Early Intervention!

Welcome back friends!

Today I wanted to share a little about Early Intervention (EI) - a free, in-home service for infants and toddlers under 3 years of age that many people haven't heard about!

Early Intervention is a nationwide service in the US that provides therapies including physical, speech, occupational, nutritional, and behavioral. They also perform social work and vision services. Not only are these services extremely beneficial to the child especially when implemented early on in life, but EI also seeks to empower parents who are concerned about their children’s development.

In Western PA, Early Intervention services are broken down by county, but the CDC has a helpful listing of Early Intervention contact numbers by state here.

Sometimes EI is involved right from birth, such as for premature infants, newborns who spent time in the NICU, or children born with conditions that will most likely affect their future development. These services are an excellent guide and support for families as they navigate their child’s healthcare needs.

So your kiddo was a full term, otherwise healthy baby with no known underlying problems. Why would you want to utilize this service for your infant or toddler?

As pediatric provider, I write referrals to EI at least weekly and sometimes daily. The referral may be based on a concern from the parent, often regarding speech or developmental milestones. However, sometimes it is due to a finding I noticed during the check up... which is why well child visits are so important!! Anyone can refer a child to EI! They do a full evaluation in your home which is where your child is most comfortable. If the specialist feels your child qualifies for any type of therapy, they will get it set up for you. If not, at least you have the peace of mind of knowing you looked into it!

When reviewing developmental milestones, it is important to remember that all children develop at different paces and the milestones provided here are guidelines. If you are at all concerned about your child's development, you should make an appointment with your pediatrician.

Common Reasons for Early Intervention Referrals:

• Motor delay: This is when a child is not meeting appropriate physical developmental milestones. Rolling, sitting, crawling and and walking are examples of gross motor skills. If there is concern that a child is out of the range of the normal timeframe or there are any physical problems causing a delay, they may qualify for physical therapy (PT) to help them catch up or progress. Picking up small objects, stacking objects, scribbling and using utensils are examples of fine motor skills. For difficulty with these skills, occupational therapy (OT) may be appropriate.

• Speech delay: A good rule of thumb for assessing a child’s speech at age one is is “one word by one”. This should be something they say with intent, for example they look at dad and say “dada”. At age 18 months, they should have about 6 words they use with intent and fairly regularly. By age two, they should be putting together two words in phrases: “my book”, my toy” and be about 50% understandable to someone who isn't around them all the time. If there are concerns about a delay in speech, and a problem with hearing has been ruled out, they may qualify for speech language therapy (SLT).

• Cognitive Delay: This can include impairment in understanding concepts or in social development such as interactions with peers and family members. An 18-month old should notice when his mom or dad leaves the room, and they should want to interact with you. Sometimes they will point, sometimes they will bring objects to you to show you. A 2 year old should begin to understand cause and effect and simple concepts of time.

• Behavior concerns: Being able to identify what is abnormal behavior for a toddler is difficult. Luckily, there are behavioral therapists available to help with issues that may be abnormal or that are causing a problem at home.

• Social concerns: If a family has limited resources or is going through a difficult time, EI has options to help them get or stay on track :)

• Common Physical/Anatomic Differences

  • Torticollis: This is when a muscle connecting the head to the sternum and collarbone is tight or shortened. Parents may notice that their baby prefers to keep their head tilted in one direction. Pediatricians will monitor for this at well exams too. It is important to involve EI for PT to stretch the neck muscles and avoid uneven flattening of the head. Left untreated, this can impact overall head shape and may require further treatment such as a helmet. Any time you have concerns for head shape or size, you should see your pediatrician.

  • "Bow legs" or "knock knees": These anatomic differences are often normal and do not require treatment, but at times parents notice that they cause the child to walk abnormally or fall. Your pediatrician will check to make sure it is a variant of normal leg development and may refer for PT to help!

EI services provide the most benefit for children when started as early as possible, so don’t hesitate to discuss any concerns with your pediatrician. If you are in between well checks and don't want to wait, most of the time you can schedule a separate visit! As with everything, prevention is the best medicine!