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Spending Money on prevention than cure the society when changes can not happen

  • 1.  Spending Money on prevention than cure the society when changes can not happen

    Posted 09-03-2019 04:48 PM
    We focus so much on Early education after the child is already 3-5 years and talk a lot about  STEM programs to make a child shine better in life.
    What can we do as a society to prevent poor neurodevelopmental pathways that happen rapidly 0-36 months, critically by 24 months.
    We labeled AUTISM and diagnose the condition to this date very late in life at 24-=-36 months and lost all opportunities to prevent it from happening.
    Autism is 1/34 in New Jersey state
    1/59 as per CDC.
    Time to get any help ranges between 48-52 months , when the pathways had been set for life time.
    Social Emotional Learning or Withdrawal happens starting from Birth mostly.
    Every parent needs to know the facts about Multi Sensory Integration and the causes for multi sensory Segregation. 
    We have now thrown the terminology to AUTISM SPECTRUM DISORDERS /SENSORY PROCESSING DISORDER. 
    We sit around , the providers, educators and every one involved in caring for infants to toddler stage, blame vaccines, but we do not focus on facts that will integrate the 5  senses.
    Personally and Professionally, it is not possible to have a significant genetic factor every 2-3 out f 100 and end  up with Autism Spectrum, ADHD and Behavioral problems that includes mad rage and impulsive actions.
     I implemented behavioral counseling with every well child care visit and sometimes even with sick visits to teach parents what is involved in Multi Sensory Integration, How family can impact the Sensory integration or segregation, what electronics will do and how Bayesian inference gets disturbed, why we should not challenge through regimental parenting but with love, conscious discipline , music , touch therapy in a sequential way to prevent Developmental and Behavioral disorders from the prenatal visit.
    Why is community at large still a sleep and trying to fix problems when they can not be easily done.
    When are we going to make the Universal Multi Sensory Integration based Nurture Curriculum available to each caretaker and parent ??
    When are we going to open the eyes to the fact that the public awareness of the primary teacher being a PARENT to give Nurture, STEM preparation and Linguistic abilities. When will the parents come out of the BOX and stop blaming gut microbes, immunizations and move into the realm of accepting major research data on 0-3 year neuroplasticity and focus on creating robust connections for adaptive, SEL and Intelelctual wellness. 
    It can be done and I accomplished the results in my own practice since 1995. I can teach the facts and How and What to do 0-3 years for Robust Pathways.
    M.Chintapalli. MD FAAP


  • 2.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-04-2019 07:17 AM
    I'm sorry, but as a parent of a child with Autism, I take offense to your statement, indicating that I'm somehow responsible for my son's Autism. My son had sensory sensativities from birth. He was adverse to certain sounds and textures as an infant. He was exposed to nature and wasn't given screen time, we (his parents) didn't even watch much TV when we were around him. He was an infant/toddler before smart phones. Yes, he was exposed to screens occasionally, but that was not normal for him to watch them. His father and I are warm/loving parents and he frequently comes for hugs and cuddles, even at the age of 14. He's highly intelligent, taking Algebra 2 as an 8th grader. I've spent the last 13 years reading anything I could get my hands on regarding autism and I am currently pursing my Master's degree as an Autism Specialist with certificates in ABA and Transition.

    I don't disagree that children are given too many screens and need more true playtime, but please don't insinuate that parents who have children with autism did something, or failed to do something to cause it.

    Side note, I have 2 children, both boys, fully vaccinated only 1 has autism.

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    Heather Finnegan
    Preschool Teacher
    Our Redeemer Lutheran Church with School
    Delavan WI
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  • 3.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-04-2019 06:04 PM

    Meena:

    There are things that I agree with in your statement; and several things that I do not.  I grew that all caregivers need to be educated in multi-sensory awareness.  It would help all children, not just those with ASD.  You seem to be  implying, unless I'm misreading, that it would prevent ASD or that often a child who is diagnosed with ASD actually has sensory issues instead (rather than along with).  I don't think I agree.

    Your approach to teaching parents aligns with mine and with the best Early Intervention clinicians and Infant and Toddler teachers.

    I especially take issue with your blaming parents, as has been addressed in Heather Finnegan's post,  and Early Childhood professionals.  You write: We sit around , the providers, educators and every one involved in caring for infants to toddler stage, blame vaccines, but we do not focus on facts that will integrate the 5  senses.

    I know NO EEC professionals who believe that ASD is caused by vaccines, and I work with dozens of teachers, EI clinicians, and other professionals.  Your urgency about getting help for children sooner and about caregivers learning about sensory integration is commendable.  I would urge you to stop blaming caregivers. It diminishes the good in your message.



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    Aren Stone
    Child Development Specialist
    The Early Years Project
    Cambridge, MA
    she/her
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  • 4.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-06-2019 02:16 AM
    Dear all
    Thank you gorcraising a constructive comment. I have 43 years I General, Developmental and Behavioral Pediatrics. I did not mean to imply about ASD alone. My interest in global developmental delay aroused in 1979 when a 3.5 year old deprivation dwarfism child grew 4" and developed some identity about self, made eye contact and developed some phonemes of expression within 6 months of a placement in a loving foster home .  He was a classic case of psych social dwarfism. I hypothesized that stress caused this global delay, how and why was my enquiry. Answers calms when I first saw the round table synopsis on growth and development and experiential neuroplasticity in1997. I grew with the later discussions and nomenclature development of ADHD, PDD, Autism,and many other disorders.
    It is a fact that the primary wiring from is life time and ACE, Toxic stress, poverty, lack of opportunities and repeating parenting experiences by the parents, extended families who love the infants and lovingly help young parents going to work, can also not realize what electronics can do. The consequences are different for different age groups. I have seen all age groups suffer with disengaging electronics exposure. I have seen languagevdelay with electronics introduced at 9 months of age to teach phonics and numbers.
    We have national census that show 48% of 18-34 year have experienced physical aggression and have 1-2 behavioral health disorders. 39.1% of 6 year olds have Anxiety disorder
    19% Of 11-13 year old have Behavior disorders
    40% have mental health disorders and 22% of them have serious conditions.
    My discussion is to open up hearts and minds to look at the proximal environment that every infant is exposed to first thousand days of life as a primary teaching ground that can create robust pathways in SEL that underlies cognitive intelligence, cognitive flexibility, emotional self regulation, pro social behaviors, linguistic abilities.
    There are principles for sensory integration and binding the information robustly for listening, language development, phonemic thematic presentations, visual spatial, auditory spatial reasoning, math and science processing, critical thinking all are 90% done by three years. Although Brain is malleable, resilient and plastic, the poor primary neural functional and anatomical networks cause weaker secondary networks in lifetime.
    The only opportunity is to prevent poor network formation through intensive education in the communities about the critical phase of first thousand days of the role of proximal environmental nurture, positive experiences helping to create pathways for eating practices to getting involved in arts, crafts,  using, fine arts, STEM programs , literary skills, gross and fine motor skills.
    Patents, society, schools all should learn about the facts.
    When the child goes to head start at 3 years, child already learned survival skills, with a state and a trait of adaptation. It is so expensive to undo the adverse traits.
    The current behavior disorders , including mental disorders and drug problems have their roots in primary network formation.  Current trends can only change by reaching out to every one to prevent ACE, Toxic Stress, understand when to use electronics, help the poor to get nutrition , explain to every person who is involved in caring for a child.
    This is not meant as mommy shaming Syndrome.
    Professionally, I saw desperate mothers discuss trying to go for poop transplant to overcome autism. I had to sit down and explain to hundreds of patients how autism is not from vaccines. I want all educators to see what a professional provider sees in the clinic. We see a lot of child trauma behind 5he scenes of multiple developmental disorders. We see resilience fail in adult caretakers in their coping skills and provider has to build their resilience.
    Positive thoughts, self care, mindfulness, getting the " Beingness" through yoga, meditation, activities, music, group discussions and compassionate counseling that cools the hidden anger and hopelessness to parents was more important in  managing behavior problems.
    When a child bites, where is the aggression coming from at 3-5 years of age ?
    When a child is screaming and darting out, what is going on in his mind?
    when a child spins the cat by it's tail and throws him, what was he or she growing up with?
    When an infant wants to tune out , what can happen and why tuning out?
    Therefore, my discussion is for a broader outlook at family, parenting, socioeconomic status, opportunities for growth, the true age when SEL actually occurs, what can be done globally that can prevent poor primary wiring, create robust  learning pathways anatomically and functionally
    While we treat current problems, let us all focus preventing weaker networks when it is opportune time. This is not a mommy or daddy shaming discussion but help look at the bigger picture that we are not looking at as a society






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    Meena Chintapalli
    CEO of The SAI Institute Of Educare and founder of San Antonio A thru Z pediatrics. retired , December 2018
    Meena Chintapalli and The SAI Institute of Educare
    San Antonio TX
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  • 5.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-06-2019 05:29 AM
    I agree that the first 1000 days of infancy are critical to a child's life. Our society however puts little emphasis on this time of life. I argued as a teenager that woman's "rights" would have adverse affects on society. Our children are suffering because six weeks of leave is not enough to raise a child.
    Currently, I am taking early retirement to help raise my grandson because I believe that the best caregiver is one who loves the child and who is educated enough to know that this time of life is critical to that child. Current brain research has proven that brain development in these first three years is critical.
    Trauma can be caused by seemingly insignificant things such as not paying attention to an infant's basic needs. A child who is not secure cannot learn. A lesson from psychology 101 that our society failed to follow.

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    Holly Kerins
    Director
    Calvary Baptist Children's Learning Center
    Norristown, Pa
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  • 6.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-06-2019 11:40 AM
    Meena, I agree with you that often times children are diagnosed with autism when it is likely that they have intense Sensory Processing Issues, and/or PTSD, and/or a slew of other acronyms!  There are multiple factors impacting children's development and their parents these days, impacting all of us of course.  But I think that there are multiple factors impacting a child's ability to learn and grow in a classroom and at home.

    People in general need a lot of support and a lot of compassion.  Parents of young children, struggling with poverty, job insecurity, food insecurity, lack of time for working multiple jobs, lack of sleep because of all of the above...need support and information.

    I give workshops/trainings for parents and educators about Sensory Processing Disorder.  So many parents do not actually know what "typical" (if there is truly such a thing anymore) child development is:  they are not around children in any focused manner, and maybe the only children they know intimately are their own, so when they bring their child to us for child care, they often do not know that something is amiss.  Many pediatricians no longer talk about Sensory Processing Disorder after a 2012 bulletin from the APA saying that it was not clear if it even is a "thing."  So depending on the pediatrician, the parent might not even be getting information that is helpful to the intensity that the child is experiencing.  That of course is where we as educators come in, and of course many preschool teachers have also not heard about SPD.

    But creating sensory friendly classrooms truly helps all of the kids, so paying attention to the kind of lights we have on, the amount of music, the amount of things on the walls, the fragrances in the room, the tone of our voices, the general level of busy-ness...all of these are things that can help with behaviors that are a result of sensory overload, whether it expresses as shut-down or overload.

    I also have two children, and like Heather, one has autism, one does not.  My son's SPD was actually evident pre-birth, as he never stopped moving for the entire 6 months that I could feel him...there are so many factors at play with autism that it cannot be hung on just one cause, but the fact that the numbers continue to explode all over the world is of course indicative that there is something going on that can likely be remedied.  I think there are many sacred cows in our modern life that are negatively impacting children, and much more robust research should be done, with double-blind testing, to start to weed out what is making life so hard on little one's neurological and  nervous systems.

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    Joanie Calem
    Columbus OH
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  • 7.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-08-2019 08:39 AM
    Dear Joanie Calem
    Thank you for seeing through what I wrote.
    Whether Autism, ADHD, Hyperkinetic Child Syndrome or Sensory Processing Disorder, all can be remedied through caring nurture with love and home bound, less expensive inter relational Primary care one to one positive activities 0-3 years. I am a TECPDS trainer for early childhood educators since 1997.
    I gave 70 lectures to head start and school programs in Texas between 3 major cities.  I developed as a Pediatrician my own curriculum that creates robust Pathways of sensory enrichment that never failed.
    Among kids who were declared to be nonverbal and the parents were told that they have to deal with " Animal Behavior" by neurologists, I educated parents do that with my persistence against the peer pressure, I proved the statements to be wrong. The children talked, maintained eye contact and mainstreamed into regular class by 1st grade. But changes needed to be addressed at home ( family engagement), communication and tone of voice, conscious parenting and teacher discipline and behavior modification models, parental attitudes and help overcome their trauma , touch with music therapy, object - word- tangible touch with cognitive associations.
    In all of the NICU graduates, ADHD, ASD, SPD , Child Trauma , I had to educate each family , individually one by one, about interpersonal communication, control or stop electronics , essential role of "Parenteese", self care, yoga, mindful meditation, guided imagery with music.
    The Multisensory Integration Curriculum helps for all children provided the triangle of parent, resources of community and the individual work together.
    I still see loopholes as not all can reach a teacher like
    you during formative years,
    Every child is mandated to be delivered at a hospital and see a doctor or a provider for immunizations 0-3 .
    During this time 90% of wiring for life time occurs.
    The families are not getting this information universally to talk about how to nurture senses during that time.
    I appeal to all to reach out locally through public education forums.
    My appeal is instead of focusing on fixing Opioid crisis, ADHD, alcohol addictions, create public awareness education about 0-3 year experiential neuroplasticity, nurture , resilience and how to enrich pathways, how to prevent poor hard wiring, so that people will take care to prevent lost opportunities.
    Electronics have a major role in creating 14 neuropsych disorders that can be prevented. The impact is bizarre network formation 0-2 years , with poor aconal connections that need experience, high brain volumes with increased non functional networks as seen autism ( high brain volumes and nerve density as described by Ziats ETV all and Eric Courchessne).
    Later effect of electronics is grey matter attrition that causes frontal lobe to thin out causing poor memory, lost motivation, poor impulse control, poor focus and attention span, poor anger management, anxiety, explosive temper, depression. ( Zhou, Lyn , Yin research articles from 2011-2013).
    There has been a lot of research that is still not a public knowledge . There is a lot of opposition to spread this message for personal industrial , commercial, promotions.
    Human Values are lost. Unless we all speak up by understanding reasons with clarity about why there is surge of adverse behavioral outcomes than blaming genes or  circumstances, unless we take control with discrete use of food choices, microwave cooking, electronics , interpersonal enhanced family time, reflective decision making, tools like yoga, mindful meditation, physical activities, soothing music for smooth brain waves ( alpha, theta), control media,
    we as a community are not controlling the risk factors among 40-45% of population.
    Well educated parents to people living in pervasive poverty will continue to have adverse outcomes from birth.
    I tried my best to publish all of the factors in my books.
    This is my awareness through my own professional experiential interventions. I learned culturally that each parent reacts or respond based upon their personal current need and past experiential motivated mind.
    The world needs human values that connect the Head with Heart and take hands in personal, family and community work - life balanced relationships.
    This cannot happen unless everyone sees the need for grass roots movement to shake the roots of current trends for optimal wellness measures.
     Thank you for your comments and opinion.
    I am loving this e change of conversation as you connect with more people than myself.

    ------------------------------
    Meena Chintapalli
    CEO of teh Institute and dfounder of San Antonio A thru Z pediatrics. retired , December 2018
    Meena Chintapalli and The SAI Institute of Eucare
    San Antonio TX
    ------------------------------



  • 8.  RE: Spending Money on prevention than cure the society when changes can not happen

    Posted 09-10-2019 04:57 PM
    Dear all parents, educators and people who really want a safe haven for our children. It is nice that we have this forum and we are exchanging views and knowledge.   Science reiterates what Spiritual seekers saw.
    My intention in discussing this blog is not for being offensive or invoking parent shaming or teacher degradation.
    Purely , I am appealing to all caring for children to understand the principles of multi sensory integration, that are 90% complete by 3 years and another 10% by 5 years. Most of interventions that teachers get educated upon are needed and all of us know about the fact that brain is malleable, resilient and plastic. That is an advantage for fixing a problem after the problem occurred..
    Einstein says "Intellectuals solve a problem and geniuses prevent a problem".
    When we know that brain connects 90% with life time wiring from 0-3 years for eating, sleeping, anxiety vs stability, moods, self regulation, self engagement, emotional balance, expression and linguistic abilities, phonics, writing, critical thinking, abstract reasoning and choice making, all the states that become future traits, if every one in the society caring for infants 0- 3 years are taught how to sustain the inherent strengths in every infant, extract the strengths , inherent abilities or powers to be expressed through nurture,, we will have no child missing any opportunity to learn ( No child left behind, capturing the heart).
    The natural tendency of every infant is love, sympathy, empathy, happiness in a state of security and with inter relational bonding, eager to learn, they never forget anything said or practiced , they learn in 7-10 days what takes a later age group months, they are peaceful, not violent , intuitive and persevere till they master a skill, in spite of falling or failing several times.
    If health is "Physical, Psychological, Intellectual, Social-Emotional and Spiritual wellness" (WHO , 1997 defined health), it is the duty of the triad of Individual primary caretaker,  Society  with it's resources and the Health Care Providers guiding the family.
    This triad has to work together. If any one has dearth of knowledge in what and  how to guide, the hard wiring had occurred before the infant is 18 months old.
    Parents are not at fault, they are not introduced to this hot topic as the providers have not been trained since 1995 when  the research was  published . The hot topic is ACE and sequela now in the Primary Care medical field and in Psychiatry fields.
    But how many people studied what Dr. Monie from John's Hopkins wrote about "Deprivation and Psycho Social Dwarfism" in 1977-1978?  After I saw a  case in 1979 and I stopped looking at scales to decide upon the behaviors but look at the pathogenesis for failed  intellectual abilities, emotional or linguistic abilities, by inquiring about the family, environment, parenting attitudes and abilities and economic disadvantages, disparities and drug - alcohol problems.(Socio-Economic Environment).
    Proximal environment examples: No parent is at fault. No culture is faulty.
    1. Parent needs to adjust to normal new born behaviors and consider crying as communication. Parent's have intuition about abnormal behavior, but some one has to reassure them by describing a first time parent about breast feeding, crying is communication, that NB will adapt to live outside the womb after 8-10 weeks. Providers have to educate parents on how 100 billion cells are like stars in the Galaxy and  how they connect with love, sense of security, soothing music, "parenteese", visual contact and tracking,  bicycling exercises, novel music every 3rd time, several 5-6 minute touch therapies with multi sensory integration techniques, introduce native language by one parent and English by the other parent or extended family member from birth, to utilize opportunities for assuring  holistic health outcome.
    2. 250,000 cells x 10,000 dendritic connections for each sensory stimulus to form a broad band from outside to inside. If 3-4 senses are stimulated together , one or 2 senses integrate well and form thick broad bands. Broader the band, faster is the transmission.
    3. Love, safety, security and trust and inter relational person to person connectedness is very important from birth . Soothing music and spiritual practices are important from 28 weeks. of gestation.
    If not stimulated every minute 600,000 cells x 10,000 connections are lost, or permanent cell death. NO neurons develop after birth even in Hippocampus.  (Sorrel et al)
    4. Initial emotions are for trust, belonging, love, security and safety prenatally also. Demand and gratification are very important to connect well. I have seen vulnerability when infant is always held as the care takers love the infant so much that they are insecure when infant cries. They will not give an opportunity to cry. Love is there, but  infant's senses are deprived rapidly of emotional bonding, belonging and trusting robustly.
    5. Unless a health care provider guides the parent  on the facts about neuroplasticity, opportunities for social - emotional bonding, sensori motor coordination, listening and crossing fibers in corpus callosum,  dorsal tegmentum and ventral pathways are lost through mid brain junctions. Why can not we prevent this loss?
    6. In most recent studies, voxel based flow differential anisometry ,fMri studies between Autism , ASD, ADHD and OCD with normal controls, the common path way functional deficiencies were seen in corpus callosum, front and back ( this connects right and left brains),, Thalamic pathways are deficient, Fronto temporal pathways ( Human cortex to mammalian cortex). Fronto Occipital pathways.
    Therefore we need a curriculum to enhance development of these pathways. That is what my curriculum does is to connect these pathways from birth  and used it with unflinching success since 1995.
    How did I know??
    Only my creation to connect all senses together. Hundreds reversed in sensory segregation to healthy integration.

    7.  By training parents I had seen infant develop a social smile and steady look by 2 weeks.  I have never seen colic and never seen a parent seek meds for colic. We had some cases of GERD and milk protein intolerance, even in breast fed infants through mother's Beta Lacto Globulin.

    8. Infant needs to cry not beyond 45 seconds and primary care taker has to give her scent and warmth with no tension. This can happen only if some educated person can guide a mother. Reading is totally different than experience. I always fell back upon a family mentor and trained a family mentor to break away from old school of child psychology and taught parenting skills based upon the facts of neuroplasticity, early nurturing multi sensory integration, experiences in a calm parental and environmental set up.
    Johnson and Johnson Institute and Tampa Institute have guidelines on Touch therapy.
     9. I incorporated that even before because of my back ground of interest on neuro - endocrine mechanisms.
    Touch from buttocks up, fanning movements, with soothing classical music within reasonable distance and spatial consistency, in prone position and some bicycling exercises helps the infant relax, listen and motivate to turn towards the music. right ear listens and crosses to the left frontal lobe via Temporal lobe and Corpus Callosum proximal genu. Very important. Binding of auditory stimulus and motivation. Infant has neck rightening reflex and lifts head up;this enhances the spine muscle strength. Sensori motor cortex is stimulated through pathways from cerebellum to the brain stem and to the Amygdala with emotional tag and to sensori motor cortex also.
    Only 3 minutes. Done 6 times a day. I asked parents to invest 60 minutes per day on nurture early on.
    3 minutes in the Supine position from lower girdle up to shoulders, chin lift gently and look into the eyes and communicate. Gradually start encouraging tracking eye movements and have objects dangling on the limbs of the GYM MAT.
    This alone from 14 days -6 months encourages motivation, calming, bonding, movement, looking at objects, tracking, less colic, trust, social belonging, early motor movements and early motor milestones in par with emotional mile stone and language development.
    10. By 5-6 months infant gets phonemic discrimination and ability to learn multiple languages is lost when not introduced to native language from birth. One caretaker one language and another caretaker another language, but one pitch , tone and frequency of voice should not speak 2 languages.
    I could facilitate and accomplish so much by 0-6 months and if I did not guide the parent , how can help prevent emotional lag, social, lag and listening skills in a state of relaxation.
    11. Breast feeding enhances milestones as it has DHA ARA ( LINOELIC Acid) in right amounts fro myelination of rapidly developing nerve fibers.
    12.  By 6 months infant is developing immune system and loses maternal antibodies and gets infections frequently, social brain(frontal lobe)  is connecting rapidly and separation and stranger anxiety take over, only a primary caretaker can prevent anxiety and encourage self soothing to sleep, which is important to overcome stress and learn. Infant who is not sleep trained, who has tremendous separation anxiety, grows up with anxiety, that hinders social mingling and opportunities to learn. That is why along with VAKT , this sleep training , exposure to playful social places offering reading, play , like Gymboree,  library visits for infants and toddlers is important.
    13. Language acquisition is disturbed in co-sleeping , anxious infants. Right age to sleep train is as soon as stranger anxiety is noticed (6-9 months). Too late to start after 12 months.  Read 4 books, teaching phonics, numbers, all go into the brain and they come out as learned skills 18-36 months. Phonic and Object association is important. Book in hand and sound "B" and feel alphabet "B"
    An infant keeps in memory and object explored in mouth and identifies that in a cluster at 9 months for memory games. Not flash cards. This is Declarative, procedural memory, an important tool for sensory integration of touch, spatial reasoning and word memory and identification and language acquisition. There is a critical role of health care provides to offer ERO scan testing for hearing loss detection and intervene post ear infections in this critical phase to prevent future auditory processing deficits.
    14.  Some one has to guide a parent with all these dynamic transitions. If infants cry at this stage, Tylenol, Barnie or similar shows,  I -pad nursery rhyme watching are not the solution. Redirection and sleep training and making frequent eye contacts without  picking up but redirecting is important , for pathways of choice making and self regulation and self - soothing.

    15. Teething never causes pain, crying and infections. It is a phase of building one's own  immunity with 85% of viral infections.
    Starting foods weaning with Zucchini, Green Beans, Spinach, Kale, Broccoli, Cauliflower, are more important to hard wire for healthy food choices and avoiding sweet vegetables like sweet potatoes and carrots after all bland colored foods are introduced. Blanco adn Back beans have proteins also. Gut matures around 9 months and better to introduce lean turkey and chicken. If foods can be made a home with organic foods and no salt and teach parents, my personal experience is that they made their own foods and were more in control of getting the Anti Oxidants, Very little Turmeric, Xanthines, Luteins and Omegas 3's. Quinoa consistently, and little barley, wheat, peanut butter here and there can be introduced after 8-9 months to prevent food allergies. If exclusively breast fed, AAP recommends by 6 months to try gluten and peanut butter to prevent the most common food allergies . It is a guarded recommendation when formula fed as there is no local immunity. Food sensitivities do cause some behavior problems( Doris Rapp). Quinoa is a good grain substitute for calmness.
    16. We can facilitate through parent training and education,  lifetime pathways  for better motivation, better Social -  Emotional Learning, linguistic abilities, Gross and Fine motor skills, better food choices, prevent obesity, better choice making, self soothing, self regulating and self engagement by 12 months. Infants identify numbers and alphabets and may even say 10 words by 12 months.There is more to this nurture curriculum than I can write in a page for discussion.
    Do you all see what I am talking about the Bayesian inference and integration, binding abilities fro all senses dynamically occurs very rapidly 0-12 months?
    Now there are ASQ-SE scales for early detection, DECA scales and may more, that medical community is now realizing that the mini columns get disturbed very easily with environmental influences,  that also change unpredictably and drastically  . Parents therefore are the first teachers who need to be trained and even if the providers are busy in their practice, to take this as a task, as parents  have the best vested interest  to prevent averse networks anatomically and functionally.
    I hope I was tangible enough to give a glimpse of what can be done to  by the community resources to prevent adverse outcomes through preventive 0-3 interventions and guidance. Parents do not have to be bad, but they are exposed to health  care that focuses on  doing the needful in health , immunizations, safety, identifying problems , not so much focused on early emotional development but motor and physical growth and development, old patterns of nutrition ( Nutrition has tremendous influence on prevention of allergies, cancer, offering immunity and help make better neuronal pathway development) and treating bacterial infections.
     I come born into Eastern wealth of knowledge offering immunity from Ayurveda and basic food care to prevent many disorders. I was against packaged foods with GMOS and preservatives to infants from 1979 and guided parents on home made foods and tips given, turmeric a pinch was also advised for preventing infections.
     Inrespect fro your time I am stopping now.



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    [Meena Chintapalli, M.D. F.A.A.P
    Founder and C. E.O of A thru Z Pediatric Clinics, retired December, 2018.
    Founder and CEO of The SAI Institute Of Educare
    April, 2002.
    Society For Assistance International
    San Antonio, Texas.
    ------------------------------