Hope for HIE – Hypoxic Ischemic Encephalopathy Hope for HIE – Hypoxic Ischemic Encephalopathy


Focus on what they CAN do

By Ashley Fielding

Is your child able to roll? Are they able to sit independently? Are they saying any words? Are they able to hold their own bottle?

These are the questions I have to ask. It’s my profession, it’s my job, it’s how I determine whether someone’s child will qualify for services.

But is it what I wish I had to ask you as a fellow parent? Absolutely not.




After the traumatic delivery of my son, I realized not only how painful these questions can be for families, but also how insignificant they often are in the grand scheme of things.

What?! A physical therapist saying milestones are insignificant? Now don’t get me wrong, milestones are important and exciting -- if and when they happen.  

But what about when they don’t happen? Is it possible for us to focus on what truly defines a child without taking milestones into consideration?

After being thrown into the HIE club abruptly and going home from the NICU after 3 weeks, having absolutely no clue about how our life would be 3 months, 6 months or 1 year from then, I had a realization.

Do milestones define your child? Do they determine whether your child is happy and loved and experiencing a fulfilling life? Absolutely not. I realized this on my journey of worrying about every little milestone that my son may or may not have been meeting.

When I went back to work when he was 5 months old, I had a major wake-up call. I started to hate asking the families I saw what their child was and wasn’t doing. Why?  Because I knew they’re likely not doing many of those things, and it’s painful to the parents to be constantly reminded of that.

I knew the milestones that medical professionals have to look at may not be important to families.

Instead, we should focus on what a child CAN do.

I’ve come to realize that what’s really important to a family and child may have absolutely nothing to do with “typical” milestones. And you know what, they aren’t always important to me either. I may meet a child and think to myself that I’d really love to work on sitting, but what is important to the family? Maybe they’d simply like their baby boy or girl to tolerate a car ride to a family dinner. Or hold their bottle on their own so that they can have a free hand sometimes. Or tolerate a tube feeding without vomiting. What comes next is me trying to figure out how to help them accomplish these things.

So if we don’t focus on whether a child is doing x, y, or z, then what can we ask? Instead of focusing on what they can’t do, let’s focus on what they can do. Let’s focus on that child as a beautiful individual who can:

  • Be loved and love back.

  • Feel joy and happiness.

  • Feel sadness and displeasure.

  • Live a fulfilling and wonderful life even if they aren’t doing “x, y, and z.”

We can ask families questions that are truly important and have meaning to a family:

  • What makes your child happy?

  • What makes them smile?

  • Who do they love and who loves them?

  • What makes them feel joy?

  • Do they have a favorite book, toy, or movie?

  • Who is their favorite person who can always comfort them?

There is so much more that we can focus on in a child’s life. A child’s happiness and value are not defined by “typical” milestones.

As a pediatric physical therapist it’s part of my job to ask about milestones, but is it all I really want to know? No.

I want to know how your family is doing and what’s important to you. I want to know what makes your child happy and sad and what they love. I want to know who they are as an individual.

And I want you to know that I have also worried about milestones. I have also worried about the unknowns. And most of all, I want you to know that you are not alone.

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