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Abs_1986 · Feb 15, 2012, 01:46 PM

I'm a day care provider of a 14 month old girl and wondering what I should do...
She cannot roll over from a laying down position OR even sit up from a laying down position. She can sit on her own if you put her that way but if she somehow looses herself, she'll fall on her face as she won't put her arms out to protect herself. She cannot stand or pull her-self up, which in the end, she's not walking. She cannot even crawl. She broke her leg back in November at 11 months (she still wasn't showing signs of anything above) and her parents said the doctor said she'd be where other kids are within 6 months. I don't know if the doctor knew before hand that she wasn't doing ANYTHING regular 11 month old could do... its been 2 months since she's gotten her cast off and like I said she is now 14 months and has no basic motor skills except for moving her hands and feet. What is wrong with her? And how should I bring it up to the parents (who is also some-what friends of mine) without offending them or getting their backs up. They feel she'll be fine as the doctor said that she would be.

Wondergirl · Feb 15, 2012, 02:17 PM

My first thought was that she has some form of muscular dystrophy, but then, I'm not a doctor and haven't examined her. Does she seem alert otherwise without any other signs of physical problems?

Even if she will supposedly catch up in 6 months, it seems like it would be a service to her to provide her with a regular series of exercises to keep her limbs and muscles moving and working well. The very fact that she can't sit up without falling forward at her age seems like a warning bell that something is wrong. I know parents don't want to hear bad vibrations about their children, but there has to be a way to voice your concern in a kind way. Maybe another member here will have that perfect comment for you to make. I too feel the little girl needs immediate intervention.

jenniepepsi · Feb 15, 2012, 08:25 PM

I am not sure what may be going on. But I definitely think you should bring it up to her parents. Let them know your observances and concerns, and even suggest a good ped specialist they can turn to.

DoulaLC · Feb 16, 2012, 04:57 AM

Is she not doing anything with her hands as well? Picking up and turning over toys? Feeding herself?

While there is a fairly wide range of what is considered normal in terms of fine and gross motor skills, she is lagging behind. I am surprised the doctor would not have observed some of this back in November.

I would simply tell the parents of your concern and ask if they have mentioned this to her doctor before. Since they are somewhat friends of yours, present in with love and caring. "I just love little Rebecca so much, and I am very concerned about what she is still having trouble with". You might want to document what you have noticed. Observe the basics: feeding herself, picking up toys, and of course being able to sit and stand, or at least be attempting to stand. What does she do when you try to entice her to come to you or to go get a toy? What are her verbal skills like? Does she seem to understand much of what you say to her?

They may dismiss the walking due to having had the cast on, and that is possible, but if her fine motor skills are underdeveloped, that would be another red flag. If she mostly lies there just moving her feet and hands, it needs to be addressed.

They simply may not be aware of what motor development she should be exhibiting at this stage. Perhaps researching some information for them and showing that to them when you discuss it will help.

Abs_1986 · Feb 16, 2012, 05:49 AM

Thanks for the responses so far. I should clarify to Wondergirl that she can sit on her own and will not fall forward but if she is trying to reach for something and looses her balance, she will fall on her face without putting her arms out. As for the physical problems, she did break her femur bone very easily at a diaper change, which I'm not sure could be associated with muscular dystrophy.
DoulaLC- she can hold toys and feed herself (not with a spoon but with hands). She sits there and turns her bunny blanket over and over again and tries to reach for some toys I purposely put out of reach to like you said 'entice' her to crawl to get them but she won't. I try getting her to stand up but she just lifts her legs back into a sitting position and crys and crys. Same with getting her to crawl. I put her in a crawling position and she'll hold herself up for a few seconds and then lets her arms give out and just lets herself fall face first. She doesn't even attempt to sit up in a laying down position or roll over. At quiet time, you'd expect a child to get up and stand up in their crib once they are don napping but she'll just lay there. Just seems so weird for a 14 month old. As I said, some kids aren't walking by 14 months and the cast could have been a set back.. which isn't what really concerns me.. I'm concerned about the fact she isn't capable of doing other simply functions that a 4 month old can do, such as roll over.
It's very hard subject to bring up to the parents as they have noticed it but their orthopaedic surgeon who worked with them on her leg, told them within 6 months she'll be where every other kid is at. But he isn't their family doctor and I don't think he knows that she can't even roll over. She hasn't had her yr shots get so I'm hoping that's soon and maybe their family doctor will have a better idea so I think I'm just going to hold out for a bit. I don't want to cause even more stress on her parents. They have two older children who also had a later start and also speech problems and potty training issues.

J_9 · Feb 16, 2012, 06:43 AM

One of my concerns is how her femur broke during a diaper change. This is very odd as the femur is the strongest bone in the body. Does she have a bone disease?

I have some thoughts going in my head, but I don't want to go down that path until I get the answer to the above question.

Abs_1986 · Feb 16, 2012, 07:51 AM

Hi J_9,
We still don't know the answer on how her femur broke. She has an appointment with a geneticist to get testing done but it's a yr from now. Her parents have talked to a doctor in a neighbouring city to speed the process up though. So a bone disease isn't ruled out. Her mother's niece has a bone disease that causes her to get fractures but the doctor said it wasn't that type of bone break but he also ruled out unnecessary force and the investigation has been closed.
The whole broken femur is what got my cluing into that fact that she hasn't developed any major motor skills and this is why I have asked the question and hopefully a doctor or nurse could shed some light on what it could be... that maybe she does have some sort of disease and this is why she hasn't developed these skills and why her bone broke so easily.
This is also why I'm not sure what to do because if it is something more serious then I should let the parents know because what if something serious happens again but then I don't want the parents to feel stressed in case she's just very behind. Ugh, I'm so torn.

J_9 · Feb 16, 2012, 08:01 AM

I really feel your pain. I understand the dilemma you are in.

It seems you aren't in the US due to some of your spelling? With this type of injury it shouldn't take a year to get into a geneticist where I am from.

My first concern was possibly neglect, and I'm still not sure that this isn't a problem. Babies should be rolling over, etc. by about 3 months or so of age and you said that there are other children who are problematic in that they are/were behind as well and have other issues. But I really don't think we should visit that idea at this point.

Osteogenesis Imperfecta would account for such a break, but there would be other bones broken as well.

So, an investigation has been done already?

Abs_1986 · Feb 16, 2012, 08:10 AM

Hi J_9.
I am from Canada. And it usually takes a bit to see a specialist for things. I don't believe it is neglect, especially on my end, also the fact that every parent knew about the incident and all of them felt confident enough that their children continue in my care as well as the parents of the girl. She has continued coming to me as well as her older brothers. I take care of her older brothers who have been in my day home for over 2 yrs anther mother returned to work in September and that is when I started watching her. I also don't believe it is neglect as her father is a police officer and her mother is a social worker and the kids are good solid weight and never come bumped or bruised, unless it's on they knees from kids being kids!
An investigation was opened and closed through children aids society as well as 24 doctors involved with the baby unanimously concluded that there was no unnecessary force that broke her leg.
Now, it could be that every time I did see the girl outside of my home as an infant, her parents were holding her or put her in a swing and she had no tummy time so thought maybe that's why but now she just isn't doing anything!

J_9 · Feb 16, 2012, 08:19 AM

Okay, thanks for putting my fears to rest. However, tummy time has little to do with this as what she SHOULD be experiencing are developmental milestones and should develop within a certain timeline.

Now I'm left wondering if the mom had a complicated pregnancy, something that could have been caused within the womb.

You need to look up the developmental milestones for children her age and younger. It would be best if you present your concerns to the parents as in what she should be doing by her age and what she is not. I can understand her not walking or standing, but I'm concerned about her not reaching for things.

Two questions before I go to sleep as I've been working all night... Does she hold her own bottle? Does she reach for it when it is shown to her?

Abs_1986 · Feb 16, 2012, 08:29 AM

Thanks for all your insights J-9.
She does not hold her own bottle from what I've seen. She refuses a bottle from as well as milk. Her youngest brother was also like this and never took a bottle from me. She is very stubborn and rarely will take a bottle from her dad... basically the mom has to give it to her. Even when she first started coming to me, she refused to eat from me. She eventually warmed up and eats now but probably for a good week she refused. I even took video of me trying to feed and her sent it to her parents to show them.
She does though, hold a sipping cup that has a built in straw but she doesn't tip it back. She just holds it and puts her head down and sucks water up from the straw (she will not drink milk from it)

DoulaLC · Feb 16, 2012, 03:23 PM

It will be interesting to see what comes from her next doctor's visit as they will check her over and ask questions regarding her development. You mentioned that the family's other children were also late in development, so that may be an indication of the same. Usually, since they already have had other children, the parents would be aware of whether she is doing what the others did at the same stages of development.

You might just voice your concern and suggest that they might want to discuss it the next time they see her doctor just to make sure that all is well... then leave it at that. Please do let us know if you hear anything.