On Noticing a Noticeable Difference. (Editor's Desk)

Article excerpt

It's not an unusual scenario. Concerned parents bring their infant to the pediatrician to report something they are observing or not observing. The physician calms the parents by saying "it's not so unusual," or "let's look at it in another six months." Most of the time the developmental milestone is reached, albeit on a timetable that isn't always by the book. Sometimes the parents will do their own rationalizing and turf the decision to mention it to the doctor, or not even see the doctor for another six months.

When growth deficits, developmental delays, sensory deficits or serious behavioral problems manifest themselves, they occur on a continuum. A child doesn't suddenly get diagnosed with failure to thrive or fine motor impairment or autism. When is something that's noticed noteworthy?

By age 2 years, the typical child runs well.

When do we see the red flags? When do we call for an assessment, when do we initiate treatment, when do we bring in the labels? When does "runs" become "runs well?"

The answer, of course, is based on perception, judgment, experience, school of thought and--certainly--comfort level. The latter reflects that of the clinician, the parent, the payors and the community. "Aggressive" pediatricians will perceive (and act on) things differently from conservative pediatricians. The actions of either will, of course, be modulated by the insistence of the parents, their practice environment and their instincts.

The preschool child normally grows about 3 to 5 pounds and 2.5 to 3 inches per year.

How does a thermos bottle know whether it's full of hot or cold liquid? How does a clinician know when to mobilize the troops of inquiry?

Most of the pediatricians I know will usually be at a loss to answer that question. You'll hear things like: "You just know;" "You'll know when you know;" "It somehow announces itself"; or "It will hit you." Not exactly pearls of wisdom the medical student can transfer from case to case, nor a response that would be applauded by an attending physician on rounds. So how does a clinician know and, more important, how does a parent know when to be alerted to these things? when does a mental note become an office visit?

By 7 to 9 months an infant will use partial thumb opposition to grasp pellets (and where do parents get these pellets, anyhow?).

How do we take what we observe as parents and professionals and assign them to the front or back burner of concern? when does "Oh" become "Oh!" or "Oh my!" or the defining "Oh my God!"? How do parents monitor coordination, when grasping and reaching (gradually) come under visual guidance and voluntary control? …