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Friday, March 7, 2014
15 month old not walking or talking
My daughter is 15 months old (born 6 weeks early). She babbles fine, but has does not have any words for anything. She points, but does not use words. She seems to understand most things, but is inconsistent in pointing to her body parts when asked. I am also concerned that she is not walking yet. She has been cruising the furniture for ~ 2 months and is standing on her own for brief moments, but has not taken steps on her own. She will `walk` with a toy. Our pediatrician didn`t seemed concerned at her 15 month appointment, but my husband and I are. Should we seek some kind of speech or physical therapy? Would we need an MD referral? Thanks for your help.
You and your husband are good observers of your daughter's skills and obviously have considered what developmental milestones she should be reaching. She is fortunate to have such informed and caring parents. Language and hearing problems are common among preterm babies for many reasons. We know that the use of furosemide (lasix) and aminoglycoside antibiotics such as gentamicin cause hearing loss. Other medications do as well but these are two of the most common offenders. Treatment with a ventilator for respiratory distress syndrome also may cause hearing impairment. Consequently, annual audiological evaluation is a good idea, especially for the child not meeting language milestones. Gross motor delays are also extremely common among preterm infants related to poor postural positioning in the NICU as well as all of the nutritional and neurological challenges many preterm infants face over the course of their hospitalization. The good news is that motor development does not predict intellectual development. However, preterm infants are at greater risk for cerebral palsy, so careful evaluation of motor development is important. I will address each of your concerns separately below.
First, I apologize for telling you again what others have undoubtedly said before, which is that is necessary to "correct" developmental expectations backwards from those associated with her chronological age to those associated with the age she would be if she had been born at full term. So in your daughter's case, developmental expectations would be those associated with about a 13 month-old child. It is desirable to do these corrections until the child is 2 years corrected age or 26 months old in your daughter's case.
Language has two components, receptive (hearing and understanding spoken communication) and expressive (producing oral communication). Expressive language skills at 13 months include having 4 to 10 clear words, saying mam and dada purposefully as a greeting or to call a parent to her, and talking in long, jabbering sentences as if holding an understandable conversation with you. Receptive skills at 13 months include the ability to point on request to at least two pictures of familiar objects, responding to her name, and following simple, one-step requests, such as "Give me the ball." It seems from your description that your daughter is struggling in both areas of language, although it is very positive that she is pointing to indicate her desires and that she is producing sounds. If she was deaf, she would not be producing sounds. It is likely that she would benefit greatly from early speech therapy.
Gross motor milestones at 13 months include pulling to stand and cruising holding on to furniture or an adult's hand, getting the heels of both feet flat on the floor, and walking alone a few steps. Independent walking has a large range of normal from the early walkers at 8.5-9 months to the late walkers at 15-17 months. Seventeen months is the accepted upper limit for onset of independent (just a few steps) walking. Signs of a problem include standing on her toes in an upright position, rarely getting her heels flat on the floor, leaning heavily to one side when sitting, and using only one side of the body for stepping or reaching. Your description of your daughter's cruising skills sounds as though she is on track in this area. However, if you observe any of the warning signs of a problem, it would be good to seek help now.
Where to get help is an easy question to answer. In Ohio the Help Me Grow program contains all of the early intervention services mandated by the federal government and the good news is that they are all free regardless of income. These services include Speech Therapy, Physical Therapy, and Occupational Therapy. In urban areas of Ohio, families may choose home-based services or to bring the child to a center for services. Choice among types of services is more limited in Ohio's rural counties. You can call toll-free 1-800-755-GROW (4769) and receive directions to the nearest Help Me Grow program in your county. You do not need a physician referral. If your child's evaluation shows the need for services, they will be provided free of charge. If your child's evaluation is normal for her age, you may still be eligible for free, in-home services for families with children at-risk for developmental delays, and preterm infants certainly fit in this category. Home visitors are often social workers and early childhood educators who provide information and other types of support. There is also a website with information about programs and services in Ohio, www.ohiohelpmegrow.org .
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University