What's Goin On With My Baby?
Babies change so much during the first two years. Here what's normal (and what's not).
Parents often wish their babies came with an instruction manual, but manuals are meant for machines. When it comes to child rearing, your pediatrician is the one who can guide you through the early stages of your child’s development.
“Various concerns may arise in the first years of life,” observes Janet Geiger, a pediatrician with River City Pediatrics. “The key is to observe and follow-up frequently for improvement of conditions and concerns.” We spoke with Dr. Geiger to find out what some of the issues are that affect your baby during the first two years of life — and when those issues might require a specialist’s attention.
MP: A lactation consultant can get the baby started on a breast-feeding routine. What are some of the common feeding issues and when should I seek a specialist’s help?
Geiger: Following delivery, a consultation is often done with a lactation specialist. Once you arrive home, common issues during the first week are that mother’s milk is not adequate, that the baby does not latch on well, and that establishing a breast-feeding schedule can be difficult. Generally, a pediatrician can help you work through these issues. Close monitoring of the baby’s weight is crucial in determining whether a specialist’s help is needed.
MP: How often do you come across vision problems such as blocked tear ducts, cross-eyes, lazy eyes, or droopy eyelids? When should a child be seen by an ophthalmologist?
Geiger: Blocked tear ducts are common; nearly all resolve by 6 months of age. However, should the condition persist, a pediatric ophthalmologist may need to intervene surgically.
Many infants have the appearance of cross-eyes due to a flat nasal bridge with broad skin folds on the sides; they aren’t actually cross-eyed. In the first few months, a baby’s eyes may wander, thus appearing crossed. The wandering is transient, and this too generally resolves after a few months. On the other hand, true cross-eyes leading to lazy eyes and droopy eyelids that interfere with vision need referral to a pediatric ophthalmologist as soon as the condition is recognized. Early intervention in these cases is important to preserve vision.
MP: Ear infections are very common in babies. What should I watch for and when should I take my child to an ear, nose and throat (ENT) specialist?
Geiger: Frequency and/or persistent ear infections dictate when to see an ENT doctor. A cluster of four or more infections within six months or an ear infection that persists despite sequential antibiotic treatment would be cause for referral. If hearing loss is suspected, especially if there is delay in language development, one would want to refer earlier.
MP: How common are signs of eczema or diaper rash in babies?
Geiger: There is a wide spectrum of eczema, from one small isolated area of skin to nearly the entire body. Eczema is generally seen more in cold weather. It is not really a common problem. There is also a wide spectrum of diaper rashes — from a few tiny red bumps to bleeding, raw red skin covering much of the diaper area. Contact with urine and stool under the confines of a diaper leads to diaper rashes; so it is fairly common. When your child has diarrhea, the increased frequency of stools can make a rash worse. Most skin issues, such as eczema and diaper rash, respond to standard topical ointments or creams.
MP: Crawling, walking, and using hands to play are indicators of your baby’s gross motor skill development. What should you watch for and when should you seek professional help?
Geiger: Pediatricians assess a child’s growth and development at each check-up visit by asking you questions and by examining your child. There are also written questionnaires used at many offices that can be scored to measure all five areas of developmental skills (language/gross motor/ fine motor/ cognitive-adaptive/ interpersonal-social).
Although specific milestones are met at specific ages, there is a range in time when new skills develop as well as a range in the way skills are mastered that are considered normal. Just like many things in nature, there is a bell-curve distribution for developmental skills. If delays are recognized, close follow-up is arranged. If the delay is significant and/or a follow-up does not show the expected improvement, a referral (for children under 3) is made to the State Early Intervention Program (TEIS in Tennessee).
MP: What are some indications of communication problems?
Geiger: Language is one area parents are more concerned about. Parents worry about what words a child can say at a particular age rather than focusing on what he or she understands. Parents don’t always realize that non-verbal communication, such as pointing to a picture to identify an object or using sign language, is part of language development. During the first two years, receptive language is developed far ahead of expressive language.
Unless a child has physical problems such as a cleft lip or palate, it is highly unusual for you to need a speech pathologist during the first two years of life.
MP: How do you measure cognitive skills?
Geiger: Certain cognitive skills, like any other developmental skills, develop at certain ages. For example, the recognition that some people are strangers (and thus a child acting fearful) begins at 4 to 6 months. The examination of a toy by passing the toy between one’s hands and flipping the toy to “study,” it is a skill that begins around 6 months. Pediatricians ask parents/caregivers questions and examine children during check-up visits to measure these skills, and arrange for follow-up and/or referral if there are concerns.