HOW IMPORTANT IS EARLY INTERVENTION?

We often refer to a person as a ‘complete man’. Have you ever wondered what we exactly meant by ‘complete’? We all seem to be complete; nobody has seen a half-man after all! But no, completeness encompasses many a parameters & dimensions.

A baby grows from a neonate to a toddler, and then through the stages of childhood and adolescence, gradually evolves into an adult. All the while he grows in length, breadth and weight; his sensory perception, cognitive ability & intelligence develop so that he gradually gains control over his own self, then over his surrounding environment. The better control he has over himself, the more poised his personality becomes. The extent and magnitude of his control over his environment determines his level of success. This constant evolution starts from the moment of conception of life. It occurs in different dimensions: physical, mental, intellectual, emotional and spiritual. Evolution to the fullest in all these dimensions ultimately produces a complete personality.

We, the care-givers of small babies, visualize this evolution when we think of his growth & development. Any deficit, any deviation at any point will curb the blooming process. A thousand and one deficits may be silently residing in the baby’s system, which, if not identified in time, will manifest as a hindered development in later days. For example, a child who doesn’t learn to smile in time may not learn to interact and play like other children and he may develop mental retardation later on. Similarly, a baby who is late in holding his head may be late in all limb activities like sitting, standing, walking, etc. So all who care for babies and children must know the markers of normal development and must learn to pick up deviations EARLY.

How does this early detection help? Any inherent deficit in a developing child can be supported and the process of development in that area enhanced through early intervention. It’s like offering a hand to a person unable to climb a high step. He can make it with your help and the next time he has the confidence to try it himself.

What exactly is early intervention? It is a comprehensive process, by means of which stimulation is given to the child in areas where his development is faltering, thus guides him through the normal developmental channel. Through these techniques the affected brain parts are stimulated to become more active. But how can a dead cell in the brain become alive and active? It has been proved that though brain cells do not regenerate, synapses (connections between cells) are regenerable and with early stimulation healthy brain cells, through new synapses, take up the job of the damaged cells. Thus brain activity can be made to improve. This plasticity of the brain is made use of in early intervention techniques.

Who does this early intervention? As different aspects of brain function, like gross motor (sitting, walking etc), fine motor ( picking up things, handling etc), cognitive
(understanding, imagination etc), language, learning etc may need to be assessed and supported, this process calls for a very well co-ordinated team approach. The team comprises of a developmental Pediatrician, Ophthalmologist, Psychiatrist, Physiotherapist, occupational therapist, developmental psychologist, speech therapist, special educator and counselor. Whatever these specialists have to offer need to be conveyed regularly to the child, and, who else, but the mother, will happily render this effort 24 X 7? So she remains the pivot of the early Intervention program. It is thus obligatory for her to be well informed and convinced about the whole approach, to get the best benefits for her child. This is a long process and calls for a lot of perseverance and patience to reap the ultimate reward.

So, mothers (& fathers as well), get informed about your child’s normal development and danger signs to be identified. Next time we will talk about these issues.

How could we prevent this distortion?

'Born to bloom but fated to be nipped'
A flower in full bloom is beauty personified. Every bud appears with the potentiality to bloom to the fullest, to radiate all its beauty and fragrance. Yet so many get nipped at the bud, so many wither away. Have we ever stopped to ponder whether this loss, this wastage could be prevented? Wouldn't the world be so much more beautiful, had all the flowers blossomed?

Every time I look at a developmentally challenged child, this question keeps coming back to me. Can we just sit back and watch the bud get distorted and wither away?
For every 1000 otherwise healthy babies born, 3 are going to be spastic, with stiff limbs and difficulty in ambulation, 2-3 will develop autistic traits, mental developmental delay & retardation to some extent will be noted in 20-25 children, of whom 4% will have profound retardation, 7% will have moderate problem % rest 89% will have mild retardation. Another 30 children are expected to develop Hyperactivity Syndrome, which we call ADHD. Later, as they start going to school, 16-20 children will develop learning disability of some sort. So out of these 1000 delicate buds how many are going to bloom to their fullest? Quite a grim picture, isn't it?

Let us take a closer look at the problem and try to find out whether we have anything to improve the present scenario, and who is to shoulder the responsibility?
A developmentally challenged child may present in various ways, with various disabilities, of different degrees, associate with a wide spectrum of complicated neurological diseases, all arising from a multitude of aetiological (read causative) factors. Confusing, right? No, I'll not go into any further medical jargon. To put it simply, the gamut of the problem is immense, both in prevalence and severity. But the silver lining lies in the fact that severe problems and grave presentations, though difficult to diagnose and treat, are relatively much rarer. Conversely, the milder varieties of developmental delay and retardation are more commonly met with. They are caused, to an extent, by environmental factors, hence are somewhat remediable and reversible. Milder mental challenges are prevalent in the weaker section of society where nutrition, basic health care, environmental stimulation and education has a lot to do with their intellectual and cognitive stunting. These challenged kids create a greater burden to the already compromised living of these poor families. Developmental challenge;;; a torture for the child, a source of anxiety and burden to the family, a burden and negative resource to the society.

I'm sorry if I'm sounding too gloomy. No, the scenario should not be so grim if we take a little effort, for much of this problem is amenable to correction, provided we act EARLY! Detect early & intervene early to prevent the disability from becoming really disabling! Moreover, much of the challenges & disabilities can be overcome or circumvented to allow the child to function much more effectively and efficiently, utilizing all his potential.
This is exactly what we mean by the common medical term of 'Early Detection and Early Intervention.'

Now the question comes, how early and by whom? In other words, who is to shoulder the responsibility and when?
By early we mean as early as possible, preferably at birth. Why? A baby's brain develops most when he is in his mother's womb & the 1st few months of life. And coming out of that pleasant home called 'mothers womb' to this angry world & surviving here is a trial for the delicate baby. Any maladjustment here can have a bearing on the child's developing brain, giving rise in later life to a developmental challenge. These perinatal and early infancy assaults can leave tell-tale signs, which if identified in time, will give us a premonition that the child may develop a disability. Also, as the baby grows, he can show subtle signs of a developmental lag, which can be picked up by a searching eye. We tend to ignore these minor signs and put it off by saying," It'll be OK as he grows older"....only to admit the disaster when it stares back at us when he really grows older.And this 'we' includes the parents, grand-parents, care-givers, neighbours, even physicians!!! Blissful ignorance!

So, dear parents and grand parents, please consult a developmental pediatrician if your baby was born too early (preterm) on too small (LBW) or was very ill after birth, had to be kept in the NICU. Keep a vigilant watch on how he grows : does he smile, does he hold his head up, does he sit & stand, does he talk in time? Does he see & hear properly? Does he look into your eyes? Does he play the way other babies do? Any suspicion, don't wait, consult your doctor. Dear doctors, please acknowledge a delay or aberration when you note it and for Heaven's sake, do not pacify your client with a "Don't worry, it'll be OK" unless you're dead sure. If it's not your special domain, refer to a 'development' colleague.

Early detection calls for early Intervention. Some problem in the tiny brain cells is preventing the child from functioning normally. If these weaker areas of the brain can be given constant & proper stimulation, they will grow to the best of their potentiality. Moreover, neighbouring areas of the brain can lend a helping hand. Thus the child can learn to improve his skills to the best of his ability. He is also taught to circumvent his disabilities by using his other acumen to perform a particular act. Thus he adapts to life in a more effective & purposive way. All this takes time and patience, but the reward at the end of the day is really fulfilling. The wide smile on the mother's face and the confidence in the child's look will surely tell you that.

This early intervention is not a single dose therapy. It has to go on and on and on. It needs specialized team effort : a team of specialists including a developmental pediatrician, a developmental psychologist, psychiatrist, ophthalmologist, ENT Specialist, a physiotherapist, an occupational therapist, a speech therapist, who will work with the child at regular intervals, through play based interventions, but the pivot of the team remains the mother, who will effectively work with the child day in and day out. It is her perseverance, on which the final show depends! A confident and patient mother wins the race. We have many an example of such battle-winners.

Every challenged child who learns to live a purposeful life, who attains the best of his potentiality, is one more happy person on this earth, with one more happy and content family surrounding him. We thus lighten the burden of one family, the social burden by one unit.

What a divine pleasure to see that smile of fulfillment on the lips of that little 'different child' at the back!
So, though a deformed bud, it wont wither away. It will bloom and it's deviant beauty may surpass the normal flower!