Host: Dr. Pavlakis, every mother is concerned of my baby is going to be normal. You can't just look at a new born and guarantee the kid is going to be normal. So what would we look at along the way that would be hallmarks, may be the kid is a little bit development. Say kids are above three months what would you be looking at?
Dr. Steven Pavlakis: Well, there are certain developmental hallmarks that happen overtime and those are the things that one has to be sure that a child needs. There are different hallmarks or development that occur at every age. Certainly a parent with a good pediatrician scream for those hallmarks. At three months of age that child should visually fixate, follow visually, have a social smile, start cooing and move around quite actively. If a child doesn't do any of those things that would be a red flag something to be concerned about that should be gone over with the pediatrician.
Host: When we were looking to keep a tick a rattle of one hand and for instance to the other side what would you be concerned about that?
Dr. Steven Pavlakis: Well, when a child just start reaching at six months or so when transferring between 6 and 8 months and that's what one will expect, if a child does not do that, that would be a red flag as well. Again not necessarily in and of itself a serious red flag, but a red flag should be dealt with the pediatrician to start with.
Host: When should may baby sit up?
Dr. Steven Pavlakis: Sitting is actually genetic and all these things have a tremendous range, but a child in US, the upper limits when a child just sit by themselves, in other words from a lying position get up and sit by themselves, this is about eight months of age.
Host: When should my child be able to walk?
Dr. Steven Pavlakis: Again that's genetic and it's also different in different gender, I mean, girls walk a little bit later than boys. But the upper limits of normal in the US for a boy is about 14 months, and for a girl it's 15 months. Again, if someone walks later than that it doesn't mean there is a major problem, but it's a red flag and should be looked at and considered.
Host: If a child is 18 months old, how many words would you think as a neurologist the kid should be speaking?
Dr. Steven Pavlakis: Well at 18 months the child should be walking and should have a handful of words. More importantly they should understand child at 18 months can follow simple commands verbally, a child at 18 months can point to body parts with verbal cues and may even be able to say some of the body parts. So that would be the kind of interaction one would expect at 18 months.
Host: How many words would you think would be reasonable?
Dr. Steven Pavlakis: There are normal kids that don't have any words at that age but understand, but I think 20 or 30 words would not be unreasonable for 18 months.
Host: But sometimes kids will use pointing gyration with their own type of language.
Dr. Steven Pavlakis: Correct! That's correct!
Host: And that could be perfectly normal.
Dr. Steven Pavlakis: Perfectly normal, and their perfectly normal 18 months don't have any words or may have one or two words but understand point, follow commands and those children are not of concern. But again, if a child has no words whatsoever at 18 months that's something that you would discuss with a pediatrician not necessarily need to go to a neurologist because it can be normal.
Host: If multiple languages are spoken in a house, sometimes it makes it more difficult for the kid to speak English because of the fact it's happening around the kid.?
Dr. Steven Pavlakis: That's correct! There are two issues here that are interesting. One is some children don't have a lot of expressive language and that can be normal and they have been done a long time ago in the 80s on this and people found that those children that don't speak a lot tend to be quite as adults. Could be smarter than everybody else, but they tend not to be talkative people.
The second issue is having multiple languages which is the neat thing about Brooklyn and that probably half of the people we see speak at least two languages at home. Sometimes we see more than that which is confusing.
In a child that doesn't have a language disability those children can acquire both languages very normally although may have some relative delays especially in vocabulary and the like up until about age four years. After that there is not much in the way of the real delay. So a child that has no inherent language problems can pick up two languages quite readily may have some mild expressive delays but not a lot relative to the children that have one language and by age four it should be pretty much entirely caught up.
Host: A lot of this can be based in good observation by your pediatrician looking for expressive language, any language, is that correct?
Dr. Steven Pavlakis: That's correct! So you want to look at expressive language meaning what you say and at the younger ages when there is not a lot of expressive language even more importantly the receptive language what the kid understands.
Host: So in other words, there is no fixed rule, many kids learn at different rates but the overall picture should be looked at by your pediatrician.
Dr. Steven Pavlakis: I think that's right, the pediatrician should look at this first and if there is a concern the patient may need to be referred to a neurologist. But there is no real fixed rate specially with expressive language which is really all over the gamete and one has to be very careful about using that alone.
Host: Thank you Dr. Pavlakis!
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