Understanding Developmental Delays

There's a lot to know about your child's development. Here, our experts define what a developmental delay is, and explain what parents can do to help.

Mother talking to baby Alexandra Grablewski

The phrase "developmental delay" uttered by a pediatrician at a benign well-child visit is, of course, scary for a parent. More often than not, though, with proper care and intervention, developmental delays usually dissolve with time. But it's important to address potential problems right away: According to the American Academy of Pediatrics (AAP), between 12 and 16 percent of children age 0 to 18 years have a developmental or a behavioral disorder and only 30 percent of them actually get help.

Defining a Delay
Clinically, pediatricians use the term developmental delay when a child doesn't reach milestones in his motor, language, or speech within the broad range of what's considered normal. Common types of delays include language (receptive communication, or understanding Mommy when she says to pick up a toy); speech (expressive communication, or saying a sentence); gross motor skills (throwing a ball); and fine motor skills (using a crayon to color). "Most kids are walking between 12 and 14 months of age and saying words between 15 and 18 months of age. If a child is not making an effort to walk by 14 months of age or saying some words by 18 months, that is definitely a concern," says William Levinson, M.D., a developmental pediatrician at Children's and Women's Physicians of Westchester Valhalla, New York. It's common for a child to be advanced in one area and behind in another. For example, a child may be walking by 1 year, and be able to understand what Mommy wants, but she can also be hesitant to start speaking.

Why is my child delayed?
When parents ask this question, I find that what they really want to know is whether there was something they could have done to prevent their child's delay. The answer is probably not. "In most cases we don't find a real reason," Dr. Levinson says. "We often don't find any anatomical abnormalities in a child. In fact, the speech and motor center in the brain will actually be fine." There are exceptions -- such as if a toddler has been exposed to lead paint or is severely malnourished. (You should also make sure your child's hearing is normal.) But otherwise the delay is most likely already programmed genetically. If Mom or Dad crawled or walked later, so will the child.

It's easy for parents to compare their child to others, but it's important to remember that kids develop at different rates. What to watch for, though, is progress, Dr. Levinson says. A child should be advancing in milestones, even if at a slower rate, but never losing acquired skills, which may be a sign of disability.

When is a delay more than just a delay?
An isolated developmental delay affects one area, such as motor or speech. A global developmental delay may involve a significant delay in two or more domains (for instance, a toddler who is not walking and not communicating), according to the American Academy of Neurology. "Significant" means that a child's performance is two standard deviations or more below the average age at which the developmental milestone takes place.

When to talk to your pediatrician
You should address any concern right away with your child's doctor, Dr. Levinson advises. According to AAP guidelines, kids should be screened for specific developmental milestones at the 9-month, 18-month, 24-month, and 30-month well-child visits. "In the first year, motor delays are most obvious because we can see them," says Penny Glass, Ph.D., a developmental psychologist and director of the Child Development Program in the Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences at Children's National Medical Center in Washington, D.C. Language delays are subtler, especially if your child is otherwise socially engaging and attentive. Some children are by nature fairly quiet, but their receptive language--the words they understand--should be similar to that of their peers. Once kids hit preschool, language delays are more obvious.

Between birth and 6 months, an infant should show signs of curiosity by reacting to voices and by reaching. By 4 months, signs of a possible delay include a failure to startle at loud noises, track an object with his eyes, look at you or smile, or hold her head steady when supported in a sitting position on the end of your lap. By 12 months, a baby's early vocalizations should transition to sounds with clear identifiable consonants and vowels. The baby should giggle when playing peekaboo, imitate actions, and understand the word no.

By 18 months, children engage in simple pretend play, often toting a doll or pushing a small toy car. Words enter their vocabulary at this age, and a child should be able to use several words without prompting. By 2 and 3 years, kids should have no problem with simple verbal instructions. Princesses and superheroes become a part of the household as kids begin to understand the concept of playing make-believe.

When to intervene
Children fare substantially better if problems are detected early and services are provided. Children up to 36 months can benefit from early intervention programs through their state agency: Agencies normally take referrals from pediatricians, but parents can contact the program directly and request a developmental screening. If the child does not pass the screening, a developmental evaluation will follow. More than one developmental specialist will observe and test your child and ask you questions about typical behavior at home. If your child's performance is below a set level, she'd be considered eligible to receive therapy services. The program will create an Individualized Family Service Plan (IFSP), which consists of goals in all areas that were identified. For children 3 to 5, preschool special education services are available through state-run agencies. Both of these programs are federally mandated through the appropriate agencies of each state. Your county Office of Education can provide further information.

Although all children can benefit from early intervention, children with mild to moderate delays typically make the most progress. "Changes happen in the brain continuously and that is what early intervention is all about," Dr. Glass says.

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