What is Preschool Development
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In this video, Paediatrician Ben Lloyd discusses development in preschool children.


Nina Sebastiane: Bringing a new baby into the world is an exciting time for parents, but it also brings a wealth of challenging questions to inexperienced mums and dads. Of course, every baby is different and may not follow the textbooks stages of development, but it can be worrying if your child hasn't yet uttered a word when others are jabbering away. Joining me now is Dr. Ben Lloyd, a consultant paediatrician from the Royal Free Hospitals in London to discuss concerns around preschool development. Welcome to the show, Dr. Lloyd. Now, assessing a child's development in your clinic, what do you look for? Dr. Ben Lloyd: Well, it's going to vary with age and of course it's going to vary with what the worry of the parent is. I mean the five areas are motive that's moving about, vision, caring, speech, and behavior, if you like. Nina Sebastiane: When do you begin to sense there is a problem? If a parent thinks, oh, my child doesn't seem to be developing like Joe next door, what are the things they should be looking for? Dr. Ben Lloyd: Well, the first thing I say of course is that most babies and children grow up absolutely fine without any help at all from doctors. So it's very, very important. There is a lot of worrying, and of course there are developmental problems. But most children do very well. The two commonest things that I see in my practice are concerns about talking, the child who is slow to talk and quite a lot less common than that is the child who is slow to walk. Nina Sebastiane: In terms of parents being able to say stimulate their child from an early age, how important is this do you think? Dr. Ben Lloyd: I think it's overrated. Nina Sebastiane: Really, that's not what I expected you to say. Dr. Ben Lloyd: Well, I mean it's just natural to stimulate your child. Just being in the same room as the child is going to stimulate him. Of course, the child who is not stimulated at all is going to be in big trouble, but children are very, very adaptable, and there is a lot of leeway with children and I don't think that parents need to work on stimulating the child at all. I think they should work on being with the child and looking after them and loving them and paying attention to them. Nina Sebastiane: Okay. Following on from that, can you give some simple examples about how parents can improve their communication with their children, for example? Dr. Ben Lloyd: Well, it seems perhaps are bit surprising to say this, but I mean just being with them is really - I am afraid, I do meet parents who aren't with their children and the biggest bogey I think is television. Nina Sebastiane: In a good or in a bad way? Dr. Ben Lloyd: So with respect to the baby channel and other stations, television is generally a bad thing for child development and television is a great force for good, but too many children are put in front of the television with people thinking that the action, the sound, the music is going to be good for their child's development. And I am not saying that a little bit of that isn't good for the child development, but not eight hours a day or 16 hours a day. Nina Sebastiane: When you talk about television on a slightly different subject, there is heck of a lot on TV at the moment about childhood behavior. How you can improve on it? How can parents be better parents, and pick up on things earlier. What do you think about this? Dr. Ben Lloyd: I think that's a very good use of television. I think it's tremendous. Supernanny is one program what we don't like to miss in our house. I have learned -- I think she generally dispenses superb advice and is very, very vivid. I wonder sometimes about the consent of the people involved, but I think it sends very clear messages to parents, I am sure that other people other than me have found useful. Nina Sebastiane: I mean as the old adage, isn't that? You need a pet license for dog, but you don't need a license to have a small child. I mean would you concur with -- do you think that there should be some kind of compulsory parent training before people go into having a family? Dr. Ben Lloyd: No, on libertarian grants, I am against that, but that isn't to say that all of us. I think many, many parents including certainly myself could benefit from simple advice about parenting. They are on the television now. Nina Sebastiane: Well, let's go to some questions actually. Just now what we have done is we have compiled some frequently asked questions and concerns many parents have. So let's run through them. At 15 months, my son is not walking, but still bottom shuffling. Is that normal? Dr. Ben Lloyd: It's normal for quite a lot of children to bottom shuffle. Most children are walking by 14 months, but a significant number about 10%-15% aren't walking by 14 months. Nina Sebastiane: So what if it's 16 months or what if it's 18 months, they are still not walking? Dr. Ben Lloyd: The later it gets, the more likely it is that there is a problem, but actually it's very rare in my experience for late walking, if that's the only problem to represent one of the pretty rare medical things that can cause late walking. People worry about muscular dystrophy and cerebral palsy and I have seen both of those. Nina Sebastiane: So if you are seeing something in isolation, it's not necessarily a problem? Dr. Ben Lloyd: Yes, I mean exactly in that question, the child I put -- quite a lot of -- I own put my house on it, but I put quite a lot of money, I mean very quite a lot of money that will be normal, that the problem be normal. And children with bottom shuffling sometimes they don't walk to let two-and-a-half. Nina Sebastiane: Or there is the old thing where they bottle shuffle and then they just simply get up and walk rather than doing the next stage. Dr. Ben Lloyd: Yes, they don't crawl. And of course it's a name in the north, Shufflebottom, because it runs in families. Nina Sebastiane: I didn't know that Dr. Ben Lloyd: I have a friend called Shufflebottom, but his children didn't shuffle their bottom. Nina Sebastiane: Well, I must be true them. Okay, I have got another one for you. A baby born four weeks prematurely is now three months old, should parents be thinking of him as being three months or two months old? Dr. Ben Lloyd: Well, that's an interesting one. I think most parents of the three old month child, if he is born on April the 7th, on July the 7th, they think he is three months old, and I think that's a sort of healthy thing to do. It's confusing, because quite lot health professionals will take a month off when they are plotting the weight and that's also reasonable, but at some point, it gets ridiculous. Nina Sebastiane: But you'd expect that child to catch up in all sense? Dr. Ben Lloyd: Yes. At two weeks of age the child will not be behaving like a baby who is two weeks, who is born at full term, but by the time he is four to five months, it's four, five, six, seven months, the gap will narrow and he will be the same. Nina Sebastiane: Is it okay, for example, one of the questions here, to let a 15 month or we talked about television, to watch television for say, several hours a day? I mean, what's acceptable? Because I mean I know in my house, my daughter has this one particular DVD that she adores and it gets to the point where she pulls in the bottom of my pants regularly each day to watch this 20 minute program, and I do let her watch it. But what's normal, what's acceptable? Dr. Ben Lloyd: I think that sense absolutely fine. The American Academy of Pediatrics, the British Royal College has I believed not pronounced on this, but the American Academy of Pediatrics takes a very strong line. And I think it says, no television at all under two and one hour a day after. But I think personally that's absurd and I think television -- but I think they old phrase is watch with mother, and I think watching with mother is you could do an hour or two a day probably. Nina Sebastiane: How realistic is that? Because I mean I know in my own home, those 20 minutes I get everyday are a godsend. I can wash the dishes from breakfast. I can get myself ready. Maybe if I am really lucky, get a shower and -- Dr. Ben Lloyd: How do you extend that 20 minutes constituent? Nina Sebastiane: Well, okay, alright. Dr. Ben Lloyd: But I think -- what was the question, seven hours? Nina Sebastiane: Several hours. Dr. Ben Lloyd: Certainly not. Several hours, I think is really pushing it. But as I said earlier, there is a lot of leeway with children, but I think several hours sound too long. Nina Sebastiane: Well, especially if she is tugging at me to watch it. Dr. Ben Lloyd: Absolutely. Nina Sebastiane: Okay, alright. Well, I feel better about that. Dr. Ben Lloyd: 20 minutes is fine. Nina Sebastiane: My child of two years is still not speaking, is that okay? Dr. Ben Lloyd: Well, most children the first word is sort of soon after one, certainly by sort of in a 15-16 months, but there are millions and millions, yes, millions of children who are saying nothing or very little by two. Nina Sebastiane: But gurgling or bubbling or babbling? Dr. Ben Lloyd: He should be making some noise and it comes back to the point I was making earlier about are there other problems? At two, I think that is time to by then I would sought advice and there are some important causes of not talking by two, but most children who are not talking at two will be fine and will be indistinguishable from other children by sort of four or five. Nina Sebastiane: I have got a question for you. So if you end up talking earlier, does it not make you more intelligent? Dr. Ben Lloyd: It makes you more verbal. Nina Sebastiane: Well, I certainly -- it doesn't equate, doest it? Look at some of our politicians as I suppose. I didn't say that. Dr. Ben Lloyd: I think, it's obviously encouraging. I am sure that there is a greater chance that child is going to be highly intelligent, certainly highly verbal. But I don't think you necessarily be putting him down immediately, just because they are a bit advance. there's a huge, huge range, huge range. Nina Sebastiane: I know that mothers are certainly competitive about when their children do their first thing, I am sure fathers are too. Now another question for you. I have heard that smoking is bad for baby's hearing. How can that be? Dr. Ben Lloyd: A lot of parents say, well, I know he is chest is fine, so my smoking doesn't matter, does it doctor? Well, it does. Because one side effect of smoking is on eustachian tubes, which are the little tubes from your ear to your throat, which drain fluid from the ears. And so in the same way that smoking bungs up the tubes in your lungs, it actually bungs up the tubes in your ears and a lot of parents aren't aware of that. Hearing is a very -- you ain't going to talk properly, if you can't hear properly. Nina Sebastiane: So hearing isn't bad -- My baby is six months old and I am worried he can't hear properly, but my doctor says, he is too young to test. We should wait and see. What should I do? Dr. Ben Lloyd: There is an old, old principle in pediatrics, that if a mother is worried that her child can't hear, that child should be treated as possibly deaf and seven months and 6 months is certainly not too young to test, you can test a newborn baby. So if she is worried that her child can't hear, she should be tested and she should go to and have a doctor, go back to her doctor insist, go to her health visitor and insist. There are hearing clinics everywhere. Nina Sebastiane: And parents can do, can't they? They are the first protocol. If they think there is anything wrong, go and have it checked out. Dr. Ben Lloyd: Definitely. She should just get back to her doctor and ask again and quote the Baby Channel at him. Nina Sebastiane: Okay, quote the Baby Channel, fine. I am sure she will. My five week old baby sometimes jerks or stiffens certainly while sleeping. This is not in relation to any background noise and I have not noticed it when he is awake. Is this normal? Dr. Ben Lloyd: Probably, I mean jerking is a worrying symptom and your viewer -- I can understand why she should be worried, but there is a syndrome of jerking in very young babies which they just do typically when they are falling asleep or when they are asleep. And as long as the baby is otherwise fine, then in my experience that's some, you didn't find anything. Nina Sebastiane: I think I did it myself before -- not at all if I am sure. I think it's muscle spasm or something isn't it? Dr. Ben Lloyd: Indeed. Nina Sebastiane: My three-and-a-half old son was dry during the day for last six months, only needing nappies at night. But for the last month, he has started having regular accidents during the day and seems on aware that it's happened. What should I do? Dr. Ben Lloyd: Well, that's almost certainly nothing. Again, if there is no other worries. Thirst, wetting could be assigned that you're developing diabetes, but with that because you're passing so much urine, you'd wet yourself, if you got an immature bladder. But if he is not particularly thirsty, that's pretty unlikely. The other possibility is a urine infection which again I think he is unlikely, but both those things have very easily tested with a dipstick and a visit to the doctor. So it's kind of depends on how bad it is and what the other symptoms are. Nina Sebastiane: Absolutely brilliant. Dr. Ben Lloyd, thank you very much for coming in and sharing your thoughts with us. Dr. Ben Lloyd: Pleasure!