Baby development checks: Pincer grips, Cheerios and a thousand more things to worry about.

Be afraid, be very afraid.

Be afraid, be very afraid. 

Through our letterbox this morning arrived a very important document. It was the letter notifying us of our son’s 8-9 month health and development check. I had been eagerly awaiting this as he is already 9 months old and, you know, I think he’s pretty well developed. However, I was not quite prepared for the Spanish Inquisition that lay inside the envelope.

Now, before I go any further lets just get one thing straight. I am eternally and overwhelmingly grateful to live in a country where my son receives a health and development check, free at the point of delivery, as standard. The NHS is quite a wonderful thing. I have been to hospital 3 times since my son was born (including the birth) and I have never had to worry about anyone handing me the bill. This is a brilliant part of our society and one that I’m scared will be eroded over the next decade if bloody ‘Dave’ and his school friends have anything to do with it (grr, arg). So I will proceed to have a good long moan with the proviso that you know I really really really love the NHS. Good.

So, the 9 month ‘Health and Development Review’ letter arrives. The title is enough to instill fear into the heart of any previously employed mother. Review? That’s what they do at work to see if you’re doing your job right or not. You know, they get you to fill in that crappy self-assessment form, which you always lie on because your boss is going to read it, and then there’s the meeting. *shudder* It’s hard not to immediately jump to the conclusion that my parenting thus far is about to undergo a performance review. And guess what? There’s even a self-assessment questionnaire attached.

If you are a parent who has not yet received a questionnaire like this then I just have one piece of advice: DON’T LOOK AT IT. Leave it neatly folded in it’s envelope and put some time aside the day before your appointment to go through it with your baby. Granted, that will still give you 24 hours to obsess over the weird and wonderful list of accomplishments your baby doesn’t have but but you will marginally more sane than if you had been thinking about it a fortnight in advance. So, just ignore it as long as you can. It’s either that or be an uncommonly balanced individual who has no care for what health professionals think of their child and feels completely secure in their parenting abilities. Though, if you are that person I’m really not sure why you’re reading this blog. Can I read your blog please?

The reason I give out this sage advice is that a) the questionnaire is about what your baby can do at the point of the ‘review’ and b) because the amount of things that it asks if your baby can do is insane. I shall give you a few choice examples (if you are easily prone to my-baby-is-underdeveloped-paranoia look away now):

Does your baby pick up a small toy with tips of his thumb and fingers? (You should see a space between the toy and his palm.)

Well, that’s oddly specific for a start. I don’t if the person who compiled this questionnaire is aware of this but babies have quite small hands. How exactly am I supposed to observe said space? Should I crouch on the floor and crane my neck? Won’t that just freak him out? Also, have you ever tried to get a 9 month old to pick up the specific toy that you want them to have? Unless you complete this task in an entirely white room with no objects or furniture, I guarantee that they will charge off to play with a table leg as soon as you place the item in front of them. And believe me, I tried it today. Oh no, I am not above getting irrationally anxious about whether or not I can see a gap between a building block and my son’s palm.

Next question:

Does your baby say three words, such as “Mama”, “Dada” and “Baba”? (A “word” is a sound or sounds your baby says consistently to mean someone or something.)

Well, thanks for clarifying what a word is. Those brackets are really starting to irk me. And the answer is no, my son doesn’t have THREE WORDS at the age of 9 months. And even if he did, how would I know? He says “dadadadadadadada” a lot and, less frequently he says “mamamamamama” (encouraged enthusiastically by yours truly). Who’s to say when that random babbling suddenly turns into words? Not me. I know babies who haven’t had any language til they’re closer to 18 months. So, back off survey, alright? (Actually, I had words at 9 months and am still perversely proud of the fact, bleurgh).

And last but not least, the pinnacle of randomly specific infantile feats:

Does your baby poke at or try to get a crumb or Cheerio that is inside a clear bottle (such as a plastic soda pop bottle or baby bottle)?

Again, thanks for clarifying what a clear bottle is, would have struggled with that one. And, more importantly, what the fudge? In what scenario would I know the answer to this question? Why am I taking food from my baby’s hand and putting inside a vessel that he has no hope of retrieving it from? I’ve got it! They’re trying to trick us into doing this and then, when they see we’ve ticked yes, they will point their fingers in ours faces and say “Aha! So you torture your child with food they can see but have to hope of eating??” Enter social services.

Okay, maybe not, but what’s all this Cheerio business? There are actually three questions that refer to a “crumb or Cheerio”. What’s that about? You better not try this out with a Cornflake, mate, or the whole exercise will be null and void. You’ll have to start all over again. Crumb or Cheerio. These are your only options. I feel like Nestle paid someone somewhere serious money to get their branding on the Ages and Stages Questionnaire. I really wouldn’t put it past them. I have visions of mothers rushing out to buy the ‘multigrain Os’ just so that they can make double sure their child has that prefect pincer formation that the Health Visitors will be looking for. And if you think the supermarket own brand will suffice for this activity think again, cheapskate. 

Oh and by the way, you’re not supposed just fill in this form based on your existing knowledge of your own child; you’re supposed to observe your child doing all of it and “make completing this questionnaire a game that is fun for you and your baby”. Fun? Fun?? In what universe is attempting to get a 9 month old to complete a series of specific tasks fun? “Reach for the Cheerio darling, no, no, not the remote control, come back here!”

What makes this whole process even less fun is the dawning realisation that you will have to tick ‘no’ several times. It’s like someone is coming into your home and pointing out what your baby can’t do yet. “Oh, he can’t hold onto the sofa, bend down to pick up a toy and then return to standing?” Awkward.

The thing is that my rational mind knows that no one is expecting my Bubs to be able to do everything listed on the survey. I’m pretty sure that no baby can ever do all of it. They must put extra-advanced stuff on, you know, just in case. But if that’s true then I think there should be a little note stapled to the front of the questionnaire that reads:

Dear parent, we would like to reassure you that you’re baby is in no way supposed to tick all of the following boxes. In fact, if they did then it is likely that they would be one of those weird genius children* who take their Maths GCSE at the age of 8 and never truly fit in with their own peer group. Rejoice, therefore, in your own child’s uneven and average development; it bodes well for their future social interactions. Yours sincerely, the NHS.

Or something like that. Just a suggestion.






*Apologies if you have a weird genius child. I actually think that’s pretty awesome. But you know, comedy value and all that.


32 thoughts on “Baby development checks: Pincer grips, Cheerios and a thousand more things to worry about.

  1. My thoughts exactly when I received the 12-13 month questionnaire. When I received it my baby wasn’t doing have of the stuff and it made me feel as though she wasn’t developing properly, I filled it in the day before our appointment and she was able to nearly do it all. Can’t wait for the 2 year one!?! NOT!

    • Yep, I had to rearrange our appointment and have just been sent a 10 month questionnaire. I’m not even opening the envelope! Thanks for the comment Claire x

  2. Fantastic post! I don’t know what I found more worrying – the completely insane questions, or the knowledge that in our health area, this questionnaire was used IN LIEU OF, rather than as well as, an actual health check with a doctor. It asked you to self-assess whether your child had any unusual bruises or injuries that led to hospital treatment: firstly, shouldn’t the NHS already know this; and secondly, isn’t that letting off everyone who cares to cover up abuse a little too easily?

    I took my daughter to the clinic to get her weighed and measured properly at a year old, so I could at least fill that bit in without fibbing: I was asked, sotto voce, to wait outside by the lift for someone to measure her – ‘otherwise they’ll all want it done’. I love the NHS too and am incredibly grateful for it, but sometimes it beggars belief…

    • Wow Becky, at least I get an actual appointment! It’s crazy that it’s different everywhere; what age the check is, what they check and who checks it! And I’m sure part of the reason you don’t get a face-to-face is because every bit of funding is so squeezed!!

  3. Aah the two year one….! This asks for examples of sleeping pattern… ( Pattern..? is waking up asking for mummy every night a pattern?!), Examples of the foods she will eat. ( In my case a list of foods she wont eat was easier) and examples of how she plays with her dolls.

    Re reading the review and seeing how my child still wakes up several times a night, wont eat ‘healthy’ foods and drags dolly round by her hair really did make me want to cancel the review and work on these areas. Review is on Monday. I am actually terrified.

    • Oh Nicola! This is exactly what I’m saying! How is you feeling anxious and self-conscious helping any one? These checks should help us feel supported not judged! I’m sure you’ll be fine; you know your own child and so what if she pulls her doll around?? She’s two!!!

  4. It sounds like it was halfway written in America, where plain old-fashioned (unsweetened and oat only) cheerios, are such a common ‘finger food’ for babies that i wasnt even sure how to cope without them when i parented in the UK. I know very few people in the UK who feed them so regularly to their babies that this question even makes sense. And I admit, I would be a little judgey of anyone was giving their infant handfuls of the sugar coated version sold in the UK several times of day!

    • Hi Kayelem, thanks for the comment. Ah, that makes more sense, wish you could buy those here! Still Nestle have done pretty well marketing themselves as baby food somewhere along the way!

  5. It annoys me that questionnaires like this are given to parents to assess their own children. Generally they’ve been developed by developmental psychologists as a way of charting children’s progress in a general way, in order to obtain averages across hundreds of children. They are by no means a list of what every child should be achieving at a certain age and they should be carefully interpreted by someone who understands what each measurement means. For example the pincer grip thing is to assess possible low motor control due to undiagnosed mild cerebral palsy or other physical difficulty. Lack of a pincer grip doesn’t mean that difficulty exists but it’s a red flag that should lead to further assessment. Equally not saying any words could indicate deafness, not poking at a Cheerio (which is there because the assessment tool was standardised in America and that’s what was on the original form – it can’t be changed or the averages then don’t work and the whole thing has to be restandardised) could indicate a sight problem, etc. It should be filled in by a professional who is watching the child, who understands what the questions mean and who is able to elaborate on them with the parent so an accurate answer is given. For example with the Cheerio one, lots of parents might say no because they’ve never seen their child doing anything like that. But if a professional then says “Does she ever paw at the window to get at your cat who’s outside,” and the parents says yes then that indicates there’s no problem a no to that question doesn’t trigger a referral. Equally if the parent says no to that question and then the professional probes further and finds out that the baby doesn’t look for anything, doesn’t appear to reach beyond a certain distance, then there’s cause for concern.
    I used tests like these in research and they were very useful, equally they are useful for health visitors, GPs, paediatricians, etc but they only worry parents as there’s no rationale given for them. Giving them out is really lazy and it bugs me.

    • Thanks for the comment Frances, I feel more informed and empowered just by reading it! Actually a friend of mine said that when she went to the check the health visitor ‘upgraded’ a lot of her ‘no’ answers to yes; shame my friend had to worry before hand!

  6. I can’t help but feel that this is another post bashing NHS staff. I would agree that if you receive something like this in the post it may be alarming if your child is not performing some of the actions that are listed. I would also add that within my area of practice, it is not something that would happen and that the ASQ questionnaire is competed in conjunction with the parents so that its use can be explained, as can the assessment criteria and if further referral is required this can also be discussed and consent for referral gained. As with any screening tool, is it not diagnostic, but can suggest to the assessor if further assessment or diagnostic tests are required. Using the example by Francis, an immature pincer grasp can indeed suggest a vast array of different conditions or nothing at all, but she is indeed correct that a competent health professional would use there numerous assessment skills to assess the whole child, not just that particular skill. I also would doubt that the questionnaire is being sent to parents out of ‘laziness’, but perhaps more out of being overworked, under appreciated and tied in knots by copious amounts of red tape and paperwork. Just out of interest, was there a covering letter explaining why you had received this questionnaire, and that it is something that would be discussed with the health professional when they review the child? As I understand it, this is not something that is merely sent to parents and left, but sent ahead of an agreed appointment time, is that correct? Granted, the questionnaire isn’t perfect and there are some Americanisms throughout, but as Francis rightly pointed out, an assessment tool has to be standardised and this is one of the very few tools available. Gone are the times when a review could be completed using professional competence and knowledge alone, as we all know, the health professional that refers a child to a paediatrician due to ‘gut feeling’ and god forbid is wrong, is likely to receive complaints from parents, reprimand from employers and in our present time trial by media is thrown into the mix. The fact that the child is well and the numerous other children referred by the same professional due to gut feeling are diagnosed and treated effectively is forgotten. I would also like to think that the children who have been picked up through the 1 and 2 year checks that are now being treated for various conditions would consider the ASQ a necessary intervention. I unfortunately cannot explain why children have to be measured by the lift as the example given by Becky and agree that questions regarding bruising and suspicious marks should indeed be asked by a health care professional. Finally, I would like to say that not all NHS workers are ‘lazy’, there are some that continue to work hard, putting theirs and their families lives on hold to provide evidence based compassionate care for the patients that they look after.

    • Peggy Sue, thanks so much for your comment. It gives me an opportunity to say I’m very sorry if that is how this post comes across to you. I purposefully began my post by saying how much I value the NHS and how grateful I am to have this health check. I have a wonderful health visitor (who I have mentioned in previous posts) and she has been a real support to me this year. I would certainly never suggest that NHS workers are lazy (perhaps someone else used that word in a comment?). I totally understand that the reason for reductions in services is to do with cuts (as I mentioned in my reply to Becky). But I do see how putting the post in the category ‘health professionals’ is ill-advised so I think I’ll change that.
      In answer to your questions yes there was a cover letter and I have an appointment (I thought I mentioned that too?). The letter could have been a bit more reassuring in explaining the purpose of the ASQ and I will feed that back when I go.
      This blog is supposed to be a place of cutting humour and gentle reassurance for parents who feel lost in the midst of all the guidelines and milestones. However, I never mean for this humour to come at anyone else’s expense. Thank you for the work you do (thankless though it is!)

  7. I have read this with much interest and amusement. I too have been a victim of the dreaded, pointless American questionnaire, fortunately I took the process with a pinch of salt and amusement. My daughter at 12 months had no inclination to walk, cruise or stand. Was not at all concerned, her older brother walked at 19 months, myself at 20 months, and my mother at 24 months. Unfortunately this a big fat NO with the questionnaire. The health visitor sat and went through the questionaire with me, then stated that my 12 month old daughter had FAILED! Nice way to label 12 month olds as failures! Fortunately I had no concerns myself, and dutifully made an appointment to see health visitor at 18 months (self confident that my daughter would be mobile at this stage). Pleased as punch I attended the appointment with a daughter who had tentatively taken her first steps 6 days before… Only to find out that we still did not meet the criteria on 18 month questionnaire! For example she did not walk up stairs etc… On receiving my 24 month questionnaire in the bin, this was swiftly placed in recycling bin.

    It is worth pointing out, that today at 26 months my daughter can walk, run, jump and dance as well as her peers. It’s a huge shame that health visitors have decided to adopt these questionnaires as assessment tools, rather than using their own professional judgement.

    • Go you for staying strong and really being secure in the fact that you know your child! I should imagine that there are quite a lot of health visitors who hate these questionnaires as much as we do, but everything seems to have to be tick boxes these days!
      But FAILED?? What a crappy this to say. I bet a lot of parents have been really shaken by that.
      Thanks for sharing your story, Jess.

    • It is. Sometimes I think with some children not walking is a physiological sp? issue rather than a sign of development delays. My son is a paraplegic but I’m aware that some children are late walkers. I’m glad that we are concerned about non typical children developing but sometimes we need to remember children are children.

  8. This is another NHS bashing post.
    For all those hard working, caring HV’s out there (& they do exist!) you’ve degraded them. If we don’t like what is being offered to our children then let’s makes noises in the right place, idle gossip on a blog won’t make a difference.

    • Thanks for engaging Kate, sorry you feel this way. Actually I’ve already had a health visitor saying she will feed this back to those taking the lead in her area so maybe it will make a difference. Also, if it lets mums out there who have felt their children are being labelled as ‘behind’ feel they’re not alone then I think that’s making a difference in itself.
      I love my HV, as I have mentioned in previous posts. I was taking the piss out of the questionnaire, not any individual.
      Will regards to NHS bashing that is absolutely not my intention, which is why I dedicated a paragraph to it in my blog! For more on this please see my reply to Peggy Sue.

  9. As a Health visitor I would just like to point out the use of the ages and stages tool was decided at national level and not by health visitors, as so many things that govern our practice are.
    The idea is that the parent gives their opinion of what their child can do and the health visitor probes it further if needed. There are no failures, just children at different stages, some of whom may need further referral or help- and picking this up is the purpose of a developmental review, however no child scores yes in every box in my experience, and there are specific cut off points about when this indicates a problem.
    Try not to worth mums, if you think the questionnaire is indicating concern discuss it with your health visitor in the appointment.

    • Thanks Daisy, this is a great comment, glad you took the time. Yes someone else mentioned it was a department of health directive, which doesn’t surprise me at all. Your explanation of the idea behind the questionnaire is really helpful, I reckon it should be on the accompanying letter.
      Thanks, too, for all of the work you do, I hope it is clear that this post is in no way an attack in health visitors, but just a sarcastic look at a strange form!

  10. Prefacing this with wholehearted agreement that the NHS is awesome, maternity wards are massively understaffed and I am indebted to every single ER doctor who has treated my children for what turned out to be nothing-too-major:

    My HV wouldn’t use a cheerio at the 9 month check because food was too big an incentive to get her to pick it up, and “she may put it in her mouth”. Instead, she screwed up a small piece of paper. And sat patiently whilst I retrieved said item from my daughter’s mouth. My daughter reciprocated by weeing on her a short time later.

  11. Pingback: Pincer Grips and Cheerios #2: Test or guide? You decide! | The (mal)Contented Mother

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  13. Thanks so much for your blog, we had just been working through the 30 month questionnaire and becoming very disheartened. Our covering letter did say that our responses to the questionnaire would be discussed at an appointment, but didn’t explain that we didn’t need to worry about ds not being able to do many of the ‘tasks’. I can now sleep at nights, at least until the next trauma!

  14. Oh my goodness I couldn’t have written this any better. I just came across this post whilst googling if bloody Ne*tle had paid to get there fudging baby killing brand in this dumb ass questionnaire that I have just had to do with our local nursery nurse today. I argued the point that I hated the brand being mentioned in the questions and secondly like you say who the heck puts it in a bottle? I said no to that question because let’s face it how am I going to know? The outcome is apparently they are going to ring me at 12 months because my little one doesn’t say mama and dada in the correct context! WHATEVER!! Thanks for the post!

  15. Fab post and it echoes my sentiments entirely.

    I’ve just completed mine and added a list of concerns about the questionnaire under the box for “concerns about your baby”. They included points about Nestle, anxiety-provocation, poor food choices on a “health” review and the fact they haven’t mentioned this is part of a stuffy for the gov. I hope they enjoy a read in the office and it made me feel better about filling the pointless thing in.

  16. Pingback: The Ages and Stages questionnaire: return of the cheerio! | The (mal)Contented Mother

  17. Thank you!! Love your writing. We just went through this and my new pedi tallied the sheet and asked if we wanted a therapist to come to our house because son doesn’t eat cookies/biscuits or drink from cups…welllll I have a breastfed baby who doesn’t eat processed grains or drink from cups!!! Someone needs to take this thing down–it’s like a list of culturally biased SAT questions!!

  18. I only ever did one. The questionnaire is anything but fun so I don’t really relish the task. It’s like filling out the DLA form although that has a purpose. I’ve since learned that the questionnaire is not supposed to be used if it’s known that the child has a development delay. Every time I’ve been asked since I’ve responded that they know that he is a paraplegic so he has development delays. They’re using it wrongly.

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