Developmental Delay / Delayed Milestones

Developmental delay is a condition where the specific child is delayed in attaining the require age appropriate milestone in the specific domain beyond the standard deviation. As for example, Child “X” is 12 Months old and he has not achieved the sitting balance, then the child is considered as a case of developmental delay or delayed milestone. If a child is slightly or only temporarily lagging behind his age appropriate milestones, that is not called developmental delay. There are six domains of child development. Namely, Gross motor, Fine motor, Cognition, Social-emotional, Expressive language (Speech) and self help (Activities of daily living). Delay can occur in one or many areas / domains for example motor, speech, social or cognition. If the child is delayed in two or more than two domains, then it is considered as Global Developmental Delay. 

If the child has problems with Gross motor and Fine motor activities, it is called Developmental delay in Physical Abilities. Similarly a child can have developmental delay in cognition or communication.

Developmental delay is generally diagnosed by an experienced pediatrician or developmental pediatrician based on strict developmental guidelines. Although, parents / grandparents / relatives are the first who notice the delay. Unfortunately, the developmental delay is commonly considered as weakness of the body which is always not true. Due to misconception about developmental delay, a large number of children are deprived of the benefits of early intervention program. Developmental delay can be due to so many factors, it can be environmental, genetic, complication during pregnancy, at the time of delivery or postnatal. Sometime a child can have developmental dissociation. Developmental dissociation is a condition where a child has widely differing rates of development in different developmental domains.

There is another condition which is called developmental regression. Developmental regression is a condition is a condition where a child loses previously acquired milestones or skills.  It is a matter of concern as it is associated with serious neurological and metabolic disorders.

Incidence

According to WHO about 5% of children under 14 years of age have some type of developmental delay or childhood disability. In India the prevalence of developmental delay under the age of 2 years is approximately 2%.

 Following are the conditions where developmental delay is common

  • Cerebral Palsy
  • Down Syndrome
  • ADD / ADHD
  • Bipolar disorder
  • Mental Retardation
  • Infantile spasm
  • Angelman syndrome
  • Fragile-X syndrome
  • Central Auditory processing disorder
  • Expressive language disorder
  • Landau kleffner syndrome
  • Learning disabilities
  • Neural tube defects
  • AMC
  • PKU
  • Seizure disorder
  • Prader willi syndrome
  • Sotos syndrome
  • Traumatic brain injury
  • William syndrome
  • Rett syndrome
  • Tourette syndrome
  • Lot of other syndromes

If you suspect there is a developmental delay in your child, please consult some developmental pediatrician in your locality or mail us to get the “Developmental Checklist”. We will guide you further.

Your child can be helped by these three Standard Approaches

  1. Developmental Screening
  2. Developmental Surveillance
  3. Diagnostic Assessment


According to the prenatal, perinatal and postnatal history, these infants are considered as high risk babies

  • Prematurity
  • Low birth weight and very low birth weight
  • Birth asphyxia / Hypoxia
  • Tonal abnormalities
  • Hydrocephalus
  • Poor APGAR Score
  • Hypotonic / floppy baby
  • Feeding dysfunction
  • Etc

APGAR Score

Low APGAR Score has been linked with developmental delay. Generally the following criteria has been in practice for better outcome through early intervention

  • If the APGAR Score is less than 8 but more than 6 at 3 consecutive assessment, the baby is considered as observational baby. It means parents and consultant will observe the developmental of the baby closely till the age of 4 months
  • If the APGAR Score is less than 6 at 3 consecutive assessment, the baby is considered as High risk baby. It means parents should start early intervention program

Importance of Early Intervention

Early intervention is a systematic and planned effort to promote development through a series of activities during the first five years. Early intervention has the following essential components

  • Preventive measure
  • Developmental measure
  • Functional measure

Early intervention Program can provide the following support

  • Medical Services- For diagnosis making and Assessment
  • Aids and Appliances
  • Nutritional Services
  • Therapies like Play therapy, developmental therapy, physiotherapy, occupational therapy, speech therapy, cognitive therapy, vision therapy, etc

All studies have shown definite benefits from early intervention. It not only reduce the impact of disability on the individual but also reduce the cost of disability management in the long run on the care providers and society.

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