her hands to play with toys, and will start mimicking others.
  • 12 months:
    • Physical development: During this time of rapid growth, your baby’s leg strength will truly begin to progress with pull-to-stand movements and walking alongside furniture with two-handed support. Your baby may begin to stand independently and take a few steps!
    • Speech development: Get ready to hear ‘mama’ and ‘dada’ frequently as your baby now will be able to call you by name and will be able to follow 1-step instructions!
    • Play development: With play, your baby will be able to use a pincer grasp to hold onto tiny objects/toys, and be able to grab and release toys/objects; at this time, your baby will also be able to start feeding himself using his/her finger.

Though the above characteristics of movement, speech, and play development are TYPICALLY observed in normal developing babies, do not be alarmed if milestones are not met right on time. Some kids develop at a more rapid rate while others may take more time.

There are some red flags to watch for and may indicate a possible need to make an appointment with your baby’s pediatrician, and potentially be referred to a developmental therapist (physical, speech, or occupational). These include (not inclusive of all signs):

• Stiff movements that are consistent throughout the first 3-6 months
• Decreased arm movement or asymmetrical arm movements that lasts through 9 months
• Rounded back
• Difficulty with or inconsistent visual tracking or lack of turning towards auditory stimuli
• Difficulty putting full weight through legs or needed hand support during sitting at 12 months
• Frequent toe-walking at 12 months onwards

Remember, each child is unique and though it is crucially important to monitor your child’s development, it is also important to allow your child to develop at his/her own pace and realize that ‘normal’ can be defined differently for each child.

[Source: Developmental milestones handouts (Cook Children’s), Pathways Awareness Foundation 2006, endorsed by the American Academy of Pediatrics, revised 09/10]

About the author

Radhika Trivedi, PT, MSPT, DPT, is a physical therapist at Cook Children's. Physical therapy focuses on large motor and functional skills to enhance development restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's offers Rehabilitation Services in Fort Worth, Hurst and Mansfield.

You may be thinking, “Am I the only parent in town dealing with dinner drama every night?”

The answer is no. It is reported 25 to 45 percent of typically developing children experience feeding and swallowing problems, while a staggering 30 to 80 percent of children with developmental delays struggle with mealtime (Arvedson, 2008).

Now for the million dollar question: what causes feeding problems? There are several factors that can impede a child’s ability to develop a happy, healthy relationship with food, including: sensory processing disorders, gastrointestional complications, prematurity, and dysphagia.

Food should be fun. And for most of us, it is just that. But children may not see eye to eye with us when it comes to mealtime, causing this to become a stressful time for the whole family. Little ones can be incredibly stubborn when it comes to food choices.

Most parents have described their children as picky eaters at least once or twice. However, it is important for parents to know the difference between “picky eaters” and true problem feeders and when to seek assistance.

Picky eating can be a typical stage in normal development. Ready for the skinny on picky eating?

A picky eater will typically:

• Accept approximately 30 foods. That may sound like a lot, but it’s really not.
• Tolerate a new food on his or her plate and may even taste it once or twice. This new food may become a new favorite. But then again, it might get tossed on the floor. This truly depends on the child’s sensory reaction to the food in question.
• Eat meals with his or her family, but requires different preferred foods.
• Eat only one food from each food texture category (puree, crunchy, solids,etc).
• Consume one preferred food consistently, and then suffers “burn out” and refuses to eat this food for a period of time (picky eaters will usually begin to accept this food again after a brief break).
• Eat new foods after frequent exposure.

So, how can you nudge your picky eater toward the leafy greens and save your sanity? Here are a few simple suggestions for success at the dinner table regardless of whether you’re serving pizza or brussel sprouts.

1.Develop a routine and stick to it. Offer meals and snacks at about the same time each day

2.Don’t force feed or bribe your child to eat. This will likely increase refusal behaviors or even worse, bring on a power struggle.

3.Offer a variety of foods, including 1 to2 of your picky pumpkin’s favorite items, at the family meal.

4.Persistence is key! Remember not to shy away when he shudders at his first taste of peas. You may need to offer those peas up to 20-25 times before he will tolerate them.

5.Explore food with your child. Talk about the way it looks, smells and feels. Invite her into the kitchen to help you prepare the foods. Bring her along to the grocery store or farmer’s market to choose a new fruit or vegetable. Star fruit? Why not?! Eggplant? Coming right up!

6.Make it fun! Serve fruits and veggies with dips. Use cookie cutters to make a Shamrock Sandwich for St. Patrick’s Day or Santa for Christmas. Eat dinner by candlelight. Serve breakfast for dinner. Better yet, have everyone put on their coziest jammies for a pancakes and PJ’s party. Get creative!

7.Practice what you preach! This means you, parents. If you want your little ones to eat salad for dinner, you will need to dive into that bowl of greens yourself and forgo the drive-thru on your way home. Our children are always watching and learning from our actions and habits.

8.Don’t become a short-order cook. If your child refuses the family meal, it can be tempting to head back to the kitchen to whip up the macaroni and cheese he is coveting. Resist! This may promote picky eating.

Now, let’s get down to business. While picky eating can be frustrating, it is a typical stage in normal development. However, problem feeding is a true disorder that requires specialized assessment and/or intervention and is downright disheartening for parents. A child that does not eat well can evoke feelings of anxiety, fear, and helplessness, leaving caregivers struggling for a solution.

A problem feeder may:

• Eat fewer than 20 foods.
• Refuse the bottle/breast or drink a small amount and then refuse during infancy.
• Refuse an entire texture category (for example, a problem feeder may refuse to eat all pureed foods).
• Not accept new foods on his plate and may cry, scream or tantrum at the sight of a new food. Problem feeders may even gag or vomit at the sight of an offensive foods.
• Be unwilling to try new foods, despite multiple exposures.
• Eat the same food over and over, but once he experiences “burn out,” he will most likely not go back to eating that food. This will cause him to slowly, but surely, shrink his group of tolerable foods.

If your child is showing symptoms of problem feeding, talk to your child’s pediatrician regarding a feeding evaluation by an occupational therapist or speech-language pathologist. A thorough evaluation is necessary to determine the best course of individualized treatment for your child.

Hang in there, parents. There IS hope! Our feeding therapists are trained to help your child with a wide array of feeding difficulties.

References:

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Incidence_and_Prevalence

http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

Resources for Parents:

www.feedingmatters.org

www.yourkidstable.com

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

The answer is complicated.

Yes, it's very important for toddlers ages 1-3 to interact with other kids their age and challenge their balance, strength and coordination. Sports are a great way to promote these skills and literature shows that athletes who play sports at a younger age are more likely to be active adults than their peers who don't participate in sports.

However, organized sports  may not be the best solution for children 3 and under, and aren't the only way to teach our children these skills. The list below describes activities for toddlers and some benefits of these activities for their development.

Swimming: Helps strengthen the arms and legs, as well as improve coordination since the child has to use both arms and both legs at the same time. Learning swimming at an early age helps promote good water safety habits later in life. You can practice swimming in a "parent and me" swimming class. 

Dance: Improves balance, coordination, strength and flexibility. You can practice in a class setting or by having a "dance party" or playing a game of "freeze dance" at home.

Biking: Between ages 2 and 3, kids should be able to begin riding a tricycle. For young kids, there are tricycles that offer a parent guide bar to help kids move and steer. You can practice biking in your neighborhood or on trails.

Soccer: Most teams start between ages 3-5; however, kicking a ball in the backyard with your toddler is a great way to help them learn to run, develop core strength and balance on one foot for a short period of time.

Basketball: Helps kids develop hand-eye coordination when dribbling and shooting and improve running and jumping skills, as well. You can play with an adjustable hoop in the driveway, or sing up for a community team (which will generally begin between ages 3-5).

T-Ball: Teaches running, balll skills and coordination skills. Using larger balls for young children will help them be successful with catching and throwing.

Yoga: Helps improve flexibility, which is very important since toddlers are growing quickly and develop tight musles quickly. Yoga can also improve strength (especially in the core muscles) and balance. Several toddler yoga videos can be found online, and classes are available throught out the DFW area.

Gymnastics: Another way to gain strength, balance and flexibility, gymnastics is a sport that children can begin learning as early as 18 months old. Many gyms have special toddler and preschool classes, as well as "parent and me" classes.

Yard games: The old staples of "tag" and "hide and seek" are great for teaching turn taking and problem solving, as well as practicing and running and climbing. Taking your child to a local playground also offers a wide variety of ways to practice climbing stairs, running, swinging, balance, etc. 

With all of these, safety is a primary concern. Toddlers are at high risk of injury when practicing new things. Contact your pediatrician if you feel like your child is having difficulty learning new skills and they may refer you for evaluation by a physical therapist to evaluate your child and help them learn these new skills.

About the author

Jodi Burgett PT, DPT, CPST, is the clinical coordinator of Neurodevelopmental Physical Therapy at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.

Now she prays for Tre’s caregivers to make her son all better.

Tre, who is 9 years old, has been seen by the Rehabilitation Services team at Cook Children’s since his parents adopted him as an infant. Most of those issues centered on his articulation skills. Tre’s history with Rehabilitation Services started with audiology and other physician specialists; speech therapy services began at 7 years old working on articulation skills. 

Then about 15 months ago, Sara Adams, Tre’s speech pathologist, received a call from Jennifer to say her work with him would have to go on hold indefinitely.

Tre was involved in a horrible boating accident. He sustained a head injury and was in a coma at another hospital. But the miracle for the Faulkner family occurred and within two weeks, Tre was up and walking.

After his accident, Tre returned to therapy at Cook Children's Urgent Care and Pediatric Specialties – Mansfield and worked with Occupational Therapy, Physical Therapy and Speech Therapy to regain skills that were lost after his brain injury.

A year later, much of Tre’s care takes place at the Cook Children’s Rehabilitation Services at Mansfield. The focus is on Tre’s short-term memory loss and his severe ADHD, as a result of the injury.

“God has blessed us so much,” Jennifer said. “The Mansfield community has been with us since the beginning, I’m so thankful. I’m also thankful for the amazing care Tre has received since his injury. At Mansfield, Tre has really been helped in many ways, through his physical, occupational and speech therapy. They have helped him so much with his memory and his balance. It’s truly been miraculous.”

The rehab at Mansfield is working for Tre. Academically, Tre’s test scores are in the average range for a child his age. His mom says he’s learning and making strides every day.

And Tre’s doing very well physically. He recently received his gold belt in karate. Makes sense for a kid who has proven time and time again how tough he is.

“The progress Tre has made since his accident is truly remarkable,” Adams said. “Tre still has some struggles with his attention and memory that impact him every day. However, he continues to improve and learn how to work through these struggles. Tre’s sense of humor, determination, and supportive family are his greatest strengths. Tre is such a funny kid! He loves to tell jokes and riddles. One of his favorite jokes is: ‘Why don’t ducks tell jokes when they are flying? … They might quack up!’”

To see how far Tre’s come since his injury it’s hard not to smile at the miracle that’s occurred and the occasional duck joke.

For more information

At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices throughout Texas. Thanks to our skilled group of clinicians who support the leading-edge technology found among our specialty services, Cook Children's is the destination when it comes to taking care of your children.

Cook Children's Urgent Care and Pediatric Specialties - Mansfield is located at:

801 Matlock Road

Mansfield, TX - 76063

To make an appointment, call 817-347-8400.

Specialty services at Mansfield inlcude:

• Endocrinology and diabetes
• Gastroenterology and nutrition
• Nephrology and dialysis
• Neurosciences
• Orthopedics
• Pediatric surgery (inpatient/outpatient)
• Psychiatry and psychology
• Rehabilitation
• Urgent care

Now I know that the reason that no one got whooping cough when I was younger was due to a vaccine that I received called DTP. We now give a slightly different version of the vaccine called DTaP. Children are supposed to received DTaP at 2, 4, 6, 12-18 months, and 4 years of age. They then get a booster dose of a related vaccine called TDaP at 11 and a second TDaP booster in adulthood (recently added to the recommendations).

Whooping cough, which is also known as pertussis, has been on the rise all over the country for several years now. I see it in our clinic in Mansfield and throughout the area. There are various theories as to why it is coming back. Some theories center around the idea that people’s immunity toward pertussis wears off as they get older. Others deal with the issue of people who do not vaccinate themselves or their children. Still more center on possible mutations in the illness itself. Whatever the cause, what we do know is that it is here and causing problems.

Whooping cough can be very dangerous for children, especially if they are under age 1, but many parents don’t realize that their children have it until they have been sick for at least a couple of weeks. At the beginning, it can look like a simple cold. The typical story is that the child has been sick for 2 weeks or more and is having “coughing spasms” that can cause them to “lose their breath,” vomit, or even pass out. Regular cough medicine hasn’t helped (not to mention it isn’t recommended in children). Parents have typically tried all of the regular tricks like honey, humidifiers, vapor rubs, etc.

Under age 1, however, children don’t necessarily cough. Instead of coughing, infants may simply not breathe, which is called apnea. Since that is a very dangerous and silent problem that can kill, we must do our best to protect infants from even catching pertussis – which is where vaccination comes back into play. All people in the same household as an infant, including adults, should have a current pertussis vaccination.

Unfortunately, pertussis doesn’t have a simple, quick test like strep or flu does. In our office in Mansfield, we do have a test that we can take the sample in the office, though, which isn’t typical of many clinics. The result from the test is usually available in about 3 days. Pertussis can be treated with an antibiotic, but only if it is caught early. Once past the early phase, a person must simply recover from it, and that can take up to 3 months, even if there are no complications from the infection.

Vaccination is not a 100 percent guarantee that children will not get the whooping cough, however, it has been shown to greatly reduce their chances of getting it, and if they do get it, their case will likely be less severe than if they were not vaccinated. There are also children who cannot receive the DTaP vaccine for various reasons, some of whom have serious health problems. We all need to do the best we can to protect ourselves and our neighbors from this disease, which is making quite the comeback in our community.