Early Intervention: Know the Red Flags

                              Navigating Developmental Milestones:

When to Consider Pediatric Occupational Therapy

As pediatric occupational therapists (OTs), we frequently encounter parents who are diligently observing their children's development, wondering if they're on track while seeking guidance and support. It's a natural and commendable instinct. Sometimes, it's hard to know when a little quirk is just that, or a sign of something that needs professional attention.

Understanding when to seek help can feel challenging, but recognizing potential developmental red flags early on is key.

Today, we want to provide you with clear, actionable insights into recognizing potential developmental red flags. Pediatric OTs help children develop the skills they need to participate fully in their daily activities - from fundamental motor skills to complex sensory processing to cognitive-perceptual skills...with the aim to empower children to achieve their optimal functional independence.

Early identification and early intervention can make a significant difference in a child's development, helping them build a strong foundation for future success and fostering their developmental trajectory. 

Recognizing Developmental Red Flags (Expert Insights):

Through ALL STAGES & AGES

1) Fine Motor Skill Observations: We often assess children experiencing persistent difficulty with refined & precise hand movements or fine individual muscle control as observed as :

1. Difficulty grasping small items like beads, raisins, or Cheerios. 

2. Difficulty using hand tools /utensils such as spoons or forks. 

3. Early writing difficulties where the child uses their whole fist to grasp a crayon or a pencil instead of a tripod grasp. 

4. Consistent clumsiness when handling said small objects. 

5. Avoidance of activities requiring fine motor skills such as pincer grasp to hold small objects.

If you observe your child struggling with these age-appropriate fine motor tasks, a professional evaluation is warranted.

2) Gross Motor Skill Observations: Delays in achieving expected gross motor milestones, such as rolling, crawling, or walking, should prompt a thorough assessment. These difficulties can manifest as:

1. Early movement: Limited leg movement in infants, poor head control, not pushing up during tummy time, difficulty rolling.

2. Sitting and standing: Unable to sit independently by 9 months, not pulling to stand by 12 months.

3. Walking: Not walking independently by 15-18 months, persistent toe walking, frequent falls.

4. Coordination and balance: Difficulty running, jumping, hopping, kicking, catching, or balancing for their age.

5. Overall movement quality: Stiff or awkward movements, relying on unusual ways to move (like "walking" hands up legs to stand).

6. Regression of milestones: Losing previously acquired gross motor skills.

These red flags suggest a need for further assessment by a healthcare professional or therapist as these can impact a child's participation in age-appropriate physical activities.

                                      

3) Sensory Processing Observations: Sensory processing differences can significantly impact a child's daily life.  We observe children who exhibit heightened sensitivity to sensory input or those who seek out intense sensory experiences. Watch out for:

1. Extreme reactions (tantrums, avoidance) to everyday sensory experiences like loud noises, bright lights, toe-walking, closing ears, humming, avoiding certain textures of clothing or food, or being touched.

2. Unusual seeking behaviors, such as constantly touching things, crashing into objects, or seeking intense movements like spinning.

3. Apparent lack of response to stimuli that others notice, like not reacting to their name being called or seeming unaware of pain.

4. Difficulties with daily activities like dressing, grooming- hair-washing, nail-cutting, hair-cutting, brushing teeth, etc., and eating due to sensory sensitivities.

5. Clumsiness or poor coordination that may be linked to body awareness/ body schema.

If you notice several of these signs consistently, it's important to seek professional advice from a pediatrician occupational therapist.

4) Social and Emotional Skill Observations: Social interaction & emotional regulation are integral to a child's overall well-being, & its challenges affects child's social play, emotional control, and the ability to navigate transitions. These skills are fundamental for successful participation in various settings. Social & emotional skills difficulties may manifest as:

1. Infants: Lack of smiling/interaction, avoids eye contact, hard to soothe, no back-and-forth social engagement.

2. Toddlers: No interest in peers, doesn't imitate, extreme separation anxiety (excessive distress when separated from parents or caregivers), flat emotions, rigid routines, aggression.

3. Preschool: No pretend play, trouble sharing/turns or understanding personal space (frequently grabs others’ toys), can't cooperate, doesn't understand feelings (can’t tell if someone is happy or sad), social withdrawal, intense emotions (intense tantrums, difficulty managing frustration, meltdowns).

4. School-Age: Difficulty making/keeping friends (plays alone, has no close friends), isolated, misses social cues, poor conflict resolution, lacks empathy, avoids social situations.

5. General: Consistent difficulty with emotions, relationships, or social situations for their age.

5) Learning and Attention Observations: Cognitive and attentional skills are closely linked to a child's ability to learn and engage in academic tasks. We look for the following difficulties: 

1. Infants/Toddlers: Slow to respond, little exploration, doesn't follow simple directions.

2. Preschool: Difficulty focusing on activities, can't follow multi-step instructions, trouble remembering simple things, struggles with basic concepts (colors, shapes).

3. School-Age: Difficulty focusing in class, trouble organizing tasks/materials, easily distracted, poor listening skills, struggles with following directions, forgets learned information, difficulty completing work.

These challenges can impact a child's academic performance and overall learning experience.

6) Cognitive Skill Observations: Be aware of potential difficulties with basic thinking & learning. This can manifest as significant delays in 

1. Language development (not saying single words by 18 months). 

2. Difficulty understanding simple directions for their age (not understanding “where is your nose?”). 

3. Struggles with basic concepts like colors or shapes (for preschoolers). 

4. Challenges understanding basic concepts like “big” and “small” by age 4.

5. Lack of interest in exploring their environment (in younger children).

6. Difficulty remembering / recalling already learnt information / narrating day's events in sequence.

7. Slowness in responding to stimuli/ question/ information received

8. Difficulty with logical reasoning for their age.

 

7) Executive Function Observations: Observe difficulties with higher-level thinking skills needed for goal-directed behavior. 

1. Impulse Control: Acts without thinking (difficulty waiting, grabs toys from others, blurts out answers, interrupts/ butts in).

2. Working Memory: Forgets instructions right after hearing them, struggles to hold information in mind to solve a problem.

3. Cognitive Flexibility: Gets very upset by changes in routine, struggles to switch between tasks.

4. Planning & Organization: Difficulty starting tasks, messy backpack/desk, trouble breaking down big projects.

5. Task Initiation: Procrastinates or avoids starting tasks, even easy/ known ones.

6. Self-Monitoring: Doesn't notice their own mistakes, unaware of how their behavior affects others.

7. Emotional Control: Has intense emotional outbursts that are hard to regulate.

These include inflexibility in behavior or thinking, & challenges with self-monitoring.

Professional Guidance: What to Do ??

• A comprehensive developmental skills assessment by a qualified pediatric occupational therapist can provide valuable insights into your child's developmental needs.

• List down detailed observations of your child's behaviors & challenges- it can be invaluable during the assessment process.

• Advocate for your child's needs. We are here to support you in navigating this process.

Conclusion:

• Early identification & intervention are critical in empowering children to reach their full potential. 

• Pediatric occupational therapy offers evidence-based therapeutic tools & strategies to address developmental challenges & promote functional independence.

• At Anmol Child Development Clinic, Kandivali, where we are committed to providing compassionate and expert care to children and their families in form of Pediatric Occupational Therapy services- screening, consultation, assessment, OT sessions, parent training sessions as well as online services...

Call to Action:

• Contact Anmol Child Development Clinic, Kandivali to schedule a consultation & learn more about our services. Request a Call-back

• Share this information with your network to raise awareness about developmental red flags.

• Engage with us by leaving your questions & insights in the comments section.

“Learn the Signs. Act Early.”

Be aware of your child's development, & if you have any worries, reach out early. We, as occupational therapists and the wider support system, are here to help your child bloom..

Thank you for patient reading,

Feel free to connect us.

- Dr. Aakanksha Patwardhan (MOTh), 

Pediatric Occupational Therapist

- Dr. Pooja Mehta (MOTh, FAOT, MA-Psychology), 

Pediatric & Mental Health Occupational Therapist

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