23 month old - Should I be concerned?

[VillageFete]

Son is 2 next month.

Long story short, i’ve suffered with anxiety since he was born as it took years to get him, I always feel like he’s too good to be true and that something must be wrong

I’ll start with saying what his strengths are - his speech is fine. Loves nursery rhymes and knows loads of the lyrics. Can count to 10 and knows the alphabet (This will definitely be because of little baby bum ) He repeats words, shouts his big sister by name, mama, dada etc...

Walking to nursery today he saw different objects and said the ones he knew by name (Flower, leaves, tree) His voice is quite deep and his pronunciation isn’t 100% but I think his speech is fine, I don’t really have concerns there.

Loves animals, makes all the animal noises and says what they are. Knows his body parts such as head, eyes, ears and mouth.

What my concerns are is that he has always been later with milestones. His sister was always ahead. I know every child is different but he always seemed to make them in the nick of time of what was considered “normal”

His understanding is hit and miss. If I ask him to drink some water for example, he will. If I ask him where a certain object is the knows, he will reach out to it rather than point to it. If I ask him to bring something to me he often won’t. It’s like he only listens when he wants to (He is waiting to be seen at ENT as one ear is blocked with wax and his sister had glue ear as a toddler so I wanted to have him checked) Basically his understanding seems a bit hit and miss? But he does definitely understand some stuff.

Pointing - he rarely does it. He can do it, and he does it sometimes, and started just before turning 15 months old, but as I say he doesn’t appear to be a regular pointer. Sometimes he will point at something he takes an interest in, but often he reaches out to it instead.

He likes other children, enjoys nursery and he likes to pick items up and pretends it’s a phone, saying “Hello” So I’m happy with that, but my biggest worry is that he walks on his tip toes a lot. He doesn’t do it all of the time, he will walk flat footed in shoes, but in bare feet and slippers he walks on tip toes. He does occasionally tip toe walk in shoes, but can also walk flat footed in them.
I would say though that at home he’s mainly always on tip toes.

Sometimes when he’s excited he flaps his arms. I thought it was usually when he wants me to get him out of his cot or high chair, but i’ve noticed tonight he’s done it when excited at something on TV. He’s had no nap today and is overtired and he seems to be doing it a lot this evening. He’s been running around flapping his arms and tip toe walking, so of course my mind has run away with me.

Please be honest with me, are there any red flags here and do I need to look at private assessments/speaking to my HV?

I would wait until his ears have been done and see what happens.

Nothing too concerning jumps out in my opinion - a lot is still age appropriate, and while pointing and following simple commands sound a bit inconsistence he is able to do it which is positive. For his pointing, is he pointing to both request things (like something that it is out of reach) and to show interests (like a plane in the sky)? have you taken the MCHAT, it would be very interesting to see how he scores as he is perfect age for the test. I would keep monitoring his progress and pay particular attention to his current skills, if he were to loose skills in the next few months then that would make me concerned.

@AladdinMum Yes, he is low risk on Mchat.

He doesn’t really point to request things, he reaches out to them and whinges/shouts at me to tell me he wants it. He points to things of interest. So, for example we had some balloons in the house yesterday and he repeatedly pointed to them. In general though he’s not an avid pointer, but he definitely can do it.

In terms of development he has come on leaps and bounds these last few months. He loves flash cards and can name every bloody one such as “house” “circle” “keys” etc... Things I didn’t even know he would know If I say “Where’s the house” etc with the flash cards, he will point to it or grab it to show me that he knows so there’s definitely some understanding there. If I tell him to stop eating and to take a sip of water then he will. If I ask him to shout his sister he usually will shout her name, but not always.

Leaving nursery today he said “Bye” followed by the nursery nurse’s name, so he understood he was leaving nursery. It’s just sometimes he will ignore my requests and that makes me worry that he doesn’t understand?

The tip toe walking is bothering me, but I noticed today if I walk slowly and hold his hand he walks flat footed. If I hold his hand and walk quickly, he tip toe walks because it’s quicker.

He hasn’t flapped since Friday. I’ve been watching him like a hawk. I’d never really noticed him doing it much before Friday either, only if he’s tantrumming he will flap his hands a little but. If he gets excited at something on TV he’ll jump up and down and dance in an excited manner, usually to nursery rhymes that he likes.

I don’t know... He was just later with some milestones. For example he didn’t walk until 18 months, didn’t wave bye bye until later on etc... but he was well within range for cooing and babbling. His eye contact is great too of that’s at all relevant.

Should I speak to the HV? Or do you think he sounds like he’s doing somewhat ok?

Oh @AladdinMum if it’s relevant he loves books. Really loves them. Will point to characters or objects and say their name, turns the pages etc...

I can understand why you are concerned but overall I personally don't see autism - he passes the MCHAT, and as a whole his skills are within 'normal' range for his age, even if on the latter side on some of them, i.e. while walking at 18M is on the latter side it is not outside the normal average range. Pointing to share interests is considered more significant than pointing to request and I have seen children that have pointed to request but not to show interests and later be diagnosed while I have never seen it the other way round. Walking in tip toes is not too concerning at his age, in some European countries is treated as a milestone to be reached, as all young children will do it to some extent at some stage, some longer than others but tends to stop after 24M, though it might last a little longer with your son due to him walking at 18M. To be on the safe side, I would keep an eye on his development for the next few months, what you don't ever want to see is him loosing skills as that could mean a regression - regressions where a child is developing totally normally and then all of a sudden starts loosing significant skills tends to occur on average between 1.5Y to 2.5Y, extremely rare after 3Y.

@AladdinMum Thank you so much for taking the time to offer your opinion on this. I can’t tell you how helpful it’s been.

I have a tendency to compare him to his sister. She was always ahead with milestones, was always grown up beyond her years and is now a very bright, very academic child. I had zero concerns ever with her.

I know they are all different, but the not pointing until almost 15 months old, the not waving and walking until later on has really panicked me.

Sometimes with the M chat he scores medium risk, but that’s when I answer “yes” to the deaf question. I have never worried about him being deaf, but I have worried about his hearing due to not always responding to his name in the past (Usually when he’s engrossed in an activity) He actually does have an issue with his right ear and we are waiting to be seen by ENT. When I go back to not clicking yes to this, it comes back low risk.

What I will say is that his skills have exploded these last few months, particularly his speech, but I just have this niggling feeling sometimes that his understanding/pointing isn’t exactly where it should be but that could just be me being a natural born worrier and panicker. I do baby him more than I should and am working hard on offering him choices etc rather than doing everything for him and not giving him any independence.

As I say, he does point to things that interest him but not to request things as much. If something comes on TV that he enjoys, he will look at me and smile before looking back at it. I take this as him sharing an interest with me, but I could be wrong. I don’t really know how to interpret the shared interest thing, as he’s not really a sharer!!

I really think he sounds fine, he has a strong set of skills and progressing well. There is a lot of misinformation on the internet, and I'm surprised that you were worried that he pointed at 15M, on average it happens at 14M and it would not be considered late until past 18M, in addition on average girls tend to meet most communication/social milestone way before boys, including pointing. In assessment and diagnostic centers where they test for autism a child responding to their name at least 50% of the time (when not engrossed in an activity) would be considered to have a 'good name response' (they call their name six times in the space of an hour in six occasions when they are not busy doing something, three responses/lookbacks are required to pass the test).

@AladdinMum Thank you so much for taking the time to offer your opinion and assurance. It’s appreciated more than you can know

He seems very normal. Flapping arms - my 2.5 year does this CONSTANTLY, it's like how she gets the excitement out. She is 100% not SEN in anyway, she is just super excited.

Walking on tip toes - DD also does this all the time but can walk flatfooted. She's also decided she likes "lay back walking" where she leans back and I support her. Kiddos just like to do silly things.

Not listening to your instructions? I hate to say it, but he's 2! Sometimes they just don't listen! Or are busy thinking about something else. Better than screaming "NO NO NO NO NO I DO NOT WANT A BATH" as I'm sure he will soon!

I think you really need to try to differentiate between what he CAN do and what he sometimes chooses not to do. We all choose not to do things sometimes and what the milestone trackers are really highlighting is what he is unable to/never does. For example, he's clearly not deaf, he CAN hear, sometimes he is distracted and chooses not to respond. He sounds really normal and it sounds like you are torturing yourself a bit with checking on his progress super regularly...

I actually really like the CDC's guide: www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html because it stresses that MOST kids are doing these things at roughly this age but most kids also aren't doing all of the things. And it highlights a few things that are true red flags, not internet rabbit hole red flags. It really does feel like you've gone down a bit of a rabbit hole.

@Happyhappyday Thank you so much, you’re absolutely spot on with what you’re saying. I have indeed gone down a rabbit hole, sparked by him being on the later side with milestones. I will definitely try to relax and enjoy him now