DEVELOPMENTAL DELAY: Delay in Reaching Milestones

31March 2023

What are Developmental Milestones?

Developmental milestones are the checkpoints reached by babies in the process of their growth. Milestones act as the assessor of their overall development. Rolling on the back; sitting without support; recognizing faces, smells, and tastes; speaking the first word; smiling, and scribbling with crayons are all developmental milestones.

What is Developmental Delay?

Delay in attaining milestones is known as developmental delay. It is when your child has not reached the checkpoints within the specified time limit.

A newborn baby's actions are reflexive. Their nervous system does not facilitate conscious thinking. However, as many of these reflexes fade with the baby's growth, they develop the ability to consciously do carry out actions. Each milestone has a range of several months associated with it. If a child falls short of being in the range, they are said to be developmentally delayed.

There are 3 degrees of developmental delay.

Mild developmental delay	Functional age is 33% less than chronic age
Moderate developmental delay	Functional age is 34-66% of chronic age
Severe developmental delay	Functional age is less than 66% of chronic age

What are the Types of Developmental Delay?

Developmental delays are of five types -

Gross motor delay
Fine motor delay
Language and speech delay
Cognitive delay
Social-emotional delay

What are the Causes of Developmental Delay?

Many factors can contribute to the delay in the development of a child.

1. Prenatal causes –

Genetic disorders such as Down syndrome, chromosomal microdeletion or duplication, and fragile X syndrome lead to developmental delays.
Cerebral dysgenesis and vascular ailments such as occlusion and haemorrhage are other impediments to the growth of a child.
Consumption of drugs, alcohol, or cigarettes by the pregnant mother may affect a baby’s brain even before it is moulded.
When the pregnant mother contacts infections such as rubella, varicella, and HIV, the chances of miscarriage, still-birth, developmental defects, and birth deformities increase considerably.

2. Perinatal causes –

Premature babies are more prone to developmental delays than the ones born after the said duration of 37 weeks.
Intrauterine growth retardation, intraventricular haemorrhage, and periventricular leukomalacia slow down a baby’s growth before its birth.
Perinatal asphyxia is when, due to some birth complications, the newborn is deprived of oxygen. It especially harms the brain.
Symptomatic hypoglycemia during birth or neurological dysfunction can damage a neonate’s brain enough to cause troubles later in life.

3. Postnatal causes –

Early-onset of meningitis and encephalitis can lead to a slackening of a child’s growth process.
Anoxia is the lack of supply of oxygen to the brain. A cut in oxygen reaching the brain because of seizures or near-drowning experiences injures it.
Head injuries and brain strokes can cause motor delays.

4. Other causes –

Malnutrition, especially a deficiency of iron, folate, and vitamin D) slows down the intake capacity of a child.
Parental depression, maltreatment of the child, and underexposure or less encouragement to grow to keep a healthy baby from attaining the skills necessary for survival.

How to Identify Developmental Delays?

If you feel that your child is slow in acquiring new skills, refer to the milestone chart. Every child develops at their own pace; some mature earlier than the others and vice versa. There is a range of all the skills to be learned by children. For certain skills, this span is narrower than for the others. However, if your child is missing more than a few milestones, consulting a specialist becomes indispensable. Your paediatrician may help you with that.

Moreover, grumpiness of nature, lack of interest in daily activities, and loss of previously acquired skills may indicate an underlying problem. The delays may be due to consequential intrinsic ailments, therefore, waste no time in analyzing. Talk to your primary healthcare professional at the earliest.

What are Gross and Fine Motor Delays?

These are when a child is developing motor expertise later than the specified normal age. While gross motor activities refer to large movements that need arms, torso, legs such as sitting up straight, rolling over, walking, running, jumping, etc.; fine motor activities involve smaller movements requiring more coordination. They can be holding a toy, scribbling with a pencil, or even speaking (that needs harmonious functioning of nerves, tongue, lips, and face muscles). Autism may be a cause of fine motor delay.

If a parent feels that their child is not following the expected growth chart, they should contact their child’s paediatrician straightaway. The doctor may recommend physiotherapy, which involves fun activities to build up your child’s physical strength and flexibility. For fine motor delay, they may suggest you opt for speech therapy. The paediatrician may commend a neurological specialist.

For your part, you can provide your child with a healthy growth environment with the utmost chance to exceed their limits and excel.

What is Speech and Language Delay?

A speech and language delay is when a child has not developed the ability to express themselves by the anticipated time or is not speaking as many words as they should. While speech delay considers the latter, a language delay involves a hold-up in speaking, gesturing, signing, and writing.

Speech delays may be due to hearing impairment, autism, cerebral palsy, or even selective mutism. If you feel that your baby is late in speaking, talking to your paediatrician is the best immediate course of action. They may recommend an audiologist to test for hearing loss. It can be followed by meetings with a speech-language pathologist, psychologist, and/or therapist.

On your account, you can encourage your child to speak as much as you can. Talking to them all the time, encouraging them to speak, and exercising patience is very important.

What are Cognitive Delays?

A cognitive delay refers to the condition wherein a baby’s mental ability is not enhanced enough for its age; its intellectual capacity and adaptive behaviour are restricted. Cognitive delay involves inaptitude for basic communication and social skills.

Cerebral palsy, autism, epilepsy, and Down syndrome are some conditions commonly associated with cognitive delays. According to the Center for Disease Control, it occurs in approximately 1.2% of the children.

A doctor may recommend several analytical tests to determine the intellectual and adaptive functioning of your child following which you can consult therapists for treatment programs. Also, many schools give concessions to such kids.

What are Social-Emotional Delays?

Social-emotional developmental delays occur when children are not able to interact with the people around them well. Due to this, they perceive their environment later and differently than their peers which further affects their capability to deal with their surroundings as well as their emotions. If they subconsciously use their imagination as an escape from reality, their potential to distinguish their physical existence from dreams and fantasies may reduce. They may even go on to lose previously acquired skills.

Persistent therapy for a few years and individual treatment programs are supposed to help with the situation.

What is Autism Spectrum Disorder?

Autism Spectrum Disorder or ASD is a complex neurodevelopmental condition that restricts patients’ interaction, behaviour, and communication. Autistic people may think, talk, move, and behave differently than what is normally expected. They face a delay in developing speech and language.

Autism’s conditions are noticeable since the early stages of the growth of a child. Provided a little consideration is given, the treatment may start soon.

There is no cure for this ailment. However, therapy may help your child adjust to their surroundings, deal with their emotions, and relax more. A homely environment is essential for the treatment to work.

What is Cerebral Palsy?

Cerebral palsy is a condition that affects a person’s muscle movement, coordination, and posture. It is caused by injury to an individual’s brain usually before it develops, that is, before birth.

Symptoms appear in infancy or during the initial days of preschool. These include –

Fine and gross motor delay
Abnormal posture and reflexes
Unusual rigidity or floppiness of limbs
Unsteady gait
Unsteady gait
Eye muscle imbalance

Intellectual disability may or may not be an effect of cerebral palsy. Though this disease cannot be completely cured, early diagnosis and treatment can help babies with cerebral palsy grow and live a valuable life.

Conclusion

It is normal for babies to achieve a few milestones late in life. Constant support and guidance from their caregivers are all that they need. However, if they do not suffice, the guardians of the child have to consult a medical professional. Also, they must be provided with a positive learning environment. Early identification and treatment of ailments may help the child to develop as is required of them; or, at least, to lead a healthy life.