When I see families for assessment of development, learning, attention or behaviour, many recommendations are patient- and condition-specific. However, others are useful for any child with any developmental concern. There are many aspects that contribute to healthy child development, many of which are modifiable. No diagnosis is required for these interventions so anyone can start them at any time. Here are some things to consider:
Early intervention is key!
- Referral: If there are red flags at 15-18 months, a referral should be made. Wait lists range from several months to over one year so a child still may not be seen until 2.5-3 years. If concerns dissipate, the appointment can be cancelled.
- Speech and language assessment: Any parent or physician can refer to Early Abilities/York Region Speech and Language/ErinoakKids etc… If a child is referred for a developmental assessment, a speech and language referral should be done at the same time.
- Early Intervention Services: Any family, physician or Early Childhood Professional can refer to CITY KIDS/Centennial Infant and Child Centre etc… for Early Intervention Programs in the home or Child Care settings.
Hearing and vision assessment:
- Children of any age should be referred for a hearing assessment if there are concerns about language development. This can be done free of charge at several sites in the city, including SickKids, Sound Advice, Audiology and Sound Associates and Humber River Hospital.
- If there are concerns (e.g. turning an eye inwards), a child should be seen as early as possible. Starting at age 3-4, all children should be seen by an optometrist. Children get a free pair of glasses in Junior Kindergarten if they are identified as needing them.
- NOTE: School screening is NOT sufficient for hearing or vision testing if there are developmental concerns.
Contact with other children: All children, starting at the toddler age should have regular contact with other children. This can be in any environment, including:
- Early Years Drop-in Centre
- Libraries
- Literacy Centres at schools
- Daycare
- Preschool
- Parks and Recreation activities
- Private activities
- If there are developmental concerns, full-day daycare is recommended. Childcare subsidies are available for children with developmental concerns/risk factors in low-income families.
Literacy: All children should have reading time scheduled into every day. The Toronto Public Libraries provide programming to foster this, including “Dial-a-story.” For older children with reading difficulties, the “Leading to Reading” Program is a free after-school tutoring program available at many libraries around the city.
Screen time:
- Children under the age of 2 should have NO screen time at all.
- Children aged 2-5 can have up to 1 hour/day of supervised, interactive screen time.
- Children and teens 5-17 can have up to 2 hours/day of recreational screen time.
- The family should develop a “Family Media Plan” to decide times when everyone turns off screens and times when all electronic devices are left in a centralized location before bed. Healthychildren.org has an online link to help develop this.
- There should be no screen time for 1 hour before bed.
Iron-enriched foods: Many children are extremely picky, which leads to an unbalanced, high-carbohydrate, low-protein, low-iron diet. The key nutritional ingredient for development is iron.
Sleep: Development and attention can be affected by poor sleep habits or sleep disorders. If there are concerns that there could be a sleep disorder, such as obstructive sleep apnea, the child should be referred to a sleep clinic (e.g. Youthdale) or a Paediatric Ear, Nose and Throat specialist.
Behaviour resources: Each region has its own children’s mental health organizations. Families can self-refer for counseling, anxiety/behaviour management, and parenting programs, without a formal diagnosis. In Toronto, these programs include the Child Development Institute, Yorktown and the SickKids Centre for Community Mental Health. There are many more centres in each region, including Adventure Place; Blue Hills; the York Centre for Children, Youth and Families; Etobicoke Children’s Centre; George Hull; Aisling Discoveries; Peel Children’s Centre; Reach out Centre for Kids.
Useful websites: Many parents like to educate themselves online. Here are some valuable websites:
- The Centre for ADHD Awareness Canada, caddac.ca
- The Canadian ADHD Resource Alliance, caddra.ca
- The Canadian Paediatric Society’s website for parents, caringforkids.cps.ca
- The American Academy of Paediatrics’s website for parents, https://healthychildren.org
The most important thing that parents can do to help their children is to spend uninterrupted time with them every day down on the floor, playing, reading and talking. Having a strong bond with the child allows for a better understanding of their strengths and challenges and more effective development and behaviour management. If parents choose to seek out private therapy, remember to look for high-quality, evidence-based therapy and ensure that the child has time to enjoy every day as an active, curious child.
