Jennifer Cross MD

Developmental Pediatrician, Weill Cornell Medical College

The Role of the Developmental Pediatrician in Caring for your Child with Special Needs.

As a Developmental Pediatrician (DP) I completed the same training in General Pediatrics as your child’s pediatrician, but instead of going into Practice I, and my DP colleagues, then went on to do a Fellowship in Developmental and Behavioral Pediatrics. Although this is a relatively new subspecialty it has been growing rapidly over the past decade. The Regulatory body responsible for ensuring all Pediatric Residency programs meet standards, now requires all residents to spend time with Development and Behavioral Pediatricians learning about this field.

Developmental Pediatricians generally do not follow the traditional Medical Model style of practice. This involves analyzing a set of symptoms, making a list of possible diagnoses, running tests to confirm and then prescribing a treatment. My personal philosophy, and that of many of my colleagues, is to see the child, not in the context of a list of problems, but more holistically taking into account how they are functioning within the family and their school and community environments. Most of my patients are not sick, in that they do not have a disease that needs to be cured in the traditional sense of the word. I see my role as helping parents understand some of the factors that may have led to their child’s difficulties. I want to ensure that the child gets the most help that they can, to be the most successful they can be.  My goal is to try to develop the child strengths, while also trying to address and remediate weaknesses. Many parents say to me “but this can be fixed right?” That is a difficult question to answer, almost all children will continue to develop and improve their skills, but sometimes it is best to reframe the question. For children with more global developmental delays they cannot always be ‘fixed’, and we should shift the paradigm from fix to fit in. We all want to ‘fit in’ but sometimes that means changing the environment rather than the child. I believe we should have an expectation that the best outcome is to find a role for the child within their family and community that allows them to feel positive about themselves and contribute as best they can.

All children will have a General Pediatrician who provides their medical care and follows the child’s growth and development. However if concerns arise regarding the development, either from the parent or the Doctor, a consultation with a Developmental Pediatrician should be recommended. Below I have laid out certain expectations for parents when deciding to take their child to a DP.

• There will probably be a waiting list.
• These services are not always covered by Insurance.
• At a DP visit there will be time to take a history and perform a physical exam. There will be some Developmental testing performed. This is testing that measures the skills your child has in certain areas and then compares those skills to typical children of the same age. This will determine if your child’s skills are about the same, better, or worse than their typically developing peers. Sometimes this testing is done at a lengthy first visit, sometimes it might be done at a 2nd visit.
• The DP then has to score and analyze the results. This is also a time when a parent may be asked to give copies of old evaluations and the Individual Education Plan (IEP). The DP may also request that teachers and parents complete standardized questionnaires about various aspects of the child’s functioning at school and at home. Sometimes a school visit may be part of the evaluation.
• These days it can also be helpful to include videos taken of the child at play or in school.
• A follow up visit is then required to present the findings to the parents and discuss and formulate a plan. This may include other testing such as additional blood work or consultations with other subspecialists.
• This is a time consuming process and parents may get anxious or frustrated that they have to wait and do not get straightforward answers right away. In my experience it is always better to take the time to really observe and interact with a child, collect data, reports from other caretakers and teachers, review records, video’s and school visits as needed. This gives us the greatest number of tools with which to help your child.
• There will generally be a written report compiled after the visit with documentation of all the findings and a concise list of recommendations. But even then the process is just beginning. Behaviors change and development by its very nature is ongoing, so that none of us can ever know exactly what will happen in the future.
• Follow up is important; to review your child’s progress and to ensure the current plan is effective and to make changes if needed. I generally recommend follow up visits about twice a year until age 3 and then yearly after that. The exception to that rule would be if your child needs to be prescribed medication for his behavior and then the follow up is more frequent.

As DP’s we take on a number of roles for the family. Our skill set overlaps with a number of other subspecialties, such as neurology, psychiatry, social work, counseling, educational advocacy. We also work closely with therapists and educators and most of us have spent some time visiting schools, especially those for Special Needs children.  With this experience we can often provide a liaison between the medical community and the educational establishment.  Our role is that of planner, strategist and organizer, helping families to navigate between these other areas. I always try to pull the pieces together for a family to make sure they are heading in the right direction. I see myself perhaps as the team coach, not the Quarterback, for that surely is the parent, but instead the one who can guide parents forward and help them make a plan for the future.

Jennifer Cross MD

Assistant Professor of Clinical Pediatrics Department of Pediatrics – Child Development Weill Cornell Medical College New York City

Website: https://weillcornell.org/pedsdev

Email: pedschilddevelopment@med.cornell.edu