Developmental Delay / Delayed Milestones

Developmental Delay / Delayed Milestones
Developmental delay is a condition where a child is delayed in attaining age appropriate milestone in a specific domain. As for example, Child “X” is 12 Months old and has not achieved the sitting balance, then the child is considered as a case of delayed milestone. Similarly, Child “Y” is 2 years old and does not speak a single word, he is also considered as developmentally delayed. If a child is slightly or only temporarily lagging behind his age appropriate milestones that are not developmental delay. A child may be delayed in one or many of these six domains of child development, namely, Gross motor, Fine motor, Cognition, Social-emotional, Expressive language (Speech) and self help (Activities of daily living). If the child is delayed in two or more than two domains, then it is considered as Global Developmental Delay (GDD).

Developmental delay is generally diagnosed by an experienced pediatrician, developmental pediatrician and child developmental specialist based on strict developmental guidelines. Generally, 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. Developmental delay can be due to many factors, it can be environmental, genetic, complication during pregnancy or at the time of delivery or postnatal. Sometime a child can have developmental dissociation, where a child has widely differing rates of development in different developmental domains.

There is another condition which is called developmental regression, where a child loses previously acquired milestones or skills.  It is a matter of concern as it is mostly 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%. Conditions where developmental delay is common are Cerebral Palsy, Down Syndrome, 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, etc

Who is considered as a child with developmental delay?

Babies are considered as developmentally delayed in gross motor domain if

• No Neck / Head control by 6 Months
• No independent Sitting by 8 Months
• No get to sitting by 10 Months
• No crawling / bottom shuffling by 12 months
• No independent walking by 18 months

Babies are considered as developmentally delayed in fine motor domain if

• Does not bring fingers to the mouth by 6 Months
• Does not move an object from one hand to other by 8 Months
• Does not pick up a small object with three fingers by 10 Months
• Does not pick an object using two fingers and thumb by 14 Months
• Does not put an object inside a cup by 15 Months

Babies are considered as developmentally delayed in speech and communication if

• There is no babbling by the age of 15 months
•  There is no single word speaking by the age of 2 years
•  The child is unable to speak in short sentences by the age of 3 years
•  There is presence of poor pronunciation or articulation
•  There is having difficulty putting words together in a sentence

Babies are considered as developmentally delayed in cognition / mental capacity if

• Slow to learn things like feeding , dressing / undressing, Toilet / potty training, etc
• Talking late or having trouble with talking
• Inability to connect actions with consequences
• Difficulty remembering things
• Difficulty with problem-solving or logical thinking

Babies are considered as developmentally delayed in social development if

• A baby doesn’t enjoy playing with caregivers and communicate with face and body by the age of 3 months or so
•  A baby doesn’t respond to his or her name at the age of 7 months or so
•  A baby does not differentiate stranger and known people by the age of 12 months or so
•   A child does not imitate the behavior of others by the age of 2 years or so
•  A child does not start to enjoy the company of other children and look forward to playing with them by the age of 2 years or more.

Management / Treatment of Developmental delays
Developmental delay is always the visible symptoms of an underlying disorder / disease. While managing or treating the developmental delays, it is important to differentiate it from developmental deviation (Dissociated Development) and developmental regression (Loss of achieved milestones). Deviated development requires scientific parenting only as some degree of deviation corrects naturally. On the other hand, regression of milestones requires lot of investigations to know the exact cause of milestones loss. Lots of neuromuscular or neurodegenerative disorders have the phenomenons of developmental regression.
In case of gross motor and fine motor delay, physical therapy in the form of play therapy, developmental therapy, physiotherapy and occupational therapy is immensely helpful.
In case of cognition and communication delay, along with physical therapy, special education and speech therapy should be incorporated    
In case of global developmental delay, an early intervention program is highly recommended. Children with Sensory processing disorders, Developmental coordination disorders, Autism spectrum disorders, Auditory processing disorders require a different management or treatment plan. Please note, two children with developmental delays can’t be same so they require different and customized treatment plan. There is no readymade treatment plan exist. 

  
There is no single medicine available which can cure or manage the developmental delay. Mostly medicines are prescribed to enhance immunity and general health. Nutritional support is an essential part of the management plan. Due to feeding disorder, a lot of children with developmental delay can be malnourished.

There is always some or the other associated disorders with developmental delay. The associated disorder require immediate intervention, otherwise the early intervention program is not going to help. Children with Epilepsy, Hearing loss,  Vision disorders, Incontinence, Drooling, Constipations, Failure to thrive, Poor Muscle Growth, Bowel and Urinary Issues, Breathing Problems, Perceptual disorder , Maturational Delay, Sensory loss, Sensory dysfunction, Hydrocephaly, Skin disorders, congenital heart disorders require intensive medical or surgical treatment.

Always remember, developmental delays are symptoms, not the diagnosis. Diagnosis should be made along with therapeutic interventions to have a clear picture about the developmental profile, right treatment approaches, and outcome of the interventions. Don’t delay the interventions to get the diagnosis done. Wait and watch policy is not applicable to children with delayed milestones. It may be dangerous and harmful. Genetic counseling needs to be done in case of progressive disorders / genetic disorders such as muscular dystrophy, Down Syndrome, etc. Parents should learn the home management technique in all cases whatever may be the diagnosis and whichever professional / centre they are visiting.

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