Worried about my nanny baby...do I say anything?

[ihugtrees]

I started nannying for this family 4 months ago, and I LOVE them and their daughter very much. I have had concerns about their daughter from the beginning...however, my own daughter is 4 months older than theirs, and I have worried about comparing them/knowing all kids are different/etc. However, other moms we all spend time with have also expressed concern to me, so I'm starting to think it is not just me. I've cared for many, many children over the last 7 or 8 years (including children& adults with special needs), and something just feels off to me here. If it was just one or two of these things, I may not be concerned, but all of them together are making me think she may need to be evaluated. However, I know she's been to the pediatrician recently and they didn't seem to think there was anything that needed to be checked out...so it could be something they miss in a 20 minute doctor's appointment, right? I am with her 40+ hours a week.

So the baby is 14 months old this week, but was 6 weeks premature (doctor told them when she was an infant that they didn't have to adjust her age anymore because she had caught up.) She walks holding onto hands, but her feet are VERY splayed out and she walks very differently than most toddlers. Despite taking a few steps on her own, she doesn't seem to be catching on to walking at all. She falls a lot, even when holding onto things, crawling, sitting etc---she will fall sideways or backwards often. She doesn't seem to have a great grip with her hands...often drops things when holding them, or drops because she can't get a grip as I hand them to her, and has difficulty getting things into her mouth with her hands. When she uses her hands to do things...ie, lifting up her shirt to show me her belly button :)...it doesn't seem purposeful...almost like she did it on accident. She has no consistent, clear words, and doesn't even babble much at all...she screams when she is upset, but does very little babbling other than that. She smiles and makes eye contact and LOVES people, but doesn't enjoy being held/cuddled very much and pushes you away, even while I'm, say, holding her to give her a bottle. She sits on her knees, splayed to the sides, and walks on her knees, more than she walks on her feet or sits on her bottom! She is extremely physical...she hits, bites, etc in a very aggressive and frenzied way when upset...when I'm trying to get her out of the carseat, she frantically throws herself out of the seat while her arms are still stuck in the straps...she can't aim her arms inside of the sleeves of her shirts or jackets...she doesn't really hold herself up when I hold her on my hip--she is just dead weight...diaper changes=her rolling around, kicking, throwing her arms around, screaming, throwing her body around...all of this is to a degree that is more extreme than other toddlers I know.

I guess my questions are, does any of this sound concerning, and what should I do about it? How can I possibly bring this up to her family, who is so dear to me? I want her to get all of the help she needs, but I could be wrong too. I am not an expert. Advice appreciated! :)

[sbgrace]

It's very hard to bring stuff like this up and if you were family I would tell you not to do it. But you're in a child care role so I'm not sure what to recommend. The child does see a pediatrician?

The thing is walking isn't late until 18 months and I believe they still use adjusted age under age two so adjusted she's not even 14 months. I'm not sure exactly what you're describing though in terms of her legs and not making purposeful hand movements. Is she pointing? Lack of pointing at 12 months is concerning. Were other motor milestones delayed or do you know? You mentioned sitting with legs splayed to the side and that is common in kids with low muscle tone and it would (I think) be seen in kids with hyperflexibility as well. Still, she's not late to walk.

The ideal thing would be for them to have an early intervention assessment. When you bring up the suggestion though it's going to sting and may not be taken well. It's hard to be told your child might be different and sometimes parents are ready to consider that and that's ok. It's also possible nothing at all is going on with this child. So I'm not sure if you should but if you do talk with them I would try to casually suggest an early intervention assessment given she was a preemie and she seems frustrated and might be helped by some speech therapy or similar. Something like that. 

If you know who the pediatrician is you could express concern to the doctor. He/she will not be able to talk with you about the child or even disclose she is a patient but hopefully they would listen to and consider your concerns. Maybe write a letter (with her name, date of birth, your relationship, your concerns, you understand HIPPA and don't except communication but wanted to make sure he/she is aware of these things in case they are important and the child needs an early intervention assessment). That's probably the track I would take in your place knowing how it felt when someone mentioned my son's issues to me for the first time.

[kathymuggle]

Oh, what a hard place to be.

Does she go to playgroups, etc?  Do the leaders there have any concerns about her?  If so, they might bring it up.  You could carefully talk to them about it. Given the employee/employer relationship the news might be better coming someone else.  

Alternately, you might want to mention one mild issue you are concerned about...say her low muscle tone.  They might take that better and seek out resources themselves than if you say you think she has xyz serious syndrome.  That might just put their defenses and denial up.

I would also offer postives with anything you say.  Let them know you love their daughter - and that she is a sweet little girl, but you have this small concern.  Sometimes parents hear concerns as criticisms and you do not want to turn them off the message through the delivery of the message.

Edited by kathymuggle - 12/10/10 at 8:06am

[askew]

Personally, nothing you write sends up any red flags to me. I have a NT 4 year and a SN 16 month old, and knowing the milestones for 12-18 pretty well right now, I just don't see the concern. My best friend had 3 kids that did not walk until 18 months. Did not even pull to stand until 14. They were fine, just on the later end of the curve. At 12 moths she should have had Mama and Dada and one word. Some don't though and they won't usually even evaluate for Speech until 2. Obviously you see things we are not, but some kids are just babies longer absent from any kind of issues. You can suggest and eval if it will make you feel better though. 

Edited by askew - 12/10/10 at 4:16pm

[marge234]

I think you're right to say something, and have gotten some good advice.  If possible, get the EI info so it's handy.  Maybe there's a brochure or something.  You can say you felt compelled to tell them because you'd want someone to say something to you.  Emphasize that of course you're not certain but just figured that since you have this sense there may be something making things difficult for her, and EI is free, it can't hurt to share it.  They and their daughter are lucky to have such a knowledgeable caregiver.  Good luck.

[jennabean]

Well, she seems like she's hypotonic to me but wherein that alone might explain much of what you've mentioned, I think I'd still, as the child's parent, want a workup done to look for other causes of the low tone.  Goodness though, how to go about mentioning your concerns to the parents... man, that's tricky.  I wish I had some advice on that score but I do think your instincts are correct.

I will say that I don't usually mention much of my child's differences to caregivers right away... they are noticeable if you know kids but not so much if you're just a casual observer... after a bit, once I feel more connected to the caregiver we usually sort of have a heart to heart.  Its always interesting to me, as the parent to see my son through other people's eyes and I've always appreciated the feedback I've gotten.  That being said though, we've had 2 1/2 years to figure out/ come to terms with my son's differences so its easier for me to hear, kwim?  Perhaps your family isn't quite there yet, but maybe a few gentle questions geared towards understanding the child would open up a dialogue... just a thought.

All the best, that's not an easy place for you to be in...  hugs :)

[inky leeuhhh]

honestly, i would probably wait a while and see if the differences became more obvious. i had a little boy in my care who i was  SURE had issues. not walking, super sensitive, fits.... flash forward a year and the kid is fine. just like any other kid. that doesn't mean i'd forget about it completely- i'd wait until the baby was say over 18 mos and re evaluate. that said it can be hard to judge just from a written description. i'm not sure how i would bring it up. i teach preschool, and i have great opportunities to bring things like this up at parent conferences. it doesn't make it easier, but it at least gives a good setting and quiet time when the parents are more receptive if i do need to bring up a concern. i usually try and use the "sandwich" method. i give some positives about the child, work in the concern, and then build things back up with more positives at the end of the convo if i can. so it would look something like "johnny is such a great kid! he is so loving and caring. i did want to speak with you about xyz though and get your input" (conversation about xyz happens) ... "i know you probaby need some time to think about what we discussed. we love johnny and we are so excited to see what the future brings for him". that was a cheesy example, but you get the idea. lol. be very gentle and understanding, and don't push. even if they insist that nothing is wrong, the idea has been put out there and chances are they will at least become more aware of what is going on. and be prepared because parents can be VERY defensive and emotional when it comes to this sort of thing. we have had parents who loved sending their children to us storm out of the center never to be heard from again. i was livid the first time someone came to me telling me they thought dd1 was "different". it took me at least a month to come around and see that something was going on. good luck to you!

[kathteach]

My pediatrician adjusts for prematurity up to age 3.