Wednesday

Am I overstepping my boundaries? Nanny seeks advice....

Received Wednesday, April 11, 2007
I am a live-in nanny for a family and their wonderful 19-month old toddler. I have been with the family for about 6 months and am wondering whether or how to bring up some concerns I have. Their child is generally a happy kid, she plays well and is well-tempered almost all the time she is with me. However, I am starting to worry about her development. At 19 months, she has no words that she uses consistently. She occasionally tells the family dog to "sit", but it is literally once or twice in a month. She also has a fascination with anything that has wheels, and would spend all day rolling the same barbie car back and forth if I didn't guide her to another activity. Sometimes when I am talking to her, it's like I am not even in the same room, and in order to get her attention, I have to literally take her by the hand and lead her to another activity. The last odd thing is that she doesn't make eye contact. She will briefly, for a second, and only when you call her name and she actually looks, but she looks away right away.

What is strange is that different parts of her behavior are always present, but sometimes she will be very vocal and affectionate, sometimes she will want to involve herself with whatever I am trying to get her to play with, and she definitely plays with her parents and the dog. It's just strange, something feels "off", but I don't want to bring up to the parents what I think she may have. I have done research in college and plenty more research lately about autism and I keep thinking that she has very autistic tendencies. The only thing is that autism sounds like a scary thing, because it has such a wide spectrum. I want to definitely see if her parents are interested in doing tests to see if she does autism that way we can start therapy now, but I don't want to step on their toes or scare them about this. What should I do? I love this family so much and I don't want them to feel like I betrayed their trust, but I do want to help their daughter developmentally get on track. I would love any advice other parents or nannies have to offer. Am I overstepping my boundaries?

38 comments:

Anonymous said...

I think its worth mentioning, maybe start out slow. I know a little boy who has similar speech issues; he doesn't use any words and is 21 months old. His mother looked into it with his doctor and he is now seeing a speech therapist. Maybe mentioning something about that will get her to the doctor, and the doctor can examine the other behaviors and can approach the mother about autism. I don’t think you are overstepping your boundaries, just showing care for their daughter—make sure its clear that you care about her. Just some thoughts...

Anonymous said...

I think you are right to be concerned, but be tactful. Let the parents know in a roundabout way what she is doing, and how her behavior is. Say something like, "she sure loves that Barbie car: if I let her she would roll it back and forth all day, so I try to direct her to other things even though she loves it..."
She is at the age where autism becomes apparent.
Good luck!

Anonymous said...

I have to say that you have only been there a short while and what have you observed may in fact lead you to be the messenger of bad tidings. I doubt that they will appreciate that. No one likes to get bad news. Is there a way to steer them in the right direction themselves? I am in the same situation myself with a sister who is dating a thief and a louse. No one wants to be the one to tell her what we know. But she needs to know. Just like those parents need to know so they can take action! Is the child in a music class or something as yet? Why not get the child in to a music class or mommy and me class? Let the people around you help bring attention to the problem. GL

Annie said...

I agree with the above posters. Definitely let the parents know your concerns, just do it slowly and calmly because it is a scarry prospect for a parent.

I hope that everything turns out fine. This family is very lucky to have a concerned & observant nanny like you!

Anonymous said...

Yes, you are overstepping your boundries.

In my circle of mommies/babies, I've had 3 friends who were told by their daycare providers that "something was wrong" with their kids. In their case, one was thought to have "high functioning aspergers," one wit "autism" and one late walker with "cerebral palsy."

In all 3 cases, the daycare providers were wrong. In all 3 cases, the moms then changed childcare. I agree with their reaction.

Assuming this child regularly sees a pediatrician, let the doctor do the questioning and diagnosing.

At 19 months, most kids are starting to rock the 2 word phrases, like "go park," but not necessarily. Many kids don't say much until after the age of 2. My friend's son only said "mama" until his 2nd birthday (everyone was losing their minds over this) when he opened a gift and suddenly said "thank you for the tricycle."

The above mentioned children are all around age 6 now, and they are all fine.

You are not qualified to make the call.

Annie said...

10:33: How can you be so short sighted? If I were this nanny I would definitely feel the slight possibility that I might need to find a new job well worth it. You are right that chances are the child is fine, but if this nanny choses to assume that and it turns out her suspicions were true she will probably hate herself for not speaking up, I know that's how I'd feel.

She loves this child, and when you love someone you often put aside fear of personal risk to protect them.

I agree that this nanny shouldn't make the blanket statement that "something is wrong" with the child. But she absolutely should point out the specific worries she has and get the parents to observe what she is seeing in the child so that they can properly describe how the child behaves to their doctor.

She is 100% qualified to make the call, as "the call" is to communicate with the people she works for.

I really question your lack of empathy and your values.

Anonymous said...

As a nanny myself, I would say be extremely careful and tactful about how you handle this. I would definitely not come right out and say anything. I used to work in daycare, and when I started the director sat me down and talked to me about the proper way to approach a situation like that.

Also, keep in mind that a lot of the "symptoms" of autism conflict with those of a gifted child (although a gifted child would probably be speaking more by now, not sure). So I would say wait it out a while longer.

Anonymous said...

I agree with the above poseter that we as lay persons are not qualified to make such decisions...but since there are people who are qualified I don't feel it would hurt anyone to investigate futher. However, I would caution you againist using the word "autism" to the parents, I would only mention my observations...remember most doctors steer clear of "calling" something...until they are sure...best of luck

Anonymous said...

Anon 10:32-
I find it odd that you feel she's not qualified. I've been a nanny for over 18 years now. In those years I've dealt with children who have juvenile diabetes (2), severe asthma, Hashimotos, Cochlear implants, Kawasaki syndrome, and anaphylaxis.

My current care was born deaf. Although there has been no link found, her gross motor skills are lacking at age 3. I spoke with her mother about adding some gym type classes to her routine and she agreed. This is what adults do. They discuss potential issues with the parents. These parents sound like first timers. Who do they compare her too?

Most Pediatricians I've dealt with see the child a total of 10 minutes and if you don't offer up symptoms, they don't generally know. They're not mind readers.

OP, you're right. At age 19 months, she should have a few words-like mama, dada, words for drink/milk, etc. At the very least she should have her hearing checked.

aml said...

Since you are the person who probably spends the most time with the child you should really let the parents know. To soften it try not saying things like "i see signs of autism" or "developmentally delayed" just tell them you've noticed some things and were wondering if they did too or if it was just with you.

I work with children with Autism and yes this child is at an age where it starts to show but I wouldnt just assume thats what it is.

I'm sure the parents will actually appreciate the communication. I think its necessary.

Nanny B said...

1033, how rude was your post or what. As a professional nanny, and someone attending school for Special Education, the one thing we are preached about is early intervention.

From what this nanny is saying, I would have concerns as well and would definitly bring it to the parents attention. In my situation I know what to look for but when I am at a lose, we always have a discussion about things. According to AAPA, this child is out of the range of behavioral milestones and is showing signs of having autism. While not able to diagnose myself, I would definitly bring it to their healthcare professional.

Nanny-you are not overstepping your bounds at all, keep it up and please inform the parents. While I to caution care in approaching the subject, please be sure to get to the point, and even back it up with some literature if you need to. google developmental milestones, and autism, and you will find a list of criteria.
best luck.

Anonymous said...

10:33-- The OP isn't making the call, she isn't diagnosing, she is expressing her concerns with very typical behaviors of autism.

She is right to be concerned for the child's well being and development, as she plays a part in it.

Mayhaps a good way to bring this up for the OP is to say, drop a the behaviors into the daily update rather than droping the A-Bomb on them. "We had a lot of fun today, but she got very focused on pushing the Barbie car, and I had quite a time getting her attention." or "Do you have trouble catching Baby's eye sometimes? How do you usually get her attention when she's zoning?"

Drawing attention to the behaviors without trying to diagnose them is a bit more tactful than say, declaring "Your child is showing symptoms of autism! Here is an informative pamphlet!" or something akin to such.

Good luck!

Anonymous said...

I am a mom of a special needs child who enjoyed many a wonderful nanny until I stopped working a few years ago. Here's my advice, for what it's worth:

The parents probably already know that there is something wrong but may be in denial. However, you are right that early intervention can make a big difference, and since you are obviously a caring person who wants to feel like she did everything you could...I would bring it up under the guise of speech rather than anything else. A lot of parents can deal with the fact that their child may need to be evaluated for speech because that is more easily "fixable". If you can say something like "In the playgroup the other day, our little sweetie just doesn't seem to talk as much as the other kids her age. Maybe she is just shy, but do you think we could ask the doctor about whether it's okay that she's not speaking too much yet?" The idea here is to get the mom to call the doctor, or a birth-to-three program (these programs are the best because they evaluate and treat, and they are publicly funded...google them!), and have an expert get involved. Speech is the most benign way of bringing it up. She may still blow you off, but at least you will feel like you did everything you could.

Are you ever responsible for bringing the child to the doctor? This may be another good way to voice your concerns confidentially.

Again, I'm pretty sure that the mom probably knows something is wrong, unless she is a very disconnected parent. I know I did. But it's hard to deal with. Do what you can, and be there for this little girl. She needs people like you in her life!

nynanny said...

if these people have a nanny then she probably spends a great deal of time with the child. when the child goes to routine checkups at the doctors office, the parents may say everything is fine with the child when the one who should be answering that is the person who spends the most time with the child. i would offer to go along on one of the doctors appointments and mention these things in a casual way to the doctor. good for you for caring enough about the child to seek advice about this instead of not caring about your job like so many nannies we hear about on this site!

Anonymous said...

10:33:
You really sound like you have serious issues with childcare providers: is it guilt or jealousy perhaps?
Most nannies as well as childcare providers that I know, myself included, have an early childhood background and are indeed qualified to bring concerns of their charges to parents. When a lead teacher takes on a position at a center (most of the nannies I know were once center-based lead teachers) they are expected to get to know their children in-depth in the amount of time or less that the OP has had with her charge.
Your post is ignorant and speaks very loudly of your own insecurities as a parent.
Perhaps you are the unqualified one, since every parent of a autistic child knows that early diagnosis is very important.
The OP in this post is merely asking for advice: clearly she is not planning to run to the parents screaming "autism." I think she sounds like a gem: I wish she were my nanny!

Anonymous said...

I hope this little child has good parents. But let us not overlook the fact that many parents outright suck. They hire nannies not because they have to but because they can't handle and won't spend 4 minutes alone with their children. So if this is the case nanny dearest, you might have to call the specialist yourself.

a mom said...

I think if you approach the parents with an assumed diagnosi then you are definitely overstepping boundaries. But if you do a little research and try some occupational therapies for the problems you mentioned, then you work on helping the problem.

From then it's just a matter of good communication with your employers to let that you've been concerned (without mentioning a diagnosis) and what you've been working on, and the results.

Good luck!

A mom who knows... said...

When my son was 18 months, he did not say any words. At that age, he should have been saying at least 5. Missing that milestone alone made him eligible for an Early Intervention evaluation by the state. With the help of my pediatrician, I was able to get my son a multitude of special services that have made a WORLD of difference in his development. The characteristics described by the Nanny are very similar to what my son exhibited at the same age. As a parent, it was the most traumatic and heart-wrenching experience of my entire life. The word “autism” made my husband and I want to run and hide. However, I was the one who suspected that something was "off" with our son from the time he was an infant, while everyone, including my husband told me I was over reacting.

My point is, there is hope. The fact that this little girl exhibits positive behaviors, i.e. will look at you when you call her name, will be affectionate from time to time, etc. is very encouraging. It has been almost one year since my son was diagnosed with "Pervasive Development Disorder - Not Otherwise Specified, PDD-NOS" which is another way of saying, he's not definitely autistic but he exhibits behaviors that can be considered to be on the autism spectrum. Well, less than one year later and no less than 4 therapists and a full schedule of Special Ed, Occupational Therapy & Speech Therapy sessions, our son is now considered to be off the spectrum and only in need of speech therapy. He has made dramatic improvements in his interaction, socialization and language abilities. We are thrilled.

There are parents who refuse to believe anything is wrong, I've met them, in fact, I married one. Our son's situation put a strain on our relationship, but in the end, my husband does see the remarkable improvement that our son has made and knows that it could NOT have been accomplished without help from the Early Intervention programs offer in NY State.

I encourage you to mention your concerns to the parents. There might be consequences, but in the end, it's the little girl who needs the help, regardless of hurt feelings by her parents. The only help right now, at such a young age, is for her to be evaluated and to have a program created for her specific needs. You may want to use my story and say "I'm your friend whose son wasn't saying anything at 18 months so our doctor referred us to the Early Intervention program in our state." Each state has a program and if you "google" the information, you'll find it. It's free to everyone.
The nanny is more than qualified to make this assessment. I wish I had you as my Nanny at the time. Instead, I had a Nanny who refused to admit that something was wrong for fear that she might insult me. People need to stop feeling insulted and start putting the needs of their children first.
Good luck!
Here's the site in NY.
http://www.health.state.ny.us/community/infants_children/early_intervention/

lauren said...

I am a parent and I appreciate the thoughtful input by nannies to this question. Being able to hear how these wonderful nannies think is a constant reminder to the fact that most nannies are good.

Having said that, I would be mortified if my nanny observed something that I failed to observe. But I would still want to know. I think I am fortunate to have a great relationship with my nanny who came to me with more child rearing experience than I as a first time mother had.

I agree with what the majority of posters have said, do not use the word autism. Make reference to the specific behaviors you observe. I would just ask, "When you are playing or ___ with X, do you notice that X does _____?". That is very open ended.

Good luck! I am sure your employers recognize what a smart and on the ball nanny they have. I know lots of people who are lost in their search for such!

jennifer le carlo said...

Smart families appreciate smart nannies.

Anonymous said...

I don't see a difference between the nanny telling the parents she wonders if the kid has developmental delays vs. telling the parents she thinks the kid might have a fever or a runny nose. Any physical, mental, emotional or other problem a nanny suspects the kid might have, she should let the parents know. Good parents will appreciate the nanny's advice. Some parents are too busy and or distracted (with depression, work, marital problems, whatever) to notice what's wrong with their child - Especially when it's a first-born and the nanny might know better than the parents what's normal and what's not simply because the nanny has more experience with kids in general.

But to everyone here who thinks the nanny could take the child to the doc - I don't know any docs who will see young children unaccompanied by a parent. I had our nanny drive my kids to the pediatrician to meet me there (I drove there from work, it was an urgent sick kid visit) and the pediatrician wouldn't even let our nanny "check in" with the kids (we're talking about signing in at the front desk, not about going back to the exam rooms.)

Anonymous said...

10:33 I can't believe your advice to OP, which is basically to be selfish and irresponsible, and put her own interests ahead of the child's. I'm glad you aren't a nanny!

I think it is absolutely a nanny's responsibility to alert parents to these kinds of observations. It is a tough thing to have to do. You sound like a terrific nanny, and hopefully the parents will be receptive. I can't add anything to all the good advice above, especially 1:27, and 2:32, but wish you the best in your efforts to help this little girl, and her parents.
A nanny

Anonymous said...

It seems the trend is to attack 10:33, but I agree with her. You barely know the family or the child, and this is something for her parents and pediatrician to deal with.

Anonymous said...

I wouldn't want to be the messanger of that bad news. I would call the child's pediatrician and tell them you are concerned but feel that maybe this is something they should look into further so that you are not making false accusations. Tell the Dr. to keep your conversation of such confidential. Then at the child's next visit the Dr. can ask the parents about the child's lack of development and possible implications that this could be related to.
Good luck.

shel said...

as a nanny, i wouldn't come right out and make a call, but i would mention to them some of the things that are worrying you.

perhaps you could say something like "i noticed that when i try to talk to x and get her attention, they only way i can is to take her hand and lead her to another activity. have you had similar experience?" maybe it will open up a conversation.

do they fill you in on the doctor visits? seeing her age, she must have just recently went to a checkup. maybe ask the parents what the doctor said would be good to get her involved in the last time they visited. this could get the ball rolling on finding out what has gone on there.

no parent wants to hear that there is something NOT perfect with their child. we, as nannies, know that. but at the same time, i would hope that they would appreciate your concern and your input. you may be the one spending the majority of time with the toddler, so you may notice things that parents don't.

and lastly, as i was reading your post, my first thought before you even said it was that this could be autism related....for what it's worth.

good luck and let us know what happens.

Anonymous said...

I have never commented on this site before but I would like to urge this nanny to speak to the parents. Yes, it will be hard for them to hear. Yes, your concerns might be unfounded. Yes, you might lose your job over it. But your concerns might be RIGHT ON! And early intervention can really help. If you care about the child, speak up, as tactfully and gently as you can.

Anonymous said...

As a parent I would definitely want to know if something is going on with my child. I personally have a live-in nanny who spends a lot more time with my kids then me, and I trust her to come to me if she notices something unusual in their development.
I think you should definitely be careful how you present it and you probably should not mention term autism, but you should describe the behavior patterns exactly how you did it in your posting.

Anonymous said...

4:15, if the parents aren't aware of the concerns, they aren't going to be able to talk to the doctor about it.

And the OP has been living with the family for 6 months. This is a fair bit of acquaintance.

Anonymous said...

Do both parents work outside of the home? My husband and I have high profile careers, as such we are out of the home all day Monday thru Friday. We rely on our nanny to bring to our attention everything she notices! Whether it is a skirmish between our 9 year old daughter and her friends or a change of appetite in our our 4 year old. Please point out your concerns. Be honest and say, "I wasn't sure how to bring this up and it may be nothing, but I observed such and such".

Let us know what you decide to do and how it turns out!

Anonymous said...

This is 10:33 again.

A parent's intuition and a pediatrician's expertise is what I would bet the farm on.

I stand firm on my words. No one has to agree with them, of course. It's a world of free thinkers, no?

The OP can make her own decision and roll with it. I gave my advice. No gun is being held to anyone's head.

Anonymous said...

Hey this is the OP again. Thank you so much for your (mostly) very insightful and honest responses. I definitely found a lot of the advice to be helpful and am more encouraged now to bring it up to the parents somehow.

To the 10:33 poster, I spend 10+ hours a day with this little girl; I was there for first steps and every single day since I was hired, without calling in sick one time. I feel like I have an intuition with children as well as wonderful relationships with them. I am not "some daycare provider" who is jumping to conclusions, and honestly, her mom and grandma have both asked me more than a few times whether or not I think her speech is delayed more than it should be. The last time this question came up was 3 months ago, and I thought that since she didn't actually "miss" a milestone yet, she would be fine. At that point in time, I didn't want to worry them, and I thought that her age might have more to do with not talking than her development.

But after the last 6 months of me working intently with her on letters, shapes, colors, numbers, nursery songs, etc., there have been zero results, and hardly any changes at all. I have worked with children that have autism, cerebral palsy, and down's syndrome, and have recently practiced a lot of the exercises from those therapies in general play with my charge.

I guess what I am saying is, I am not some stranger that waltzed into her life and who is trying to point fingers. I would never bring up a concern I didn't think was very valid and without reason. I love this family very much, and they have embraced me and what I know since the moment I showed up. I appreciate that so much too, and try to show it every day.

And when it comes down to it, if it means risking my job to tell them what I think, I'd rather she didn't have autism and I get fired. Yes, it would stink to sever the relationship we have built, but I want her to be healthy in mind and body, and will not put my job security over that.



Thank you everyone so much for your kind advice. I will gladly use it and soon tell her parents gently the different things I see happening during the day, and ask how they feel about that behaviour personally. Open up the conversation so it is not a confrontation and is, rather, a discussion about their daughter without being threatening.


Cheers!

Anonymous said...

I sense a stinker here.

You failed to write in your initial post that the mom and grandma also seemed to think something is wrong with the kid and asked for your input. You made it sound like you'd be breaking some horrible news to them out of the blue.

Why, may I ask, are you here asking us if you are overstepping your bounderies? I find that highly odd if the child's relatives have already asked for your thoughts. Almost unbelievable.

More importantly:

If the parents brought this issue up with you 3 months ago, why was it not brought up with the child's pediatrician?

You say the child is 19 months old. That means she would have had an 18 month well-baby appointment. What gives? Do they trust your evaluation more than the pediatrician's? Why wouldn't they ask for professional advice?

By the way, there is another appointment coming up at 24 months. Are they going to withhold this information then?

Something sounds amiss about all this.

I'm happy to go against the pack on this one.

10:33, over and out

Anonymous said...

FRom a Concerned Mom Re: 10:33:
I guess you are just so much smarter than the rest of us and just can't fathom that some people just aren't as smart as you, i.e. the childs parents. Might I add that you also sound a bit paranoid. For what purpose could you conceive that someone would make this up? Was it just to snare a blogger like you into making overly harsh, short-sighted statements in which all the rest of the bloggers would attack? Paranoid thinking would probably have you thinking so.
You probably need to re-read the OP's last message more carefully so as to answer your questions. If the OP is in anyway worried about the child, she needs to speak up.
You are also probably someone who needs to have the "last word". Especially if you now feel foolish. So go ahead, go on another senseless attack.

Anonymous said...

Blah, blah, blah, blah....bull*hit.

Anonymous said...

I am a Mom who will be eternally grateful to a daycare provider who expressed concern about my younger daughter. I had not noticed an issue, I thought my sweet, quiet second child was simply a different personality than her outgoing, bubbly two year old sister. However, the head teacher in my youngest daughter's daycare told me she was concerned that my daughter was not verbalizing or attempting speech at one year. I asked my pediatrician (who is highly rated and recommended) and she said she would not worry since many children don't speak at one year. My daycare provider gave me the number for early intervention and asked me to have her evaluated. I did and it was discovered she had a correctable hearing impairment. As someone with an early childhood education degree and many years experience caring for newborns, her frame of reference was better than mine even though I am her Mom and she was right to challenge the pediatrician's finding. The daycare was wonderful too. Not only did the head teacher raise the alarm when the problem was still reversible. They participated in the early intervention evaluation process to make sure my daughter got speech therapy to get her caught up to her age level. She is now almost four, her hearing is OK following a few procedures and you would never know she had been speech delayed. Tell your employer tactfully and have confidence in your training and experience. Isn't that why the family hired you after all?

Anonymous said...

well said, mom at 11:35!

Anonymous said...

Hi, Im a nanny with a really good rapport with my boss. We talk about literally everything. I am the go between her and the kids. She trusts me to let her know stuff, when they outgrow clothes, groceries are needed, I athink theyre coming down with the cold, etc, or other stuff. Were it me, I would say that I would like to speak to her about something that I have observed over time. May be she has too. Although some parents and most nannies are not the same, it depends on what type of relationship you have with your employer and only then will you know if you can broach such a topic with her. Only you would know this. In my six years with my current employer, I have been able to approach her and husband with anything and we have a wonderful relationship with the kids as well because they know everyone is working and communicating on the same page. Good luck to you. I hope this helps in some way.

Unknown said...

You are DEFINITLEY NOT over stepping your boundaries. As a nanny myself, I'm going through a similar issue with the boy I nanny. I am pretty sure he has a learning disorder. I know it's incredibly difficult to bring this up because of the fear of offending the parents however you spend a great deal of time with the child and you're noticing concerning behaviors. Parents want to know you care and you may be doing the child a disservice by not speaking up. I might wait a bit longer if I were you, as every child develops at a different rate but if it persists it's definitely something worth mentioning so the parents can keep an eye out. Of course don't say "somethings wrong with your child". But there is a mature and proactive way you can speak up. If the parents get offended over your concern and care for their child, that's then their problem. Even if you're wrong, you could be right. Better safe than sorry.