Early Childhood Intervention

Q. My four week old daughter holds her tongue to the roof of her mouth all the time. In the beginning this lead to eating problems. She will not take the breast, only a large, bottle nipple that forces her to put her tongue down. Is this something she will grow out of or is there a problem that I need to push my pediatrician to explore further? Renee, New Orleans, LA

A. My answer is more about developmental problems and delays in general and not specific to the problem you asked about...

Since her problem was so severe that it interfered with your breastfeeding, you might want to seek an early evaluation in this case. On the other hand, since she is now eating well, some Pediatricians would call for a more 'wait and see' approach. And neither approach would necessarily be wrong, since we don't have a crystal ball to see how see is going to do in two or four or six months from now...

Each approach does have its consequences. Jumping into an evaluation for a delay or problem too early can unnecessarily worry parents that have a baby that is just a 'late bloomer' and that is eventually going to pick up all of her milestones on time or just a little late or has a 'problem' that is going to go away on its own. And it can lead to invasive tests that may be unnecessary.

But then waiting when there is a real problem causes you to lose valuable time when you could have started early treatment and maybe avoided later problems.

It is usually best to seek an early evaluation instead of just observing your child if:

• you have already been observing the condition and have seen no improvement during the 'wait and see' time period
• you are very worried about it and don't feel comfortable waiting
• your instincts tell you that something is really wrong and it is not something your child will simply grow out of
• your child has other problems or medical conditions or isn't gaining weight well, etc.

It is also important to let your Pediatrician know just how concerned you are about a 'problem.' For example, if you ask why your nine month old doesn't have teeth yet or why your eleven month old isn't walking, you may get a quick 'oh, that's normal,' because it usually is. If you are not satisfied with that answer, ask for a more detailed explanation so that your Pediatrician can put your mind at ease and that you can understand that infants often don't get teeth until some time between six and 15 months and many infants aren't walking well until 15 months.

And of course if your Pediatrician suggests that you 'wait and see' and you aren't comfortable with that, be sure to mention that too. You can say "I'm sure you are right, but I'd feel more comfortable with a second opinion," or "I'm really worried about this."

In the case of your child and her holding her tongue against the roof of her mouth, it is hard to know if these tongue issues might interfere with starting solids later on. And of course you could decide to wait and see how she does once you start solids and then seek help if she is not able to start eating an iron fortified infant cereal when she is around four to six months.

In addition to discussing this with your Pediatrician, parents who are concerned about their child's development can seek an evaluation from their local Early Childhood Intervention or ECI Program. Remember that although your Pediatrician can do a referral for your child, you can also usually call yourself.

For this specific issue, a speech pathologist at your local ECI office could do an evaluation.

Here is a link to the early steps early intervention system in Louisiana if you are interested in contacting them. Hopefully she will just grow out of it, but please give us an update in the future as to how she does with this problem.