Taking your toddler to the pediatrician is obviously important to their health, but pediatricians train to check for more than a snotty nose or ear infection. So what can a pediatrician tell about your toddler at their appointment? Turns out, they can determine plenty about your child’s mental, emotional, and behavioral development.
Toddlers tend to get nervous when the doctor enters the room. That nervousness and what happens next is the first opportunity to assess a child’s health. Randy Thornton, M.D., pediatrician at Jacksonville Pediatrics and Wolfson Children’s Hospital of Jacksonville, told Romper that those first few minutes show him everything he needs to know about whether a child has a healthy attachment with their parent.
“When I first come in and meet parents I’ve never seen before, I see how the child is reacting with the parents, because they’re in the peak of separation anxiety and stranger anxiety. Those start around eight months and peak around a year and a half. Usually I’ll walk in and this little 18-month-old starts screaming. I can tell if they’ve developed a bond with that parent because they’ll go right to the parent and calm down, and that’s a great sign. Parents will get embarrassed, but I always say it’s a sign of great parenting that your child has a bond with you and is consolable.”
On the contrary, if a child isn’t seeking out the parent for comfort or is inconsolable, it may signal that the parent and child need to interact more (or differently) in order to bond.
“If they won’t settle down with the parent when I leave the room, and they’re still going ballistic, is that attachment not there? Can the parent console them? If not, that’s when I start asking questions about what’s going on outside of the office."
Thornton adds that while many children will be anxious in the exam room, that usually just means they're scared of the doctor. He places more importance on how toddlers behave with familiar adults outside the office.
“How do they do with a sitter they know well? Can they separate from you easily once they get to know a person? Are they happy outside of the office? That’s where history is really important,” he says.
As the appointment continues, Thornton watches how the parent and child interact, especially when it comes to toddlers. Ensuring that any discipline occurring is healthy is one of his priorities.
“They call it the terrible twos, and they’re incredibly impulsive anyway, but how is the parent responding? Are they yelling or spanking? That’s my chance to teach," he says.
Pediatricians also assess how the child looks to gauge whether things at home are going well, he continues: “Especially with a parent I’m meeting for the first time, how does the child look? Are they clean? Are they dressed? Does the kid look totally disheveled? You can tell pretty quickly if this is a healthy, thriving child. Medical issues could always influence this, but so much of that comes down to parenting and whether the parents are interacting with the child,” says Thornton.
Docs may also be keeping their eyes on your toddler’s eyes, and whether they meet yours when you interact. This can be a telling milestone, but not about autism, like most parents think. It's more about a healthy connection between child and parent.
“The next thing I look for is eye contact. Is the child attentive to the parent and vice versa? Every parent worries about autism, especially as you get towards 18 months, and maybe they’re not speaking. What I look for is whether the child is playful and interactive with the parent, and if they are starting to say a few words,” Thornton said.
Speaking of language, it’s on that first appointment checklist, too. While speaking or not speaking is not a foolproof test for autism, Thornton said pediatricians like to see that a child is attempting to say a few words. If not, he may inquire about what kinds of language building activities are happening at home.
“The biggest thing I look for is language. A child who’s not speaking, it’s not necessarily autism, but how much the parent is interacting with the child,” he explains. “The single best thing a parent can do for their child is to read aloud. It does not have to be out of a book, even just talking to them or singing to them. If you read the stocks in newspaper, read it aloud. ‘AT&T, up a quarter!’ It matters not what you’re reading and saying, but that the child is hearing that spoken language. If that child’s language is really coming along, that’s a sign of great parenting.”