Expert: Jene Aviram - 3/16/2010

Question
QUESTION: hi, first, thank you very much for your time.
My daughter is 11 months (2 months premature, so that makes her 9 months now). whant conceres me is that last 2-3 weeks she does not seem to smile as much and look me in the eye like before. she still does, a lot, but before, she was really continuously smiling and looking me in the eyes. she has an eye infection; could that be upsetting her ? we started treatment today.
other than that, she does not smile as much when I come home from work. her dad ia a stay home father so she is always with him. when she sees me, thought, she hugs me very tight, smiles (reserved) and cuddles. she laughs loud a lot but we have to try harder than before and always new things. she has a favorite toy that she brings to me when I ask. she gives me her hands when I ask. she started to wave a little. she bangs objects on table or floor, takes toys from us, and sometimes gives back and she transfers from one hand to another, also puts then in a bucket and takes them out. she babbles very much but mostly when she wants. rarely she imitates and rarely she responds. she answers to name too. until not long, when another baby cried, she showed empathy and cried too. now, she laughs loud. I heard that this can be a sign of autism ..?  she does not crawl but sits for unlimited periods, using both hands and rolling very well. she does bottom shuffling. still, left arm gets caught under her sometimes, which she manages to free by herself. is this associated with autism (when an arm gets caught under them at this age ?) she had bad colics as a little baby and has lots of gas now. very healthy otherwise. head was small at birth (27.5cm)and is now 46cm. how do you think these dimensions are, is 46cm ok for 9 month old ? she also likes to look at books and laces and studying her hands but not flapping, just fanning and flexing fingers when she is on her back. she plays appropriate with toys, she knows to turn buttons and make toys sing. she also used to sing but not since 2-3 weeks anymore.. she also plays peek-a -boo and finds hidden toys easily. she loves the cat and noises do not upset her.so, what worries me is:
- not smiling as much (especially not at strangers)
- not smiling as much when I come from work
- studying her hands a lot
- studying laces (from my pants, shoes)
- not crawling (but then again, looking back, we did not give her enough tummy time)
- not crying when other babies do (she will laugh)
- generally not imitating (rarely she does, though)
- especially when in a supermarket or when playing with her hands, she will not look at me or smile at me, only at shelves, objects, other people
- she used to sing, now she stopped
For the word NO, I know she will not understand because we never said it to her. We rather prevented her from going into hazards than saying a firm NO at her. Is this wrong ? Should we start with NO ? As you can see, I am a quite confused mother; I am sorry if I repeated myself too much. I have no friends/family with a young baby and my mother has forgotten a lot since I was young.. :) Please tell me if she dispalys signs of autism ? Thank you very much, Carina.

ANSWER: Hi Carine,

I wouldn't be concerned about any changes in your daughters eye contact in the last couple of weeks because of the infection.  Once that clears up things will probably change right back to the way they were.  I also wouldn't be too concerned about head growth.  For every person that agrees with that theory, there's another one that disproves it.

You have said some very positive things, for example she brings you things when you ask, she babbles, she waves and responds to her name.  These are all great signs.

I do think it's important that your child gets evaluated by early intervention - or whatever the equivalent is in Australia.  Please talk to your doctor and find out the next steps.  Your daughter is still so young and being premature, she is bound to need some catch up time.  And so I wouldn't stress over it too much but it's always good to be ahead of the game.  Tell your pediatrician that you are concerned about some of the behaviors she displays such as not imitating, gross motor skills and studying her hands while tuning you out.  These might not be a big deal in context with everything else but it will get you on the list for an evaluation.  (I don't think you need to be in a huge rush for this evaluation and I don't know how it works in your area, but in the USA you can often wait 6 months before there is availability).

Please keep in mind that your daughter is so young it would be impossible to determine if she is on the autism spectrum.  She has a lot of growing to do and you will be amazed how much she'll change.  One can't possibly diagnose before 18 months anyway.  Although I will say that sometimes people have written to me when their toddlers are 12 months and I see red flags everywhere.  This NOT the case with your daughter.  Perhaps she just needs some time to mature but since she was a preemie I'd keep an eye on it to give her a head start.

I wish you the best of luck and success.

Jene Aviram
http://www.nlconcepts.com

---------- FOLLOW-UP ----------

QUESTION: hi Jene

Thank you very much for the quick response. I will definitely talk to her doctor and put her on the list. In the meantime, please answer a few more questios:
- what is considered normal babble a day, in length and occurence ? to me it seems she babbles a lot but since I never saw other kids her age, maybe she doesn't..
- she initiates peek-a -boo with us by leaning against door frames. this must be a positive sign ? is it still good if she does not play the classic way, by covering her eyes ? she just rolls behind big furniture and pops half her head out then goes back again laughing.
- she follows my finger point if I show something to her but she will of course not point herself
- she loves to touch and scratch different textures and sucks her thumb when upset. that is a red flag ?

I know it is still so early to diagnose, as you said, but what can I do, it's hard to stop worrying, even if I know she is still same baby as she was, my little joy.

Thank you again, this a very kind thing you do for parents like us and I wish you all the best in everything !

kind regards

Carina

ANSWER: Hi Carina,

Firstly thank you so much for the rating you gave me.  I truly appreciate it.  Let me answer each one of your questions.

Babbling - your baby is babbling just fine.  At 6 months babies begin making vowel sounds.  By 7 months they start making wet razzing noises.  By 8 months they start trying to imitate sounds.  By 12 months they start to say "mama" and "dada" discriminately,  Bear in mind that your daughter is a preemie.  So you can afford to give some extra time.

Peek-a-boo - You have nothing to worry about here.  All around the world babies play peekaboo.  In every language you can think of.  In some countries they say "koo-koo" instead of peekaboo.  In some countries they hind behind pillows instead of their hands.  There is no set way to play.  The point is that your daughter loves and enjoys this game.  And she does.

Pointing - It is MORE than great that your baby follows your point.  This is a Big one.  Babies usually only start pointing when they are around a year old.  And your daughter is not even there yet.  And she's a preemie.  So nothing to worry about here.

Upset - We all do things when we're upset or tired.  Some of us bite our nails.  Some of us stomp our feet. Some of us twirl our hair.  Some of us suck out thumb.  Your daughter has found an outlet to deal with her frustrations.  Nothing wrong with that.  Touching and scratching surfaces constantly - instead of playing and communicating would be a concern, but as a method of consoling herself it's perfectly fine.

So as hard as it is, try to relax.  You're going to schedule that evaluation anyway because that will finally give you total peace of mind and your daughter will be a bit older by then.  But at this point, I say relax and enjoy every minute with her.

My very best to you.

Jene Aviram
http://www.nlconcepts.com

---------- FOLLOW-UP ----------

QUESTION: thank you so much Jene I am happy with what you wrote back. We'll see the pediatrician next week and thanks God he has knowledge of developmental issues. I think in my heart I know I should relax but yeah, it will be hard until I get an evaluation done. I think my main disadvantage is I never dealt or even met a young baby this close, and so I read stuff on internet which is probably only a guideline, but looks like I take it too deep. Now that I'm a mother I seem to do all the things that before I said I'll never do (like worry :)).
You are a great person and I will keep you posted. Thank you.

Answer
Hi there,

Just checking to see how you're doing.  I know you haven't seen your pediatrician yet but you are doing all the right things.  The best thing you can do is keep a log of anything that concerns you.  It's amazing how we tend to forget all these things when we're at an appointment and then when we get home we think "Oh no, I wish I had mentioned that."
And LOL - nobody can ever prepare us for all that mommy worry when we have kids.
:-)

Jene Aviram