EXCEPTIONS TO DEVELOPMENTAL MILESTONES:
TEN TO TWELVE MONTH

If your infant has required lengthy or frequent hospitalizations since discharge from the NICU, or your infant is still on supplemental oxygen, feeding tubes, and/or a large number of medications, she may not be able to put forth much effort to accomplish developmental milestones at this time (just like you would be unlikely to get up and learn a new dance step if you were home in bed with the flu or just recovering from surgery).  If your child is still in the NICU at this time her developmental progress will definitely be affected by her health status.

If your child has a tracheotomy, is on a ventilator, has a possible hearing loss, or for any other medical reason has a barrier to developing a language system, it is very important that you find a way to facilitate communication.  It is important for your child to experience the control and autonomy emerging language skills can provide.  When a child is not able to participate in a "conversation," adults tend to gradually talk less to the child.  Since feedback is necessary for learning to talk, you will need to be especially attentive and look for other ways to read your child’s responses.  Remember that your child is constantly communicating with you; this is accomplished by pointing, fussing, facial expressions, hand movements, and/or touch, to name a few.  Your job is to keep your child learning and develop a system so she can communicate what she knows.

Here are several things to try with your child.  Talk to your child frequently about what you are doing and name what your child is touching or looking at.  Look for a response in your child’s facial expression or gestures.  Give your child choices.  For example, ask if your child wants to wear the green or red pants, eat the wheat or rice cereal, play with the ball or the blocks.  As you are asking what she wants, point to or handle the object.  Your child can indicate a choice by pointing, reaching, nodding the head, shifting the eyes, or any other consistently used movement.  Once you and your child have developed a system by which she can let you know what her choice is, you can make a "choice book."

A "choice book" is a scrap book or a photo album with pictures of your child’s favorite foods, toys, people, and places to go.  The pictures can be photos, pictures cut from magazines, toy or food containers.  It may be helpful to use a notebook to which you can add pages and dividers.  The dividers can be used for category labels; foods, toys, people, etc.  You can then "read" this book to your child, pointing to pictures and labeling them.  As a means of helping your child communicate point to two things and ask which she wants.  Later she can bring you the book to initiate "telling" you what she wants.  If this is a successful method of communication for you and your child, you may want to have two books, a large one for home and a small abbreviated one to take when you go out.

If the barrier to your child’s communication is expected to persist for an extended period of time you may want to work with a speech therapist experienced in working with sign or other alternative communication systems.  It is important to strongly stimulate language acquisition now.  Do not wait until your child begins to talk to start working on language skills.

Another group of children who may need assistance in getting the stimulation they need for age appropriate learning are children who have difficulty moving about freely.  These children are at risk of missing the kinds of experiences that enrich young children’s lives.  Sometimes, because of the demands of therapies, treatments and doctor’s appointments, there is little time left for play in these children’s lives.  Sometimes, families feel they must spend their time with their child working on exercises, and subsequently feel that "play" is not effectively utilizing the time they have with their child.

Play is a young child’s work.  Children learn through play.  They discover and develop concepts about size, shape, color, texture, and problem solving, to name but a few, through play and exploration.  Children who have trouble getting around or exploring with their hands because of a motor impairment may miss out on a great deal of this learning.  If your child cannot get to the toys bring the toys to your child.  Toys can be household objects as well as commercially bought items.

Positioning is very important for children with motor problems.  You want to physically support your child so both arms and both legs are used to their fullest capacity.  It is important to vary your child’s position, locations, even the heights the world is viewed from.  Children should experience being placed on the floor, on grass, in water, up in a chair, in a swing, and being carried around.  Make use of trays when your child is supported in a sitting position.  Toys can be played with independently, even if your child has difficulty holding them, when they are placed on a tray (Consider covering the tray with a non-skid material if toys seem to slip too easily on it.).

If your child is in therapies, ask the therapists to help you figure out ways to make play easier and more available to your child.  As they say, variety is the spice of life.  You and your child need time to play and enjoy relaxed activities together.

Visually impaired children are another group of children who will need assistance in learning.  It will be very important for your child to be involved with a program that can help you structure an environment conducive for independence and learning.  Two sites you may want to look at are:  Georgia PINES and BEGIN.  If your child's visual impairment is serve she may qualify for services from the Babies Can't Wait Program.