The American Academy of Pediatrics’ recent decision to move away from the “wait and see” philosophy to more proactive intervention when dealing with childhood obesity got me reflecting on how “wait and see” is still used in many other aspects of children's development.
My son was born 6 weeks early, which can be a real cause for concern for many parents including me. We had noticed that he seemed to be a little behind in developing grasping skills, so we decided to raise our concerns when we went to his 2-month check-up at the pediatrician. She told us to “wait and see,” after all, some kids will gain the skill a little later than others. The parent in me was reassured, but the Speech-Language Pathologist in me was less so. Medical professionals typically view clients or patients from the lense of their profession because that is their training. A speech-language pathologist often will look from a speech-language perspective, a physical therapist from a physical perspective, and a pediatrician from a pediatric perspective. Given I was concerned about my son’s physical development, I felt more comfortable getting an opinion from an occupational therapist while valuing what the pediatrician said. Thankfully, my son is meeting all his milestones, but this may be because I went against the medical recommendation to “wait and see.”
The “wait and see” method
Recently, I had an intake conversation with a parent to inquire about my speech services. The parent was concerned for her 6-year-old son. At his check-ups at both 4 and 5 years old, she was told to “wait and see.” Her now 6-year-old son is severely impacted by his stutter and no longer wants to go to school. Another parent called me to inquire about language services for her 3-year-old daughter. She was still not talking by the age of 2, and the pediatrician recommended she “wait and see.” Her now 3-year-old currently has three words in her vocabulary.
Now, I want to pose an entirely different scenario. If you had a small crack in your ceiling, and you contacted a contractor, what would you do if he told you to “wait and see” it may flood or it may be fine? ” There is a risk, we don’t know how much of a risk, but the risk exists nonetheless. Is it prudent to wait?
If the child who stutters had gone to a Speech-Language Pathologist when he was 4, he may not be as severely impacted by his stutter and could now be enjoying a more comfortable life in school. If the 2-year-old had gone to speech therapy earlier, she could have attained a larger vocabulary and may now be on a par with kids her age, or at least not be as far behind as she is now. Early intervention programs have been shown to yield many benefits including academic achievement and behavior
The “wait and see” method is very reassuring to parents because, from a medical professional’s point of view, it is true, many children develop skills at a slower rate and some children outgrow their stutter. It gives a parent the feeling that nothing is wrong. However, this begs the simple question, “is there any harm in providing services to your child if they do not really need it?” But the real question is, “what is the harm in delaying services if they need them?”
Did Early Intervention help my son?
I will never know whether occupational therapy helped my son with grasping or whether he simply needed more time to achieve the skill on his own. What I do know is that he did finally achieve the skill, and that is the most important thing.
Warning signs a child may need Early Intervention for Speech
Speech-language pathologists work with children who demonstrate, or are at risk for developing delays or disabilities in communication, speech, language, cognition, emergent literacy, and/or feeding and swallowing. It is hard to know whether a child may show signs of an impending delay or disability. The American Speech and Hearing Association (ASHA) provides a wealth of free information on all speech, language, and hearing disorders as well as red flags that may indicate a need for an evaluation.
Some signs that a call to your local Early Intervention may be warranted include:
Not smiling by 3 months old
Not babbling by 7 months old
Not understanding what others say by 15 months old
Not putting two words together by 1.5-2 years of age
Saying fewer than 100 words by 24 months old
Not saying the sounds b, p, m, h, and w 1-2 years of age
Has trouble playing with other children by 2-3 years of age
Repeating the first sound in a word (for example, “b-b-b-b-ball” for “ball”)
Prolonging sounds in a word (for example, “rrrrreally” for “really”)
Having a hoarse, scratchy, or breathy voice
Coughing frequently following swallowing food/liquid
Extreme pickiness with food preferences
The “wait and see” method may indeed be appropriate for some children, but we cannot predict which children need therapy and which may simply be a little slower to achieve skills. We can take the risk, or we can air on the side of caution. Think again about that crack in the ceiling and decide if you would rather fix it before the drip turns into a flood.
About the author:
Stephanie Jeret is a Speech-Language Pathologist and the owner of Speak with Stephanie LLC. She obtained her Bachelor's and Master's degree from the City University of New York. She has practiced speech therapy in a number of settings including outpatient rehabilitation, telepractice, skilled nursing facilities, schools, and a private practice. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including articulation disorders, receptive/expressive language disorders, and fluency disorders. Information is available by emailing her at firstname.lastname@example.org or by visiting www.speakwithstephanie.com.