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Talk Walk & Roll: Childhood Behavior & Development

Online Health Chat with Lynn Milliner, MD

January 30, 2013

Introduction

Did you know that well-child visits at the 9, 18 and 24 or 30 month marks are usually used to screen children for possible developmental delays and disabilities? According to the American Academy of Pediatrics, these specific checkups with standardized tests allow health care professionals to monitor a child’s health and development at the time of typical milestones. These include social and emotional breakthroughs, language and communication landmarks, cognitive improvements and physical development. Additionally, the Centers for Disease Control and Prevention have developed a list of major milestones that children should meet at the three-, four- and five-year-old well-child visits.

Childhood development is certainly more than growing tall and gaining weight. Certain medical conditions, such as autism and muscular dystrophy—among others, can be identified through such testing. Early and proper intervention when target developmental milestones have not been met helps ensure your child gets the attention he or she needs in order to get on a path for the best outcomes in life.

For More Information

On Cleveland Clinic
As a member of the Cleveland Clinic Children's Hospital staff, Lynn Milliner, MD is one of more than 50 pediatric primary care physicians who serve the well-being of newborns, infants, children and adolescents at convenient Cleveland Clinic locations throughout northern Ohio. Our pediatric physicians offer comprehensive general and preventive care, as well as care for children with complex or chronic health issues. With access to leading-edge diagnostic and treatment resources, as well as a total commitment to family-centered care, our pediatric professionals are well-equipped to diagnose and treat common, everyday illnesses, as well as serious childhood diseases and conditions like cancer, diabetes and attention deficit/hyperactivity disorder.

Cleveland Clinic Children's Hospital and Pediatric Institute provides primary pediatric care at Family Health Centers throughout the community as well as specialized and subspecialty pediatric care for the most complex cases at Cleveland Clinic Main Campus, Hillcrest and Fairview Hospitals. Our team includes board-certified pediatricians, nurses, nurse practitioners, therapists, social workers and other specialists who provide comprehensive, family-centered care for a wide variety of acute, chronic and complex children's illnesses.

On Your Health
MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult


For Appointments

If you would like more information on Cleveland Clinic Children's Hospital or the Department of General and Community Pediatrics, visit us online at clevelandclinicchildrens.org. To make an appointment with a pediatrician or pediatric specialist at one of our 30 convenient locations in northeast Ohio, please call 216.444.KIDS (5437) or call toll-free 800.223.2273, ext. 5437.


About the Speakers

Lynn Milliner, MD is an associate staff member and community pediatrician for Cleveland Clinic Children’s Hospital Pediatrics Garrettsville, in Garrettsville. Dr. Milliner is board-certified in pediatrics. Dr. Milliner completed her fellowship in developmental behavioral pediatrics and her residency in pediatrics at Rainbow, Babies & Childrens Hospital, in Cleveland. She graduated from medical school at the Case Western Reserve University School of Medicine


Let’s Chat About “Talk, Walk & Roll: Childhood Behavior & Development

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialist Dr. Milliner. We are thrilled to have her here today to discuss childhood behavior and development. Let's begin with some of the questions that have come in so far.


Colic

goldenrod: How do you know if a baby has colic? What can be done to treat it?
Dr_Miliner: This is a period between roughly six weeks and three months where an otherwise relatively content infant has long periods of crying and fussiness that are not related to feeding or changing. Infants often respond to rocking, holding, white noise or sometimes taking the infant out for a car ride. Be patient and if you are feeling overwhelmed, enlist the help of other relatives. By all means, contact your child's primary care provider for help with this very common but often stressful concern.


Physical Development

tulip_time: What are the typical milestone markers in a child’s development as it relates to rolling over, crawling, first steps and unaided walking?
Dr_Miliner: Development generally progresses from head to toe and centrally out to extremities. Rolling over begins around four to five months old As muscle and neural strength increase, sitting up unaided follows, and then crawling. Many will cruise around furniture after nine to 10 months of age, and are often walking at around one year of age.

chapter_1: Do you have any suggestions on how to encourage a baby to roll? To walk? My older child struggled with both of these and I’m seeing signs in my younger child that make me think this may happen again with him. I want to see if there’s any way I can prevent that from happening.
Dr_Miliner: Giving babies lots of floor time is a great way to spur development. When your baby is active and awake, place him on the floor with objects within reach to encourage your baby to move towards them. Keep an eye out for when the baby might becoming frustrated, but reward the achievement of these milestones with lots of smiles and applause. The same thing goes for walking—provide a safe environment to allow a child to cruise around a table or walk with a parent.

gingerbreadman: I know that coordination will be different in each child, but at what point do you know that there is a problem? Is there a way to help a child become more coordinated?
Dr_Miliner: Some children are ‘clumsy’ and seem more ‘accident-prone’. By the time a child enters elementary school, if they appear to lag behind their peers in terms of coordination and development, share your concerns with your child's physician. The solution may be as simple as providing more activity that may help strengthen already developed skills. Your child's physician can help with tips or identify issues that may require further investigation.


Breastfeeding

had_to: What are your views on the controversy created by the magazine cover of a woman breastfeeding an older child? In your opinion, at what age should a child be weaned from the breast?
Dr_Miliner: It's truly a personal choice. There is no argument that breastfeeding provides nutrition and bonding. Choosing the time to wean involves many factors.


Exercise and Your Baby

nettie: Do you think that exercising a young child makes a difference in their development? When my first son was born, I exercised with him all the time, moving his arms and legs as if he was crawling or walking (kind of like physical therapy). He crawled and walked at a very young age, and was very adept in his movements. I did not have the luxury of doing that with my next two kids, and they were a lot slower in these things. Did this make a difference or was it just coincidence?
Dr_Miliner: Probably a little bit of both. Every child develops differently and at their own pace. Exercising in this way provides just as much social interaction as it does physical activity. As long as your child grows, develops, and reaches milestones appropriately, there is no cause for concern.

jollyb: At what age is it good to start exercising with children or introducing sports? I want to encourage my child from an early age to be active and fit, so that hopefully it will last throughout her life.
Dr_Miliner: It is never too early to introduce your child to physical activity as part of a healthy lifestyle. With the advent of home games that feature physical activity, this can also be a great way to squeeze in some quality family time. By the time your child is school aged and older, introducing organized sports is a good way to further develop skills of following directions and rules, team play, and still provides an outlet for physical activity.


Verbal Language Development

grillers: What are the typical milestone markers in a child’s development as it relates to verbal interaction (cooing and laughing), words and sentences?
Dr_Miliner: This is one of the most exciting things to happen in development. Initially, babies coo and gurgle—often in response to parents' smiles and words. The initial smiles become social at around one to two months of age, and are priceless. Later in infancy, babies blow ‘raspberries’ and laugh. They start their first words of ‘Dada’ and ‘Mama’—often not correctly identifying the specific parent. From there vocabulary rapidly increases. Your child can say several words between 18 and 24 months of age. Around this time will start speaking in shorter sentences that become longer as the vocabulary grows.

lt3: I’ve read that a typical two year old knows around 200 words. I feel like my son only knows a few dozen words. Is there a test to check his development? How do you suggest trying to teach him more words so that he picks up more?
Dr_Miliner: The average range is somewhere between 50 and 200 words, and it sounds like your child is on track. The best way to encourage vocabulary development is to read to your child daily. Picture books are great. Make a game of it and have fun. Contact your child's physician if he doesn't seem to be catching up.

take_care: Will speaking baby talk really hinder a child’s development or ability to pick up on words? My mother used to yell at us when we spoke baby talk to my little brother, and I wondered if her claims had any merit.
Dr_Miliner: Baby talk is great—your child loves it and you do too! It is a great way to help strengthen the bond between a parent and child, and will not hamper language development in any way.

keep_going: My toddler is often unable to communicate her feelings verbally, although I know something is wrong. Is there a way I can pull words out of her to try and understand what’s making her feel the way she does?
Dr_Milliner: Be patient and talk to your child in a calm manner. Further questioning with choices for what may be going on—for example, ‘Do you want that toy?’; ‘Are you hungry?’; and ‘What can Mommy get for you?’ As your child’s vocabulary increases, your child will learn to express her feelings, wants and needs with words as well


Verbal Language and Reading Disorders

daddyo: At what age do you recommend starting speech therapy for a child that still has trouble producing certain sounds? My daughter is six years old, and still has problems with certain sounds. Her teacher hasn't said anything yet. Because I'm with her all the time I don't always notice. To me, that's just the way she talks. However, when family members who don't see her as often are around, they have made comments.
Dr_Miliner: Share your concerns with your child's physician who can help your child get a speech evaluation that will help determine if speech therapy is indicated. Minor articulation problems are not unusual at this age and may resolve over time. If needed, speech therapy can be started at any age.

granniev: At what age is a child typically diagnosed with dyslexia? How is dyslexia actually defined? My granddaughter reverses letters as she writes them (writes them backwards), for example, e's, p's, and b's. She is seven years old. Her father is dyslexic.
Dr_Miliner: Dyslexia is usually identified right around seven or eight years old. Share these concerns with your granddaughter's teacher who may be able to assist in having your child evaluated. If diagnosed, schools are very successful in helping to provide appropriate accommodations to help your child succeed academically.

call_me: When my child talks, her words sound muffled and clipped. Most people say she sounds normal. Do you think she needs an evaluation for this?
Dr_Miliner: Discuss this with your child's physician. How much others understand may be within the acceptable range. If it is a problem at school or for others outside your immediate family, your child's doctor may help alleviate your concerns.


Separation Anxiety

moonstruck: My baby has major separation anxiety, even if I just leave the room. Is there anything I can do to teach her that even when I step out of the room, I’ll be back? The situation is beginning to become very overwhelming as I can never really leave her side or she cries incessantly.
Dr_Miliner: Talk to your child while you are out of the room, so they can still hear your voice and know that you are nearby. Depending on the age of the child, you can help him or her develop ways to gradually lengthen the time that you are away. Enlist the help of other relatives or friends that may be able to distract or keep your child occupied while you are out of the room. Upon returning, give your child lots of attention to reinforce that you have returned.


Toddler Aggression

bogot: My daughter is 14 months old and very aggressive with new people. She pulls hair, snatches things out of people’s hands, etc. Do you have any suggestions on how I can stop her from being so aggressive?
Dr_Miliner: Respond with a firm, ‘No!’ Keep your instructions simple, age appropriate, and consistent. For example, just say, ‘No, we don't hit!’ When she is less aggressive, be sure to point out her good behavior. Overall, set a good example. Don't encourage others to hit back or snatch back. Help her find outlets, and make sure your daughter is not hungry, tired, overwhelmed or frustrated.

tell_all: My toddler likes to bite a lot. Do you have any suggestions for preventing biting and how to respond when he does bite?
Dr_Miliner: Give a strong and firm ‘No!’ Often your child will stop just by the tone in your voice. The temptation for some is to bite back, but this should not ever be the appropriate course of action. While it's not likely that this behavior can be prevented —if you respond quickly and sharply, your child will get the message to stop.


Preschool Enrollment and Adjustment

pop_stars: My wife and I are trying to determine when the best time is to enroll our son in preschool. She currently stays home with him during the day, and is able to devote a majority of that time to teaching him. But, we also know that child-to-child interactions are invaluable in teaching our son how to form relationships, collaborate, be independent, etc. Do you have any suggestions around timing or when you know it’s time to enroll in preschool programs?
Dr_Miliner: Excellent question. Sometimes exposure to group experiences and other social activities prior to starting school are helpful in smoothing that transition. Around three years of age is a good time to consider enrollment. Ask friends and relatives for suggestions. If available, other options are library story time  and mom-and-baby exercise classes, which are good outlets as well.

until_then: We just began taking my three-year-old daughter to a local preschool. It is becoming increasingly harder to leave her each day as she throws tantrums in the playroom when we begin to walk out of the door. Do you have any suggestions on how to ease this situation, so that she’s comfortable with us leaving?
Dr_Miliner: Enlist the help of the other providers in the preschool. Providing a more gradual time that you separate may help your toddler, or have the preschool provider be there to help calm down the tantrum. As with many stages in development, this too will pass if handled with love and caring.


Age-Appropriate Socialization

jessie: What happens developmentally when a young child is always treated like an adult? Is it good or bad? My sister talks to her four-year-old son as if he is her 'equal’, and acts and treats him in a similar manner. It bothers me—let a child be a child. What do you think?
Dr_Miliner: While there is not likely to be any long-term harm in talking to a child in this manner, the concern is more that the child may not understand the adult world given his age. Talking to young children like adults can not only make peer relationships challenging, it also hampers their ability to learn socialization and coping skills on their own. Age-appropriate conversation is better in the long run.

T_Ton: My first grader will not make eye contact with strangers, but will talk with family and friends. Should I be concerned?
Dr_Miliner: It would be more concerning if the child was not making eye contact with everyone—including family and friends. Some children are shy and more of the ‘late bloomer’ socially. Talk with your child's teachers to see if this is a problem at school. You can encourage this behavior by pointing out how well your child does this with family and friends, and this will help broaden this skill to others outside the family circle.


Playtime Socialization

helpme: How can you help a child stand up for herself when playing with friends?
Dr_Miliner: Be flexible. Let your child know that game playing should be fun. The keys to success are being able to take turns, learning how to both win and lose well, and not to play with friends if they are teasing, bullying, not sharing, or your child is unhappy or uncomfortable.


Childhood Frustration

helpme: How do I help a child overcome her negative behavior when she clams up, cries and thinks she is stupid when she cannot do or understand something? No matter what I do or say seems to make a difference.
Dr_Miliner: First reinforce that she is not stupid and validate what she is feeling at the time. Point out your child's strengths and keep an open dialogue. Let her know that it's OK to be frustrated or nervous. If she is doing something that's complicated, help her break down the activity into smaller tasks. It's OK to give her a little time to calm down and start over. Patience and encouragement on your part will go a long way towards helping her overcome her frustration.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic pediatrician Lynn Milliner, MD is now over. Thank you Dr. Milliner for taking the time to answer our questions today about childhood behavior and development. You provided a lot of strategies to think about.

Dr_Milliner: Thank you, this has been an absolute joy to answer these families’ questions. I encourage you to call your child's physician with concerns about development. And always enjoy, read to, and have fun watching your children grow and develop.


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