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Carolina Kids Blog

Posts for tag: developmental and behavioral consultations

By Carolina Kids Pediatrics
April 08, 2019
Category: Children's Health

It seems to me that managing physical illness often represents the easy part of being a pediatrician. The real challenges we often face are behavioral visitsin the domain of child development, behavioral health, and mental health.

Although there are plenty of excellent child psychologists and psychiatrists in our area, we believe that being a pediatrician in Raleigh, North Carolina means being available to address many childhood behavioral and developmental challenges in our office. In order to facilitate this, we provide extended visits for developmental and behavioral consultations to help you and your family.

During an extended visit and consultation appointment for developmental and behavioral issues, your pediatrician may address a number of concerns. Common challenges we address may include:

  • Infancy: Common concerns that in infancy include development of normal gross motor skills, including rolling, sitting, crawling, and walking, as well as challenges involving feeding, including breastfeeding and transitioning to solid foods. We conduct an evaluation at every well visit and perform standardized developmental screening through the Ages & Stages (ASQ) measurement tools in our office. Through these evaluations, we can help you evaluate if your baby’s development is truly behind. If it is, we can gauge how much additional evaluation and intervention is needed. For example, delays in gross motor development may require simply home intervention (for example, a neck stretching program for a baby with mild head flattening which we can teach you in our office). More significant delays may require intervention by a trained therapist. Some of these therapy services can be obtained through private referral. However, if developmental needs are likely to require more in-depth intervention over time, we often refer to the Children’s Developmental Services Agency. This is an arm of the school system which provides a free developmental assessment for kids from birth to age 3 with developmental delays. The CDSA can provide physical therapy, developmental therapy, speech therapy, and occupational therapy if it is warranted. You can contact the CDSA by calling (919) 662-4600, extension 239, if you believe that your child needs an evaluation – or check out the early intervention website at https://beearly.nc.gov/index.php/contact/cdsa .

 

  • Toddler years: Common developmental challenges include delays in communication skills, and sometimes concerns about autistic spectrum disorder, as well as increasing struggles with autonomy surrounding meal choices, potty training, aggression, and defiance. In addition to ASQ screening, we add specific, standardized screening for autism, as well as standardized vision screening in the second year of life. If you have concerns that your toddler has developmental delays that might be due to autism, please take the following steps: First, call us for an appointment. Second, please check out the website http://firstsigns.org – a great resource, with reliable information and screening tools. Third, consider contacting the Children’s Developmental Services Agency (contact information listed in last section) for a complete early learning evaluation through the school system.

 

  • Preschool: The focus during the preschool years often involves early learning skills and school readiness. This can include a more in depth consideration of peer social interactions, fine motor skills and skills needed for early literacy. Your best community resource for evaluating these concerns include Project Enlightenment, a public service offered by the Wake County School system which serves preschool age children and their families. Services include daycare and preschool behavioral consultation, developmental screening, parent behavioral workshops, and individual parent behavioral counseling. Check out their website at https://www.wcpss.net/projectenlightenment . If a preschooler has delays that might affect school readiness and require classroom-based services, you can request an evaluation for these public preschool services through Wake County also – for more information, check out https://www.wcpss.net/Page/4310 .

 

  • Elementary school: Changes in academic performance or behavioral concerns can raise questions about a possible learning disability or attention deficit hyperactivity disorder (ADHD) at this age. Review of school report cards, standardized testing assessments, as well as reports from psychoeducational specialists can be helpful in evaluating these questions. You can also complete standardized questionnaires including the Vanderbilt Teacher and Parent Diagnostic Rating scales – these can provide us with helpful information, and are available at https://www.brightfutures.org/mentalhealth/pdf/professionals/bridges/adhd.pdf . If your child has a medical condition that affects learning (including ADHD, depression, anxiety, etc.) or a learning disability, you have the right to request a Section 504 plan or an Individualized Education Plan (IEP) through your public school. These plans can provide access to specific modifications which might help your child, including behavior plans, extended time on tests or assignments, a modified homework schedule, etc. They can also provide access to special education services – which could be as limited as a once weekly “check-in” with a special education professional, or as extensive as separate classroom placement. When appropriate, we can advocate for you during this process by writing needed letters, providing needed documentation to your school, or making any additional needed referrals. Your best online resource for learning more about ADHD is the organization CHADD (https://chadd.org).

 

  • Adolescence: Although kids can struggle with issues surrounding possible depression and anxiety disorders at younger ages, these challenges can become more prominent during adolescence. We include confidential questionnaires for teens at well visits – these ask age-appropriate questions on mood disorders, substance abuse, and sexuality, which often opens the door to determining if other interventions are needed. These interventions might include cognitive behavioral therapy (changing thought patterns that affect mood), family therapy, and sometimes medication management.

The pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina can provide developmental and behavioral consultations on these and other concerns.


These are in depth conversations and require time and follow up – which is why extended visits for developmental and behavioral consultations are so important. To find out more about how a pediatrician can help with your child’s development and behavior, contact the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina today by calling us at (919) 881-9009 or sending us a message about your concerns through the patient portal.

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC



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