ediatricians who start their practice afresh know
principles of development and milestones by heart. As they start getting
busy, the practice starts becoming ‘gross motor’ and vaccination
supersedes developmental assessment! They get fumbled when anxious
mothers ask: ‘Whether my child is normal or abnormal ?’ ‘What can I do
for detection?’ ‘What will be his future?’ ‘What can I do to increase my
child’s intelligence?’ ‘My child is not behaving properly; is there any
way to bring him on the track?’
The program in IAP Action plan 2016 – "Cradle to
Crayons" – aims at sensitizing a common pediatrician on child
development. Development starts from cradle and continues right upto
school where child starts performing, writing and drawing using crayons.
This critical period of early childhood is very important; the role of
pediatricians in child development is multifold and unique. In early
years, when a baby is brought for check-up/vaccination, while measuring
height and weight, we can watch the development of the child. This
developmental watch will hardly take a minute, but it will help us to
pick up developmental deviations at the early age. A pediatrician has to
be enabled with the knowledge of developmental milestones and simple
screening tools for developmental disorders. Well baby visit or
immunization visit is an opportunity for development watch, early
intervention and parent counseling. One should not miss it. It will be
worthwhile putting up charts providing age-wise information on
vaccination, feeding, milestones and red flags, in the clinic. For
example, when a child presents at 6 months of age, the pediatrician,
after administration of OPV1 and HBV3, can give advice on complementary
feeding, check for milestones like rolling over in both directions,
bringing things to mouth, responding to own name, and knowlege of
familiar faces. Inability to roll-over and absence of babbling/squealing
should be considered as red flags.
The survival of high-risk neonates has improved
considerably in the past three decades due to improved perinatal care,
but the quality of survival is also important [1]. These high risk
neonates remain at a substantial risk for long-term morbidity, including
cerebral palsy, developmental delay, intellectual disability, school
problems, behavioral issues, growth failure and overall poor health
status. When it comes to intact survival, the care beyond neonatal
intensive care unit (NICU) is forgotten. The job starts right at the
doorstep of NICU [2]. The program ‘cradle to crayons’ starts with NICU
advice, identification of high risk, screening the children, and simple
advice for parents to stimulate their child. Pediatricians need to be
empowered so as to enable the child to achieve maximum potential.
Although a continuous process, the initial years of
life and pre-school years are the most critical period in the child’s
development [3]. Developmental problems are one of the most prevalent
health problems among children and adolescents. We need to be prepared
to evaluate and identify factors that may influence normal child
development. We are also responsible for prevention, early diagnosis and
coordination of the multidisciplinary treatment of these patients in
addition to basic medical assistance that is essential to guarantee a
good quality of life [4]. We all should know that the developmental and
behavioral problems are taken care of by a team of professionals where
developmental pediatrician is master of orchestra. The team includes: (a)
clinical psychologist who can administer developmental tests as well as
can give inventories; (b) educational psychologist who gives
guidance on study skills and examination techniques; (c)
counselor who is necessary for handling stress in parents as well as to
give different ways to solve their problems; (d) physiotherapist
who is necessary for correction of tone abnormality as well to manage
motor delay in children; and (e) occupational therapist who gives
guidance for handling, positioning, bathing, daily care, dressing,
feeding etc. Pediatricians – at the centre of this team – can
help the parents to coordinate with this team for the best results. The
knowledge imparted in ‘cradle to crayons’ will also help pediatricians
to guide the parents with ‘Facts and Acts’ about various developmental
disorders. Pediatrician should learn simple and quick screening tests.
Appropriate use of such screening tests will help pediatricians to
diagnose developmental disorders at early age and start early
intervention. Research shows that early intervention treatment services
can greatly improve a child’s development and help children from birth
through 3 years of age learn important skills. Services include therapy
to help the child talk, walk, and interact with others [5]. Making child
emotionally intelligent is also the need of hour. Nurturing emotional
intellingence skills at an early age acts as the ‘psychological
vaccine.’ Emotional intelligence is the key to body-mind wellness.
Children and their parents should learn emotional skills to become
successful as well as to face stress in their life. This also implies
understanding parenting style and its emotional consequences [6].
The Craze of ‘Fast Schooling’: Parents nowadays
are crazy about putting their tiny tots in an aggressive academic
oriented pre-school, in spite of awareness of child-centered education,
knowing the importance of ‘learn through play’ and advice by
pediatricians and child-friendly educationists. Probably this attitude
comes from our ‘immediate gratification’ culture. We, in our modern,
fast, computer-based world, expect to change the world by ‘a touch of
finger.’ Similarly, the parents want their children to achieve great
academic feats at an early age. This pushes the child on a wrong track
that may ruin their beautiful childhood. Here we should remember a
simple analogy – the artificially ripened mangoes may look more
attractive than the mangoes which take time to ripen on the tree; but
when you taste them, you know the difference!
Let us SHARE:
S: Set the tone: create a holding
environment in the context of the pediatric visit.
Support parent and child, Build a therapeutic
alliance.
H: Hear the parents’ concerns about their
child’s behavior and development.
A: Address specific risk factors for
child development and family functioning.
Allow parents to reflect how cultural
conditions contribute to their expectations of child behavior
and development.
R: Reflect with parents their experience
of their child.
Reframe child behavior and development in
terms of the child’s developmental level.
Revisit the therapeutic goals set.
E: Empower the parent and child by
formulating an action plan to address the concerns voiced during
the visit.
The development of a child is a continuous process.
It continues right into adulthood. We too are developing. We need to
develop academically too! The experts, I am sure, will take us on a joy
ride along this path. We all are torch bearers, and I earnestly expect
our colleagues to take this knowledge to each corner of the country and
help every child. I hope that our colleagues get ‘stimulated early’ with
‘cradle to crayons’, and at the first birthday party, the child ‘waves
bye bye’ to the pediatrician who leaves with an advice on diet and
vaccines.
References
1. Elenjickal MG, Thomas K, Sushamabai S, Ahamed SK.
Development of high-risk newborns: A follow-up study from birth to one
year. Indian Pediatr. 2009;46:342-5.
2. Purdy IB, Craig JW, Zeanah P. NICU discharge
planning and beyond: Recommendations for parent psychosocial support. J
Perinatol. 2015;35(Suppl.1):S24-8.
3. Holden GW. Childrearing and developmental
trajectories: Positive pathways, off-ramps, and dynamic processes. Child
Development Perspectives. 2010;4:197–204.
4. Miranda LP, Resegue R, De MeloFigueiras AC.
Children and adolescents with developmental disabilities in the
pediatrics ambulatory service. J Pediatr (Rio J). 2003;79 (Suppl
1):S33-42.
5. CDC Fact Sheet, Learn More about Your Child’s
Development: Developmental Monitoring and Screening, 1-800-CDC-INFO
(1-800-232-4636).
6. Alegre A. Parenting styles and children’s emotional intelligence:
What do we know? The Family Journal. 2011;19:56-62.