Dr Glascoe is correct in stating that expressing concern to someone and noticing a problem are not synonymous. However, we did not ask about expressing concern to a professional; we asked about expressing concern in general. Moreover, the children in our study were diagnosed with neuromotor problems and not language problems or learning disabilities (although these problems may have manifested later). Delays in achieving gross motor milestones are usually recognized at an earlier age than delays in other domains of development, such as self-care and cognitive and social functioning.1 Although parental education may affect communication between parents and a health professional,2,3 perhaps having older children may be another important aspect related to concern about child development. We included whether having older children was associated with earlier parental awareness of potential problems, and although the result was nonsignificant, the estimated odds ratio was 1.47 (95% confidence interval, 0.53-4.03).
Feldman DE, Couture M, Grilli L, Simard M, Azoulay L, Gosselin J. If You Don't Ask, Parents May Not Tell: Noticing Problems vs Expressing Concerns—Reply. Arch Pediatr Adolesc Med. 2006;160(2):220-221. doi:10.1001/archpedi.160.2.220-b