Beyond the Label

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Baby's First Year Matters

The first year: what every parent needs to know about developmental milestones

 

By: Karen L. Schiltz, Ph.D., with guest, Aimee Ketchum, OTR/L, CNMI

“Jack said his first word at 12 months old. He is now 21 months old and says just a few words. It seems as if Jack is falling behind. My parents think this is happening because we have a babysitter who speaks Spanish. My mother thinks Jack will be o.k. However, his vocabulary is really limited and Jack does not really respond to his name, directions, and even questions. What should I do at this point? Should I worry about this?”

“It is so competitive out there. All the parents at my child’s school want their child to be # 1. My daughter, Isabella, is not walking yet and she is already 15 months old. Is this normal?”

“I have read many books about walking before crawling and there are exercises in these books to get a child to walk earlier and maybe even skip crawling. Should I do these exercises with my son, Anthony? Does every child need to crawl before they walk? It just seems that Anthony would be further ‘ahead’ if he just learned to walk instead. Is that true?”

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“Is it possible to ‘spoil’ a baby? My husband tells me not to pick up Natalie so much. Natalie is four months old. I think playing and reading to her is good for her. Am I right or am I spoiling her?”

These parents are clearly concerned at this point. I’m sure every parent wonders whether his/her baby is “normal” and if they are doing the “right thing.”

To explore this topic, I recently interviewed pediatric occupational therapist, Aimee Ketchum, founder of Aimee’s Babies. Aimee has worked for years with babies, toddlers, and school-aged children, many of whom had treatable developmental delays. These delays were subsequently due to the result of missed or under-developed milestones in the first year of life.

 Aimee and I share a common thread. As a pediatric neuropsychologist, I wish to educate parents about development so they recognize healthy development as well as unhealthy development. By doing so, parents can be an advocate for their child and work with their pediatrician to take care of problems before they surface into a big problem.

Aimee agrees! What was interesting to me when reviewing Aimee’s Babies website, blog, and her DVD’s were her upfront thoughts on normal development and the warning signs parents should look out for as their baby develops. What was particularly thought provoking to me was her candid discussion of popular myths that we all have heard about especially when a baby develops during the first year.

 

 

Karen Schiltz, Ph.D.: Thank you, Aimee, for joining this educational blog. First, what is an occupational therapist?

Aimee Ketchum, OTR/L, CNMI: Occupational therapy (OT) is an allied health profession. We work with people of all ages and diagnoses from newborn to geriatric and physical disability to psychiatric disability. Our goal is to use our skills as therapists to help people be as independent as possible. Most of our therapy is activity-based therapy. Where a physical therapist would use exercises, we practice the actual activity, such as getting dressed, kicking a ball, writing with a pencil, or making a meal. We adapt activities and environments to help people be independent. As a pediatric OT, I help children be independent with play, school, self-care, activities, eating, and general movement.

Karen: I enjoyed your DVD, First Year Milestones. Your DVD was informative because it answered questions parents typically have concerning their baby’s first year of life. What are some key points parents should know during this first year?

Aimee: The key points all parents should know about the first year are: Babies should reach all milestones sequentially, never skipping any, babies development should always progress, never regress or plateau, and babies require tons of stimulation. I always like to point out that babies learn so much new information in the first year that their brain actually doubles in weight when they are adequately stimulated.

Karen: I brought up the concerns raised by Jack’s mother. Should she be concerned at this point? And if so, who should Jack’s mother talk to?

Aimee: Early speech is very highly variable! It is perfectly within the normal range for a 21 month old to say 50 words or 150 words, so the lack of words spoken is not a huge red flag. What is concerning at this age is the lack of interaction. By six months babies should be responding to their name and imitating sounds and by 12 months they should be responding to questions with gestures at least. It sounds like Jack would benefit from an early intervention speech evaluation. If his motor skills are falling behind, he may also need a physical therapy (PT) and OT evaluation and if his social skills have truly regressed, he may need an evaluation from a neurologist. Lack of social interaction across the board can be an early sign of autism spectrum disorder.

Karen: Isabella and Anthony’s parents are clearly worried about motor skills. Is it advisable for a baby to skip a developmental milestone such as crawling? Is this even possible? Can you please educate us on why every milestone builds on a previous one and the implications of this for later development?

Aimee: Isabella and Anthony should definitely not skip the crawling milestone. It is vital to early development. As each developmental milestone builds on the previous one, no milestone should ever be skipped, but crawling is really important. The five or six months that babies spend crawling are the only time in our lives that we spend an extended amount of time on our hands and knees. When babies weight bear through their shoulder and hip girdle, they are helping to strengthen these stabilizing muscles and joints as well as all of the trunk muscles. Babies cannot develop fine motor coordination without core strength and control. In addition to strengthening, crawling has an important sensory component. The contact of hands and legs on the floor and carpet helps babies to build sensory awareness and overall body awareness, which will help with coordination skills later on.

The most interesting thing about crawling, in my opinion, is that it also helps visual development and reading skills later on! Not just because babies are close to the floor and all their toys, but the reciprocal movement of left, right, left, right arm and leg movement helps to strengthen the corpus callosum, the part of the brain that connects the left and right hemispheres. Reading requires both sides of the brain to work together, so the repetitive crawling movement primes the brain for vision and reading skills.

Some babies prefer to pull to stand and cruise on furniture instead of crawl. My youngest daughter was one of those babies. I just kept picking her up and placing her in the middle of the floor and making her crawl.

Karen: Natalie’s father thinks that his wife is spoiling Natalie because she spends so much time with her. Can a baby be truly spoiled?

Aimee: It is impossible to spoil a four-month-old baby. Any attention you provide them will just stimulate their brain and help those important connections to form.

Karen: Clearly, knowledge is power when raising a child. You describe what a parent should expect from the newborn stage to 12 months in your DVD. I like that you also provide everyone with the warning signs when something is not quite right during those stages of development. You also suggest helpful exercises, which are important when interacting with your baby. Could you please describe some of the exercises to enhance a baby’s development during the 10-12 month period?

Aimee: At 10-12 months most babies are on the move. They are typically crawling and starting to pull themselves to stand. One of my favorite exercises for this age is balancing on a beach ball. A small beach ball from the dollar store is all you need. Place your baby on the beach ball on their back or tummy, and hold onto their waist as you rock them forward and back and side to side. You can also sit your baby on the ball and gently bounce them and rock them forward and back and side to side in sitting, using your body to support them on the ball. Babies love this activity and it has so many developmental benefits. It helps to build trunk and neck support and strength and helps with balance skills. It also helps with body awareness and awareness of position in space.

Karen: Thank you, Aimee, for your time in answering these important questions. Can you please tell us about your background in occupational therapy and about your educational materials?

Aimee: Thank you Karen! I earned my BS in Occupational Therapy at Misericordia University 17 years ago and have worked primarily in pediatrics ever since. I have also done some work in rehab, neuro, amputee, psych, geriatrics, and brain injury. After I had my own children, I learned the true value of baby massage and I got certified in Baby’s First Massage. I also got certified as a yoga instructor with a special certification to teach yoga to children with special needs. While working in a neonatal intensive care unit, I learned that parents of children with special needs require a lot of support and education and I decided to combine all my passions to create a program to provide this support. I started making DVDs, videos, and apps to teach baby massage, early developmental exercises, and basic milestone awareness. I call my business, Aimee’s Babies, because my mission is to give all babies everywhere the best start possible!

Karen: Clearly, you point out that a baby needs to progress and not regress during the first year. In addition, an infant should never skip a developmental milestone because every milestone builds on a previous one. Last, we know that active parenting (one-on-one parent-to-baby contact) involves providing lots of experience and stimulation for the newborn and infant because the essential wiring of the brain linked to learning is just beginning. Most of all, you made it very clear that parents need to educate themselves about their child’s early development and to seek out consultation from their pediatrician if something is “a little off.”

*Thank you, Todd and Crystal, for sharing the beautiful moments of your lovely twins, Drake Otis and Savannah Betty, after they were born!

Karen Schiltz, Ph.D. is a clinical psychologist who maintains a private pratice in pediatric neuropsychology in Calabasas, California.

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