Disagreement with paeds re Nursery, what's MNs opinion?

[SoonerThanYouThink]

DD is 2 years, 7 months and is referred to a paediatrician due to a developmental delay (including a physical delay) and speech delay. She has other conditions as well; asthma, eye problems and hearing problems. She was also born with a hip dysplasia but this has recently resolved itself.

She attends a private nursery 3 days a week while I work. And the progress she has made is amazing, she can now actually speak and says a few 3 word sentences. Most of her speech is still unintelligible but she keeps trying and I'm noticing more and more words from her I'd say she's picking up a new word every few weeks. She is also not stalling on her development, even though she's still 6 months behind she's developing at the rate of her developmental age which is great. I am forever grateful for the work the Nursery have done with her both 121 and in a group.

We attended a Paeds appointment on Monday and the Paediatrician is keen for her to attend Nursery an extra day a week. We can afford it (we get DLA for DD and use the 2 year funding to fund 15 of her 30 hours) and the Nursery have space for her but I don't want to put her in the extra day.

I already feel like I don't spend enough time with her as we have a busy week. Plus when we don't have hospital appointments I like to attend groups. I feel our week is balanced and busy enough without adding an extra Nursery day in. So I wanted to ask MN if they agreed with me so I can take it back to the paediatrician and say this is why it's a no. I do like her to have a bit of time at home playing with her own toys too.

Our week looks like this, DD still naps so everything fits around her naps. It's also Nursery policy that as long as it's not raining/snowing the children should spend at least 2 hours a day outside, in bad weather they spend as much time outside as they can:

Monday am - Stay and Play Group
Monday pm - Week 1 - Swimming
Week 2 - Afternoon at home
Tuesday - Nursery - Messy/Sensory Play
Wednesday - Nursery - Forest School and/or Nature Walk around a local nature reserve
Thursday am - Toddler Music Group at local play centre. We visit the library as we walk home to swap books.
Thursday pm - MIL spends the afternoon with her - they do a variety of things from visiting MILs parents, to shopping, to baking and walking MILs dog.
Friday - Nursery - relaxed day with lots of free play and free access to the garden. They do 1-2 structured activities but children are free to take part or not
Saturday am - Weekly Shop
Saturday pm - Week 1 - Visit my DM
Week 2 - Afternoon at home - but DH might take her to the park
Sunday - Chill out day at home we go as far as the park opposite our house or might walk down to MILs and walk the dog as a family but that's about it.

So MN AIBU to not put DD in an extra day? Paediatrician wants her in on Thursday so she loses her time with MIL, which I actually feel is just as beneficial to her as seeing me/DH.

WWYD?

Does the pead realise that she does so much on the non nursery days?

Unless it was to help access some therapy (most of ds salt has been done through nursery and now School) then I wouldn’t change things at this point.

I would give it a trial period and see if there is any improvement.

You have to do what you feel is right. I wouldn't even bother explaining to the paed about your decision - you don't have to explain yourself. However if you feel you want to then I think just explaining how busy you are otherwise would be fine.

Your dd is still very young, I think what your doing with her sounds great.

If your DD is making great improvements due to nursery then it sounds like a great suggestion to me.

I think it's a massive mistake to ascribe all her progress to nursery! I'm sure it is fab and that they are playing their part, but it sounds like you, DH and MIL are all playing your part too! She has a busy happy life which seems to be working for everyone - I wouldn't upset the balance if you don't feel there's a compelling reason. Nursery is super tiring for wee ones too so I'd worry that another full day would tire her physically which would have a knock-on effect on developmental progress.

I'm not anti-nursery in the slightest btw, just think you can give yourself a wee bit more credit for DD's progress.

I think it's always best to have a really strong evidence based reason to go against medical advice. Perhaps ask yourself and the dicotor whether what dad does at nursery is more beneficial developmentally than what MiL does without her?

If there's a chance or developmental problems improve I personally would be trying the extra day.

Your week sounds perfect for you and DD, why would you change something that is working. She has a great time at Nursery and is learning more all the time (whether that is to do with Nursery on its own who knows). She has a lovely mum who does lots of interesting things with her and she spends time with loving relatives also.

The time will fly and she will soon be at school full time. Make the most of it if you can spend time with her now.

It’s interesting when progress is linked to nursery, no one can say whether development would have been the same or actually even better if not attending as you have no control to compare with. Don’t sell the amazing work you are doing short. The day with MIL sounds great a proper 1-2-1 experience for the whole day. I don’t think you would be be unreasonable to say no to paediatrician. My children both attend nursery and I think the mix of experience they get between nursery, home and grandparents provides them with optimum opportunities for development.

Sorry just re read and realise it’s an afternoon with MIL and am with you. Still perfect.

I think what you're doing sounds like a great balance.

It's just the paeds opinion. It's not evidence based.

Paeds are aware of the groups we do and the time spent with relatives, he said it was beneficial but could be done at a weekend if necessary as Nursery is just as important. I don't think that's fair to MIL though either, and DD loves her "grandma afternoon" - I feel her regularly walking the dog/standing to do baking etc helped get her discharged from orthopedics.

No specific therapies, DD did have physio for awhile but that stopped when she got discharged from Orthopedics. Physio was going into Nursery on a Friday once a fortnight to see DD. We're awaiting SALT, but I don't want to change/add days until we know when that will be.

'i think it's a massive mistake to ascribe all her progress to nursery! I'm sure it is fab and that they are playing their part, but it sounds like you, DH and MIL are all playing your part'

I have professional experience in this area and I completely agree. Nursery can be great but it's not a magic bullet. Sounds like she's getting lots of stimulation and support outside of nursery and at home. No need for her to do an additional day in my opinion. In fact, she doesn't 'need' to be in nursery at all at her age! You obviously are happy with the nursery and DD enjoys it so carry on as you are

There are numerous studies that suggest nursery is not beneficial for some groups of children, I looked at one that suggested that it could result in lower IQ in some demographics. Perhaps ask your paed for their evidence base, or suggest that you continue as you are and if there is a stall dd’s progress then you will revisit your decision not to increase her nursery attendance.

Op they are young for such a short time. Enjoy every second with her and how lovely she gets time with her grandma too. Your week sounds perfect to me and as another poster said it's wrong to attribute all her progress to nursery.

Enjoy your little girl x

It sounds as if your dd has had a developmental spurt and the paed is linkingbit too closely to her nursery attendance.

Do they do special speech and language with her? Perhaps if so you could do some sessions to practice at home.

Your week sounds perfect for a child of her age. And btw my ds could barely speak at all at this age and had no sn at all. It’s very much an age where children vary enormously.

I have been in this situation when my DS was young (and am a physio) and your week sounds great in my opinion.
What I learnt quickly when DS was young was that I am in charge of his care and know what is best for him (and the whole of the family). The health professionals can give advice, but ultimately it is your decision.

You and your family sound to be doing a fabulous job with a great nursery as well.
Time goes so fast and full time school comes quickly. As long as she continues to progress and thrive at her pace I'd hold off with the extra day and enjoy the days at home. Xxx

I'd keep things as they are for now but maybe think about increasing from September. Pp is right, this is just as much about the things you're doing with her as a family as it is what's happening at nursery.

If Dd was stuck in front of the TV when not at nursery then your Paed would be correct. But she’s getting loads of stimulation with you, more 1-1 attention than at nursery and all that time will promote a healthy attachment which is good for development. I’m not anti nursery either, but I’ve read a lot on child development and not read anything that would support the Paediatrician’s views on this.

My DD (nearly 4) has delays similar to your DD’s and she does 3 days at nursery, which seems like plenty. No one has ever suggested she should do another day. It seems a bit odd that your paed is getting involved with this. I think it’s really important while they’re small to get a good balance of busyness and down time. And children with additional needs generally have to spend lots of time at appointments and therapies, which makes the time at home just relaxing with family all the more important.

Your Dd is clearly thriving and coming on atreat at nursery however you want to spend the extra day with her and that is important for you and her.

As a SALT I would say you don't need to change things. The research on nursery v home at this age is mixed, but in general says (unsurprisingly) that the quality of the care matters. You are clearly providing quality care when you ar with her. Whilst she is probably benefitting from social interaction at nursery, I'm sure 3 days (plus groups etc) is plenty. You (or your MIL) can provide as good quality 1:1 care as the nursery. It also means you have more flexibility for scheduling appointments etc without having to alter your nursery schedule. SALT therapy is often based around 1:1 activities to do at home.

I would tell the paed you have considered things and decided on balance it is right for now, as it allows her the range of activities at home and at nursery. You could add you will review again in 6 months if you prefer.

Tell the consultant to bolt. The only thing I would do, would be to talk to the nursery to see if there is anything specific they are doing which you don't, which they feel might actually help with development. Other than that, you are Mum, and you know best. A day a week in nursery isn't going to matter all that much, if you are doing stuff at home. Unless your consultant can point to something specific and give reasoning, i would ignore.

Your DD sounds very similar to my twins at the same age. And I get where the paed is coming from and I'm Also an early years teacher. However, I think she is doing enough at home. I'd ask the paed of there was any particular reason as in to access more speech therapy or anything and if not ask to delay it for now. It isn't long untill she gets her 15hrs in the grand scheme of things I'd wait until then. I think this advice assumes that she isn't doing tons of worthwhile stuff at home which she is. Just to reassure my twins caught up mainly and although their speech is still delayed they are lots better than they were and are no longer under developmental paeds (they are 4) xx

It irks me when all progress is put down to nursery, they may as well say they think your shit so it would be better for other people to have your child for longer