Thought Experiment. I wonder
I wonder if infants with developmental problems were all detected earlier, what might happen?
I read an interesting blog the other day about a man who talked about his thought experiment. If everyone stopped shopping, what might happen? So, I began to wonder.
I have spent most of my career being interested in trying to figure out methods, tests and strategies to identify infants at risk for developmental disabilities at the earliest possible time after birth. (See Screening | Vickie Meade Therapy Services) Early on, there was very little evidence to say that early identification would change the course of the disability for an individual. But even in those days, it seemed logical and practical to support parents who were struggling. Now there is recognition of early brain plasticity. From birth to age 3 the brain produces more than a million neural connections each second (www.zerotothree.org). In the first 90 days of life, the brain grows 62% and doubles by age 1.
So I began to wonder… what if?
What if we could prevent delays in motor development?
What if we could prevent parents feeling their infant was ‘lazy’?
What if we could prevent communication delays?
How much ‘disability’ could we prevent?
By 9-12 months, parents, family and others begin to notice their infant appears delayed in milestones compared to other infants of the same age. And by 12-18 months, parents become very concerned, but now try to think ‘well if he starts to walk, I won’t worry anymore’. Then, the concern becomes ‘Oh no, she is not saying anything’
Even if all infants were identified by 9-12 months of age, professionals could support the parents’ concerns that their infant can’t move because their infant is lazy. Parents are more concerned; symptoms are confusing. Why is my infant not rolling, crawling or taking weight in standing? Professionals could give targeted exercises to prevent delays in crawling, walking and talking. Having an infant who is ‘different’ makes it hard to see life from the infant’s point of view and understand just how much effort might be going into attempts to move against the force of gravity with very limited skills.
I wonder if all professionals used the clinical practice guidelines, a process of recommendations for infants under five months and a second set of guidelines for infants over five months. (Novak, et al 2017) and infants could be identified even earlier than 9 months? Instead, by three to four months of age?
Parents could first address any concerns and then focus on assisting their infant to be able to tolerate many positions against gravity, first protecting head shape, but also setting the stage for the infant to develop motor milestones. Relaxed parents would start reading to their infant, which could result in an estimated 300 more words by age 2 (see Fun Facts About Children’s Brain Development in Educational Resources | Vickie Meade Therapy Services
[For a direct link to pdf: FAST FACTS ABOUT CHILDREN’S BRAIN DEVELOPMENT (vickiemeade.com)]
Currently, parents’ first notice that their infant’s head appears flat on one side and parents want to know what to do. Recently, over the course of six months working with infants referred to physiotherapy by community health nurses, I evaluated over 100 infants referred under six months of age. Of these 100, most did in fact, prefer to keep their head turned to one side resulting in a misshapen head (plagiocephaly). With early changes in handling, most have done well. However, there were about 10 infants who had great difficulty learning to move against the force of gravity as time went on.
So, I wondered if all infants who would have developmental difficulties were identified even earlier, say by seven weeks of age, perhaps based on concerns regarding an infant’s head preference, what might happen?
Infants may be having a hard time feeding, become cranky, overtired and not sleep, which leads to more difficulty feeding. Early parent support, in addition to addressing early head shape, could assist parents to be more successful with early feeding and sleeping skills, resulting in a more settled infant. Happy infant, happy parents. Relaxed parents would be more aware and interested in protecting head shapes, and promoting developmental skills such as focusing on tummy time and carry positions instead of laying the infant down on his or her back to take a break away from stressed out infants! Relaxed parents might talk more to their infant. And eventually read to their infant.
But we aren’t there yet! We need to be able to take advantage of the amazing rate of brain growth so indicative of brain plasticity. And if the infant is recovering from an early insult, to be able to pace along with brain recovery by supporting the parents at each step of the way! A diagnosis needs to cover all categories of delay and occur under six months of age to create the best outcome possible for the infant’s family and siblings.
I wonder if, maybe, we could prevent disability?
Novak et al 2017, Early, Accurate, Diagnosis and Early Intervention in Cerebral Palsy. JAMA Pediatr. 2017;171(9):897-907. doi: 10.1001/jamapediatrics.2017.1689