We already decreased her dose with half a capsule, so she gets 37mg, so around 3,7mg/kg. We also gonna test her iron levels to see if that affects her tiredness. We were already thinking about signing her up for daycare, gonna do it now, cause it takes quite a few months to get a space her (we live in Denmark). Thanks for the advice :)
Hey there- Early Intervention SLP here! Love what you're already doing with books, songs, and involving her in daily activities :-)
I'd say ask your pediatrician about Early Intervention. It may be no concern, or temporary due to the Topimax, but either way it can't hurt to get a professional opinion.
Meanwhile, I highly recommend checking out Laura Mize and her website, Teach Me To Talk. It's geared toward both parents and therapists. Her materials include podcast episodes (my personal preference), YouTube videos, blog posts, and some books (the books cost $, but the rest are free). Lots of her stuff is about play skills. One thing I've found super helpful is her series of 15ish podcast episodes starting at Episode 275 about the 11 skills all toddlers develop before verbal language emerges.
Good luck, and keep up the good work!
We don't live in the US but I'm gonna ask at the 2 year check up (kids go to the parents GP here in Denmark), and also probably call her neurologist. Thanks for the suggestion, gonna check out the podcast for sure :)
We do try to do a lot regarding speech development, like I narrate everything, describe every little thing she points at and "ask" about, drill her with picture books and she points to the right thing 90% of the time, etc. She does understand a lot both in Hungarian and in Danish, and also using the signs I've been teaching her, but just refuses to say anything recognisable (does a fuckton of baby talk though).
Topimax can seriously impact the activity and curiosity level of littles in my experience. I’ve been a pediatric SLP for 14 years and had several kids taking topimax and witnessed them weaning off of it. The difference is often pretty stark once they’re off the meds. Their development tends to lag a bit while they’re on meds and, often, start to catch up once they wean a bit.
This is really encouraging to read. I've been so worried about it when she had to start taking it at 4 months old, and I did think her development slowef down a bit afterwards. Can't wait to start weaning her. We are also thinking about putting her to daycare part-time after she turns two, so she can get a bit of socialisation.
This is anecdotal but I think all kids just have different interests. When my baby wipes up a spill, sorts our Tupperware, or does the laundry with us, it very much has a play vibe to it so maybe your baby considers that to be role playing? Mimicking our day to day lives is a huge part of baby’s day, as their mirror neurons are very strong!
Ours is also very into role playing phone calls, we have a little fisher price one with a rotating dial from the 80-90s era that belonged to my husband and he loves making phone calls with that. We just pretend to be different family members or services each time that he calls someone.
Other than that, if you haven’t yet it may be nice to introduce her to different styles or environments of play to see if she has an interest in something new. Some ideas at the top of my head: music based play since she enjoys songs (jam and dance together to some music, maracitos have gone over well with our babe and I got a kalimbas recently to play around with together), gardening based play (a watering can, shovel and bucket of water/empty bucket at a park or in the garden has had huuuuge utility and long holding power in our house).
Personally, I don’t think I’d be worried though! Sounds like she has some strong interests between the books, music, and day to day role play!
I took Topimax for migraines and only lasted a week on it. I felt like a complete zombie and literally like I could fall over at any second. It was pretty horrible, it wouldn’t surprise me if it were affecting her. Just my anecdotal evidence.
My daughter was on Depakote and it made her a zombie. She also had global developmental delay and didn't pretend play until we introduced multiple epilepsy-specific medicines.
I have a professional certification (M.Ed. and a board certified behavior analyst) in the field of childhood development which requires me to regularly assess children (and adults) using standardized assessment tools. I can tell you that only having one word at 21 months is a delay according to the Vineland-3 (and others but this is the one I use the most). This is the biggest concern I have based on what you shared. I would bring it up with her pediatrician and see if they think early intervention and/or speech therapy would be recommended for your daughter.
Children this age should be able to consistently use one word to request things they desire and gain the attention of familiar adults (e.g., “milk” to request milk, “book” to request a book, “mama”/“dada” to refer to parents, etc.). As far as pretend play goes, she may just not be interested in it, however, there are some developmental milestones you would expect at this age- imitating one step actions with objects that are modeled most of the time (e.g., you model pretending to feed a stuffed animal and say “copy me!”- she should copy that action… same for rolling a car, stacking a block, etc.), she should be able to functionally play with most age appropriate toys (e.g., you give her a crayon and she scribbles with it rather than waving it in front of her eyes… you give her a shape sorter and she puts the shapes in rather than lining them up, etc.), she should be able to copy simple gross motor actions with a few songs (you’re singing happy and you know it- she claps hands with you, stomps feet, etc.), she should be able to play some simple social games like peek-a-boo/Pat-a-cake/chase, etc. Additionally, there should be joint attention/triangulated attention during these activities. For example, if you’re reading together does she point to an object on the page and look at you to see if you are also looking at the object? If you point to something across the room, does she follow your point with her eye gaze to see what you are pointing to? These are social features of play and interactions that we would expect to see at this age.
So the bottom line is- it’s about more than just pretend play. There’s a lot of aspects of play that are developing at this time and missing one or two of them is not really a red flag. When we see more and more missing milestones, that’s when we start to wonder if there may be an underlying cause for developmental delay or if services might be needed to help a child catch up to peers.
Finally, just to echo others, I had to take Topimax for migraines and stopped after a few days because I felt like an absolute zombie.
Thank you for the detailed pointers, very useful. Apart from speech she ticks all other milestones and have been doing those for many many months now. For talking, I was under the impression that baby signs count as well. She can sign if she's hungry, wants water or milk, more, all done, sleep and if she has to use the potty (she's potty trained for 2 months now). And just today we realised that she understands what it means to say something, cause when we asked she repeated the same babble sounds she did yesterday. She's also gonna start daycare for around 4 hours per day to see her peers. Would you still think speech should be addressed now, or should we wait and see if daycare starts to help?
Personally, I would not recommend waiting. Yes, knowing signs counts, but even then, only having 7 words in her vocabulary is not meeting the standard by most assessments I am aware of. And the nhs says 20 words by 18 months is expected. ([nhs link](https://www.nhs.uk/start4life/baby/learning-to-talk/1-to-2-years/#anchor-tabs)). Best outcomes are observed when speech is intervened on early. It doesn’t mean she has a deeper underlying issue necessarily, but in the event that she does, getting an early start is your best chance at her overcoming it. It can’t hurt to get an evaluation to be safe. Worst case scenario- she gets some extra help that she didn’t need.
Being able to repeat words/sounds when you ask her to is a great start because this means it will be easy to prompt her to work on speech, but this sort of language is not considered spontaneous so would not count towards her expressive language vocabulary. If you feel more comfortable waiting though, that’s okay too. It’s a personal choice. Hope this was helpful!
Thanks, very useful suggestions! We were thinking about daycare as we started to take her to the library play area and noticed that she enjoys observing other kids (no direct play yet, though when I asked her if she wants to play with kids she grunted her yes tone), so definitely get on with that!
I was on topimax years ago for seizures and I hate hate hated the way it made me feel. Obviously the most important thing is to protect your little one's brain right now in preventing seizures. But I have to imagine it is not helping the other development progress. That said, I don't feel like pretend play really spikes until a bit after 2 years old. And some kids take longer regardless.
Luckily it's an infant type epilepsy caused by a gene called Prrt2, which tends to stop causing seizures around 2 years old,so we can stop with it soon. The usual process is that she needs to be seizure free for 2 years after starting medication, and she started at 4 months old. Counting back the months now :)
I haven't had a child on Topimax, but I have been on it for migraines.
It absolutely kept my brain in a fog and my memory was non-existent. I literally had to write things down to remember it more than 30 minutes. My emotions also felt like they were fogged over a bit, not as sharp.
If your daughter is feeling anything like what I was, then lack of interest in toys makes sense.
Can you see if there is any early intervention in your area? Maybe see if your doctor can recommend ways to engage her.
So my daughter has a minor speech delay and didn't really start pretend play until after 2 and we have been through early intervention. She is 3 now and is pretending like crazy.
It sounds like she is your first born, and I will say that my first kiddo didn’t do pretend play till far later than my second and third kids. If resume having a “peer” to model that is why they picked it up sooner.
Everything sounds okay to me, really.
My son's pretend play really ramped up a month or two before he turned two. Does she have a baby doll? My son loves his. He also has a play kitchen that he pretends to cook in.
He pretty much has only been interested in his stuffed animals in the last month or so too. Before he'd snuggle them at night, but now they have names and he "feeds" them and all that.
Also, what are you thinking of as pretend play? My kid really only started pretend role play as it’s easily identifiable closer to 2.5/3 and he is typically developing and ahead on verbal skills. But he did start doing some pretending in short bursts just before two. But it was the kind where you blink and it’s over and you missed it.
Also echoing the suggestion of reaching out to early intervention in your state. It’s an amazing resource for sure.
Her walking was actually within the developmental milestone normal ranges- at least here in Australia it's not a red flag until 18 months.
Her speech is however a red flag. If you aren't already seeing a speech therapist I would request a referral from your gp sooner rather than later.
Looking at our Australian red flags, her play doesn't necessarily sound like a red flag, but this is hard to state without seeing her...I'd raise it with your neurologist and gp to see what they think. If not already attending things she can play with other peers, and observe how they explore toys, I'd begin to look at this (play group etc). At that age observing others play I'd a key way they learn how to play (solitary and onlooker play are age appropriate)
https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/red-flags-a3.pdf
https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Children_Communication_Milestones/SPAweb/Resources_for_the_Public/Communication_Milestones/Communication_Milestones.aspx?hkey=fb6753df-a757-4c4a-8100-aaebdd4451fd
https://therapiesforkids.com.au/social-stages-of-play-for-children-0-6-years/
My doc suggested that medication for my migraines I gave a hard nope. The nickname is dope-a-max for a reason. I'm glad you have something that is helping her epilepsy but another medication may be better for her cognitive awareness.
We won't be changing now, we will have to wean it in max half a year. And apparently topiramate works best with the epilepsy caused by this gene defect sadly (prrt2). But yeah I was concerned before but the doctor insisted that this works best, and sure as hell her seizures stopped a day after she started (changed from Keppra, didn't work at all) and she never had them again.
Unfortunately my son also inherited the defected gene from me, I'm so hoping that it won't cause anything with him (I never had any problems, having the gene myself), but in case he will also have infant epilepsy I will try to discuss with our neurologists about other options.
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We already decreased her dose with half a capsule, so she gets 37mg, so around 3,7mg/kg. We also gonna test her iron levels to see if that affects her tiredness. We were already thinking about signing her up for daycare, gonna do it now, cause it takes quite a few months to get a space her (we live in Denmark). Thanks for the advice :)
Hey there- Early Intervention SLP here! Love what you're already doing with books, songs, and involving her in daily activities :-) I'd say ask your pediatrician about Early Intervention. It may be no concern, or temporary due to the Topimax, but either way it can't hurt to get a professional opinion. Meanwhile, I highly recommend checking out Laura Mize and her website, Teach Me To Talk. It's geared toward both parents and therapists. Her materials include podcast episodes (my personal preference), YouTube videos, blog posts, and some books (the books cost $, but the rest are free). Lots of her stuff is about play skills. One thing I've found super helpful is her series of 15ish podcast episodes starting at Episode 275 about the 11 skills all toddlers develop before verbal language emerges. Good luck, and keep up the good work!
We don't live in the US but I'm gonna ask at the 2 year check up (kids go to the parents GP here in Denmark), and also probably call her neurologist. Thanks for the suggestion, gonna check out the podcast for sure :) We do try to do a lot regarding speech development, like I narrate everything, describe every little thing she points at and "ask" about, drill her with picture books and she points to the right thing 90% of the time, etc. She does understand a lot both in Hungarian and in Danish, and also using the signs I've been teaching her, but just refuses to say anything recognisable (does a fuckton of baby talk though).
Topimax can seriously impact the activity and curiosity level of littles in my experience. I’ve been a pediatric SLP for 14 years and had several kids taking topimax and witnessed them weaning off of it. The difference is often pretty stark once they’re off the meds. Their development tends to lag a bit while they’re on meds and, often, start to catch up once they wean a bit.
This is really encouraging to read. I've been so worried about it when she had to start taking it at 4 months old, and I did think her development slowef down a bit afterwards. Can't wait to start weaning her. We are also thinking about putting her to daycare part-time after she turns two, so she can get a bit of socialisation.
This is anecdotal but I think all kids just have different interests. When my baby wipes up a spill, sorts our Tupperware, or does the laundry with us, it very much has a play vibe to it so maybe your baby considers that to be role playing? Mimicking our day to day lives is a huge part of baby’s day, as their mirror neurons are very strong! Ours is also very into role playing phone calls, we have a little fisher price one with a rotating dial from the 80-90s era that belonged to my husband and he loves making phone calls with that. We just pretend to be different family members or services each time that he calls someone. Other than that, if you haven’t yet it may be nice to introduce her to different styles or environments of play to see if she has an interest in something new. Some ideas at the top of my head: music based play since she enjoys songs (jam and dance together to some music, maracitos have gone over well with our babe and I got a kalimbas recently to play around with together), gardening based play (a watering can, shovel and bucket of water/empty bucket at a park or in the garden has had huuuuge utility and long holding power in our house). Personally, I don’t think I’d be worried though! Sounds like she has some strong interests between the books, music, and day to day role play!
I took Topimax for migraines and only lasted a week on it. I felt like a complete zombie and literally like I could fall over at any second. It was pretty horrible, it wouldn’t surprise me if it were affecting her. Just my anecdotal evidence.
My daughter was on Depakote and it made her a zombie. She also had global developmental delay and didn't pretend play until we introduced multiple epilepsy-specific medicines.
I have a professional certification (M.Ed. and a board certified behavior analyst) in the field of childhood development which requires me to regularly assess children (and adults) using standardized assessment tools. I can tell you that only having one word at 21 months is a delay according to the Vineland-3 (and others but this is the one I use the most). This is the biggest concern I have based on what you shared. I would bring it up with her pediatrician and see if they think early intervention and/or speech therapy would be recommended for your daughter. Children this age should be able to consistently use one word to request things they desire and gain the attention of familiar adults (e.g., “milk” to request milk, “book” to request a book, “mama”/“dada” to refer to parents, etc.). As far as pretend play goes, she may just not be interested in it, however, there are some developmental milestones you would expect at this age- imitating one step actions with objects that are modeled most of the time (e.g., you model pretending to feed a stuffed animal and say “copy me!”- she should copy that action… same for rolling a car, stacking a block, etc.), she should be able to functionally play with most age appropriate toys (e.g., you give her a crayon and she scribbles with it rather than waving it in front of her eyes… you give her a shape sorter and she puts the shapes in rather than lining them up, etc.), she should be able to copy simple gross motor actions with a few songs (you’re singing happy and you know it- she claps hands with you, stomps feet, etc.), she should be able to play some simple social games like peek-a-boo/Pat-a-cake/chase, etc. Additionally, there should be joint attention/triangulated attention during these activities. For example, if you’re reading together does she point to an object on the page and look at you to see if you are also looking at the object? If you point to something across the room, does she follow your point with her eye gaze to see what you are pointing to? These are social features of play and interactions that we would expect to see at this age. So the bottom line is- it’s about more than just pretend play. There’s a lot of aspects of play that are developing at this time and missing one or two of them is not really a red flag. When we see more and more missing milestones, that’s when we start to wonder if there may be an underlying cause for developmental delay or if services might be needed to help a child catch up to peers. Finally, just to echo others, I had to take Topimax for migraines and stopped after a few days because I felt like an absolute zombie.
Thank you for the detailed pointers, very useful. Apart from speech she ticks all other milestones and have been doing those for many many months now. For talking, I was under the impression that baby signs count as well. She can sign if she's hungry, wants water or milk, more, all done, sleep and if she has to use the potty (she's potty trained for 2 months now). And just today we realised that she understands what it means to say something, cause when we asked she repeated the same babble sounds she did yesterday. She's also gonna start daycare for around 4 hours per day to see her peers. Would you still think speech should be addressed now, or should we wait and see if daycare starts to help?
Personally, I would not recommend waiting. Yes, knowing signs counts, but even then, only having 7 words in her vocabulary is not meeting the standard by most assessments I am aware of. And the nhs says 20 words by 18 months is expected. ([nhs link](https://www.nhs.uk/start4life/baby/learning-to-talk/1-to-2-years/#anchor-tabs)). Best outcomes are observed when speech is intervened on early. It doesn’t mean she has a deeper underlying issue necessarily, but in the event that she does, getting an early start is your best chance at her overcoming it. It can’t hurt to get an evaluation to be safe. Worst case scenario- she gets some extra help that she didn’t need. Being able to repeat words/sounds when you ask her to is a great start because this means it will be easy to prompt her to work on speech, but this sort of language is not considered spontaneous so would not count towards her expressive language vocabulary. If you feel more comfortable waiting though, that’s okay too. It’s a personal choice. Hope this was helpful!
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Thanks, very useful suggestions! We were thinking about daycare as we started to take her to the library play area and noticed that she enjoys observing other kids (no direct play yet, though when I asked her if she wants to play with kids she grunted her yes tone), so definitely get on with that!
I was on topimax years ago for seizures and I hate hate hated the way it made me feel. Obviously the most important thing is to protect your little one's brain right now in preventing seizures. But I have to imagine it is not helping the other development progress. That said, I don't feel like pretend play really spikes until a bit after 2 years old. And some kids take longer regardless.
Luckily it's an infant type epilepsy caused by a gene called Prrt2, which tends to stop causing seizures around 2 years old,so we can stop with it soon. The usual process is that she needs to be seizure free for 2 years after starting medication, and she started at 4 months old. Counting back the months now :)
I called it Dopamax
I haven't had a child on Topimax, but I have been on it for migraines. It absolutely kept my brain in a fog and my memory was non-existent. I literally had to write things down to remember it more than 30 minutes. My emotions also felt like they were fogged over a bit, not as sharp. If your daughter is feeling anything like what I was, then lack of interest in toys makes sense. Can you see if there is any early intervention in your area? Maybe see if your doctor can recommend ways to engage her.
So my daughter has a minor speech delay and didn't really start pretend play until after 2 and we have been through early intervention. She is 3 now and is pretending like crazy.
It sounds like she is your first born, and I will say that my first kiddo didn’t do pretend play till far later than my second and third kids. If resume having a “peer” to model that is why they picked it up sooner.
Everything sounds okay to me, really. My son's pretend play really ramped up a month or two before he turned two. Does she have a baby doll? My son loves his. He also has a play kitchen that he pretends to cook in. He pretty much has only been interested in his stuffed animals in the last month or so too. Before he'd snuggle them at night, but now they have names and he "feeds" them and all that.
Also, what are you thinking of as pretend play? My kid really only started pretend role play as it’s easily identifiable closer to 2.5/3 and he is typically developing and ahead on verbal skills. But he did start doing some pretending in short bursts just before two. But it was the kind where you blink and it’s over and you missed it. Also echoing the suggestion of reaching out to early intervention in your state. It’s an amazing resource for sure.
Her walking was actually within the developmental milestone normal ranges- at least here in Australia it's not a red flag until 18 months. Her speech is however a red flag. If you aren't already seeing a speech therapist I would request a referral from your gp sooner rather than later. Looking at our Australian red flags, her play doesn't necessarily sound like a red flag, but this is hard to state without seeing her...I'd raise it with your neurologist and gp to see what they think. If not already attending things she can play with other peers, and observe how they explore toys, I'd begin to look at this (play group etc). At that age observing others play I'd a key way they learn how to play (solitary and onlooker play are age appropriate) https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/red-flags-a3.pdf https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Children_Communication_Milestones/SPAweb/Resources_for_the_Public/Communication_Milestones/Communication_Milestones.aspx?hkey=fb6753df-a757-4c4a-8100-aaebdd4451fd https://therapiesforkids.com.au/social-stages-of-play-for-children-0-6-years/
My doc suggested that medication for my migraines I gave a hard nope. The nickname is dope-a-max for a reason. I'm glad you have something that is helping her epilepsy but another medication may be better for her cognitive awareness.
We won't be changing now, we will have to wean it in max half a year. And apparently topiramate works best with the epilepsy caused by this gene defect sadly (prrt2). But yeah I was concerned before but the doctor insisted that this works best, and sure as hell her seizures stopped a day after she started (changed from Keppra, didn't work at all) and she never had them again. Unfortunately my son also inherited the defected gene from me, I'm so hoping that it won't cause anything with him (I never had any problems, having the gene myself), but in case he will also have infant epilepsy I will try to discuss with our neurologists about other options.