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Developmental Delay

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Medical experts have developed checklists of "developmental milestones." These milestones describe skill sets that children should meet by certain ages. Your child’s ability to crawl, sit up, speak, and hold objects—and even throw tantrums—are a few examples.

But what if your child doesn’t seem to be meeting the averages? It’s possible that he may be affected by a condition called developmental delays.

There’s also another type of developmental condition, which involves regression. You may observe that your child seems to have lost certain skills, either due to outside influences (e.g., accidents or toxins) or to deliberate regressive behavior (like thumb sucking or deliberate and inappropriate urination). If so, she may be affected by what is called developmental regression. 

Developmental delays/regression causes and risks

Children exhibit developmental issues for a variety of reasons, including:

  • Genetics (e.g., Down’s syndrome)
  • The mother engaging in poor prenatal practices (e.g., smoking, drinking alcohol)
  • Head trauma
  • Prenatal exposure by the mother to toxins (including environmental toxins) or the child’s exposure to toxins after birth
  • Low birth weight
  • Premature birth
  • Untreated jaundice in newborns
  • Infections

Infections are a common cause of disorders. For example, experts estimate that 25% of hearing loss is due to babies’ exposure to infections during pregnancy.

With developmental regression, your child may appear to be developing as expected but then seems to start losing certain skills. This regression can be caused by injury. Children who have suffered head trauma, for example, may no longer speak as well as you had witnessed earlier.

Sometimes regression is a personal fight by children to take control of their environment. Your child may go back to sleeping with a stuffed animal in order to feel secure after a death in the family, a divorce, or relocation to a new home.

Symptoms

Symptoms

Developmental delays occur at different life stages. For example, at a certain age your child should be crawling. You may not notice, though, that your child isn’t crawling as you’d expect until he reaches the age when that should be a mastered skill.

Another example: By two months of age, your child should start smiling at others, make gurgling sounds, moving her head toward sounds, and start pushing up on the arms so that her head is up.

By one year of age, a child should be able to talk with single words, recognize ordinary things like a spoon, and even throw tantrums (a part of emotional development).

Understand that experts base developmental skills on averages, but if your child seems to take longer to mature than what’s generally accepted as normal, then there could be a problem.

If your child has already been diagnosed with a disabling condition, such as cerebral palsy or autism, you should be prepared for the kind of developmental delays that tend to be common with such conditions. Children with autism, for example, tend to avoid eye contact and stay focused on the same repetitive actions.

Take early action

Your baby’s doctor will look for developmental advancements during regular check-ups. Another great information resource is the Centers for Disease Control and Prevention’s (CDC) website.  The site offers a complete list of milestones that children should reach by specific ages. The CDC encourages you to learn the signs, so that you can act early if a problem arises. Early action can lead to effective intervention.

Tests & Diagnosis

Tests & Diagnosis

Currently, no lab or blood tests can predict developmental delays. Instead, your child’s progress can be gauged by developmental monitoring. Your doctor—and you—can recognize a developmental problem by closely observing your child. In this way, you can determine if he is reaching the appropriate developmental milestones. For instance, at certain ages, your child should be crawling or following an object with her eyes. Meanwhile, your family physician will check the more complex areas such as reflexes and hearing.

When your child is old enough, the physician can work with him directly, observing how he works with someone else.

Developmental screening is the most basic kind of testing. An expert—often your child’s doctor—asks questions that help determine how well she speaks and behaves.

If the physician suspects any problems with your child’s development, she may refer the case to an expert who can take your child through a much more extensive battery of tests. This is called developmental evaluation.

The earlier your child is tested and diagnosed the better, since it can lead to earlier access to the proper course of treatment – and enhanced quality of life for your baby.

Treatments

Treatments

Any effective treatment plan will consider your child’s unique qualities. This helps determine the best—and most personalized—course of action.

What type of therapy?

Three factors indicate the kind of therapies that might be best for your child:

  • What has caused your child’s delay?
  • In what stage is your child’s delay?
  • Has your child now been diagnosed with a specific disease or condition?

For example, a child who has had a hearing loss, but not seizures, will need a different kind of treatment than would a child with both. And the overall treatment for either of those children most likely will be different from the regimen designed for a child with cerebral palsy.

It’s critical that any signs of developmental delays or regression are recognized immediately, so that early intervention takes place. You want your child to begin the proper kind of treatment ASAP.

What treatments are available for my child?

Treatments generally include

  • Speech and language therapy, to enhance communication skills
  • Occupational therapy (OT), which allows children to learn and enhance fine motor skills needed for daily living, like dressing, eating, and bathing
  • Physical therapy (PT) – which involves learning and enhancing physical capabilities, including walking, jumping, good balance, and holding things
  • Behavior therapy – which is used to minimize and correct negative behaviors such as throwing tantrums, or refusing to interact socially or hitting others.

Periodically, medications or surgery might be advisable, but this is determined by the root cause of a child’s developmental problems.
 

Resources

Resources

This page has links to descriptions of several kinds of treatment for children with a developmental delay.
MyChildWithoutLimts.org

For links to checklists of common developmental milestones for children from age 2 weeks to 5 years:
Centers for Disease Control and Prevention

What to say … how to start a conversation about your child’s development with a doctor, a school, or an agency you hope can help.
Centers for Disease Control and Prevention

This page has information about what causes regression and what you should do about it.
American Academy of Pediatrics
 

FAQs

FAQs

What does “developmental delay” mean?

It means a child is not achieving certain sets of skills that children should be able to meet by certain ages. These include being able to sit up, speak, crawl, hold things -- even throw tantrums.

What causes such delays to happen?

Sometimes it’s genetic, but there is a wide range of causes. Among them: accidents (especially head trauma), low birth weight and especially toxin exposure before or after birth. The latter includes the mother smoking or drinking alcohol while she’s pregnant.

So it’s a specific condition?

Actually, no. The anomalies called “developmental” are actually found in a whole host of conditions, including cerebral palsy, autism, and epilepsy.

What about regression?

Regression is another issue. Children may be developing as expected, and then actually start losing certain skills. Children that have had a head trauma, for example, may no longer speak as well as they did previously.

Sometimes regression is a fight for a child to take control of his environment. A child may go back to sleeping with a stuffed animal in order to feel secure after a death or divorce.

What should I be looking for?

You should start noticing different issues at different stages of life. For example, by age two months, you should expect your child to be gurgling, while by one year of age, a child should be able to talk with single words. Your baby doctor should be looking for red flags during your baby’s regular check-ups.

Online, the Centers for Disease Control offers complete lists of milestones which children generally should reach by certain ages. 

How can my child be tested?

Checking for the milestones listed above is one kind of testing. Developmental testing involves some basic questions an expert often asks a child directly, while developmental evaluation usually involves an extensive battery of tests. The tests chosen depend on what experts believe might be wrong.

What are the treatments?

Generally there is no one treatment for all the conditions listed as developmental issues. Sometimes medication, surgery, or other aids can help. For example, a child with hearing loss may “catch up” to her peers once she is fitted with hearing aids. A child having seizures may stay perfectly controlled with the right medicine.

Otherwise, there are many therapies that can teach a child to be more self-sufficient. Speech therapy provides better communication skills, while occupational therapy teaches dexterity in what’s called activities of daily living (ADL). The latter involves areas such as dressing, bathing, and eating without help.

Medical Staff

Medical Staff


Preston Wiles, M.D. - Dr. Preston Wiles is the Drs. Anne and George Race Professor of Student Psychiatry at UT Southwestern Medical Center and the director of the student wellness and counseling program there. He is also medical director of the UT Southwestern Children’s Medical Autism Center.

Michelle Kandalaft, Ph.D. - Dr. Michelle Kandalaft is a clinical assistant professor of psychiatry at UT Southwestern Medical Center.

Patricia Evans, M.D., Ph.D. - Dr. Patricia Evans is an associate professor of pediatrics and neurology and  neurotherapeutics at UT Southwestern Medical Center. Her clinical interests include fragile- X syndrome, neuro-behavior, and neuro-developmental disorders.

Sailaja Golla, M.D. - Dr. Sailaja Golla is an assistant professor in the Department of Pediatric Neurology, specifically specialized to see patients with neurodevelopmental disabilities. She is also the director of the POST ECMO Neurodevelopmental clinic.

 

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