Infant Development: When to Seek Pediatric Evaluation

Baby Growth and Development

Hello Dr.
Lin: I am a mother of twins.
My fraternal twins are currently 11 months old (born at 36 weeks + 5 days).
I am taking care of my son, who can only lie on his stomach, roll over, and kick his legs.
He is not stable when sitting and makes sounds like "A," "ah," and "mm." He often cries and gets fussy, and when he cries, his mouth trembles, and he grabs his face and hair.
His legs are rubbing against each other and getting red, and his testicles appear dark; is this normal? Does he need to undergo a developmental delay assessment? My daughter is in daycare and is preparing to walk.
When I bathe her, her chest feels hard; is this a sign of precocious puberty?

Shuang Bao Ma, 40~49 year old female. Ask Date: 2020/04/16

Dr. Lin Yishou reply Pediatrics

Hello parents, the symptoms are mild, so you can take the opportunity to have the doctor evaluate them during the vaccination.

Reply Date: 2020/04/16

More Info

When it comes to understanding infant development, particularly for twins who are 11 months old, it's essential to monitor their milestones closely and know when to seek a pediatric evaluation. Based on your description, let's break down the developmental aspects of your son and daughter, and discuss the appropriate steps to take.

Developmental Milestones
For infants around 11 months, typical developmental milestones include:
1. Gross Motor Skills: Most infants can sit independently, crawl, and may begin to pull themselves up to stand. By this age, many are also starting to take steps while holding onto furniture.

2. Fine Motor Skills: Infants should be able to grasp small objects, transfer them from one hand to another, and may start using a pincer grasp (using thumb and forefinger).

3. Communication: By 11 months, babies typically babble and may say simple words like "mama" or "dada." They should also respond to their name and understand simple commands.

4. Social Skills: Infants should show interest in social interactions, such as smiling at familiar faces and showing anxiety around strangers.

Your Son's Development
From your description, your son is showing some typical behaviors for his age, such as rolling over and making sounds. However, there are a few concerns:
- Sitting Stability: If he is unable to sit steadily, this could indicate a delay in gross motor skills. Most infants can sit without support by 9 months.

- Crying and Hand Movements: Frequent crying and hand movements like grabbing his face or hair could indicate discomfort or frustration. It’s essential to observe if these behaviors are consistent and if they seem to be linked to any specific triggers.

- Skin Changes: The redness from rubbing his feet and the appearance of his testicles should be evaluated by a pediatrician to rule out any underlying issues.

When to Seek Evaluation
Given that your son is not yet sitting steadily and has some concerning behaviors, it would be advisable to seek a pediatric evaluation. The American Academy of Pediatrics recommends that parents discuss any concerns about their child's development with their pediatrician, especially if:
- The child is not meeting milestones (like sitting or crawling).

- There are unusual behaviors (like excessive crying or discomfort).

- There are physical concerns (like skin irritations or abnormal appearances).

Your Daughter's Development
Regarding your daughter, who is preparing to walk, it sounds like she is on track for her age. However, you mentioned that her chest feels hard during bath time. This could be a normal finding, as some infants may have temporary breast tissue development due to maternal hormones. However, if you notice any unusual lumps or if the hard area seems painful, it would be wise to consult her pediatrician for reassurance.

Conclusion
In summary, while your daughter appears to be developing well, your son may benefit from a developmental assessment due to his challenges with sitting and the behaviors you’ve observed. Early intervention can be crucial in addressing any delays and providing support for their growth. Always trust your instincts as a parent; if you feel something is off, it’s best to consult with a healthcare professional. Regular check-ups and open communication with your pediatrician will help ensure both of your children are on the right developmental path.

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