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Where's My Manual?

It is a huge milestone when your baby turns one.

Every baby grows tremendously over that first year - even though each baby is different. They have gotten longer and bigger. They might have gotten hair or first teeth. They all seem to have razor sharp nails that you can never ever file down properly.

But that first year is also an amazing achievement for you as a parent -- you've fed your baby using breast, bottle, formula, or tube; you've helped them learn to sleep outside the comfort of the womb in a bassinet, a crib, or your bed; you've been by their side as they learn to move their bodies, engage with their environment, and communicate with others. You've held them during their first colds, kissed their first bumps and bruises, and listened to way too many renditions of Baby Shark.

You've kept them alive for a year -- a tiny baby that needs you for everything -- with absolutely no manual.

It's the hardest job I've ever had.

But let's talk about that manual for a second. Seriously, where is the manual?

Why is it that many parents turn to Instagram creators for tips and tricks for helping their baby sleep? For information about how to encourage crawling or walking? For ways to help their kids finally say those first words?

Where. Is. Our. Manual?

The Role of Pediatricians

For most families, especially before social media, the "manual" came in the form of the highly popular baby books -- What to Expect: First Year -- and, of course, the standard visits to the pediatrician.

Your pediatrician checks your overall baby's health and development. This means looking at their growth chart, doing a head-to-toe physical exam, and asking general questions about baby: sleep, feeding, motor, and communication. This is also an important time for children to receive their immunizations against deadly childhood diseases.

But pediatricians are generalists, not specialists. So, while pediatricians are helpful for broad health questions and understanding basic milestones, they are not experts in things beyond physical health. That is why pediatricians will refer families to specialists when they are struggling with sleep, feeding, motor, or communication challenges.

This is something that has become a bit more worrisome with the recent change in the CDC guidelines in early 2022. While the CDC encourages families and providers to "Learn the Signs. Act Early", their recent changes to milestones were not based in recent research, especially in the fields of occupational therapy and speech language pathology. They also did not consult experts in these fields (OTs and SLPs). The change in milestones MAY lead to pediatricians waiting longer to refer to experts rather than sooner -- something that has many providers and parents worried.

The First Year Visit

While there are many many well visits in the first year of life, the big one is the one-year-old visit because 12 months is a time where there are many milestones that are expected to be hit. It's a great time to see if your child is on-track and to determine if there are any supports the family will need moving forward.

(Before I begin, let me just say that I truly do like the doctors that I see for my children. I think they are smart, kind, and caring. I also want to say that I appreciate how difficult it has been over the past three years during the Covid pandemic. This blog post is not a reflection on them as much as it is a general reflection of the healthcare system and the disconnect between what parents need and what they often receive)

Quite honestly, my son's one-year-old appointment was a complete shitshow. It was the beginning of Covid, and this was the first in-person appointment we had during the pandemic. We were still actively in quarantine that May and when I showed up at the door, it was locked. Apparently there had been some sort of miscommunication and I had been scheduled for a virtual visit that day instead of in-person. I stood there, near tears, with my very unhappy one year old in my sling who was trying very hard to pull the mask off my desperately frightened face. This was the first place we had gone inside since the pandemic began a few months before.

After lots of apologies, they managed to get our doctor to come see us. We waited for a long time, and by this point all I wanted to do was get the shots, get his blood draw, and then leave. I don't remember what they asked me about his development. I don't remember what I asked them -- if anything at all. All I remember is that I finally got to leave without the goddamn blood draw because they didn't have anyone to pick up the blood that day (since ... we weren't supposed to have been there at all).

Just another wonderful day in the life of a pandemic parent.

My daughter's one-year-old appointment was thankfully so much better. Three years into the pandemic, I still wore a mask but the office was open and running smoothly. This time, I was prepared to ask questions and answer them.

When I went in, I got a clipboard with a general visit form asking what concerns I had with a small checklist of "skills" for the 12 month old visit.

The paper asked: Is your child ...

  • Pulling to stand

  • Cruising/walking

  • Playing peekaboo

  • Using a cup

  • Using pincer grasp

  • Feeding self