Is your little one hitting those all-important milestones? It’s easy to play the comparison game as parents. Your friend’s 2-year old is talking in full sentences but yours is only saying a few phrases. Or your niece started walking at nine months but your little one just passed his first birthday and is still crawling. Is something wrong?
There is such disparity of growth among toddlers that it’s hard to know what’s considered “normal” sometimes. Often those who seem to be behind actually fall within the expected guidelines, but sometimes toddlers need a little extra help to reach those early milestones. Parents don’t always know how to recognize when their little one isn’t reaching their milestones, or where to go for help.
Ehrica from Milestone Mom is a pediatric developmental therapist who works with parents every day to help give their children an extra boost to hit those milestones. She talked with me about everything you need to know regarding early intervention, what that means, and how to get help.
Erica also provided us with tons of resources to check out, with info on everything from lists of milestones, help for speech or feeding, who to call in your state if you have a concern, and more. Check out the list of resources below to see all those links!
Here’s the interview. And if you don’t watch videos (like me) because there’s too many little people making noise around you or you just want to peruse the info in writing to find what you need quickly, check out the transcript below.
What is a Pediatric Developmental Therapist and how do they help little ones hit their milestones?
Amy: Hey everybody, welcome to Starting Parenting Over. We are doing our next installment of our interviews with the experts series. Today we’re talking to Ehrica from Milestone Mom. She’s a pediatric developmental therapist and she helps parents figure out if their little ones need early intervention for things like walking and talking. She’s gonna tell us a lot more about that and she’s going to give us a boatload of resources to give you more info about those milestones, which I’m super excited about. So, Ehrica, welcome to our interview today. Could you start by telling us a little bit about yourself? What is a pediatric, pediatric developmental therapist and how did you get started in that field?
Ehrica: 00:40 Sure. That’s a mouthful, isn’t it? Well, Amy, thank you so much for having me on. What I do as a pediatric developmental therapist for the early intervention program is my thing–it’s my passion. So a pediatric developmental therapist is a therapist that works with kids who are in the early intervention program, which is birth to three. So you always need a developmental therapist to come in and do the initial evaluations. And also the annual evaluations. So let’s say a referral comes in that maybe there’s concerns with speech milestones for your child. You’re not just going to have that speech therapist in there. You’re going to have a developmental therapist in there as well. I’m looking at your child’s developmental milestones. So we look at five different areas of development and the first one is adaptive and this is more of their self help skills.
Ehrica: 01:34 So are they using utensils to feed themselves? Are they sleeping well? Are they assisting with dressing by putting their arms and legs in? Are they taking any clothing off? And then there’s communication. So when that speech therapist comes in there and myself as well, we’ll look at two different areas, which is receptive language. So what your child is understanding and are they following some of those simple commands and eventually are they following two step directions? Like bring mommy your sippy cup and go get your shoes. So one command, but two different directions. And then also what falls into that category is that expressive language piece. So how many words are they saying? Are they able to communicate their wants and needs or are they still using a lot of gesturing and whining to get their needs met?
Ehrica: 02:26 A third component that I don’t look at as a developmental therapist, but a speech therapist might if your child is old enough and actually speaking in phrases is that articulation piece. So sometimes we can come in and see what some of those errors are that they’re making when it comes to articulation. So those are three components the speech therapist will look at, but I only look at those two pieces. And then next is motor development. So the gross motor, which is all of the child’s a big things, are they going up and down stairs? Are they crawling? Are they rolling over? Just depending on how old your child is. Are they kicking a ball? Are they throwing a ball? And then fine motor also falls into that area, which is, well, their fine motor skills. Are they using any pincer grasp to pick up small objects or are they still raking?
Ehrica: 03:20 Are they able to manipulate a puzzle piece and put it where it’s supposed to go? And then the next area is personal social. So this is pretty easy. This is how they are interacting with others in their environment. So whether it be other children their age or also adults. So we look at those personal social milestones and then the last one, there’s a lot of them isn’t there? Is cognitive development, so this is their pre academic skills. Are they able to put rings on a post? If I put an object in my hand and cover it, are they able to pull the cloths to retrieve the object? If I had an object in one of two of my hands, are they able to find that? Are they matching shapes, colors? Are they saying their shapes and colors? So all of those pre academic skills is what we look at as developmental therapists.
Amy: 04:15 All right. It sounds like you have a lot, you just kind of cover everything, right. And you just work closely with the speech therapists and other people who are in the specific areas, correct?
What is Early Intervention?
Ehrica: 04:26 Yes, absolutely. So I should back up a little bit. Can I explain what early intervention is? I think that’d be a great segue into kind of how we look at that. So early intervention is a birth to three program. So it helps us as parents who maybe think that their child has a delay or we already know that their child has a delay and if that child is in our program, they will age out the day before they turn three. So all the way up until three years old referrals can come from a lot of different places. The health department, a NICU–so maybe we have a drug baby that’s been withdrawing from methadone, a lot of times they’ll be put in our care, pediatricians, and something that I really want to be specific about is parents.
Ehrica: 05:14 Parents don’t think that they can refer to our program. A lot of times they’ll go in and talk to a pediatrician and maybe have a concern about their child’s milestones and a pediatrician won’t be as concerned and they’ll just say, you know what, let’s wait a little bit. I want to tell parents right now, today I’m going to give you a link, Amy, that you can give to your readers and it’s specific by state. So look up what state you’re in. If your child is under three and you have concerns, you can call and refer your child to early intervention.
Amy: 05:42 That’s great. And that’s usually a free service, isn’t it? I’m pretty sure here in Minnesota it is. That somebody who has a concern, can have somebody come out and just talk to you and observe your kids and help you decide if they are hitting their milestones or if they should have some early intervention.
Ehrica: 05:58 So that’s how it works. Yeah, and that’s a great question. So the answer to that is yes, it’s free and no, it’s not free. So let me explain that. So if you were to call and refer your child and get an assessment the service coordinator would come out and do an intake. So they would gather all kinds of information for the therapist and then the evaluations would be scheduled. So all of that is free. There is no charge to you at all to assess your child. Even if we come in and we don’t feel like ongoing services are needed, but maybe a three to six month reassessment of those milestones is needed, still no charge. The only time that a charge comes into play is let’s say a speech therapist comes in and says, you know what? Let’s do weekly speech services with your child
Ehrica: 06:50 The family fee is based on gross income and family size. So at that point we determine how much that family is going to pay for services. And they know right up front, cause we talk about it, we actually talk about it at intake and evaluations. Cause they have to give some financial information. Once that therapist is gonna start, they’ll call the service coordinator and say, you know what, I’m going to start on December 4th. So the service coordinator will put the authorization in the system. Once that authorization is entered, it activates that fee. So you’re right, it is absolutely free up until that point if the family has public aid or if they fall within that specific income bracket to where they’re still at zero, it could be where the family does not have a fee.
Amy: Sure. Yeah, that makes sense. So okay, so what you’re saying is that if a parent has concerns about their child hitting their milestones, the best thing to do might be just to do that evaluation. Just to either find out if they need services or put their mind at ease.
Ehrica: 07:55 Yes, absolutely. Yeah, because development is so broad. I mean, we say children walking between 10 and 18 months is typical. You know, if a parent is concerned at 13 months why not call us. At least to get the child assessed and see where we’re at. Even with language, there’s such a broad spectrum, by 24 months we say we want them to be saying 50 to a hundred words and two to three word phrases. So it’s so broad and this is what I tell moms all the time and have for the past 10 years, if your mama heart is saying that something’s wrong and maybe your family members have said, Oh don’t worry about it. Or the pediatrician says, well let’s wait six months, call. I mean cause if your child doesn’t qualify, you have peace of mind knowing that you got him or her assessed and if they do, they’re going to get those services early.
Amy: 08:57 I wonder if pediatricians are different. I mean the pediatrician I have for my girls is always erring on the side of caution. Like to you know, get the evaluation and I don’t know if he’s like that with everyone or because my girls, they started out as foster babies and had a late start to life. So that could be why. Or maybe he’s just different that way and he just wants to be more cautious and just have those milestones checked.
Ehrica: 09:24 Well, it’s good that you have a pediatrician like that because I do see both sides. I mean I have parents that we’ve been in the house where the child is two and a half and not talking. So my question is why weren’t they referred earlier? And I, you know, it’s a hard discussion to have, but I tell the parents in that moment, you could have called a year and a half ago and parents do not realize that. They think it has to come from a doctor or some outside source. And that is not true. Yeah. And then, so we have some, I can list handfuls of pediatricians in our area that err on the side of caution, and the parent mentions a concern and they’re referred to our program. And then there are some that are, you know, let’s just wait.
What is the ASQ and how can parents access it?
Amy: 10:08 Right, right. All right. So I have a question about the ASQ. One of my readers was asking about how parents can access that. And I have to admit, I don’t know what that is. I have no idea. But my guess is it has something to do with those little papers that we fill out at well child checks where they want to know different milestones that kids are hitting and they do some sort of score. So yeah, if you could tell us, am I right about that and maybe what that is.
Ehrica: 10:34 Yeah. So I’ve kind of done my research on that as well and I honestly don’t think that parents have access to those. It is a testing kit that professionals use. And I do have two in front of me that I want to share with you. Okay. So part of the intake process that we do for early intervention is the ASQ. And there’s a couple of different kinds. We actually do the ASQ SE2. And I can kind of show it to ya. It’s right here. And this is more for personal social. So remember we’re birth to three. So this is looking at, this would be able to identify if the child maybe has some sensory overload issues going on, maybe some autism. If there’s really some quirks in their personal social skills this would help to identify that.
Ehrica: 11:29 So like I said, I don’t think parents can get this. Imagine how many parents would be taking this in, so worried like, Oh my gosh, my child is so delayed, because you could ask the parents to questions. I think in the doctor’s office though, the parents actually fill them out themselves. But I do ask parents the questions, and then on the back I score it. So I’m taking the six month questionnaire right here. And if you look on the back, the cut off is 105. So anything below that is pretty typical. I’m right here. It says no, we’re low risk. Once we get to that 75 mark, maybe monitor the child a little bit and then 105 and over shows definitely a delay. Okay. And usually if the child scores above the 105 or close to, I mean we already know, okay before we even take this because the way the referral comes in and what the parents have been telling us.
Ehrica: 12:28 So a lot of times if the child scores low on this, we already either have behavioral therapy scheduled to come in and assess or an occupational therapist. And the other one is the ASQ 3. This one’s a little bit different and I don’t know which one the doctor’s office gives. Honestly. My youngest child is 10, so I haven’t had to fill these out in a while. But my guess is it’s more like this. So even when we go in and screen at daycare centers or in the school district, the ASQ three is what we use and this is more what I do as a developmental therapist. It goes over the five different domains I talked about. So the communication, the gross motor, the fine motor problem, solving and there is a little bit of a section here for personal social. Okay, let’s go over that piece. So they are definitely different. Both of them you have to score and kind of know what you’re doing. This one’s a little bit more intensive, but that’s why I don’t think it’s free to families. But if a parent has a question or something, they are welcome to contact me about it. And I gave you a link that you can share with your readers. I think it’s called ages and stages, which is where you can get all the information you want about ASQ.
Amy: 13:49 Oh, okay. Great. And also I noticed the CDC link that you gave me goes through each age and what to expect from your child at those ages and a lot of resources out there that aren’t specifically ASQ but will give us some good information to kind of get an idea of where a child is, right?
Ehrica: 14:08 Yes. And that CDC is the one that parents can go to and look up their state and there’s an address and number of the early intervention program in their area. And you’ll notice all of them are called something different, but it still is birth to three.
How can parents help their child reach those milestones?
Amy: 14:22 Right. Okay. I’ve got a question, maybe a little bit different question, but if a parent is concerned about their child or maybe if their child is tested and they’re kind of on the fence of needing services, is there somewhere they can go to get ideas on what to do to help their little one hit their milestones? I mean, for instance, a couple of years ago, I was a nanny to twin boys. They were twins, they were boys, they were also learning three languages simultaneously. So they kind of had a lot going on in the speech department and they had a speech therapist out to the house to help. But a lot of what they did was teach the parents and me how to interact with the boys and how to help them. And so I’m wondering if there are things like that that parents can be doing or a place where they can find resources to help them know how to help their children get closer to hitting those milestones.
Ehrica: 15:07 Sure. And that’s a great question. So part of the early intervention model is to come in and work with the parents as well as the child, right? We actually call it home programming or parent education. So one time a week with your child for 60 minutes. I mean it can help, but we really notice those parents that are carrying over what the therapist tells them to do every week until the therapist comes in next week to give them more homework.
Amy: 15:34 Right? Because the parents are spending all the rest, how many more hours in the week with their child besides that one. So that makes sense.
Ehrica: 15:42 Yes. And I always tell parents you are your child’s advocate and experts, so you are 100% part of this program. So that’s the way it’s set up. You will be getting a lot of information from the therapist if your child does qualify. But let’s say maybe your child’s not in early intervention, right. And maybe mom’s not ready to call and get an assessment done. There are a lot of resources and websites that you can go to. And I actually did give you a few, which I know you’ll be sharing with your audience. So milestonemom.com, which is mine. Everything in there about child development you can go to. There’s a couple of specific ones that I’ve really, really liked. And I wish I would have wrote them down. I think one of them was Mama OT and also The OT Toolbox. So if you have any issues with fine motor or any of that sensory processing, those would be good websites to go to. If you have any issues with feeding and maybe some of that oral sensory component Your Child’s Table is a really good website to go to and I think she even gives free workshops and then mrsspeechiep.com is really good for that speech.
Amy: 17:03 That’s awesome. Yes. I know you sent me a whole bunch and I didn’t have time to look at them this morning, but I saw some that you had sent before then too, so that’s great. Goodness is there, what else did you want to tell us about? I’m looking at my list of questions and I feel like we’ve covered almost everything that I had, but is there more you want to say?
What is the process that takes place when a child is referred for early intervention?
Ehrica: 17:23 Well and I did forget, don’t ever forget the Baby Center cause if you go to babycenter.com they’ve got a lot of stuff on development and I think you can even track your child’s development on there. Something popped up when I went to that website. I think I want to backtrack and just finish talking about the stages of the early intervention process. So the referral comes in. Once the referral comes in it gets sent to a service coordinator. So the parent will then be called from the service coordinator. Then the intake is completed. That usually takes about 45 minutes, is completed in the home. So everything that we do here in Illinois as far as early intervention is natural environment. So we actually come into the family’s home. And then after that the evaluations are scheduled. And like I said, so if you have issues with or concerns with speech, you’ll have a speech therapist and a developmental therapist come out.
Ehrica: 18:17 You’ll know that day of the testing if your child qualifies and what the next steps are. And then every six months we have meetings to determine your child’s progress to revisit those goals and strategies that we’ve set for them. So we’ll have that six month meeting and then in another six months we’ll have that annual meeting, which is all new reassessments. And then part of our program is helping to transition into the school system. So like I said before, your child ages out the day before they turn three and legally the school district has to have your child ready to go for school based services by the time they turn three. A parent can decline that. There are some parents that don’t want to move forward with the school district, and that’s fine. So we actually start that process about six months before the child turns three.
Ehrica: 19:08 And I know that sounds early, but from an early intervention standpoint, we have to have our bases covered and the school has to have their bases covered. So instead of telling your child, bye, see you later, I hope you do good in kindergarten. We like to get them set up with those next steps in the school system. Yeah. And I think that’s all I have. Your readers, if they want to come to my website, milestonemom.com I’m at the top there, they can sign up, put their name and email in and that will give them free access to my free resource libraries where they can get some printables. And a lot coming up in 2020 for Milestone Mom. I’m actually in the process of creating a membership site where some of those moms can come to if they have questions or like you said, if they’re on the fence of what do I do.
Ehrica: 20:01 And connecting some of those moms together because yes, the foundation of Milestone Mom is development, but doing this for a decade, I realized that there is such an emotional underlying thing that comes along with this. I mean, I’ve had parents that didn’t really think that their child would qualify for speech and they’re in tears, right? Like it’s devastating to them. Or the mom that’s dealing with their child that has leukemia and has been laying in a hospital bed and is now home and behind in gross motor. There’s such an emotional component and I really want that membership site so I can connect those moms together. They just really need the moral support from each other and to know they’re not alone and yeah, just to know that everything’s going to be okay.
Amy: 20:48 Okay, well I will make sure to post all the links you’ve given us and definitely information on you and your website and so people can go there and get more information.
Ehrica: All right, well thank you so much Amy.
Amy: Thank you so much for meeting with us today. I appreciate it. All right. Bye.
Developmental Milestones Resources
Milestone Mom Ehrica’s site has info by age (baby, toddler, preschool) or early intervention category (physical, speech, feeding, etc)
CDC Early intervention contact info for each state, and lists of developmental milestones by age from two months to five years
Ages and Stages All about the ASQ
The OT Toolbox How to help your little one with motor skills
Mama OT Great resources for motor skills milestones
Walkie Talkie Speech Therapy This is a great YouTube channel that includes all you need to know about speech milestones and how to help your little one
Your Kids Table Lots of great info on helping your picky eaters or helping your little ones hit their eating milestones
Baby Center Includes a section for toddlers to age two, with help for sleep, potty training, eating, and more
I hope this interview was helpful to parents and provided resources or answered many of your questions about your little ones and their developmental milestones. Please contact Ehrica at Milestone Mom if you have more questions!
Those developmental milestones are so important in early childhood, but I’ve also found that a lot of parents are eager to know whether their toddler knows all that they need to know. If you’re wondering what a two year old should know that has nothing to do with hitting their milestones, check out one of my most popular posts: What Should a Two Year Old Know?