Early childhood red flags that need attention --
“Einstein didn’t speak until he was 4 years old” is perhaps the most unfair and misleading statement to make to a parent, as it is often used to assure them that suspicion about speech delays are unwarranted and that their child will catch up to his peers in time. The truth is that delayed speech can be one of several recognizable red flags that a child may have developmental delay, and the earlier it’s identified and treated, the easier it is for him to thrive later in life.
Karyn Searcy, the clinical director of Teri-Crimson Center for Speech and Language, suggests that there are several key language milestones. “In early childhood, children should be demonstrating communicative intent, even if sound production isn’t perfect. A child needs to want to convey a message to you,” says Searcy. “If your child isn’t talking or trying to communicate by 10-12 months or isn’t using two-word combos by 2 years old, these are red flags.” There tends to be an explosion of language after age 2. Children who have communicative intent, but are unable to express themselves, can get frustrated and angry. Parent-to-child early intervention helps curb this.
Sometimes there are physical problems that need to be addressed. Some children struggle with coordinating their lips and tongues to form sounds, while others can’t recognize the difference between the sounds they make and the sounds made by others. Hypernasal speech, which causes nasal-sounding tones when making M, N, or “ing” sounds, can be indicative of palatal issues. The soft palate is raised and lowered and air goes up and down in the nasal cavity during sound production. If there are palate issues, a child may sound as if he is making sounds in the “front’’ of his nose (because he can feel the air in his nose better than he can in his mouth). Nasal speech can also be associated with hearing problems. Pediatricians can help diagnose a palate issue, refer children for a speech/language evaluation or recommend an auditory evaluation.
Occupational Therapist Andrew Gilbert, whose son has special needs, addresses physical and communication milestones he identifies during observation and evaluation. As an OT, his job is to help people perform and maintain their job or task, and for children, their job is communication and play. He looks for red flags of social isolation: preferring to play alone and not communicating with loved ones, which can be an early indicator of autism. He also looks for patterns of task avoidance. If a child will sit and listen to a story intently, but avoids drawing or writing, Gilbert investigates vision and hand strength issues. He looks at full-fisted grips around crayons and chalk in older toddlers (versus the traditional tripod grasp), which indicates a child may need to develop finger strength.
Gilbert warns against too much car seat time. “Car seats used outside of travel can be detrimental to a child’s peripheral vision, as the sides of car seats are designed to protect the head from too much motion and keeps the gaze forward,” he says. “A child who is not moving his head toward a sound or object of interest is a red flag because this may indicate torticollis (inability to move neck muscles), a vision problem, a hearing problem, or even a social/emotional difficulty. It’s important to determine which one (if any) for proper intervention.”
Emotional warning signs are harder to spot. The inability to make eye contact, excessive fussiness, angry outbursts, absence of imaginary play and the inability to problem-solve simple toddler tasks may be signs of social or cognitive dysfunction.
Physical warning signs are often the most obvious: the inability to sit up by age 12 months, the inability to walk by age 2, clumsiness, and extreme floppy or rigid postures, can all be signs of motor delay, which has many root causes. All of these red flags indicate a much-needed visit to the pediatrician.
Where to Find Help
Diane Niles, recently retired service coordinator for the San Diego Regional Center (SDRC) and mother of an adult with Williams Syndrome, guided parents through the early childhood support process for many years. Niles explained the various service routes to parents and says the route a family takes depends largely on their pediatrician’s recommendation.
If a family is unsure of a diagnosis but suspects their child needs early intervention, they often begin with CA Early Start. Parents fill out paperwork and within 45 days children are assessed in five areas of suspected delay: large motor, fine motor, language, social skills and adaptive skills. Once a child has been assessed and determined to be eligible, services begin in a reasonable amount of time through SDRC.
When a pediatrician is sure of global delay in a child 0-6 years of age, the doctor may send families to the Rady Children’s Developmental Evaluation Clinic where similar tests will be performed. The clinic may refer the family to Rady Children’s specialists or to SDRC for early intervention services. If children don’t meet the criteria for these services, but still appear mildly delayed or parents need support, they may be referred to First 5 San Diego, where programs meant to bridge the gap (such as Kindergarten Camp and parent training) are available through funded programs at Family Health Centers and Rady Children’s Care Connection (C3).
Parents are the best advocates for their children. If you sense something is wrong, trust your instincts and get help soon. Visit your pediatrician and the websites listed below. For an extensive list of services in San Diego and Imperial Counties, access the Special Needs Resource Foundation of San Diego and Flourishing Families, the guide for families of children with special needs.
Exceptional Family Resource Center (EFRC)
www.efrconline.org (CA Early Start intake)
First Five San Diego
Special Needs Resource Foundation of San Diego
Emily Dolton is a SNRFSD resource parent and the mom of two, one with 22q 11.2 Deletion Syndrome.