Developmental delay in young children

Developmental delay occurs when your child lags behind their peers in one or more areas of emotional, mental, or physical development. If your child is lagging behind, early treatment is the best way to help them progress or even catch up.

There are many types of developmental delay in infants and young children. These include issues with:

Language or speech
Vision
Movement -- motor skills
Social and emotional skills
Thinking -- cognitive skills

Sometimes significant delay occurs in two or more of these areas. When this happens, it is called "global developmental delay". This applies to infants and preschoolers under the age of 5 who are at least 6 months late.

Developmental delay is distinct from developmental disorders, which include conditions such as cerebral palsy, hearing loss, and autism spectrum disorders, and usually remain for life.

Causes of developmental delay and risk factors

Young children learn to crawl, talk, or use the toilet at different rates. But sometimes a child may reach these milestones much later than other children. There are many reasons for these delays, including:

Being born prematurely
Genetic conditions like Down syndrome or muscular dystrophy
Poor eyesight or hearing
Malnutrition
Alcohol or drug use during pregnancy
Physical abuse or neglect
Lack of oxygen during delivery

Here are some warning signs of different types of delays that can show up from infancy to 2 years of age.

Delayed language and speech development

These are common delays in babies. Language and speech problems are the most common types of developmental delay. Speech refers to verbal expression, including the way words are formed. Language is a broader system for expressing and receiving information, such as the ability to understand gestures.

Possible reasons. Various problems can cause language and speech delay, including:

Exposure to more than one language
A learning disability
Child abuse or neglect
A problem with the muscles controlling speech
Hearing loss, which may occur in children who have severe middle ear infections or occur as a result of certain medications, trauma, or genetic disorders
Autism spectrum disorders
No cause can be found

Types of treatment. If you or your child's doctor suspects a speech delay, you will be referred for an examination by a speech therapist. This specialist can test your child's hearing, evaluate their receptive and expressive speech, and then schedule speech therapy sessions with your child. If the delay is mild, a specialist or doctor may suggest:

Communicate more with your child -- talk, sing, and encourage repetition.
Read daily to your child.
Reinforce speech and language throughout the day.
Get treatment for middle ear infections.

Warning signs of delayed speech or language. Contact your child's doctor if your child has any of the following signs at a given age. Also, watch out for any loss of previously learned skills.

Around the age of 3 to 4 months, call your doctor if your child:

Does not respond to loud noises
Does not babble
Begins babbling but does not try to imitate sounds

By 7 months, contact the doctor if your child:

Does not respond to sounds

By 1 year, contact the doctor if your child does not:

Use any single words (like "mama")
Understand words like "bye-bye" or "no"

By 2 years, contact the doctor if your child:

Cannot speak at least 15 words
Does not use two-word phrases without repetition; can only imitate speech
Does not use speech to communicate more than immediate needs

Vision developmental delays

Up to 6 months, the vision of a newborn is normally blurry. It then improves as the child begins to coordinate vision in both eyes. But sometimes this does not happen or other vision problems appear.

Possible causes of delayed vision. Refractive errors such as nearsightedness and farsightedness are common in children. Other vision problems include:

Amblyopia (lazy eye), poor vision in one eye that may also appear to turn outward
Infantile cataracts -- a clouding of the eye's lens -- or another inherited problem (these problems are rare)
Retinopathy of prematurity, an eye disease that sometimes affects premature infants
Strabismus -- also called cross eyes -- eyes that turn in, out, up, or down

Types of treatment for visual delay. Early treatment can help correct many vision problems. Depending on your child's vision problems, you may need:

Glasses or contact lenses
Special glasses
Surgery
Eye patch

Warning signs of vision problems. Contact your child's doctor if your child has any of the following signs at a given age. Also, watch out for any loss of previously learned skills.

At 3 months, see your doctor if your baby:

Does not follow moving objects with their eyes
Does not notice hands (by 2 months)
Has trouble moving one or both eyes in all directions
Crosses eyes most of the time

By 6 months, contact the doctor if your child:

Has one or both eyes turning in or out all the time
Experiences constant tearing or eye drainage
Does not follow near objects or far objects with both eyes

If your child's doctor finds any problems, they may refer your child to an ophthalmologist for further evaluation.

Delayed development of motor skills in children

Delays in motor development may be related to gross motor problems, such as crawling or walking, or fine motor skills, such as using fingers to grasp a spoon.

Possible causes of motor skills delays. Babies born prematurely may not build muscle at the same rate as other babies.

Other possible causes of motor delays include:

Ataxia, a defect that impairs muscle coordination
Cerebral palsy, a condition caused by brain damage before birth
Cognitive delays
Myopathy, a disease of the muscles
Problems with vision
Spina bifida, a genetic condition causing partial or total paralysis of the lower part of the body

Types of treatment for motor delays. Your child's doctor may suggest taking steps at home to encourage physical activity. Your child may also need physical therapy for delayed gross motor skills. Certain types of physical or occupational therapy can help with fine motor skills or sensory processing disorders, which occur when the brain has difficulty receiving and responding to information through the senses.

Warning signs of motor delays. Contact your child's doctor if your child has any of the following signs at a given age. Also, watch out for any loss of previously learned skills.

At about 3 to 4 months of age, see your doctor if your child does not:

Reach for, grasp, or hold objects
Support their head well
Bring objects to their mouth (by 4 months)
Push down with legs when their feet are placed on a firm surface (by 4 months)

By 7 months, contact the doctor if your child:

Has stiff and tight or very floppy muscles
Flops their head when pulled into a sitting position
Reaches with one hand only or does not actively reach for objects
Has trouble getting objects to their mouth
Doesn't roll over in either direction (by 5 months)
Cannot sit up without help (by 6 months)
Does not bear weight on their legs when you pull them up to a standing position

By 1 year, contact the doctor if your child:

Does not crawl
Drags one side of their body while crawling
Cannot stand when supported

By 2 years, contact the doctor if your child:

Cannot walk (by 18 months)
Does not develop a heel-to-toe walking pattern or walks only on toes
Cannot push a wheeled toy

Delays in social and emotional development in children

Children may have problems interacting with adults or other children, called social and/or emotional developmental delays. Usually these problems appear before the child goes to school.

Possible reasons. Some causes of social and emotional delays include:

Neglect from early institutionalization or parental neglect
Ineffective parenting or attachment problems
Cognitive delays
An unknown cause

Another common reason for delayed social and emotional development is a common diagnosis of autism spectrum disorder. It used to be called pervasive developmental disorder, autism, Asperger's syndrome, and other names. Autism Spectrum Disorder includes disorders that can cause a child to have communication difficulties, repetitive behaviors, and language problems.

Types of treatment. There is no known cure for these conditions. But treatment may include:

Special types of behavioral therapy and skills-based therapy.
Medications that can help with certain problematic behaviors

As with most types of delay, early treatment can make a big difference to your child's progress. Depending on the diagnosis, treatment may also include play therapy or measures to strengthen the bond between parent and child.

Warning signs of social or emotional delays. Contact your child's doctor if your child has any of the following signs at a given age. Also, watch out for any loss of previously learned skills.

At 3 months, see your doctor if your baby does not:

Smile at people
Pay attention to new faces, or seems frightened by them

By 7 months, contact the doctor if your child:

Refuses to cuddle
Shows no affection for parents or caregivers
Shows no enjoyment around people
Cannot be comforted at night (after 5 months)
Does not smile without prompting (by 5 months)
Does not laugh or squeal (by 6 months)
Shows no interest in games of peek-a-boo (by 8 months)

By 1 year, contact the doctor if your child shows no:

Back-and-forth sharing of sounds, smiles, or facial expressions (at 9 months)
Back-and-forth gestures, such as waving, reaching, or pointing

Delays in cognitive development in children

Thinking problems or cognitive delays can be caused by one or more of the following:

Genetic defects
Significant medical problems before birth
Exposure to something harmful in the environment, such as a toxin
Neglect

Possible causes. Causes of cognitive delays include:

A wide range of different learning disabilities
Exposure to alcohol or toxins before birth or afterward, including lead poisoning
Institutionalization or neglect during infancy or early childhood
Down syndrome and other genetic disorders
Autism spectrum disorder
Severe newborn medical problems
No known cause

Types of treatment for cognitive delays. As with most types of developmental delay, early treatment can make a big difference to your child's progress. Educational intervention can help your child develop certain cognitive skills. Educators and therapists may use play therapy or behavioral therapy, and may recommend specific steps you can take at home to help your child.

Warning signs of cognitive delays. Contact your child's doctor if your child has any of the following signs at a given age. Also, watch out for any loss of previously learned skills.

At 1 year of age, see your doctor if your child does not:

Search for objects that are hidden while they watch
Use gestures, such as waving
Point to objects or pictures

By 2 years, contact the doctor if your child does not:

Know the function of common objects, such as a hairbrush, telephone, or spoon
Follow simple instructions
Imitate actions or words

What to do if you suspect your child has a developmental delay

Remember: there is a wide range of normal development of children. Most developmental delays in children are not serious, and children eventually catch up. Even children with a significant delay can make significant improvements if treatment is started as early as possible.
The main thing is to intervene in time. Children under the age of 21 can receive special public education, taking into account their developmental delay.