Reprinted from the summer issue of The Ohio Family Physician
By: Laura L. Sorg, MD, FAAFP, Medical Director, Ohio Department of Developmental Disabilities
“Let’s wait and see. Maybe we can re-evaluate in six months?”
I heard those words coming out of my mouth before I could even realize what I was saying.
The mother of a 24-month-old sighed with relief as her son played with a toy on her lap. It was 2013 at the end of a long day in my bustling group practice. We had reviewed feeding, sleep, anticipatory guidance, safety, and his development at his two-year well child check. I noticed a bit of a speech delay, but he was otherwise doing very well. He was meeting almost all of his developmental milestones, but his expressive and social speech was a bit delayed.
Fast forward to 2022, I now absolutely realize that “Let’s wait and see” may be one of the biggest medical myths in primary care, especially when it comes to a child’s development. It can be fueled by multiple items: time, access, and anxiety on both the physician and parents.
Speaking of time…time in development is critical. A child’s developing brain is most apt to learn and retain new knowledge in the first few months and years. According to the Center on the Developing Child at Harvard University, sensory and language pathways acquire the most growth during the first year of life.1
This neuroplasticity is discussed at length on its website, and is mentioned in its publication, InBrief: The Science of Early Childhood Development.2 In particular, the Center highlights that “the basic principles of neuroscience indicate that early preventive intervention will be more efficient and produce more favorable outcomes than remediation later in life.”
You or a parent may ask: “What’s the harm in waiting?” The inappropriate ‘wait and see’ philosophy may result in delays in school readiness, social skills, and academic skills, as well as an increase in mental health issues later in life.
In the January 2020 article of the American Academy of Pediatrics’ publication, Pediatrics, “Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders through Developmental Surveillance and Screening,”3 the authors highlighted the need for physicians to administer developmental screening at the nine, 18, 24, and 30 month visits.
The COVID-19 pandemic introduced new topics, prompting growing concerns in our minds as physicians, as well as in those of young families. Caring for an infant or a toddler during a pandemic, in a work-from-home world, caused many families to have delayed well-visits, routine physicals, or referrals. Between screenings for growth, development, safety, the physical exam, and anticipatory guidance, there is little time left for administering other testing, let alone interpreting results or providing resources during these well-visits.
As the astute physician knows, there are a multitude of instruments designed to assess the developing child. The Modified Checklist for Autism in Toddlers (M-CHAT), the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE), and the Denver Scale are amongst the most common instruments that should be considered. These items are free and easily administered in the office setting.
If a positive finding is seen on a screening instrument, action must be taken. Avoiding the ‘wait and see’ mindset can set the tone for the family, as well as save months or years of time and resources spent on therapies later in life when the developing brain is less likely to pick up on changes.
Key interventions should be discussed and may include occupational therapy, speech therapy, and physical therapy. A bevy of local resources exist regionally—often associated with children’s or local hospitals.
One of the simplest, but most effective referrals we can make as family physicians for children under three can be to Ohio Early Intervention. Early Intervention (EI) is often referred to by doctors or local resources as ‘Help Me Grow.’ EI is research based and provides support and resources to assist family members and caregivers. EI enhances children’s learning and development through every day learning opportunities. Infants and toddlers learn best through every day experiences and interactions with familiar people in familiar contexts. All families, with the necessary supports and resources, can enhance their children’s learning and development. EI is available statewide and is woven into federal law.
- Enhance the development of infants and toddlers with disabilities
- Maximize the potential for individuals with disabilities to live independently in society
- Enhance the capacity of families to support the development of their children
- Reduce the educational costs to our society by minimizing the need for special education and related services
- Enhance states’ ability to coordinate funding to provide services for infants and toddlers with disabilities.5
Referring to EI is simple. A HIPAA safe referral form is available online. Physicians may also call 800.755.4769 to place a referral.
To streamline processes further, referrals for EI, WIC, or Home Visiting programs in the State of Ohio can be made online.
The ‘wait and see’ philosophy is an outdated medical myth. The danger of losing time (and neuroplasticity) is evident. It’s time to eliminate ‘wait and see’ from our vocabulary as physicians on the topic of development.
References available online on the Ohio Academy of Family Physicians website.