On this episode I welcome @speechsisters (speech language pathology), @themovementmama (physical therapy) and @mammamia_ot (occupational therapy) for a frank discussion around the new CDC guidelines. We discuss the following:

• Introductions of specialties: speech language pathology, occupational therapy and physical therapy
• Concerns and discussions regarding the new CDC milestone guidelines
• The “wait and see” approach
• The parental role in a child’s development
• So much more!

Updated milestones:

• https://www.cdc.gov/ncbddd/actearly/milestones/milestones-30mo.html

Informed SLP opinion

• https://www.theinformedslp.com/review/no-sl-ps-were-in-the-room-where-it-happened

00;00;08;25 – 00;00;33;08

Dr. Mona

Welcome to this very special episode. I am so excited because not only is this a podcast episode, I’m also going to be putting it on my YouTube channel because we are talking about the updated CDC milestone guidelines the good, the bad, the ugly, and I have welcomed developmental experts in this space. An occupational therapist, a physical therapist, and a speech language pathologist, all of whom work in pediatrics.

 

00;00;33;14 – 00;00;54;00

Dr. Mona

You are going to be getting developmental experts who want to talk about the good, the bad, the ugly of the milestones, and really how to foster your child’s development in that big picture sense, but also want to know, to be concerned. So thank you all for being here. I first want to welcome Mia. She’s going introduce herself. She’s an occupational therapist.

 

00;00;54;00 – 00;01;16;28

Dr. Mona

Thank you so much for being here today. 

 

Mia O’Neill

Hi. Thank you so much. I was so excited when you reached out. And to be able to speak with you four lovely ladies about this topic. So my name is Mia O’Neill, as Doctor Mona said, and I am an occupational therapist and my handle is MammamiaOT. And so I, as an occupational therapist, let me first kind of discuss what we do as a whole.

 

00;01;17;00 – 00;01;41;25

Mia O’Neill

So as occupational therapist, we help you to do the things that you need to do every day. We help you do the things that occupy your time. So whether that’s participating in school or driving, dressing yourself, bathing yourself, any of those things that occupy your time daily. And so as a pediatric occupational therapist, my role is to help kids to be able to develop their skills, their motor skills, their cognitive skills.

 

00;01;41;25 – 00;02;01;27

Mia O’Neill

So emotional skills to be able to do those things someday. So what that looks like for infants and toddlers is maybe helping them drink milk from a bottle or breast being able to feed themselves, learning how to roll and crawl. And you’ll see there’s a lot of, overlap between speech and PT, which I’m excited to hear more about.

 

00;02;01;27 – 00;02;20;29

Mia O’Neill

But yeah, so being able to do those things that will lend themselves to the later skills of getting their jacket on, paying attention, being able to do their coursework in school. So there’s a lot to ot, but I’m really excited to discuss more about the pediatrics, and that’s why I thought this is so important because we all overlap, right?

 

00;02;20;29 – 00;02;40;27

Dr. Mona

As general pediatrician, we are the first line usually, and then with OT, speech and PCE. So this is just so great that we could do this. And like you said perfectly, I really agree with you that I feel like occupational therapist. Many families don’t know what you all do and why it’s important. I think people tend to think more about your gross motor with physical therapy and language.

 

00;02;41;00 – 00;02;57;18

Dr. Mona

But OT is, you know, not only the things that you mentioned, but the fine motor skills that you mentioned, like things that are obviously really important in infants and child development. So I’m again, just so grateful that you could be here today. And, we’ll be going over your concerns with the milestones as well. The things that you love and don’t love.

 

00;02;57;22 – 00;03;24;03

Dr. Mona

But next we have Keely, who is a pediatric physical therapist. 

 

Kailee

Hello. I’m so excited to be here. Like Doctor Mona said, I’m Kailee, I’m a doctor of pediatric physical therapy and physical therapist. Our kind of movement experts is what we say, and especially in the first year to three years of life, there’s so much movement that’s happening. Our job is really to help support and nurture that movement.

 

00;03;24;03 – 00;03;54;03

Kailee

Development in so many things kind of snowball into the next movement milestone. So we’re just there watching along the way for those motor milestones and how we can support them through play, through the way that we interact with and engage with our babies, through the products we buy and bring into our home. So I love it. It’s really an exciting time in the developmental spectrum to be a therapist for all of us, and, you know, pediatrician as well, because birth to three is just so fascinating to me.

 

00;03;54;06 – 00;04;15;03

Kailee

So much happening in brain development. So we’re really watching for all of those things to kind of come together. And like Mia said, it’s really neat because being in pediatrics, we get to kind of get a little taste of everything. But aren’t the experts in everything but so much overlap and can support and nurture the other realms? 

 

Dr. Mona

Oh that’s wonderful.

 

00;04;15;03 – 00;04;18;28

Dr. Mona

And then what about you, Brooke? Obviously you’re a speech language pathologist.

 

00;04;19;00 – 00;04;43;20

Brooke Dwyer

Yes, I am, and I am one half of my team. So my sister and I, Bridget and myself are in business together. We on Instagram are known as Beach Sisters, and we are pediatric speech language pathologist. We own and run a company here in a private practice here in Southern California, and we specialize in working with the early intervention populations.

 

00;04;43;20 – 00;05;00;17

Brooke Dwyer

So as a speech therapist, we work on building both receptive language, expressive language, and even social language. So, it’s really the foundation of I like to say it’s the foundation of everything, because from the very beginning, before a child can learn to.

 

00;05;00;18 – 00;05;01;19

Brooke Dwyer

Talk or.

 

00;05;01;19 – 00;05;24;15

Brooke Dwyer

Read, they have to learn how to understand language. They have to build that receptive language vocabulary. So like you said, Kaylee and you Mia, like this birth to three population is so fun and important to work with. And this is where our hearts are. And this is what we love so much, because we really work hard to build these little ones language and even more empower and educate parents on how they can do it at home.

 

00;05;24;18 – 00;05;50;15

Dr. Mona

And I will be adding everyone’s Instagram handle because speech sisters as well as Mia and Kylie, they all have their own educational platforms to help promote education for families on their specialty. So we’ll have that in the show notes for my podcast, as well as the caption of my YouTube video, including any necessary links. I’ll also be including links to the CDC milestones that we’re discussing so you can understand what we are talking about.

 

00;05;50;17 – 00;06;16;25

Dr. Mona

We’re not going to be going into all of the nitty gritty. We’re just going to be roundtable ING, going through the things that we maybe like and don’t like based on each of our specialties. So my realm, I didn’t introduce myself, but I think we know, so I’m a pediatrician. So the cool thing about this episode is that I see all of these things connected to each other, and I see how it relates to each other, because that’s what we are trained on.

 

00;06;16;25 – 00;06;46;06

Dr. Mona

Right? So how speech and cognitive development relates to physical versus fine motor, all of that, you know, and we rely so much on our speech language pathologist, physical therapist and occupational therapists when we are concerned or if a parent is concerned. And the hope of this episode is that by the end, you feel as a parent, more empowered if you are concerned with your child, regardless of the new CDC milestones on what to do, or if you’re feeling like you know what?

 

00;06;46;06 – 00;07;07;19

Dr. Mona

I’m not really concerned. But maybe my child is not rolling or my child is not speaking, or my child has a difficult time with feeding themselves. Maybe I need more help in those areas. And we have three amazing people that are professionals in that niche. And I just think it’s so cool that we can do this together again, just so that we can talk about not only the changing milestones, but also what we do.

 

00;07;07;26 – 00;07;27;04

Dr. Mona

We are a team here, and I spoke to each of these lovely ladies on the side, you know, about what the dream was for this episode. And it really is about understanding that infant child development is a team approach. The pediatrician is usually that first line. And we sometimes and I’m saying we because as a general profession, sometimes we get everything right.

 

00;07;27;10 – 00;07;45;25

Dr. Mona

Sometimes there’s going to be mistakes similar to any profession. Mistakes meaning oh, maybe there should have been some intervention done early. So by the end of this, again, like I said, I want you to have the tools to say, you know, I am concerned if I am concerned and my pediatrician says they’re not. I want you to ask your pediatrician, why are you not concerned about my child?

 

00;07;45;25 – 00;08;01;25

Dr. Mona

What about my child’s development is not concerning to you? When should I follow up? There’s so many different things that you can ask. And if your pediatrician is still not giving you the answers you need, and you’re feeling like something is not right in your child’s development, whether it’s something you learned or you feel, then you have options of what?

 

00;08;01;26 – 00;08;33;06

Dr. Mona

Like even Brooke just said, early intervention. That is, when you get an evaluation from experts in development to get those resources you need early, because that’s what’s going to help with outcomes in the future. So the goal of the CDC changes was to include children earlier for evaluation. But as we go through a roundtable discussion, we’re going to realize that in some aspects that’s not does it feel like that’s going to be the case and sounds like an awful thing to say, but we’re going to have to wait and see to see what happens with that.

 

00;08;33;06 – 00;08;52;09

Dr. Mona

I know we don’t love that term, but it’s unfortunate because I agree there are certain things in the changes that I’m like, oops, it only works if the person evaluating the child understands the nuance of that label, and also understands that they need to follow up with that child an extra amount of time. Do they know how to educate that child?

 

00;08;52;12 – 00;09;07;17

Dr. Mona

Which isn’t always the case. So now I want to go through and we’re just going to go in a circle of what we loved and didn’t love. So I first wanted to start with Mia, who is an occupational therapist on this. Maybe some things that you saw in the changes that let’s start with things that you didn’t like.

 

00;09;07;17 – 00;09;14;29

Dr. Mona

And then we can do things that maybe you did like. And if there’s not stuff that you didn’t like, that’s okay. But I’m just curious what your thoughts and concerns are. 

 

00;09;15;12 – 00;09;36;28

Mia O’Neill

I went through that long article they posted, and I really do think that it was made with the best intentions. I think this team of doctors came together and really did have the best intentions, you know, one of the process that the CDC guidelines haven’t been updated since 2004, I believe. And so just with any research on any kind of standards, things are always changing.

 

00;09;36;28 – 00;09;58;23

Mia O’Neill

The status of the world is changing. And so it’s good to have updated information like that. And so I do think it’s a good thing for parents to have more clear guidelines, like at this time, I do find some challenges with the new guidelines. Specifically, the old guidelines were at the point that 50% of kids could achieve them.

 

00;09;58;25 – 00;09;59;26

Mia O’Neill

And now with the.

 

00;09;59;26 – 00;10;27;07

Mia O’Neill

Cases, it’s greater than 75% of kids can achieve. The milestone is when they list it. And so while that sounds like a good thing, that more kids are able to achieve a milestone before it’s like expected, I personally kind of feel that if we push back milestones to when greater than 75% of kids are going to achieve it, it’s moving certain milestones back a month to month, ten months, whatever it may be.

 

00;10;27;18 – 00;10;48;13

Mia O’Neill

For example, the old milestones, one of them was to be able to sit from an open cup around 6 to 8 months, and now it’s listed under the 18 month milestone. And so I’m sure Brooke will probably have, you know, some to to that too, you know, and if a 6 to 8 month old is starting to drink from an open cup, that’s awesome and that’s great.

 

00;10;48;13 – 00;11;14;28

Mia O’Neill

And if they’re 10 to 12 months old, that’s still good. They’re learning on their own time. If it’s closer to 18 months, that’s kind of like the end range of the milestone that we would consider. Like typical. And so I just feel that it’s almost better to have milestones earlier so that parents aren’t waiting and seeing an extra 6 to 10 months when there could potentially not always, but there could potentially be some.

 

00;11;14;28 – 00;11;15;21

Mia O’Neill

Underlying.

 

00;11;15;28 – 00;11;37;15

Mia O’Neill

Strength issues or coordination issues that maybe would be better addressed earlier on in development instead of waiting until they’re 18 months old at the pediatrician appointment, and then waiting weeks to a month to get services. So I feel like it just kind of pushes things back. Whereas Brooke and Kailee mentioned how important early intervention is. And so it kind of pushes early intervention back.

 

00;11;37;17 – 00;11;41;04

Dr. Mona

Yeah. Brooke, do you agree with that with, introduction perhaps?

 

00;11;41;07 – 00;11;52;27

Brooke Dwyer

Oh, yes. For sure. Yes. And there’s so many milestones in the realm of speech and language. So that’s just one area. But yes, I did read that and kind of felt this. It kind of cringed a little bit like, oh yes.

 

00;11;52;29 – 00;12;14;08

Dr. Mona

I think, you know, the biggest thing and I agree with that so hundred percent. And then of course, me, if there’s anything else I love to talk about it like just topic by topic. So I agree that I am not concerned if a 12 month old is not drinking from a cup. I agree that I’m not concerned if a 15 month old is, but the issue is, is that family needs to be educated on how to make that happen.

 

00;12;14;11 – 00;12;30;17

Dr. Mona

So I think that’s what we’re going to be talking about here. Is that yes. Yes. I agree that the milestone makes sense that 75% of children are doing it by 18 months. So I’m not worried if a child’s not doing it by 18 months. But my fear with the way this is worded, and I think you all may agree, is that so?

 

00;12;30;17 – 00;12;57;13

Dr. Mona

If a family here is okay, my child doesn’t need to do that by 18 months, I’m not going to work on it. Then they don’t work on it until 18 months comes around. And then what happens at 18 months? Yeah, it’s a little too late because you could have worked on it earlier. So although they may not need to see a speech therapist or an OT in person for that, they need to be educated on, well, here is how you introduce don’t panic if your seven month old is not drinking from an open cup.

 

00;12;57;13 – 00;13;19;06

Dr. Mona

Don’t panic if you’re one year old still wants the bottle. Okay, I understand that developmentally that’s okay. But if we start that education at 18 months, I agree with y’all completely. Then we are wasting seven eight months that we could have intervened and at least taught a skill. And I am a big believer that we can teach babies skills earlier that stick longer.

 

00;13;19;12 – 00;13;33;26

Dr. Mona

You know they can learn it at 18 months, but then their toddler, it’s a little more innocent, a little more I don’t want to do it. And I think a child is capable of learning open cup and straw cup drinking before the age of one. They may not be proficient at it, but they can learn it. And I agree with you completely.

 

00;13;33;26 – 00;13;52;12

Dr. Mona

I think it makes sense to say, okay, yeah, 75% of kids aren’t doing this fine or they are doing it. I apologize, but then I worry also that but are we educating? I educate, but I can’t speak for everyone in pediatrics. Are they actually educating and saying, yeah, I work on this and this is how you’re going to do it?

 

00;13;52;14 – 00;14;07;23

Dr. Mona

And that’s why I think it’s good that I’m doing this episode, because I’m speaking from a realm of being really into child development. But, yeah, I completely agree with both of you. But that’s a concern. Was there anything else, Mia, from that list that you were like, this could lead to more of a delay or more of a concern of late intervention.

 

00;14;07;26 – 00;14;30;07

Mia O’Neill

So, yeah, so that’s one side of it that there’s some milestones that were pushed back significantly. The other side is that the big one that a lot of people on Instagram were talking about is certain milestones like crawling were omitted completely. And so now instead of giving parents like a window of like, hey, like kids should probably be developing the coordination and the strength to be able to do this around this range.

 

00;14;30;09 – 00;14;52;11

Mia O’Neill

It’s not mentioned at all. And so that’s when parents might not bring up the concern to their pediatrician. They might not even address it until child is long walking and running and going to school. And then in P.E. class can’t crawl along their crawl, whatever it may be, with the other kids. So and again, as I say this, your child must drink from an open cup.

 

00;14;52;11 – 00;15;16;08

Mia O’Neill

Your child must come. All these things because chances are, like kids who skip or delay to certain milestones will be totally fine. But there’s the chance that they might not be like, fine, quote unquote. And we might have trouble developing other milestones because of it. And so I just think, isn’t it better to be on the more proactive side of things and educate earlier and keep that conversation open with the pediatrician?

 

00;15;16;14 – 00;15;37;00

Mia O’Neill

Educate parents on how to get these resources outside of the pediatricians office. So, yeah, those are really, I think, two of the main things I wanted to discuss, the push back in ranges and then the admittance after we’re omitting certain, certain milestones. 

 

Dr. Mona

And I’m sure Kaylie, as a physical therapist, you can add to that crawling, please. Like, what are your concerns about that being omitted?

 

00;15;37;03 – 00;16;03;28

Kailee

Yeah, I think I agree with everything Mia said. And it’s just so hard because it is so nuanced. There are kids who their families and they do everything that maybe I wouldn’t recommend as being a movement expert. And then they’re totally fine. And then there are kids who parents do a lot of the things that I recommend. And just naturally, the way that they’ll develop is that they will need more support.

 

00;16;03;28 – 00;16;40;23

Kailee

And so I love what Mia said about the proactive rather than reactive. And I think this is the future of healthcare in general, is that we need to be providing that proactive mindset and not an impairment mindset of my kid needs therapy, there’s something wrong with them. But maybe my child doesn’t naturally excel in this area. I know myself I’m an achievement based personality, and to hear that my child was in the bottom 25% of the normal bell curve on a scale like that to me, is not where I want my child to be.

 

00;16;40;25 – 00;17;05;24

Kailee

Now, I’m not necessarily concerned with them being in the top 25% either, but I want them to fall within that normal range. And so I think that’s the part that’s confusing for people is it’s like we haven’t actually pushed back where we feel like kids are supposed to be meeting these. It’s more that and I see that there was such good intent there that when we were doing the 50% marker as like, well, maybe they’re falling behind.

 

00;17;05;29 – 00;17;24;00

Kailee

We were getting into this realm of what you’re talking about, Doctor Mona, where, maybe a family would get told, you know, they’re kind of borderline delayed here, but let’s just wait and see. And I think what I’ve heard from you is that you do an amazing job of saying, okay, but while we’re waiting here, some action steps for you to take.

 

00;17;24;07 – 00;17;50;17

Kailee

And I don’t know that that’s the experience that a lot of people have at their pediatrician. And that’s something that that’s a whole other conversation entirely. And something that we as therapists need to be collaborating with pediatricians more on. But I just think then if we’re waiting until that 75% marker, the Pro is that if the pediatrician sees, oh, they’re not meeting this, I’m immediately referring and I’m not going to second guess myself.

 

00;17;50;20 – 00;18;10;22

Kailee

You know, I’m going to feel confident in my decision. But what we’re seeing as the trickle down and what I’m anticipating is when we were at the 50% marker, we already were having a delay in referral of services. And then early intervention services. Sorry if I’m offending anyone by saying this, but I worked in early intervention, state based.

 

00;18;10;24 – 00;18;30;13

Kailee

Anything in that sort of realm of state based care is a very delayed and lengthy process. There’s a lot of paperwork, there’s a lot of time. And so were we already wasting that time with the way things are. So let’s just say the way it was. You get referred then. They don’t have a spot for you to be evaluated for a month.

 

00;18;30;16 – 00;18;50;22

Kailee

And then after that month, you finally get partnered with your service provider who’s going to be caring for your family. And it just feels like that already draws the process out. So, you know, my concern would be that if we’re waiting till the, you know, percentile where 75% of kids are meeting that milestone, then that’s only further delayed.

 

00;18;50;29 – 00;19;19;17

Kailee

And there’s so, so much research that shows the earlier we get on it, the better the shorter duration of treatment and intervention. And often then parents just have an opportunity to really feel like they’ve got a solid foundation to jump off of, rather than feeling like we are going to that impairment mindset where, you know, we then evaluate them and say, oh, actually, they’re not doing this skill, but because they’re not doing this skill, it’s because they didn’t do these five mini milestones before it.

 

00;19;19;22 – 00;19;37;18

Kailee

So now we’re going to have to go all the way back here and build up. So that to me signals much more of that impairment problem mindset versus a oh no big deal. Like let’s just talk about the next three months moving forward. We’re going to get on top of this and then they’re out of early intervention.

 

00;19;37;18 – 00;20;03;26

Kailee

So I think that’s the hard part for me to get through. But I like that knowing now, pediatrician, if they see that the kiddo at that marker is not meeting the milestone, that it’s not going to be this shifting conversation of, well, do we or don’t we refer it? No, it seems like we do refer. 

 

Dr. Mona

Yeah. And I think that the new guidelines should make it that, hey, if that’s not happening by that age, that means you should be referring it.

 

00;20;04;00 – 00;20;17;25

Dr. Mona

I agree with you completely that there is no wishy washy now, but I also am going to be very honest. I am very big on this, like I said, but I can’t speak for every general pediatrician on how they’re going to interpret what this means because they could think, oh, I still want to give it a little bit of time.

 

00;20;17;25 – 00;20;39;24

Dr. Mona

So it really is a matter of understanding that this now means that, yes. So if your child is not doing the milestone that’s listed on that CDC thing, we’ll get into more nuance. I know it’s speech, especially but if your child’s not doing this, then yes, there is an important reason why we want evaluation, and it’s to make sure that you don’t wait the six months, nine months to get into services.

 

00;20;39;24 – 00;20;59;10

Dr. Mona

And I can speak from personal experience because I’ve gone through early intervention with my son when he had a stroke. When he was born. That process is kind of brutal, meaning even I, as a physician who has connections, had to wait that long period and do all of those things that I can’t even imagine my families who are trying to call and wait, no one’s calling them back.

 

00;20;59;10 – 00;21;17;24

Dr. Mona

And in many states, especially states without state income tax where there’s no great infrastructure like State of Florida, it’s really crappy. Like I can attest to that, being a pediatrician, doing the whole early intervention resources, that it takes a long time, and which is why I am a little more conservative when I say, look, do you want the help?

 

00;21;17;24 – 00;21;33;21

Dr. Mona

And figuring this out? Because I really think that we need to figure this out and get you the tips that you need, rather than waiting another six months. Why don’t we start this process now? Because it could take time. Even if I’m watching and waiting on hope, I don’t think that’s a bad idea because it could take time.

 

00;21;33;21 – 00;21;52;11

Dr. Mona

And I agree with that completely. I wanted to kind of ask you again, Kailee, since we were still talking about the crawling piece, and then we are going to obviously go to your concerns as well with the updated milestones. So if a child is not crawling as a pediatric physical therapist, what would you recommend? Do you think that all children who don’t crawl need to see their school therapist?

 

00;21;52;11 – 00;22;14;00

Dr. Mona

Or are there certain signs in their motor skills that you know you’re saying this is okay, but if this is happening, I would, as a physical therapist would love to see you in that situation. 

 

Kailee

Oh gosh, putting me on the spot. 

 

Dr. Mona

Sorry, but whatever. Honestly, this is your honest way to answer you know, like what you feel is like you know, that you would think that is best for families and looking at their other milestones as well, if you even want to look at that.

 

00;22;14;03 – 00;22;34;26

Kailee

Yeah, yeah. It’s good. I mean that in a good way. Like this is a hot topic and it’s again, so hard. Same as I said before, they’re kids who don’t crawl, who may be totally fine. Yeah. Of course, as the PT, I’m seeing the kids who don’t crawl, who do need more support, and there’s just so many aspects of things that I think about.

 

00;22;34;26 – 00;22;56;26

Kailee

So if a child doesn’t crawl, I wonder why so many babies do crawl. So what are we missing in that developmental sequence that just didn’t get them there? I do believe, and I hear this a lot like, you know, my babies are so motivated to stand and they love to stand. And they went straight from sitting to walking like, I get that.

 

00;22;57;00 – 00;23;18;15

Kailee

But because so many babies crawl, it does make me think, you know, as both a mom and a therapist, it makes me think, what missing piece is there? Whether it’s part of the way that they naturally were born. So, like my daughter, I had to work with her a lot. I’m crawling because naturally her muscle tone was lower, is lower, and so it was really hard for her.

 

00;23;18;15 – 00;23;49;29

Kailee

And babies are smart and they will always take the path of least resistance, like the easiest way out. I mean, we’re that way as adults, right? And so if something’s really, really hard, then we want to kind of question why is it difficult for them. So that’s kind of one piece of it. And then also moving forward, so many things are affected by crawling for the positive that when we don’t crawl, we have to think of ways to then supplement those in so that both neurologically and physically, we’re getting those benefit.

 

00;23;50;06 – 00;24;11;21

Kailee

So it would take way too much time to go down the list of benefits of crawling. But just knowing in our mind that if my baby didn’t crawl, I know that so much of development is kind of an offshoot of that. So I’m not going to panic. But there are so many opportunities for us to crawl or for us to get similar opportunities in play.

 

00;24;11;22 – 00;24;40;28

Kailee

And that’s really what I try to encourage families with, is I never like giving a panic mindset. We shouldn’t feel like that. We should just feel like we want to be mindful advocates for our babies and our toddlers and educate ourselves to the best of our ability. But then, even if they need therapy, like that doesn’t have to be a panic moment, that can actually be this beautiful journey where you have a team of people that are helping support you, doesn’t mean you did anything wrong or there’s anything wrong with your baby.

 

00;24;40;28 – 00;25;07;06

Kailee

But this is their journey, you know, without going too much into it, we just have to be mindful that if our child is not doing something that many children generally and typically do, we want to just start asking questions about is there something here? Or, you know, how can we support supplementing activities and things like that to get the benefits that they didn’t get because they didn’t for all, or roll over or whatever?

 

00;25;07;22 – 00;25;27;05

Kailee

And, you know, rolling is the same thing. Like, I’ve got kiddos that I would see that were in elementary school that never learned to roll over as a baby. And I had to teach them to roll as an elementary school kid. And so then we just incorporate it into play and again, don’t think, but we’re mindful and we’re watching and we’re making sure that we’re staying on top of all of it.

 

00;25;27;07 – 00;25;59;04

Dr. Mona

Well, I would love to have you back on the podcast solely to talk about crawling and what parents can do if their child’s not crawling in that first year especially, you know, like you said, like parents can do to build the muscles that are important for crawling and the spatial recognition and cognitive development that crawling can bring. Mia, was there anything else that you wanted to add before we move to motor milestones with Kailee, in terms of things that you didn’t really love or things that you even liked about the milestones, 

 

Mia O’Neill

I think the only thing I wanted to add on to what Kailee was just saying about crawling is that I completely agreed with

 

00;25;59;04 – 00;26;05;21

Mia O’Neill

everything she said, especially the panic mindset. And I think it’s so important to encourage parents and give them the resources.

 

00;26;05;21 – 00;26;06;13

Mia O’Neill

They need without.

 

00;26;06;13 – 00;26;39;14

Mia O’Neill

You know, fear mongering or like, oh no, your baby’s doomed. Like if he’s not crawling. And I think it’s also important from not only like a movement perspective and navigating your environment because like you said, some kids go from, you know, sitting to scooting around or janky crawling around or army crawling around straight to, walking. But the benefits also from a sensory from fine motor standpoint are so important because you’re not only getting around your environment, you’re building the arches of your hand and building the sensory development.

 

00;26;39;14 – 00;26;56;19

Mia O’Neill

You shut your systems through your hand. That kind of lends itself to the OT side. So I see a lot of kids also that never learn to crawl. And just like Kaillee said, it’s so important to do that through play. But as far as outside of crawling, I think I covered everything that I wanted to, for the most part, for what I liked and didn’t like. And, you know, I’m sure more things will come up as we go, but I’ll go ahead and let Kaille. 

 

00;26;56;21 – 00;27;20;11

Dr. Mona

Yeah. And I think one of the biggest concerns we all had is that what will this mean for referrals? Will this mean children have more delays. And I would love we can see how things go in the next six months in terms of from my perspective and your perspective, like if you are seeing more delays, if you are seeing people that should have been referred earlier, I would love to do this again because this is fresh.

 

00;27;20;11 – 00;27;38;24

Dr. Mona

You know, we are recording this episode about a few weeks after the CDC milestone update was, done just from scheduling reasons. And I think that’s going to be an important evaluation that we are going to have to do as specialists in the field to see. Does this make sense? Are we seeing worse outcomes in terms of referral times and all of that?

 

00;27;38;28 – 00;28;03;04

Dr. Mona

Because we don’t know. We don’t know yet. I understand everyone’s concern, though, that, hey, this could potentially be like delaying some children in getting the services that they need in a system that is already underfunded and, also packed. So in that point, you know, I do believe that maybe in some ways it requires education from pediatricians and specialists so that they get the tools they need.

 

00;28;03;06 – 00;28;24;27

Dr. Mona

Maybe it will underwhelm the system and that there will be unnecessary referrals, not going to early intervention and really keeping it for the families that really need it is, I think, what the CDC was coming from. But it also means parents need to know what they’re looking out for. It also means that parents need to know how to engage with their child, which is, I think, what’s lacking a lot of some of the times.

 

00;28;25;04 – 00;28;42;21

Dr. Mona

And I attribute a lot of that to the time that we get in our pediatrician offices. I mean, this is something above I think parents even understand this is not that we don’t want your time, it’s that insurance companies only give us 10 to 20 minutes with our patient and we can’t nearly go over all the things, even if I want to go over all the things.

 

00;28;42;21 – 00;29;11;25

Dr. Mona

So that’s why we rely on social media education. That’s why we rely on our specialists in real life to sometimes help. If, like, I have a family who’s like, look, I can tell you how to do a lot of this right now, but can I be honest with you? I think you really should get it from someone who does this day in and day out, because I feel like you were going to get more time intensive time with that person focused on this 1 or 2 issues versus me, who is talking about five different questions you had today.

 

00;29;11;27 – 00;29;30;22

Dr. Mona

So that is what I think parents need to also understand that if you are concerned, like if you’re like, look, I just really would like that evaluation. We’ll get into that at the end. But you are always entitled to that. I mean, that’s something that exists, your child’s advocate and we’ll get into like that more. But yeah, Kailee, I would love to talk about your likes, dislikes with the recommendations and changes with the milestones.

 

00;29;30;22 – 00;29;52;26

Kailee

Now you need to have me on too, because we talked about the overlap earlier. Oti is so much more knowledgeable in reflex integration, visual scanning, fine motor, things like that versus mine. I know enough to get myself into trouble a little bit, but my realm of the crawling expertise at least, is more of the large motor. But they come together so much.

 

00;29;52;26 – 00;30;20;11

Kailee

So I just wanted to give that little plug, because I can talk a little bit about some of those things, but not enough to really know all the ins and outs and nuances. So all of this just felt a little bit to me. Like, I don’t know if any of you guys have ever worked for a corporate entity, but when corporate makes these changes based on research that they’ve evaluated and they are super excited about it, and I think this is going to make really amazing changes for their employees and the people that they serve.

 

00;30;20;11 – 00;30;39;29

Kailee

And then everyone, all the minions down at the bottom level are like, why? You know, we do what this is, is not consistent with what we’re seeing on a day to day basis. Like, hold it. And like you said earlier, doctor Mona, like we’ve got some time from all the emotions around it. And it reminds me a little bit of like the chatter in the work room, right.

 

00;30;39;29 – 00;31;03;04

Kailee

Like whenever they’re bringing down all of these new orders and, and rules and regulations for you as the employee and everyone’s really upset about it. And then we have some time and we calm down. But the biggest pro for me, just in even having this conversation with these changes is I think these conversations have been so necessary for so long between all professions.

 

00;31;03;07 – 00;31;33;19

Kailee

But like you said, doctor Mona, like we I feel that even speaking to like the overworked, underpaid insurance reimbursement, like parents don’t need to worry about that stuff, but they do need to know and understand that clinicians we get out of school and we are so excited to help your family and your kids. And there is red tape and restrictions and things that are kind of out of our wheelhouse and out of our control that limit what we can do, which makes it really, really hard.

 

00;31;33;19 – 00;31;55;21

Kailee

And so, you know, sometimes I will have patients come into the clinic and say, you know, my pediatrician didn’t even look. They didn’t even look at how she walked or how she crawled or whatever. And I have to have those conversations of, that’s not the fault of your pediatrician. That is like a structural problem. But that is something that I hope that we can continue to work on moving forward.

 

00;31;55;21 – 00;32;20;07

Kailee

But it’s in all realms of health care right now, is we’re facing reimbursement problems that then affect the way that we can care for families. So, Doctor Mona, like you were saying, you’d love to sit there with your patient for 30 minutes and all the knowledge that you’ve gleaned in the online space or maybe in coursework that you took, you’d love to give them that input and insight, but you just don’t have the time.

 

00;32;20;07 – 00;32;43;00

Kailee

And I think that that’s what a lot of families are running into. And on that same kind of vein, I’d love to hear you, Doctor Mona, talk about what it looks like. So, for example, in the past, whenever a family maybe was at that, like the scale should kind of be there, but we’re watching and waiting. What do you feel like for you and for other pediatricians?

 

00;32;43;06 – 00;33;03;16

Kailee

Is the hold up from a therapist perspective? We think, well, what’s it hurt? Get them in for an evaluation. And none of us are in the business of money, making sure none of us are like, yes, we want all the evaluations. We already have a full caseload. You know, it’s like none of that. But I think from a therapist perspective, we’re thinking, well, what does it hurt?

 

00;33;03;23 – 00;33;22;13

Kailee

And some of the things that I’ve thought about is, well, maybe you’re concerned that you’re going to unnecessarily refer and a family is going to be worried, and that’s going to be this whole process. But I’d love to just get your thoughts on that. What that looks like and what you would guess that is going through the decision making process clinically for other pediatricians.

 

00;33;22;14 – 00;33;41;06

Dr. Mona

I can’t speak for everyone. Obviously. I can just speak what I think when I talk to my colleagues, talk to other pediatricians who are more seasoned in terms of, years in practice, and then also people who are younger and more fresh with all the recommendations, and then also who are young moms as well, young dads, because they kind of see and live it, you know, real time as well.

 

00;33;41;08 – 00;34;05;15

Dr. Mona

I think there’s many issues. I think the number one issue is we are actually very protective of our patients time, not only with us, but also do they need this because it is another visit. And I’m not talking about the families that have means. I’m talking about the mom that’s working four jobs that has no ability to take another visit across town to go see a physical therapist that’s not in her network, to go see a physical therapist that only gives her ten minutes.

 

00;34;05;15 – 00;34;22;19

Dr. Mona

And then she leaves and tells me that this wasn’t something useful. And then she’s angry and comes back at me, that the system is not supporting her. And that is what we’re trying to protect our patients time, but also protect our child’s development. Correct? Like it’s a balance. And that is why I think a lot of pediatricians struggle with automatic referrals.

 

00;34;22;22 – 00;34;43;26

Dr. Mona

If a family has private insurance, it makes it a little easier. But I take care of a largely Medicaid population. So when you think about a largely Medicaid population, there’s not a lot, especially in Florida, that take Medicaid insurances. There are, but they have to usually go through the early intervention system. So now it’s a matter of is this something that needs absolute your time, your energy?

 

00;34;43;26 – 00;34;59;14

Dr. Mona

Because a lot of it comes from parents saying, do I really need to go? And you’re like, yeah, you really need to go. And I when I approach it and I have spoken about this, I think with broker, I can’t remember who. There’s two situations when I make a referral for development, I’m either concerned because there are multiple delays.

 

00;34;59;14 – 00;35;16;16

Dr. Mona

One delay that I feel like that family does not have the tools to educate and do what they need to do in the time frame when I’m going to have them follow up. For example, like I have some families who come in at 18 months where their child has three words, the child has joint attention, the parents are doing different things.

 

00;35;16;16 – 00;35;33;23

Dr. Mona

They maybe even took an online course about speech. They are doing the work they need to do and understand how to balance screen time. Why? I don’t want them to overuse screen time. They know what they need to do. That family is going to look very different to me than a family at 18 months, who has no clue what’s going on with their child’s development, who’s like, you know what?

 

00;35;33;23 – 00;35;53;07

Dr. Mona

Yeah, I think he says about five words. That is the reality that I see in my office. That family is going to need a referral from mine because I don’t know if they have the tools on their own and actually are going to do with the work they need until I see them in six months. Right. So I think that’s one aspect of the time balancing with the child’s development.

 

00;35;53;07 – 00;36;08;24

Dr. Mona

I think that’s actually one of the biggest ones. The second one, which is not the case of many pediatricians. And I’m so happy we’re doing this because I want to really create, fostering of love for all of us here, because I think there tends to be well, my pediatrician didn’t do this, or then this specialist didn’t do this, or this person didn’t do this.

 

00;36;09;01 – 00;36;28;10

Dr. Mona

It’s really shouldn’t be that. I think some pediatricians, not all like just like any specialty in anything that you go like obs and and you guys speech and okay you’re going to get some that either aren’t truly up to date on all the recommendations or a way to up to date on the recommendations where they’re getting pigeonholed into fear.

 

00;36;28;14 – 00;36;52;24

Dr. Mona

Right. So then you’re dealing with who is it, the person that’s educating you? I can only speak for myself that I’m on the same page as you all. I want children to get the resources they need early because I do believe it leads to better outcome. I also like to balance what a family wants. Like if it’s that borderline situation where I feel like the parent is doing the work and that they will come back to me in the next two months, we have good follow up to make sure they’re not falling behind.

 

00;36;52;27 – 00;37;09;05

Dr. Mona

Then I’m comfortable managing it with them, with me. Right. Because that way I’m their primary. But if I’m not feeling comfortable or if there’s a true delay where I’m like, guys, I’m just not feeling really right about this. Like, I feel better if we get that specialist involved. It really comes down to, you know, what does that family want?

 

00;37;09;06 – 00;37;25;20

Dr. Mona

What are the resources here? And then that wait time with early intervention. That’s that last piece is that oh my gosh. Like I think as a culture we don’t like giving referrals. I’m saying we because I will agree that I do this in general. We don’t like giving referrals because not that we don’t want to give the referral.

 

00;37;25;27 – 00;37;49;08

Dr. Mona

It’s that it’s putting more work on people. When a system like I mentioned earlier is already overwhelmed. And that’s talking about like early intervention, I agree it’s different with private insurance. With private insurance, you have a whole different ballgame. But I’m speaking to both of the situations because I take care of highly Medicaid population. And we have to understand the Medicaid population tends to have lower socioeconomic status, which means they’re working multiple jobs.

 

00;37;49;14 – 00;38;07;16

Dr. Mona

They already can’t even make it to my visits, let alone those other visits. It really tends to be, honestly, a conversation I have with the family. And I’m very big on this because I also need the parent to want to go, right. If the parents are telling me you can give me it, but I’m not going to go, I need to say, well, here, look, I see that you’re not concerned.

 

00;38;07;16 – 00;38;22;11

Dr. Mona

I want to explain why I’m concerned right now. I’m concerned that your child is not speaking X words. And this is going to be big on tantrums. You’re going to be big on communication with you. This is not just about not speaking words. And that your husband was a late talker and he’ll talk. I get that, I get that that’s okay.

 

00;38;22;11 – 00;38;39;22

Dr. Mona

That he was a late talker. He’s going to talk, but I think it’s going to really help you as a mother to have that language development for motor skills, right? With walking and whatever it may be. Also coming into that and saying, hey, look, your child may not be doing X, Y and Z. I see some things that your child is doing.

 

00;38;39;22 – 00;39;00;26

Dr. Mona

I see that they’re gaining the confidence to pull, to stand for cruise they’re not walking yet. What is it that you want? What is it that you’re doing already with your child in that development? What resources are you looking at? And then I also, if I’m concerned, I actually give your all resources like I always give my favorite social media accounts, I do I say, look, I see this, why don’t you follow this account?

 

00;39;00;26 – 00;39;15;14

Dr. Mona

I think this will really help you and see me in two months, because it’s that borderline situation, right? And I’m like, if and then see me in two months and then if I need to see you back because I want to see how you’re progressing and I want to be very honest. But if we’re not seeing progression, the goal here is getting your child what they need.

 

00;39;15;14 – 00;39;39;09

Dr. Mona

Then I may want you to do more intensive, you know, sessions with an in-person therapist to get them what they need. And it really comes down to that what a parent wants and what they’re telling me. Right. And I also last thing, and I’m going to be very honest, I think some old school pediatricians just aren’t up to date on the current recommendations and see what we’re seeing as being young moms with the things that we have meaning.

 

00;39;39;12 – 00;40;11;20

Dr. Mona

Now we’re using more container items. Now we have more screen time. Now there’s a lot of things that I don’t think are bad things, but I think that if parents are overusing those things, they can lead to some delays in some ways. Right? We know that as developmental experts that these things need to be used in moderation. I don’t think the older docs quite understand what is happening in modern parenting with all the other things that parents are doing for convenience, which I, again, I don’t think is bad, but we have to balance that and say, well, if your child’s not talking, what are we doing with engagement with screen time?

 

00;40;11;20 – 00;40;29;17

Dr. Mona

What are we doing? If your child’s not walking or meeting certain milestones, are you giving them floor time? How are you engaging them? Are they in container items? Are they in activity centers? Sometimes pediatricians don’t ask that because they don’t even know those products exist, right? They don’t even know because they’re not new parents. They’re fantastic doctors. So I love my colleagues.

 

00;40;29;17 – 00;40;48;04

Dr. Mona

I think seasoned doctors and newer doctors both provide different value. But then that’s why I think these kind of conversations are so vital. And that’s such a great question, Kaylee, because I feel like there are so many factors. Most of my families never feel left out because I’m very clear development is my jam. Like that is what I spend most of my visit doing because that is my passion.

 

00;40;48;11 – 00;41;03;21

Dr. Mona

That is what I do. I mean, I talk about growth and development, and I will spend that extra 15 minutes to talk about that because I think it’s very important. Not every pediatrician does that, and I can’t make that doctor do that. But I think when we have these conversations between the four of us, what it’s really going to do is, oh, I love it.

 

00;41;03;21 – 00;41;25;14

Dr. Mona

I just think it’s so good because I think people are really going to hear, yeah, my doctor does say that. Well, if my doctor says and we’ll get to the end on little advocacy pieces that I have, and I’m sure you all will have as well on how you can get that point across to your doctor if you’re concerned or if you’re like, look, something’s not sitting right, we’ll do it at the very end because I think advocacy, like I said earlier in this conversation, is so key.

 

00;41;25;14 – 00;41;41;17

Dr. Mona

And parents sometimes get into this realm that they’re going to a physician and they believe that the physician should be helping them. And I believe that I never for a second doubt that a physician does not have their patient’s best interests at heart. But I also understand sometimes with time or maybe they think, oh, your child will be fine.

 

00;41;41;20 – 00;41;56;24

Dr. Mona

I get that, I hear that, but then the family needs to know, well, what do I do when I’m waiting? What do I do if I’m going to be seen in six months and my child’s not talking like, what am I doing in that? Wait and see, which we’ll get into after we go through this, because it’s not just about wait and see, right?

 

00;41;56;24 – 00;42;13;12

Dr. Mona

It’s about wait and do and intervene. And then we see how that progressed. Right. But we’ll get into that. And that’s an important concept. Besides the crawling and the milestones, were there anything else that you were like, hey, they shouldn’t have done that, especially in the first three years, or maybe they pushed things around that you didn’t agree with.

 

00;42;13;15 – 00;42;31;13

Kailee

Well, just to touch on what you said, I think you hit the nail on the head. I mean, I think that’s super helpful and that’s a great narrative for us to be able to help not only for ourselves, but for our patients and their families, too. Whenever that kind of conversation gets brought up. Because, like you said, you have on the opposite end where family went and it was a waste of time.

 

00;42;31;13 – 00;42;51;20

Kailee

So I think that that’s really, really helpful in just reiterating to all families that all clinicians, you know, I can’t say there’s never a single bad seed, but I do feel like we all have the family’s best interest at heart. And remembering that and not getting into this, I think it can be really easy for us as parents when there is a problem to blame shift.

 

00;42;51;20 – 00;43;16;07

Kailee

And just because we’re trying to cope, trying to find someone in the system to blame for whatever happened. So it’s really hard. But we all have the family’s best interests at heart, for sure. Yeah, I don’t think I have anything new to offer as far as concerns, just mainly that I want to make sure that this conversation keeps going at a very grassroots level too.

 

00;43;16;07 – 00;43;41;01

Kailee

So it sparked me to think, okay, I was having these conversations with families already. I need to begin taking more proactive approach in talking to local pediatricians because, you know, doctor Mona, you’re saying you are a development expert because you take the time to be a development expert. But many pediatricians just either don’t have the time or their wheelhouse is something different.

 

00;43;41;01 – 00;43;59;27

Kailee

Their passion is a different side of their patient care. And so how can they know better unless we say, hey, here’s what we’re seeing at a clinical level, there’s no way for you to see this. We see these kids for 30 minutes, 45 minutes, an hour, once a week, twice a week, or, you know, for a six month period.

 

00;43;59;28 – 00;44;23;24

Kailee

That gives us so much information to draw from that we can then give back. I think we’re just stuck between a rock and a hard place of none of us have time, right? And we’ve got to make time. We’ve got to figure out how to make the time to be having this back and forth conversation. Because just like you said, like you have this huge clinical decision making process that you have to go through.

 

00;44;23;24 – 00;44;45;17

Kailee

So rather than a therapist getting in, this narrative of this pediatrician never errs on time. Well, you need to then be willing to take that extra step and have a lunch meeting or whatever it may be, to figure that out, rather than continuing these broken cycles of us all feeling like we’re not working together for the good of the family.

 

00;44;45;20 – 00;45;03;06

Dr. Mona

So, oh gosh, I love that. Thank you. I mean, this is so it’s like really love feeling like so love. I’m feeling empowered after this. I hope everyone listening is too. But yeah, like you said like, you know, I’ll have families go to whatever appointment. This isn’t just like developmental specialists. But then also that same comment comes I know from you.

 

00;45;03;06 – 00;45;21;23

Dr. Mona

All right. Like I went to my pediatrician, they didn’t listen to me. They didn’t say this. They said this. And I think a lot of it is one miscommunication on both parts. Like, I mean, I think sometimes we say something and the parent hears something different, and I’m being very honest, like I’ve been in those rooms or we may not be listening and it’s just it’s communication skills.

 

00;45;21;23 – 00;45;42;10

Dr. Mona

It’s time. I mean, there’s so many I don’t use the word excuses. There’s so many reasons that this can happen. And I love that these conversations are going to continue. And I love what you said. Like if you’re finding that there is a certain pediatrician, I mean, I get it if it’s like a one off or two off situation, but as a specialist in your community, if you’re like, wow, that person is notorious.

 

00;45;42;10 – 00;45;58;04

Dr. Mona

This is what we do for medical specialties, right? Like if I’m sending someone to an EMT and every time I send them to that EMT, the parent comes back and tells me, yeah, they immediately wanted to take my tonsils out. I’m going to question that a little bit. My goal is not for everyone’s tonsils to come out. My goal is for having informed decision making monitoring.

 

00;45;58;04 – 00;46;16;05

Dr. Mona

Right? I mean, we could go on and on about the medical system and what we need to do better, but that is the key here. And understanding that there’s so much out of our control in this situation in terms of like we talked about earlier, reimbursement and time with our patients and all of that. But what should never be taken out of the equation is a patient’s interest.

 

00;46;16;05 – 00;46;36;24

Dr. Mona

Right. And if they are what’s best for the patient, and if that means we have to utilize our resources, like I said earlier, like if a pediatrician is not a developmental expert, nor do they know that topic, they need to refer out. That is our job. As general pediatricians, we only know so much. We choose, like you said Kailee, to decide what our niche, my niche is.

 

00;46;37;01 – 00;46;57;01

Dr. Mona

You, my niche is development. My niche is parenting. I mean, this is what I know. This is what I know. If someone tried to come to me for ADHD, I can manage ADHD, but I’m not an expert at ADHD. I’m not an expert at asthma. I’m not an expert at everything. And that is why I think some people don’t get when they go to their pediatrician, is that we’re not going to be experts at everything.

 

00;46;57;01 – 00;47;13;17

Dr. Mona

Like you’re going to know things really well because you manage it over and over. And I’ve been practicing for only I mean, seven years is a long time, but like, I know what I know. And for anything else that I’m uncertain, I’m honest with my families and say, hey, look, I’m managing your ADHD, but I’m feeling like we’re at an impasse.

 

00;47;13;17 – 00;47;30;08

Dr. Mona

I’m feeling like things aren’t working. I’ve been able to manage some of it. Then we go somewhere else. And that’s kind of what pediatricians need to do for development, right? If they’re feeling they can’t be that resource, that’s okay. That is okay to say, hey, I need to refer you. And then it’s also okay for a parent to say, I love you.

 

00;47;30;09 – 00;47;46;26

Dr. Mona

You’re my doctor and you’ve done such great work for me, but I think I want something a little bit extra. I think a lot of us just need to take the ego out of it. And all of this, like all specialists, all pediatricians that this isn’t an ego thing. This is what does your family want? What is going to be the best thing that makes them sleep better at night?

 

00;47;46;28 – 00;48;03;06

Dr. Mona

Give them the resources they need and also, you know, provides the best outcome for that child in front of you. So very important. Is there anything else you wanted to add before we move to speech? Because I know we have some things to talk about. Speech. I also had some issues. Okay. Was there anything else? 

 

Kailee

No. You’re good. I’m excited to hear.

 

00;48;03;06 – 00;48;19;04

Dr. Mona

Yes, I hear from Brooke. So I of all of these things, I mean, I agree with Mia, I agree with Kailee. I agree that the speech that was the most the about everything. Okay. So I would love for you to just tell me the things that you did not love. And then maybe if there were anything to like.

 

00;48;19;04 – 00;48;24;05

Dr. Mona

But yes, go ahead. I would love to hear this. So I agree. So I’ll start.

 

00;48;24;05 – 00;48;42;05

Brooke Dwyer

There were a few things that we did like. First off that they added a kind of a check in at 15 months and 30 months. So I think that’s really helpful. Like the more times that we can be checking in and seeing if our children are meeting certain milestones, the better. So we really are in agreement with that.

 

00;48;42;07 – 00;49;05;06

Brooke Dwyer

Also, we liked the fact that now they’re looking at what 75% of children can do, rather than 50. So as speech language pathologist, when we are evaluating our children or, you know, children that come into our office, we are looking at the milestone is what approximately 90% of children can do. Okay, so that is what we talked to our parents about.

 

00;49;05;06 – 00;49;28;22

Brooke Dwyer

So then when a parent goes in to see a pediatrician and it was more around what 50% could do, that’s a huge discrepancy and very confusing for a parent who doesn’t understand the difference. So that’s one thing that we have been educating actually parents on for the last few years, especially on social media, like how many words should my child be saying is the number one question we get asked.

 

00;49;28;25 – 00;49;47;20

Brooke Dwyer

And when we tell parents the answer from what we know and what we look at from our research as speech language pathologist, they’re like, well, wait a minute, that’s not what my pediatrician told me. And we’re like, okay, well, that’s because they’re looking at more about the 50%, you know, what 50% of kids can do. And we’re looking at closer to what, 75 to 90% can do.

 

00;49;47;20 – 00;50;11;25

Brooke Dwyer

So we were happy with that shift and understand that the reason that they did it was that when a child gets to that age and you know, is not doing that thing, that that would be an immediate, let’s go get a referral for, you know, early intervention. But the issue is that there is a huge discrepancy as to what it looks like in the speech world.

 

00;50;11;27 – 00;50;38;24

Brooke Dwyer

Let’s call it the 25th percentile. Okay. So same as what 75% of children can do versus what it looks like on the CDC guidelines. So completely different like very I mean the discrepancies are just for example, one of the tools that we use to determine milestones is called the MCD. I it’s the MacArthur Beats Developmental Inventory. And it’s not just for speech, it’s for other developmental experts as well.

 

00;50;38;27 – 00;51;01;18

Brooke Dwyer

But we use that a lot in terms of word count. Okay. So for that for an 18 month olds, when we are looking at the 25th percentile or what 75% of children can do, that would be about 37 words the CDC is saying, with their updated milestones, that at 18 months, a child should have like 3 to 5 words.

 

00;51;01;25 – 00;51;27;00

Brooke Dwyer

That is like at the fifth percentile. So and then I can go on like, you know, same thing at 24 months. At 30 months, that is a real one. That was just like that because they added it is again, that MCD idea we look at at the 25th percentile, a 20, a 30 month old should be saying about 412 words that would be like, you know, the milestone for us and the CDC is saying 50.

 

00;51;27;00 – 00;51;27;21

Brooke Dwyer

I mean.

 

00;51;27;23 – 00;51;28;25

Dr. Mona

Wow.

 

00;51;28;28 – 00;51;58;19

Brooke Dwyer

Yeah, just such, such a big discrepancy. And it’s a little scary. What’s scary is that there wasn’t enough evidence based research or information used in, in determining these numbers. In the world of speech and what you know, what the CDC just with their changes. So, we as a speech community and I think I can speak for many speech and language pathologist, we would like to see just there wasn’t any speech language pathologist involved in making these decisions.

 

00;51;58;24 – 00;52;19;28

Brooke Dwyer

And even if there’s not going to be at least digging into some of the research that we use. So yeah, that that’s kind of where we’re coming from in terms of like receptive language. They pretty much stayed the same. There wasn’t any huge differences. It really was more for the expressive language that those gaps are just giant.

 

00;52;20;01 – 00;52;41;04

Dr. Mona

I wanted to ask two things. So they changed some of the timing with some of the infant pre-verbal communication receptive. Like, at four months they changed last to chuckles and not yet fully laughing, which I actually did like because I have some families that are like, they’re not fully laughing, but they’re chuckling or making a sound like that’s okay, like continue to reciprocate.

 

00;52;41;10 – 00;52;52;25

Dr. Mona

But that one. And then the other one was, going from two months to four months, which I also believe is like a starter, language. Did you feel anything about those changes or were you okay with those?

 

00;52;52;27 – 00;53;11;12

Brooke Dwyer

I’m okay with those when they’re infants and that young there is more of a range, like 2 to 4 months. I’m completely comfortable with cooing. Yeah. And again, like, by that four month mark, you know, so if at that four month mark, there is no sound coming out, no cues coming out, then it’s like, okay, what’s going on?

 

00;53;11;19 – 00;53;35;29

Brooke Dwyer

But I’m I’m comfortable with that. And I agree with you with the laughing. It’s very rare that, you know, an infant that young will fully laugh. And I think parents don’t really know what they’re looking at. So I think it’s more of a chuckle or a giggle, you know? So yes, I’m comfortable with that. The pretty much comfortable is everything other than, you know, those big changes in the number of words or just it’s just too big of a gap or a discrepancy.

 

00;53;36;05 – 00;53;55;05

Brooke Dwyer

And also with the Open Cup. And again, that is, you know, like you were saying before, doctor Mona, I like your area. You’re a pediatrician. You can see and kind of treat it all, but like your expertise is in certain areas, that is same with us. Myself and Bridget. We’re not feeding experts. We are experts in the early intervention population.

 

00;53;55;05 – 00;54;11;06

Brooke Dwyer

So yes, we know about feeding. We have done a little bit of work with feeding, but that one about with the cup, with the open cup, that did stick out to me because we do talk a lot about that also on social media, and we and tons of parents want to know, you know, when she, my child, be able to drink from a cup, what kind of cup?

 

00;54;11;06 – 00;54;13;16

Brooke Dwyer

That kind of thing. So that’s to me as well.

 

00;54;13;19 – 00;54;35;05

Dr. Mona

The other question I had for you was the discrepancy between your the speech language pathologist, number of words and CDC. Why do you think there’s such a big discrepancy? I mean, I don’t have my answer, but why hasn’t there been more of a discussion on bringing those numbers together, bridging the research, like to kind of bring a more middle ground approach.

 

00;54;35;05 – 00;54;45;08

Dr. Mona

And I love what you do on your social when you do the, you know, milestone expected all of that, which will reiterate again what that all means. But what would you say for that? You know why there’s a difference there.

 

00;54;45;11 – 00;55;10;22

Brooke Dwyer

I mean, it’s a great question. The informed SLP is a fabulous resource. They basically take all the research out there in the world of speech pathology, and they crunch it and make it readable for not only SLPs, but everyone. That’s a great way to kind of fully understand the data. And that was where we got a lot of our data from when we were looking at all the CDC changes.

 

00;55;11;01 – 00;55;32;16

Brooke Dwyer

And one thing that they brought up when they were really diving into all the reports was that there was actually no research about speech and language in that change at that 30 month or that addition, I should say, because it wasn’t even there before. There was no solid data or research coming from any speech and language article or research study or anything.

 

00;55;32;16 – 00;55;53;25

Brooke Dwyer

So no idea where that came from. No idea. And right now, Asha, so the American Speech and Hearing Association is trying to, you know, come up with a way to meet and have a discussion and try to come to some sort of, I don’t know, not agreement. That’s not the right word, but figure this out. You know, why is there such a massive discrepancy?

 

00;55;53;25 – 00;56;22;15

Brooke Dwyer

And why weren’t speech and language pathologist included in this discussion, or at least the data that we share, you know, used in this? What I can tell you is that because we are a evaluating children and we are using mainly, standardized test or criterion referenced assessments, that is where we get all of our information and all of our data when we are evaluating a child or when we are looking at word counts, we are always going back to that.

 

00;56;22;15 – 00;56;30;18

Brooke Dwyer

Everything we do is evidence based, so we know where we get our data from. But right. It’s not completely clear where this all came from.

 

00;56;30;24 – 00;56;45;13

Dr. Mona

No. And I and that last third comment was from what you were saying about the new. Yeah, the new speech stuff. I’m happy you agree with the infant milestone changes. I like that because I often get parents where like, my babies are cooing at two months and like, that’s okay. Three months is what I love to see it.

 

00;56;45;13 – 00;57;13;08

Dr. Mona

Four months is when the milestones should be. And just to clarify again, the milestone when they talk about these terminologies, the milestone according to the CDC and all, when we talk about milestones, that’s when 75% of children should be doing that. So if you look on the new CDC website and it says CDC milestone at four months should be a child who is doing right, so by four months, if your child is not cooing, that means 75% of children should have been cooing at four months.

 

00;57;13;08 – 00;57;35;01

Dr. Mona

We want to have a conversation on other milestones, other things in their development. I agree with you completely. My biggest concern with the language was not early on. It was the 18 month to 30 month round, because I also believe that those are the most critical language time, especially two years to 30 months. I mean, I do see we talk about language explosions a lot.

 

00;57;35;01 – 00;58;01;10

Dr. Mona

My own son went through a language explosion at 21 months, but that is because I knew what to look out for, right? My worry with this is that the visits happen at 18 months, two years, two and a half and three. Those are six month apart visits with your pediatrician. My concern is the six months. I mean, if we were seeing your children every three months, then I’d be a little more like, okay, I can monitor, I can see progression with you.

 

00;58;01;13 – 00;58;18;15

Dr. Mona

So my concern is not the fact that, you know, this could be okay if a family is doing the engagement, is doing all of the things they need to do. But my worry is what I mentioned earlier is if they’re not or even if they are and it’s not working and that’s a reality and that’s okay. There’s nothing that you did wrong.

 

00;58;18;21 – 00;58;41;18

Dr. Mona

This happens. And this is why speech language pathologist exists to help you. I worry that then we wasted six months of precious time. So what I usually do, and I tell my family. So just say it’s a two year old who has 50 words, okay? And like, okay, 50 words is good. Not the official milestone that maybe SLPs would like, but you’re also showing me joint attention.

 

00;58;41;18 – 00;58;57;18

Dr. Mona

You’re also showing me that you understand commands. You are engaging with your child. You are getting their attention with certain things you are labeling and you’re following maybe some speech account you’re doing all the education you need to do. I would want you to come back rather than six months from now. I would love a follow up in three months.

 

00;58;57;20 – 00;59;16;10

Dr. Mona

I also offer families and I say, hey, look, do you want the extra one on one? Right? Because if I’m trying to like borderline, where you’re doing the work and things are okay, but if it’s a two year old with one word, I mean, we need to get that evaluated, right? I mean, there definitely needs to be an understanding that you have to intervene when it’s necessary.

 

00;59;16;10 – 00;59;33;17

Dr. Mona

And if it means that the doctor is doing the watching and seeing and we’ll get into that, they need to either be pulling you back a little bit sooner, in my opinion, and doing an extra bonus visit. Yeah. Or they need to be telling you some tools, resources to get that topic going. And I’ll talk about that. Wait and see.

 

00;59;33;17 – 00;59;57;23

Dr. Mona

But that is, what I think is the big issue for me, because I do agree with you. 18 months to two and a half, three years is critical. And I mentioned earlier, I alluded to it that not only I understand that so many children speak late, and I respect that. I understand that even if a family is doing all of the work, the stuff that they learn from even a speech language pathologist, I have had families that still don’t see like the language explosion.

 

00;59;57;28 – 01;00;16;23

Dr. Mona

It is nothing you’re doing wrong. You are doing the work, but I need you to have the resources tied in, and I don’t want you to feel like you just sat there and waited and then did nothing. You know, that’s not something that feels good when maybe you could have done something and talk to the person who’s the specialist in that area on ways to maximize.

 

01;00;16;23 – 01;00;34;23

Dr. Mona

And that goes for everything that we’re talking about, like going back to OT, we didn’t even mention this shelf feeding skills is a very important milestone to me. I don’t think it’s even on there. I mean, there is maybe like self feeding with the spoon or fork or whatever, but to me, like shell feeding in its own entity is actually to me really important.

 

01;00;34;23 – 01;00;49;11

Dr. Mona

By one year. I don’t need them to be an amazing shelf feeder, but I think it’s a very important skill. And also textures that are not just puree by one year like I have had so many families come in who at one year they saw another pediatrician and they’re still doing care. And I’m asking like, what’s going on here?

 

01;00;49;11 – 01;01;10;15

Dr. Mona

Like we need to advance. Like, is there a feeding difficulty? Is there a speech issue like swallowing difficulty? Is there a difficulty with you not offering because you’re scared of choking? But if you wait too long with not introducing textured foods or self feeding, it takes longer because now they’ve created habits. Or maybe there’s something physiologic that we need to intervene on.

 

01;01;10;15 – 01;01;27;20

Dr. Mona

So there’s so many little things that like that matter, and I just wish there was more people that were into development as first line. Like, it really would make a difference, because I really do feel like it would give parents a lot more ease and understand, okay, this is what I’m going to be concerned. This is when I need to return.

 

01;01;27;24 – 01;01;47;23

Dr. Mona

This is my actionable tips while I’m waiting until the next visit. This is when I’m going to see a OT speech feeding therapist, whatever it may be, and watching and waiting should not be watching and doing nothing. I think there’s a misconception. So if you’re a pediatrician, I want to go into this advocacy station and do a roundtable on how parents should be advocating on your guys’s opinions.

 

01;01;47;26 – 01;02;11;23

Dr. Mona

It is not mean. And you just say, okay, well, we’re just not going to do anything. It means asking your pediatrician the following questions. Like I mentioned, this is great. What about my child doesn’t concern you? What about the fact that my child’s not saying X amount of words? Why are you not concerned? Because sometimes I will say, well, I’m really happy because your child is showing some signs of getting attention, showing signs that they’re engaged with you.

 

01;02;11;23 – 01;02;28;02

Dr. Mona

They are showing signs. I want you to build on those words, not just using the one word I want you to build on those words, and I give them some tips that I have. Then I give those accounts that I love. But I think it’s really important that they have the tools so that you’re not waiting around. And then it’s also if they’re like, well, I’m just not worried.

 

01;02;28;08 – 01;02;44;20

Dr. Mona

Every kid will walk, every kid will do whatever we’re doing. I agree to some extent they will do that. But then it’s also like, hey, I really appreciate you. You don’t have to like, hate your doctor. Your doctor could be amazing for other things, I know that, but they may not be hearing you on this. I really appreciate you.

 

01;02;44;20 – 01;03;00;16

Dr. Mona

I appreciate the work you do for me. I feel like maybe I can get this, you know, extra help, and it would mean so much to me that I get the recommendation that you think is best. Who do you think is best for this? Right. So that you’re kind of telling them that I value you? I don’t agree with what you’re saying, quote unquote.

 

01;03;00;16 – 01;03;15;25

Dr. Mona

But I want to know who you think I can go to to get more help. And that doctor, I hope, will say, you know what, I appreciate you. I will be honest. I know some parents don’t fall into that. Some pediatricians like, why not? Like I said, it’s fine, right? Like I’ve heard that and I’m being very honest.

 

01;03;15;28 – 01;03;34;11

Dr. Mona

But I think it’s important to say to yourself and say what you want. And if the doctor says, sorry, I don’t have anybody or whatever, I don’t know what they say. You can also go through your state’s early intervention plan. You just look up early intervention in your state. You can go privately to a speech language pathologist, OT or PT if you have private insurance.

 

01;03;34;18 – 01;03;57;06

Dr. Mona

There are ways to get that evaluation. If you are concerned and your pediatrician is not concerned. I have had those situations where I am not concerned at all, like I have looked at the child and I feel 100% that that child is fine, but the parent is sitting in front of me saying, I don’t feel good, that parent is going to get a referral from me because that parent is concerned.

 

01;03;57;08 – 01;04;14;28

Dr. Mona

I don’t want that parent to go home feeling like they weren’t heard, that no one listened to them, that now they’re sleeping at night looking at resources that may not be accurate. I want them to get the best of the best. And I will say, hey, look, this is what we’re going to do. And I say, I may feel like your child’s going to meet these outcomes, but I believe you and I want you to feel supported.

 

01;04;14;28 – 01;04;37;02

Dr. Mona

And I wish everyone listening, including pediatricians listening to this, will do more of that whenever they get a parent wanting a referral, not just for development. I’m talking for a GI for anything. I think we just get so bogged down that you don’t need it because medically, developmentally, we may not think that the family needs it, but a referral can also be made because of a parental concern.

 

01;04;37;04 – 01;04;58;23

Dr. Mona

That is a reality, and I know you all will agree to that. But I wanted to kind of add kind of wrapping up like, what would you say? And we’ll go again from Mia, Kailee and Brooke for Mia, what would you say from an advocacy piece here? Like, what would you want your final message to be for parents hearing these milestones and our conversation today, you have a platform here to kind of share your thoughts and feelings.

 

01;04;58;23 – 01;05;22;06

Dr. Mona

And I believe all of us are mothers, correct? Yeah. So even just as a mother and professional, like, what would you say to other people listening today? 

 

Mia O’Neill

Definitely. So I think being a mother, like you said, has added this whole other side to my perspective that, you know, I learned all these things, textbook things. And now being a mother, I’ve learned what things are so important and kind of how to modulate my thinking and development as well.

 

01;05;22;12 – 01;05;39;24

Mia O’Neill

And so what I would say as an occupational therapist and mother is that, you know, your child best parenting, know your child best. All of us pediatricians, SLPs, what we know child development best. And so if there’s an overlap there where you have a concern, like you said, Doctor.

 

01;05;39;24 – 01;05;41;00

Mia O’Neill

Mona, whether you.

 

01;05;41;00 – 01;06;07;17

Mia O’Neill

As a pediatrician might think it’s there or not, if you have a concern, don’t be afraid to reach out. There’s absolutely no harm in screening by your doctor or a diagnostic evaluation by one of us as experts. There’s actually no harm in that. So I would say always advocate if you feel something’s not adding up and also just, you know, follow these social media accounts, have that open conversation with the pediatrician.

 

01;06;07;17 – 01;06;33;26

Mia O’Neill

Make sure you have a doctor who’s listening to your concerns, and if not, then maybe find another pediatrician who will take the time and listen to your concerns and reach out. Reach out. There’s never anything wrong with reach out. 

 

Dr. Mona

I love it. Kailee, what about you? 

 

Kailee

I think we are in the era of information overload and all these things that are trying to help us as busy parents, that can sometimes hurt, and giving us too much information or information that’s incorrect.

 

01;06;33;26 – 01;06;55;20

Kailee

So, like Brooke was saying, you know, as clinicians, we look at this research based standardized evaluation when we’re evaluating our patients. And that’s the information that I’m putting out in my social media space is based on that research. And so what I would number one encourage parents to do is if you feel concerned, think about the resource that’s giving you that source of concern.

 

01;06;55;26 – 01;07;21;13

Kailee

Is it something you’re seeing that you feel like is off? That truly is just that mom gut that cannot be explained by science. It’s something that we just all have, and we know something is off that we need to lean into. Worst case scenario there, you get an evaluation and they say your baby is doing great. And then they hopefully, if they’re doing a good job at their profession, still say, but you’re concerned about this, here’s 3 to 5 things that you can do moving forward.

 

01;07;21;13 – 01;07;49;06

Kailee

And then you’ve had that evaluation. Even with early intervention it is low or no cost to families. So, you know, they should at least leave that evaluation with some actionable tips that will make them feel better. They go home with peace of mind and everyone’s happy. But the other side of that is, if you’re feeling concerned, don’t Google and look at random resources and look at someone’s resources who is an expert in the field that you’re concerned about.

 

01;07;49;06 – 01;08;07;22

Kailee

So if it’s speech, look at someone who is a licensed speech language pathologist, or if it’s feeding someone whose specialty is feeding. And I agree, doctor Mona, that can even kind of get into the side of, well, maybe there’s a little bit too much knowledge there, but that’s at least going to be a trusted resource for the most part.

 

01;08;07;22 – 01;08;26;05

Kailee

Versus you get on Google or you get on baby apps. And I don’t know where they get their household markers, but sometimes that elicits more fear than there needs to be. And I’m sure you see that in the clinic. Two doctor Mona of family saying, well, you know, my baby tracker app says that they’re supposed to be doing this and yours doesn’t align with that.

 

01;08;26;06 – 01;08;54;01

Kailee

Maybe even us as therapists, ours does not align. So trusting your mom instinct and intuition, but also really evaluating this information that we’re taking in. And that goes for everything in parenting. Right? Like let’s just stop general googling things and let’s look to someone who is qualified to give that recommendation or information. 

 

Dr. Mona

I agree with that. And I think the other aspect is you go on Facebook groups.

 

01;08;54;01 – 01;09;11;27

Dr. Mona

I think Facebook mom groups are great for mommy gear and things like, hey, anyone know what’s going on in this world? But for like his milestones tend to be comparison correct? So your other friend could be rolling or walking at eight months. Okay, like I’ve seen eight month olds walk and they’re like, oh, we did nothing. We had them do nothing.

 

01;09;11;27 – 01;09;26;16

Dr. Mona

And then now they’re walking. And then now it makes you feel like, well, I’m doing everything I’ve been told and my child’s not walking the walking range is 8 to 18 months. Obviously we want to know we want to teach you how to walk, but you can end up feeling worse about yourself when you go on those things.

 

01;09;26;16 – 01;09;41;05

Dr. Mona

So I agree with that. You got to protect your mental peace and everyone’s different. Some people love the information, it doesn’t affect them. But I know what that does to moms. I’ve seen that in my office and dads too, but more so moms, like they come in and they’re like, well, I’m not supposed to do this. I’m not supposed to give salt in my food.

 

01;09;41;05 – 01;09;55;24

Dr. Mona

I’m not supposed to do this. I’m not supposed to do this. I’m like, whoa, whoa, whoa whoa, whoa, like whoa. Let’s talk about why that could be correct or could not, right? I literally wish I had an hour with every one of my patients, because there’s so much of that that goes on like, no, wait, let me discuss with you.

 

01;09;55;25 – 01;10;09;27

Dr. Mona

Like, let’s talk about it. I completely agree, or maybe not so true, but why is it not true? Not just, oh, it’s not true, it’s. Well, why is this maybe not the case, you know, and I think I love that that is so important. And then, Brooke, what would you be your final kind of message for everyone? 

 

01;10;09;27 – 01;10;29;03

Brooke Dwyer

Yeah. I mean, I agree with what everyone is saying. We live in a world of information overload and it is both a blessing and a curse. And, you know, we just tell our mamas to go with their gut always above anything else. You know your child best, and if you feel that something is not right, get that evaluation. Reach out.

 

01;10;29;03 – 01;10;36;10

Brooke Dwyer

It can’t hurt. It’s always better to be proactive than reactive. And, yeah, that’s kind of our message.

 

01;10;36;12 – 01;10;53;24

Dr. Mona

I love it, and I have something fun I want to do. Also, I’m kind of putting you on the spot, but you are developmental experts. But have you ever had milestone anxiety? I just I’m curious. And it’s a real reality that some moms feel nervous about their child’s development and parents, you know, as well. But I’m just curious because I know I have my story, but I would love to hear we’ll go in order of Mia.

 

01;10;53;24 – 01;11;13;08

Dr. Mona

Have you ever been like, oh, is this normal? Should I be doing this? Is my kid okay? Have you had that milestone anxiety ever? 

 

Mia O’Neill

I’m so glad you said that because I was, like, thinking of this story the whole time. You know, first time mom having a newborn, I knew the milestones to expect. I knew, like, in my ideal mind, how I was going to help my son achieve all these milestones.

 

01;11;13;11 – 01;11;28;06

Mia O’Neill

And so I think he was around when he was five months old. He was only rolling tummy to back. He wasn’t going back to tummy. And so of course I do what I tell my parents not to. And I’m googling and I’m like, oh my gosh, yeah, wrong. And like the rest of his development, I’m like, is there something going on?

 

01;11;28;09 – 01;11;36;14

Mia O’Neill

And so I reached out to the pediatrician and she’s wonderful. I love her so much. And she, I think, believes the same kind of mindset you do. Doctor Mona.

 

01;11;36;14 – 01;11;37;04

Mia O’Neill

You know, like.

 

01;11;37;07 – 01;11;57;11

Mia O’Neill

She knows I have the resources to help him succeed. But she knew I was concerned. And so she said, why don’t you just get a PCE evaluation to be safe? And even me being a therapist, having a lot of connections down here, it took almost six weeks to get in to a evaluation, and by the time I did, he was rolling both ways, getting up on hands and knees.

 

01;11;57;11 – 01;12;19;07

Mia O’Neill

He was like, totally hitting the mark on stuff. And so it turned out to not probably warrant a evaluation. But it’s so easy as a mom to get in your head and to worry about these little things and show that’s, I see, like there’s absolutely no harm in asking for an evaluation and have initiative. And then if you don’t need it, you can always cancel to, you know, you don’t need to go.

 

01;12;19;09 – 01;12;46;14

Mia O’Neill

That’s my personal experience. 

 

Dr. Mona

What about you, Kaylie? 

 

Kailee

Yes, absolutely. My first daughter. She has a lower muscle tone. And that’s just the way that she was made. And I, like Mia said, had those strategies to help her at home and support her development. But it gave me such a good reference point for families walking through that, but also to realize and encourage families that I don’t excel at every realm of my life.

 

01;12;46;16 – 01;13;18;13

Kailee

I am my own individual person and our kids are that same way. So realizing where our babies need support and where they actually need somebody to come in and help nudge them forward and where maybe it’s just something that’s part of their personality. And as my coping mechanism, especially as the pediatric physical therapist who my daughter was towards the tail end of walking independently, I used to say she’s just a talker, not a walker, and has become this funny thing because she really she’s so strong in social, emotional and language development.

 

01;13;18;18 – 01;13;45;04

Kailee

But she’s probably not going to be the track star like, you know, getting first place. And that’s just the way she was made. So taking in all this information and realizing when we need help, but when it’s also something like, that’s just the way they’re made, you know, they have likes and dislikes and intrinsic motivations and things that aren’t motivating for them, and just reminding ourselves that they’re little humans to we’re not all athletes and brainiacs and all of the things all at once.

 

01;13;45;06 – 01;13;52;24

Kailee

So just really discerning with that mom gut of kind of what plays a role in that,

 

Dr. Mona

I love it. And what about you, Brooke?

 

01;13;52;26 – 01;14;14;00

Brooke Dwyer

Yeah. So actually my first step, my daughter as well, she was born with torticollis and and right away, you know, pretty much I think around three months we started physical therapy. And then she had to wear the helmet to correct her head shape. And she was very delayed in her motor skills. So like, didn’t roll till six months.

 

01;14;14;00 – 01;14;36;15

Brooke Dwyer

Didn’t crawl till a year, didn’t walk till 15 months. So we went through the whole and of course super verbal talking like a head. But motor was delayed and actually ironically, you know, she caught up with everything and it was great. And then years later she was diagnosed with epilepsy and not related to any of the motor things, you know, previously but diagnosed with epilepsy.

 

01;14;36;15 – 01;14;59;08

Brooke Dwyer

And she was struggling academically. And I thought, gosh, this is my kid who was talking in sentences by like 18 months. And then this happens. And now we deal with struggles with her, you know, meeting the standards academically because of her struggles with that. So it didn’t stop there. It continued. But, you know, it’s always a struggle. I think just being a parent is literally the hardest job in the world.

 

01;14;59;08 – 01;15;04;26

Brooke Dwyer

And we just have to, you know, all our guts and go with our intuition and do the best we can.

 

01;15;04;28 – 01;15;26;06

Dr. Mona

Oh yeah, definitely. And yeah, I didn’t I didn’t realize your daughter had epilepsy. Like Ryaan had a stroke at delivery, seizures. And so automatically whenever a child has a stroke or seizures in the NICU, they automatically get into early intervention, even if there’s no developmental concern, because they have to be monitored very closely. So I went to like, very intensive visits, you know, got to see you on the other side.

 

01;15;26;06 – 01;15;44;21

Dr. Mona

I love that experience because I have to refer my patients sometimes, but I got to experience it from the other side. And, you know, like I mentioned earlier, with strokes and seizures, you don’t know the outcome. It literally is like, he could be amazing or he could end up not walking and talking like I mentioned. And one of the risk factors of stroke and seizures is cerebral palsy.

 

01;15;44;21 – 01;16;02;20

Dr. Mona

Right. And so I as a pediatrician, I was like, you know, he’s doing well. He’s feeding good things with good tone. Looks good. I see a lot of great outcomes. And then around two months, he, a very common at six weeks, two months where they start to get very rigid when they feed, like they start to kick their legs out and like, almost refuse.

 

01;16;02;20 – 01;16;26;07

Dr. Mona

Bottle babies do this. They refuse their bottle. They refuse feeding. They get distracted with feedings. I immediately went into this spiral that this was now his hypertonic state and now he has cerebral palsy. And I was crying on my couch. I was obviously postpartum. I was like, what did I do? What? Like he was fine. My husband was also dealing with a lot of anxiety from the delivery, obviously was a very traumatic delivery.

 

01;16;26;09 – 01;16;48;10

Dr. Mona

We didn’t have the support system for someone to be logical at that moment. Right. We were both anxious and attached to my neurologist. Thankfully, I had her as my colleague. She had her number and I’m like, you need to talk to me right now. Like meaning, not like at the moment. I’m like, I messaged her and I was like, look, can you just tell me that it’s normal that a kid at this age will pick their feet and straighten their legs out and be very rigid during feedings?

 

01;16;48;10 – 01;17;06;07

Dr. Mona

And I know as a pediatrician, babies do that. But of course, with everything you get that development milestone, like what is going on? And is this going to be okay? And she’s like, Mona, go into a quiet room and feed him. I’m like, I know. Okay. So I went into the quiet room. He was just overstimulated. We were feeding in the living room.

 

01;17;06;10 – 01;17;22;01

Dr. Mona

He was okay, but I had a lot of my social anxiety that first year because of the stroke and the seizures. Right. And it was not only miles, an anxiety of like, is he going to meet? It’s that am I not doing enough? I think, you know, it was the I know development. I know how to engage with my baby.

 

01;17;22;01 – 01;17;40;22

Dr. Mona

I literally like we talked about, I’ve did this for years before Ryan was even born. And I was getting to a point. And I want to share the story that I was getting so obsessive about him meeting milestones in my brain like that. I needed him to need it because it almost made me feel that he was improving, that I almost forgot to enjoy playtime.

 

01;17;40;25 – 01;18;02;07

Dr. Mona

Like it made it more stressful because I was like, okay, well, he needs to roll in. And he did. He met all those milestones actually early or on time. He did, and it was great. But it was like the obsession and the stress that caused me made playtime less fun. It made it where I just didn’t like playing with him in the infancy years until I saw him do things, and then it got better.

 

01;18;02;07 – 01;18;21;07

Dr. Mona

But I hope parents understand that I know I’m not alone in that feeling. I know many parents feel stressed when they play with their kid, because they’re trying to play with them for a goal versus just playing with them. Meaning interacting. I should say the word to just foster their development. And that’s kind of why I created my platform and stuff, because I was like, look like I get it.

 

01;18;21;07 – 01;18;38;00

Dr. Mona

I understand that you’re going to feel sometimes that you want to meet this goal, but that shouldn’t be the goal. I understand that that happens. It really should be. How can I foster my child’s development for him or her and really get them there? And I am just so grateful for this conversation and I hope you all are too.

 

01;18;38;02 – 01;18;46;10

Dr. Mona

Mia, where can everyone find you on Instagram? 

 

Mia O’Neill

Yeah, so my handle is mama mia underscore OT, mammaMia_OT

 

01;18;47;02 – 01;19;00;07

Dr. Mona

And then, Kailee, where can everyone find you? 

 

Kailee

My Instagram handle is at the movement, mama, and it’s mama. mama. 

 

Dr. Mona

Perfect. And then, Brooke, I know you and your sister have a team, but yes. Where can they find.

 

01;19;00;07 – 01;19;03;08

Brooke Dwyer

Yes. We are at Speech Sisters.

 

01;19;03;10 – 01;19;34;16

Dr. Mona

And I’m going to attach everyone’s Instagram handle links, resources, all of that so that you can feel more educated empowered. Like I said, their accounts are amazing. I know they each have, resources, courses, whatever, but they also just have great information on their page. So I just want you all to have the education. When I was deciding who to do this with, just as a final wrap up, I was really searching hard for an OT and PT and speech therapist that really understood the feeling and vibe of what we discussed today, right?

 

01;19;34;16 – 01;19;58;06

Dr. Mona

Understanding that we all work together, the no pointing of fingers, the respect. And you know, even Kaylee brought up a really that really great question about why why maybe pediatricians don’t refer. And I think that was just so great. I really want to thank these beautiful women for joining me today. I hope that we can continue to collaborate in different ways, and I hope you all listening or watching however you are indulging in this information.

 

01;19;58;06 – 01;20;09;27

Dr. Mona

Got something useful? If you did, make sure to share it on social media, share the podcast episode or YouTube. So that people can learn about development, what each of us do in our special teams, and about the new milestones. But thank you ladies for being here today.

 

01;20;09;29 – 01;20;11;13

Brooke Dwyer

Thank you.

 

01;20;11;15 – 01;20;13;05

Dr. Mona

Bye bye.

 

01;20;13;07 – 01;20;17;29

Dr. Mona

Thank you for tuning in for this week’s episode. As always, please leave a review.

 

01;20;18;02 – 01;20;21;02

Dr. Mona

Share this episode with a friend. Share it on your social media.

 

01;20;21;04 – 01;20;28;28

Dr. Mona

Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.