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Be Your Baby's Advocate

The day my son Liam was born was supposed to be one of the happiest of my life. Instead, it was the most traumatic. He was delivered by emergency c-section, in cardio-respiratory failure, and ultimately spent nearly a month in a neonatal intensive care unit. Liam had moved his bowels while still in utero and then started to breathe, filling his lungs with meconium, the tarlike waste that babies aren't supposed to pass until they're safely out of the womb. For much of his time in the NICU, my husband and I didn't know whether our baby would survive.

We were fortunate: Today Liam is a thriving little boy. But the lessons I learned about asking questions and advocating for him during those early weeks taught me to listen to my instincts. Case in point: When we moved and had to leave behind the doctors with whom we'd become very comfortable, we chose a pediatrician who was considered the "best" in town. Problem was, he was arrogant, dismissive, and very difficult to deal with. So it wasn't long before I switched to another doctor, one whom I knew from our initial meeting would actually listen to me and, more important, support my then 1-year-old son. She is still Liam's primary doctor today, and I have every hope that she will be until he leaves for college.

There are a million reasons why a doctor may not acknowledge your concerns, and none of them really matter. The only thing that does is that you speak up every time. Whether your worry is big (my baby avoids eye contact) or small (she has no interest in reading stories), you can make sure your baby gets the care she deserves.

1. Listen to your gut. Whether or not you're a first-time parent, it can be hard to know if your baby's development is typical. After all, there is a broad range in what's considered "normal" for all sorts of milestones  -- from sitting (5 to 8 months) to crawling (6 to 10 months, if at all) to walking (10 to 18 months). "But if it's bothering you that your 18-month-old doesn't talk the way her friends do, for example, don't ignore it," says Claire Lerner, director of parenting information and resources at Zero to Three, a nonprofit organization in Washington, D.C., that promotes the healthy development of infants and toddlers. "Parents should follow their instincts, even if it's only to get reassurance that nothing is really wrong." And if there is an issue, be it speech or hearing or even autism, the earliest intervention always produces the best outcome, Lerner says.

Dana Sullivan is a writer in Reno, Nevada.

More ways to be an advocate

2. Arrive at your appointments prepared. Before your next well-child visit, take a look at the list of developmental milestones that your child is expected to have reached (find checklists at the National Center on Birth Defects and Developmental Disabilities

3. Insist on routine screenings. Last year, the AAP issued new guidelines to help pediatricians identify developmental delays and disorders that might benefit from early intervention. Though the new screenings are supposed to occur at the 9-, 18-, and 30-month well-child visits, some pediatricians have yet to work the new guidelines into their practice, says Pamela High, M.D., a professor of pediatrics at Brown University in Providence, Rhode Island. If yours doesn't bring them up at your appointment, ask for them, even if you have to schedule a follow-up to get them done.

4. Learn where to find the resources you need. Should your doctor discover a possible developmental delay, you've got a couple of options for your next step. He may refer you to a developmental pediatrician (one who specializes in treating children with delays), a psychologist, a neurologist, or other appropriate specialist. Or you can seek an evaluation through one of the state or federally funded early intervention programs. You don't need a doctor's referral to access them, and a child's initial evaluation is often free. You can find one through your local department of public health or via the National Early Childhood Technical Assistance Center

5. Get a second opinion. Any time your pediatrician recommends a procedure, medication, or other treatment that you have concerns about, ask her why she prefers to take that route. If the explanation doesn't allay your fears and you want another expert's views on the issue, don't be afraid to seek it out. "It goes back to 'listen to your instincts,'" says Dr. High. "If anyone ever suggests something that you're not comfortable with, don't ignore that feeling." In general, she says, insurance companies will cover the cost of a second opinion if you elect to get one, and in some cases they will recommend that you do. Plus, getting different takes can be helpful in a surprising way: Once a child is given a certain label, it can become difficult for parents, caregivers, and later, teachers to see beyond it. "There are certain diagnoses that should be given with extreme caution," she says. For example, many infants and toddlers display certain behaviors that suggest autism, yet as the children get older, the signs disappear. Dr. High calls such attributes "developmental variations"  -- a far cry from a true condition.

Keeping all of this advice in mind, know that good pediatricians are always open to discussing various options with you and will readily refer you to a specialist if you wish to see one. "The relationship should be such that you're never afraid to express concerns about your child's care and recommended treatments," says Susan Sorensen, M.D., a pediatrician in Reno, Nevada. If you're ever in a situation where you feel that your child needs special services for any medical or developmental issue, don't take "no" for an answer. It's better to be (respectfully) pushy than to regret not having listened to your intuition. After all, nobody  -- not even your pediatrician  -- knows your baby better than you do.