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Understanding Developmental Delays

Developmental DelaysThe development process is something every child must go through. This process involves learning and mastering skills called development milestones. They include sitting, walking, talking, skipping, and tying shoes. Children generally learn these skills during predictable time periods. Milestones develop sequentially, where a child needs to develop a skill before they can develop new ones, and builds on the last milestone developed. For example, children must first learn to crawl and to pull up to a standing position before they are able to walk.

Developmental delay is a condition that represents a significant delay in the process of development in children, usually from 0 to 8 years. Without special intervention, a child’s ability to reach normal developmental milestones and educational performance at school is at risk. Normal development falls within a range and children who mature outside this range may need special education supports. Essentially, a child does not reach their developmental milestones in one or more of the key areas at the expected times. Children that are delayed in all areas are said to have global developmental delay. These children are lagging in skills in the five main areas of development, which include

Cognitive development

The child's ability to learn and solve problems. Examples include, a two-month-old baby learning to explore with hands or eyes or a five-year-old learning simple math problems.

Social and emotional development

The child's ability to interact with others, including helping themselves and self-control. Examples include, a six-week-old baby smiling, a ten-month-old waving bye-bye, or a five-year-old child taking turns in games at school

Speech and language development

The child's ability to understand and use language. Examples include, a 12-month-old baby saying his first words, or a five-year-old child learning to say "feet" instead of "foots".

Fine motor skill development

The child's ability to use small muscles, specifically their hands and fingers, to pick up small objects, hold a spoon, turn pages in a book, or use a crayon to draw.

Gross motor skill development

The child's ability to use large muscles. Examples include, a six-month-old baby learning how to sit up with some support, a 12-month-old baby learning to pull up to stand holding onto furniture, and a five-year-old learning to skip.

Developmental delay is usually identified during infancy as part of regular health checkups. When failure to reach these developmental milestones is first noticed by a child’s parents or doctor, further medical and psychological assessments are needed to evaluate the extent of delay and the areas of concern.

The causes of developmental delay vary considerably and are not always known. In most cases, developmental delay is related to some form of neurological abnormality. This may be due to genetic or heredity disorders (such as Down Syndrome) or other developmental disorders that affect the nervous system (such as Cerebral Palsy or Spina Bifida). Other causes include premature birth, infections or various metabolic diseases.

Signs of developmental delays

Every child develops at his own pace and the range of what is normal is quite broad. However, it is helpful for parents to be aware of red flags for potential developmental delays in children.

The rate at which children move through developmental milestones varies, and may be affected by many factors including and not limited to genetic conditions, prenatal experiences, childhood illness, temperament, physical ability, environment, and some cultural and social variables. Yet, some skills can only be developed when children are physically ready, such as rolling over which requires sufficient muscle strength and tone.

Signs that your child may not be progressing through the key milestones include delays in:

Motor skills development

3 to 4 months

  • Not able to reach for, grasp, or hold objects
  • Not able to bring hands together
  • Does not support head well
  • Does not bring objects to mouth
  • Does not push down with legs when feet are placed on a firm surface

6 - 7 months

  • Not rolling over
  • Stiff and tight or very floppy muscles
  • Flops head when pulled into a sitting position
  • Reaches with one hand only or does not actively reach for objects
  • Trouble getting objects to mouth
  • Does not roll over in either direction
  • Cannot sit up without help
  • Does not bear weight on legs when pulled him up to standing position

1 year

  • Not crawling
  • Drags one side of body while crawling
  • Cannot stand when supported

2 years

  • Not walking
  • Does not develop heel-to-toe walking or walks only on toes
  • Cannot push a wheeled toy

Early speech and language development

3 to 4 months

  • Does not respond to loud noises
  • Does not babble
  • May begin babbling but does not try to imitate sounds

7 months

  • Does not respond to sounds

1 year

  • Does not use any single words such as "mama"

2 years

  • Cannot speak at least 15 words
  • Does not use two-word phrases without repetition and can only imitate speech
  • Does not use speech to communicate more than an immediate need
  • Also watch for any loss of skills that have already been learned.

Vision development

3 months

  • Does not follow moving objects with his or her eyes
  • Does not notice hands
  • Trouble moving one or both eyes in all directions
  • Crosses eyes

6 months

  • One or both eyes turning in or out all the time
  • Constant tearing, eye drainage, or sensitivity to light
  • Does not follow near or far objects with both eyes
  • Social and emotional development

3 months

  • Does not smile
  • Does not pay attention to new faces, or seems frightened by them

7 months

  • Refuses to cuddle
  • Shows no affection for parents or caregivers
  • Shows no enjoyment around people
  • Cannot be comforted at night
  • Does not smile without prompting
  • Does not laugh or squeal
  • Shows no interest in games like peek-a-boo

1 year

  • Shows no back-and-forth sharing of sounds, smiles, or facial expressions
  • Shows no back-and-forth gestures, such as waving, reaching, or pointing

Cognitive development

1 year

  • Does not search for objects that are hidden while he or she watches
  • Does not use gestures, such as waving
  • Does not point to objects or pictures

2 years

  • Does not know the function of common objects, such as a hairbrush, telephone, or spoon
  • Does not follow simple instructions
  • Does not imitate actions or words

In all of the development areas, watch for loss of skills that were previously learned.

Keep in mind that mild delays in motor development can be normal, and with the range in when these milestones are achieved, your child may not achieve each one at the same time as other children. Most developmental delays in children are not serious, and even children with serious delays can make big improvements with early treatment.

Sometimes the signs that a child is struggling can be obvious, and other times may be too subtle to notice. However, physical signs may be more telling. Slow growth, coordination and motor skills difficulties, difficulties with speech and thought processing, and not physically and academically keeping up with other children at school are all possible signs of developmental delay.

Managing developmental delays

Parents are usually the first to notice a problem with their child's motor, social, and/or speech and language development, and this is enough to initiate further evaluation. In addition to a formal hearing test for speech delay, neurological exam and developmental assessment, children with developmental delays should also be referred to an early childhood intervention program for evaluation and development of a treatment plan.

Early support for your child who has a developmental delay is critical for long-term success. The Centers for Disease Control and Prevention has a program called Legacy for Children, which provides support to families who have children with special needs. Intervention programs and peer support for parents help strengthen families and allow children to continue on a successful path of development.

Professionals that can help in your child’s evaluation and treatment include: general practitioners, child health nurses, pediatricians, audiologists, speech pathologists, occupational therapists, physiotherapists, psychologists, social workers, and specialist teachers.

The types of treatment for each of the developmental areas include:

Motor skill delay

More physical activity at home
Physical therapy for gross motor delays
Physical or occupational therapy for fine motor skills or sensory integration dysfunction.

Speech or language delay

Evaluation by a speech-language pathologist.
Hearing test and speech therapy.
More communication with your child at home, such as talking, singing, reading and encouraging repetition.
Treat middle ear infections.

Vision delay

Early treatment can help correct many vision problem.
Glasses or contacts.
Special glasses.
Eye patch.

Social and emotional delay

One of the common causes of social and emotional developmental delays are pervasive developmental disorders (PDD), which cause communication problems ranging from mild to severe. PDD includes autism, Asperger’s syndrome, childhood disintegrative disorder and Rett syndrome. Treatments include:

  • Early treatment
  • Behavioral and skill-oriented therapy
  • Medication if therapies do not work
  • Play therapy
  • Helping attachment between child and parent

Cognitive delays

Early treatment
Educational intervention
Steps to take at home

Parenting a child with developmental delays

For parents caring for children with developmental delays, it is helpful to get an early assessment and identity the possible causes. If medical conditions are the cause of developmental delays and are treated, a child’s functioning can improve substantially. If the causes are unknown or not treatable, as in genetic disorders, appropriate plans must be put in place to ensure a good quality of life for your children. Regardless of whether or not your child’s condition is treatable, building a healthy self-esteem to help your child discover their full potential should be a priority when planning for their future.

Children entering foster care are at a higher risk for developmental and behavioral problems than other children in the general population. Some of their risk factors include genetic disorders, exposure to viruses and/or drugs and alcohol during pregnancy, poverty, abuse and neglect.

However, even though children entering foster care are at high risk for having developmental problems, some of them are not presented with a developmental or behavioral challenge and meet all their developmental milestones at the expected times. Others may have only mild difficulties that may improve once they are placed in a caring and developmentally stimulating environment.

Finding the cause of a child’s developmental delay is not always possible, and for children entering foster care, detailed information may not always be available. For example, details about a birth mother’s misuse of drugs and/or alcohol during her pregnancy may not be easy to determine. Similarly, information about family history, including genetic conditions, may be missing especially if the birth father is not known. It becomes more difficult to predict how a child’s development will progress without this information.

For adoptive parents, it’s important to find out as much as you can from the child’s agency when you become interested in a particular child. Sometimes this can require considerable detective work that calls for meeting with local authorities and medical advisors who know the child, to help you gain a better understanding and what will influence the child’s development. Becoming fully informed can help in your decision-making and to determine how much you are prepared to live with and accept.

Always remember that the help of health professionals such as speech therapists and physiotherapists, specialist support at school, active support and positive encouragement from adoptive parents and families, can help children with developmental delay to thrive and develop to their full potential.

Helpful links or resources for developmental delays

Comprehensive Psychological Assessment Centre

How kids develop -

Babycenter -

Bemyparent -

Collage Paediatric Therapy -

Government of Newfoundland

Content references

University of Michigan Health System -

Kids Health – Delayed Speech or Language Development -

WebMd -