Back on Track is the book for every caregiver who has worried about their child and wants to create change. It provides an action plan for parents to help their child thrive at school, at home and at play from Dr. Rebecca Jackson, a professional who develops and implements brain-based wellness programs.
In an exclusive article for Mayo Clinic Press, Dr. Jackson helps caregivers better understand developmental red flags.
Starting with pregnancy, parents are flooded with information on expectations for their baby’s development. Popular books such as “What to Expect When You’re Expecting” and pregnancy apps provide weekly and even daily updates on growth and development.
This level of detailed and specific developmental information continues through the toddler years. Blogs and social media, as well as books and apps, outline the many motor and social milestones kids should be achieving in the first few years of life. Additionally, this time is often filled with visits to the pediatrician for ear infections, possible viruses and well-visit checks. Each visit to the doctor’s office provides an additional check on your child’s growth and developmental progress.
As kids approach the preschool years, there are fewer books available for parents that detail developmental expectations in all categories. And often (hopefully) the number of visits to the doctor’s office begins to slow down. With fewer naps and more activities for the kids, parents find themselves with less time on their hands to read about continuing development. At this stage, parents often look to their preschool teachers or daycare providers to guide them and provide insight into their child’s development, and any possible concerns.
Preschools and daycares often have a classroom full of kids the same age, providing a chance to observe similarities and differences in development. But this can’t provide the full picture of your child’s development. Preschools and daycares don’t have the ability to see your child in all environments. Trust your gut and don’t be afraid to ask questions!
Don’t wait for a teacher to bring up a concern to you. If you have a concern or worry, ask the teachers to be extra observant and be open to hear their perspective on your area of concern. And if you ask a teacher for their insight, or they share an area of concern with you, listen! All too often parents become defensive the first time a teacher shares a concern, thinking, “It’s the teacher, the environment or the other kids.” Maybe it is, and maybe it isn’t. If a teacher is taking the time to bring your attention to something they’ve seen or experienced, listen, and start watching more closely.
Beyond the well-documented milestones of the toddler years, it can be hard for parents to know what healthy development looks like, and when to take action to support your child. Here are a few common examples of red flags for concern in early development that parents often miss.
Red flag: Bed wetting beyond age 5
“They’re such a deep sleeper.” “No fluids after dinner.” “Wake them up before you go to bed or in the middle of the night.” “They’ll outgrow it eventually.” While this advice is well meaning, it rarely solves the nightly dilemma of a child who struggles with nighttime accidents. Bed wetting, or nocturnal enuresis, can be defined as nighttime accidents that happen repeatedly in kids 5 years of age and older.
While there can be many contributing factors to nighttime accidents, including heredity, the brain and development also can play a role. In fact, kids who are diagnosed with developmental conditions such as ADHD or autism have a higher prevalence of experiencing accidents. The ability of the brain to accurately sense a full bladder, and control the muscles to prevent or allow urination, comes down to multiple pathways in the brain communicating effectively. These pathways are typically strengthened and improved over time with development. Accurate perception of the bladder — awake or asleep — and lack of control can be indicators that the brain is immature in one or more aspects of this process.
The fuller the bladder becomes, the further the bladder walls are stretched. This stretch triggers signals to the brain, announcing the level of urgency. The greater the stretch, the stronger the signal is to the brain stating that it’s time to go. For some kids, the brain doesn’t register the signal until the body is doing the equivalent of shouting, “It’s time to go. NOW!” By the time their brain registers the signal to act, it may already be too late. This can be an example of a child who experiences dysregulation in some aspects of sensory input and may be underperceiving signals, requiring a stronger signal for it to register in the brain. Kids who underperceive tactile input have up to a five times greater chance of experiencing bedwetting.
Red flag: Tantrums that are frequent or last longer than a few minutes
Tantrums. Meltdowns. Upsets. These challenges are well-known hurdles that accompany the toddler years and beyond as young kids assert their independence, while not yet having the ability to recognize and communicate their needs and wants. The result can be communication that happens with tears, flailing, and even hitting and biting.
This age is also known for quick swings in mood and emotions and easy distractibility. This means your child can go from happy to melting down in the blink of an eye but should also be able to be redirected with relative ease.
These tantrums and meltdowns are all reactions that are considered a normal part of development. But when the tantrums are more frequent, more disruptive or last longer than a few minutes, this can be an indicator of problems with emotional regulation. While there can be many contributing factors, when a developmental delay exists, there can be a higher likelihood of challenges with emotional regulation.
The majority of tantrums for kids ages 18 months to 5 years should last five minutes or less and can be expected to be physically aggressive some, but not all, of the time. During these years, the frequency of the tantrums is expected to reduce significantly from up to a few episodes per day, to only occurring on occasion.
With improved development comes increased control, and an improved ability to manage reactions and behavior. If your child is experiencing tantrums that consistently last longer than five minutes, if they are physically aggressive more often than not, and if they are staying the same in frequency, or increasing over time, this can be an indicator of immaturity of development.
Red flag: Sensory sensitivity not changing with repeated encounters
Whether it’s keeping socks, shoes or clothing on, becoming upset with dirty hands, or screaming in reaction to water in their ears at bathtime, sensory discomfort can present in many different ways for kids beyond picky eating and a dislike of fireworks.
The first time encountering the feel of sand on the hands can be an unfamiliar and upsetting feeling. Perhaps the sand is cold and wet, and your child can’t figure out how to get that gritty feeling off. Then over time, with multiple positive experiences at the park in the sandbox, it is expected that they become familiar and comfortable with the feeling of sand on their hands.
Each time the brain encounters something new it utilizes a lot of resources to process and catalog the novel information. It is expected for kids (of all ages) to become unsure or uncomfortable when experiencing something for the first time. Then, with repeated exposure over time, the brain begins to recognize the now familiar information, utilizing fewer resources to process the experience. With positive experiences and familiarity, the brain typically adapts to the information and experiences, increasing tolerance and comfort over time. If repeated positive exposures and experiences are not changing your child’s level of comfort or tolerance of sensory experiences, this could be a clue that there may be developmental concerns at play.
Red flag: Being told, “He’s a boy, he’ll outgrow it.”
As a professional who has worked with kids and parents with developmental concerns for over a decade, I can share that it can be HARD to tell a parent about a concern for their child — even when the parent is open to receiving that information. I had to learn that sugar-coating information for parents was not helpful. Being kind, honest and direct, while providing hope and insight was helpful. It is all too easy for friends, family and even professionals to say, “It’s because he’s a boy,” or “He’ll outgrow it.”
The reality is there are some gender differences when it comes to areas of development, but not many. In fact, the CDC’s developmental milestones, which are guides used by parents and professionals alike, don’t differentiate between genders and development.
If you notice friends and family making comments along these lines, it may be a knee-jerk reaction of wanting to comfort you and reduce your worries. Or it may be easier to blame the concerns on gender than stating, “Your son may be a bit behind in an aspect of development.” If you yourself have thought this, or others have stated it to you, start paying closer attention to your child’s development.
A list of multiple concerns
As parents, we tend to watch and worry about each individual symptom and challenge, without realizing that many concerns may be linked — either directly or indirectly. Development is an extensive chain of events. A disruption or challenge in one area can and will impact other areas. A child with sensory dysregulation can also experience an impact on mood, attention and potentially anxiety. It’s easy to think of those as three separate concerns, with very different approaches to support each area. However, the reality (and most efficient approach) may be that improving a child’s sensory regulation will positively impact their ability to regulate their mood and emotions, and experience improved attention and less anxiety.
If you have an area of concern for your child, write it down. Then ask yourself if there are other concerns as well (without judgment). Start a list, even if that area of challenge feels unrelated to your other concerns. Remind yourself that a list of concerns does not mean that there is anything wrong with your child. You are simply identifying areas that could benefit from additional awareness and guidance. Development is complex, and we all have areas that could benefit from support and improvement. Being mindful and proactive can make a difference going forward.
Identifying a red flag for concern in development is not a time to panic, but a time to watch more closely and begin to arm yourself with additional information and understanding. The brain and development are highly complex and also malleable. Development can accelerate in areas that are lagging behind, so the challenges your child is facing today can be positively impacted! The sooner you identify an area of concern, the sooner you can implement a plan of action to support that area of development — whether from home or with the guidance of a professional.
Dr. Jackson shares more information for parents to understand developmental milestones at all ages, and tips to support healthy development in her Mayo Clinic Press book, “Back on Track: A Practical Guide to Help Kids of All Ages Thrive.”
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