Oh, fair readers, this is a tough one, like many of the things we have addressed on this blog. If you haven’t picked up on this by now, I, Tracy, the lead writer on this site, am a gray person. I rarely see black and white while discussing topics – I frequently see gray. I have a hard time coming down on one side or the other sometimes, because I can see and appreciate the well thought out arguments of both parties/sides/dogmas. So, as always, I am going to give you my best advice from the middle of the road.
Children come in many shapes and sizes, from totally different backgrounds, with their own strengths and weaknesses and likes and dislikes. One size does not fit all, and therefore, there are few hard and fast rules about when to get your child help.
Your child should see a specialist if they have a diagnosis that requires one. Duh, right? Your child’s pediatrician is probably fabulous, but she is not a cardiologist. If your child has a heart condition, you should probably have a cardiologist on board.
Your child should see a specialist if a health problem is not being cleared up through routine doctor appointments. A child who is constantly snotty with chronic ear infections should probably be referred to an Ear, Nose and Throat Doctor (ENT) who deals with that every day.
Your child should see a specialist if you are unsure that his current care is meeting his needs, to get a second opinion. For example, if you are thinking your child would benefit from medication for Attention Deficit Disorder (ADD), but your pediatrician is not in favor, it would be wise to see a specialist. I am not encouraging you in any way to disregard your doctors’ advice, but am suggesting that you will not agree with them all of the time, and a second opinion is beneficial. If the second doctor agrees with the first, you can rest easy. If not, you have options.
Your child should see a specialist immediately if there is any concern about their vision or hearing. There is much research that indicates that the sooner a child gets glasses or a hearing aid, the easier it is for them to adjust to their use, and the more progress you can expect.
You should seek specialist intervention as far as Speech Therapy, Occupational Therapy, or Physical Therapy if your child is born with a diagnosis that includes physical or mental challenges. Working with them even in infancy helps both the child and the parent in the long term.
You should seek assistance if your child is not meeting their developmental milestones at the appropriate times. A child who is not walking or saying words by fourteen months is indicating to you that they are experiencing a delay. Talk to your doctor and get a referral.
You should seek additional help if your child displays behaviors that are worrisome to you and other family members. These can include but are not limited to a child who avoids other people, a child who doesn’t seem to focus or be interested in the things other children are, “meltdowns” versus the temper tantrums expected in toddlers, extreme sadness, lack of sleeping, or a pattern of violent behavior that traditional discipline does not stop.
You may need the help of a Dietician, Swallowing Therapist, or Feeding Expert if your child has difficulty getting enough oral intake to maintain growth, weight, nutrition and hydration.
Speech Therapy is almost always warranted for a child over the age of three who cannot be understood when they speak.
For older children, kids who are displaying learning disabilities in school can sometimes be helped through outside intervention.
Always, if your child hurts themselves, becomes obsessed with death, or has unpredictable mood swings that frighten you, they need help.
Again, middle of the road and use your best judgment. If your child throws an enormous conniption fit once, you don’t need a specialist. If he does it weekly and hurts people while he does it, you need help. You’ve looked at the developmental charts and see that the average two year old has a fifty word vocabulary, and yours only has forty-eight? You don’t need help at the moment. Your child is four and nobody understands him but you? That’s a problem. Your kid is going through puberty and is moody? That’s the norm. Your kid is going through puberty and can’t stop crying? Call your doctor.
Basically you need to be concerned about things that are definitely outside of the norm – not just a little bit, because those differences are what make us unique. But, when your child is in a playgroup or nursery or daycare setting with other kids the same age, and they are not doing the same things…when it is clear to you that your child is struggling, it’s probably time to make a call. An evaluation may cost you a little money and an hour or two of your time, but it’s usually worth it for the peace of mind. Either your child will test within normal limits and not need a service (Whew! Relief!) or your child’s “scores” will indicate that they would benefit from some help (I’m not crazy! We’re doing something!).
I know that many parents worry that taking their child for an evaluation will automatically result in some kind of treatment. Reputable, ethical therapists will NOT pick your child up for services if they don’t need it. It’s against the law, and can cause a therapist to lose their licensure, and therefore their way of earning money. It happens, but not often.
Yes, you need to know your child, and yes, you need to step back and look at your child in comparison to others. But, you don’t have to be an expert in all things medical and behavioral. When in doubt, ask your pediatrician for a referral to a specialist.