Hitting Milestones: When you Don't Want to "Wait & See"
First off, I want to say that pediatricians are amazing individuals. Whether they have an MD, CRNP, or PA attached to the end of their name, they are working hard to make sure that our kids are safe, healthy, and happy. They spend YEARS of their life in school and learn about a lot of different areas. That being said, they are not specialists. They are not physical therapists, occupational therapists, speech-language pathologists, etc. who spend YEARS of their life in school learning about one particular area. So, although they are aware of milestones in each of those areas, they are not as knowledgeable as we, the specialists, are. Let’s not forget that.
Ok, so let’s go over some background information: developmental milestones are usually stated in ranges. For example, your baby should make cooing noises between 2-4 months. Solids should be started between 4-6 months. Baby’s first word should come between 11-14 months, etc. So, when you go to your pediatrician and say that you are concerned that your child has not yet met a milestone, sometimes the response is “well, let’s wait and see. Maybe he needs a little more time.” The conversation usually stops at that point, right? No other information is usually asked. That is where the breakdown occurs since we, as the specialists, know to ask other questions and look for other information that may tell us if a speech-language evaluation is warranted. The pediatrician, not being a specialist, does not always know what to ask next. So, sometimes the response is to “wait and see” when we, the specialists, would inquire further and, as a result, may disagree with waiting.
“Well, wait Miss Jordyn, if the doctor says to ‘wait and see’ but I really am not sure, what should I do?”
Excellent question! Let’s walk through some options:
If your doctor says, “let’s wait and see” and your mommy/daddy gut is telling you “eh, I don’t know…,” you can say the following things:
1. “Do you have any research to support that waiting and seeing is the right approach with children the same age as my son/daughter?”
Perhaps your son/daughter has hit all the other milestones right on time and still has time to be within the average range of meeting this particular milestone. Your pediatrician may say that it is early to have that milestone met, and that another month or two won’t hurt to wait considering that your child has been on track prior to this point. However, if they can’t really answer this question, or your child has been a little late to hit other milestones, it might be a good idea to follow up with one of the other options below.
2. “I don’t feel comfortable waiting and seeing. I would like information to contact the local Infants and Toddlers/Birth to 3 Program.”
If you want to take matters into your own hands and receive a free evaluation from a local program, your pediatrician should have a phone number or website for you to contact the right person in your area. This is a smart move to do early since the wait times for evaluations and treatment can be lengthy due to state regulations (this is a blog for another time- stay tuned). You can call right after your appointment and should be able to set something up within a matter of days to weeks.
3. “I don’t feel comfortable waiting until our next visit to see if ____ has made progress. Do you have a list of local speech-language providers that I could contact?”
If you want a faster answer as to if your child is meeting age-based expectations or not, a private practice or private SLP (like myself) can perform either a screening/consultation or an evaluation in as little as a few days from the time that you call. Most pediatrician offices have a list of local providers, or you could do a quick Google search.
I would follow up #3 with this one too:
4. “I am going to have _____ evaluated by a speech-language pathologist just to make sure there isn’t something that we can do now. Could I please have a referral before I leave today?”
Some insurances require that you have a physician referral for a private speech-language evaluation to be covered. If a pediatrician doesn’t give you a referral that day because they need a specific clinic/practice to send it to, you can call and ask for one once you’ve made your appointment for the evaluation. They can fax the referral directly to the speech-language clinic before your evaluation.
The point of this blog is that you don’t need to just take what your pediatrician is saying and agree. You can ask questions. You can make your own decisions.
Overall, trust your gut. If you don’t think waiting and seeing is a good idea, there is NOTHING wrong with a speech-language evaluation! And if your child is developmentally on track, you’ll then know for sure. The local infants and toddlers programs provide free evaluations, and a local private practice may perform screenings for free if you ask (like me)!
Early intervention is key, so the earlier you get the ball rolling, the better off your little one will be! Trust your gut. Ask questions. Advocate for your child.
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