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How do you know whether
Measuring children’s development
during the pandemic
your child is developing
as he or she should? Visit
washingtonfamily.com for
a guide to developmental
behavior, language, motor
and social skills.

28 WashingtonFAMILY FEBRUARY 2021
BY ERICA RIMLINGER
S ince the COVID-19 pandemic
began in March, child development
specialist Dr. Mary L. O’Connor
Leppert has noticed a significant drop
in referrals to the Maryland Infants
and Toddlers Program, the state’s early
intervention program. Referrals have also
declined at Kennedy Krieger Institute,
where clinicians diagnose and treat pediatric
developmental, behavioral and mental
health disorders.

The drop appeared so steep that Leppert
checked the numbers. When comparing
referrals from March through August 2019
to the same months in 2020, she found
Kennedy Krieger Institute’s referrals for
children younger than age 4 had declined
41% overall, with variations based on
programs. The drops in program enrollment
included a 35% reduction in medical
referrals, a 47% reduction in behavior
referrals and a 69% reduction in mental
health referrals.

Leppert, a member of the medical staff
at Kennedy Krieger Institute’s department
of neurodevelopmental medicine, is the
director of its Center for Development
and Learning and co-director of its Infant
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INCLUSIVE FAMILY



Neurodevelopment Center. She wondered
what was keeping kids away from diagnosis
and services.

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What happens when you can’t
‘trust your gut?’
The question “brought me back to my initial
training in development,” says Leppert.

She asked herself, “How do children come
to the attention of the professionals who
can help them?” First, parents can “trust
their gut” with their kids to “identify when
something’s not right.” Early childhood
educators and pediatricians make up two
potential developmental delay identifiers.

“Access to all of these appraisals is
different now,” says Leppert. “I don’t know
what’s happening, but these are the factors I
see coming into play.

“We say ‘trust your gut’ to parents,” says
Leppert, but gut instincts are now hampered
by social distance. In these circumstances,
parents no longer see their child interacting
in a normal social context. Humans
are social animals, but under pandemic
restrictions, kids are no longer “playing
or having much interaction with children
outside their household,” she says.

Leppert and her colleagues recently
submitted an editorial to the journal
Pediatrics that states, “As families isolate,
parents do not have the same opportunity
to draw comparisons with other children to
appraise development.”
Comparison is key to identifying
developmental issues, Leppert believes,
because developmental milestones are
based on collective averages. Today,
however, first-time parents can’t compare
their child’s development to that of other
children. Even experienced parents have
fewer opportunities to compare their child
to children outside their family. In these
circumstances, only “the youngest child
of a mother of multiple children” might
be well-positioned to spot developmental
differences, says Leppert.

The experience of daycare and school also
places parents at a disadvantage to meet and
interact with other families. While some
preschools and daycares continue to be
closed, even the ones that are open enforce
strict limitations on interaction between
families and children at school and at
“aseptic” drop-off and pickup times.

Teachers and daycare providers, who
occupy the next tier of familiarity in
children’s lives, no longer have the face-to-
face interaction they used to have.

Declines in pediatric wellness checks
may also impact screening for physical and
cognitive development, including social,
learning and behavioral differences, autism
spectrum disorders and genetic syndromes.

PARENTS SHOULDN’T BE AFRAID TO
“TRUST THEIR GUT” WHEN IDENTIFYING
POSSIBLE DEVELOPMENTAL DISORDERS
WITH THEIR CHILDREN.

A 2020 University of Oregon Rapid
Assessment of Pandemic Impact on Early
Childhood (RAPID-EC) study found that
28% of families were missing a well-child
visit since the pandemic outbreak began.

“Diagnosing and addressing these
issues as early as possible is essential for
achieving optimal outcomes over time,” the
study’s research team notes. “If barriers to
childhood preventative health measures are
not addressed as the coronavirus pandemic
continues, we are likely to see many children
experience serious health consequences.”
What are the risks for
referral decline?
Leppert sees another risk from the decline
in early identifications. Problems that
parents may label as behavioral may instead
have a root cause in developmental issues.

“The younger the child presents with
behavior problems, the more likely they are
to have an underlying developmental cause,”
Leppert says.

Not all behavior changes indicate
a developmental issue, Leppert says.

“Children are living in environments
of stress—because parents are living in
environments of stress—and there are going
to be behavior problems from that.”
Child development services can
help develop the skills we now lack the
opportunity to practice in our daily
lives. Leppert says these services are “so
invaluable in the early years, when children
are developing and forming patterns.” In
addition, a therapy service provider brings
an expert’s eye to problems caused by the
condition that might not be recognized by
a parent. “For example, if your child has
cerebral palsy and gets a fancy, expensive
wheelchair,” she says, “if they don’t have
the neck tilt, or the table at the right height,
you’re not treating tight muscles or working
with movement patterns that optimize
development.” If parents have concerns or gut feelings
that something isn’t right, says Leppert, she
recommends bringing it to the attention
of their child’s pediatrician, who can then
refer them to a child development specialist.

Even if you aren’t comfortable coming
into a doctor’s or specialist’s office, many
pediatricians offer telehealth.

Although diagnoses and assessments of
developmental conditions have dropped
dramatically, disabilities continue to exist
whether they are identified or not. n
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