Addressing Developmental Concerns in Toddlers: Growth, Movement, and Speech

Infant and toddler growth and development issues?

Hello Dr.
Lin, my brother is one year and seven months old, and I have a few questions to ask again.
Thank you!
1.
Gross Motor Skills: My baby only started walking independently at 15 months and is relatively stable, so I feel he is a bit slow in this area.
Currently, aside from walking a little, he also has a slight outward foot position, but the doctor said there is no need for corrective shoes and no issues with hypotonia.
My questions are:
(1) With my baby having a slight outward foot position, when training him to go up and down stairs, walk on slopes, or engage in other physical activities, aside from considering the quality of his shoes, are there other things I should pay attention to? (I make him go up and down stairs for 15 minutes every day, walk on slopes, grass, and slide down slides, but I’ve noticed that after walking on a slope, he seems to have less strength when climbing stairs.)
(2) Is it suitable for a one year and seven months old baby to learn swimming? Since swimming requires the ears and eyes to sometimes be fully submerged in water, could there be a risk of infection?
2.
Language Development: My baby’s fine motor skills are okay; he can stack four to five blocks, turn pages of a book, twist and open bottle caps, unwrap candy wrappers, and can identify shapes like circles, triangles, and squares.
He can drink water using both hands and eat simple food with a spoon by himself.
In terms of language comprehension, he can follow simple verbal instructions to perform actions like clapping, squatting, standing up, spinning, rubbing his hands, picking up and putting down objects, and throwing trash in the bin, etc.
His hearing is very sharp.
However, I am a bit worried about his speech; he has a limited number of meaningful words that adults can understand, currently around three: "mama" (which he says most frequently), "dog" (when he occasionally sees a dog or a picture), and "tea" (in Taiwanese).
He can mimic phrases like "What are you doing?" (in Taiwanese) and "What is this?" (in Taiwanese), and his pronunciation is quite clear.
Most of what he says is in his own language that he understands.
A friend’s baby girl, who is three months younger than my brother, seems to be very verbal and can say at least five meaningful words! My brother tends to point or cry to express what he wants instead of using words; he talks a lot when he is happy (though we adults understand very little), but when he is unhappy, he becomes very quiet!
(1) Could there be an issue with his oral structure, or could he have tendencies towards autism? Does he need further evaluation? Thank you!

Xue Er, 30~39 year old female. Ask Date: 2004/11/14

Dr. Lin Wenxian reply Pediatrics

Dr.
Lin Wen-Hsien, the Chief of Pediatrics at Tainan Hospital under the Department of Health, Executive Yuan, responded to DEAR Sher: Regarding the issue of gross motor skills, it seems that the mother has already taken the child to see a physician, and there are no concerns about hypotonia, nor is there a need for corrective shoes.
It appears that the mother needs a bit more patience to wait and see, and after some time, she can take the child back to the doctor for follow-up on any improvements.
Similarly, based on the mother's description, the child's hearing is good, pronunciation is standard, and all developmental milestones are within the normal range.
The issue of not speaking should not be related to oral structure and does not seem to indicate autism.
In addition to exercising patience, if the mother is still very concerned, she can take the child to the developmental delay center in various counties and cities for an evaluation to alleviate her worries.
The following websites may be helpful: http://www.tpscfddc.gov.tw/say_to_household.htm and http://home.kimo.com.tw/fcdd.tw/.

For a child who is one year and seven months old, it is generally not appropriate to learn swimming.
First, it may lead parents to mistakenly believe that the child can swim, which could reduce their vigilance regarding water safety.
It is important to understand that even in shallow pools or bathtubs, accidents can occur.
Secondly, the child may unknowingly ingest a large amount of water, leading to health issues.
Therefore, swimming is generally not recommended before the age of three.
If there is a strong desire to learn, parents can look for parent-child classes, where both the mother and child learn to swim together, and choose experienced instructors with appropriate safety measures, such as lifeguards.
Water safety is very important, and those interested can refer to the following website: http://www.aap.org/pubserv/backyd.htm.

Tainan Hospital wishes you good health and all the best!

Reply Date: 2004/11/14

More Info

Addressing developmental concerns in toddlers, particularly regarding gross motor skills and speech, is crucial for their overall growth and future functioning. Based on the information provided about your one-year-seven-month-old brother, let's break down the concerns into two main areas: gross motor skills and speech development.

Gross Motor Skills
1. Walking and Movement: It’s common for toddlers to start walking at different ages, with many beginning to walk independently between 10 to 15 months. If your brother started walking at 15 months and is now showing some stability, that is a positive sign. However, the observation of slight outward foot positioning (external rotation) is something to monitor.
- Training Activities: When training him to navigate stairs, slopes, or other physical activities, ensure that he is supervised closely. It’s important to encourage him to use the railing when available and to take his time. You might also consider varying the surfaces he walks on (grass, carpet, etc.) to help him develop balance and strength.
- Fatigue After Activities: If he seems fatigued after activities like climbing stairs, it could be due to his developing muscles and coordination. Gradually increasing the duration and intensity of these activities can help build his strength over time.
2. Swimming: At this age, swimming can be introduced, but it’s essential to ensure safety. While swimming can be a fun and beneficial activity, it’s crucial to have adult supervision at all times. Concerns about ear and eye infections are valid; however, many parents introduce their toddlers to water in a controlled environment, such as a baby pool or during parent-child swim classes. These classes often focus on safety and comfort in the water rather than formal swimming skills.

Speech Development
1. Language Skills: Your brother’s ability to understand simple commands and his engagement in activities like stacking blocks and turning pages are positive indicators of cognitive and fine motor development. However, your concern about his limited spoken vocabulary is understandable.
- Speech Milestones: By 18 months, many children can say a few words and understand many more. If he is only using a few words, it may not necessarily indicate a significant issue, but it is worth monitoring. Encouraging him to express himself through gestures and sounds is important, as this can help bridge the gap until he develops more verbal skills.

- Potential Concerns: The fact that he uses pointing or crying to communicate his needs is typical for his age, but if he continues to struggle with verbal communication, it might be beneficial to consult a speech-language pathologist. They can assess his speech and language development more thoroughly and provide targeted strategies to encourage language use.

2. Further Evaluation: Regarding your concerns about possible oral structural issues or autism spectrum tendencies, it’s essential to consult with a pediatrician or a developmental specialist. They can conduct a comprehensive evaluation to rule out any underlying issues and provide guidance on the next steps.

Conclusion
In summary, while your brother is showing some typical developmental patterns, there are areas that warrant attention and possibly further evaluation. Encouraging physical activity in a safe environment and fostering language development through interaction, reading, and play can significantly aid his growth. If concerns persist, seeking professional advice from pediatric specialists can provide reassurance and tailored support for his developmental journey. Remember, every child develops at their own pace, and early intervention can make a significant difference in their growth trajectory.

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