Definition

A developmental delay is a condition in which a child has not yet acquired the developmental skills that he or she should have had by that age, as compared to other children of the same age.

This results from an impairment in one of the following abilities: speech and language, gross and fine motor skills, cognitive (thinking) function and performance, social, psychological, sexual, and everyday living activities.

These delays can occur in a single skill area, known as isolated developmental delay, or in two or more areas, which is referred to as multiple developmental delays. In more severe cases, delays may affect all areas of development, known as Global Developmental Delay (GDD).

Causes

Language and Speech Development Delay

Language and speech delays are the most common type of developmental delay. Various factors can contribute to these delays, including:

• Exposure to more than one language during early childhood potentially causes mild delays in toddlers
• Learning disabilities
• Child abuse or neglect
• Problems with the muscles used for speech, a condition known as dysarthria
• Hearing impairments
• Autism spectrum disorder (ASD), a group of neurological disorders that may involve communication, social interaction, and cognitive skills issues
• Idiopathic causes (unknown origins)

Visual Development Delay

Possible causes of visual delays include:

• Refractive eye disorders such as myopia (nearsightedness) and hyperopia (farsightedness), which are common in children
• Amblyopia (lazy eye), where vision is poor in one eye
• Infantile cataracts, a rare condition causing cloudiness of the lens in children
• Retinopathy of prematurity, an eye disorder that sometimes affects premature infants
• Strabismus (crossed eyes), where one or both eyes turn inward, outward, upward, or downward

Motor Skill Development Delay in Children

Motor skill delays can be related to issues with gross motor skills, such as crawling or walking, or fine motor skills, such as using fingers to grasp a spoon. Possible causes include:

• Premature birth, which may result in delayed muscle development compared to other children
• Ataxia, a condition that affects muscle coordination
• Cerebral palsy, a disorder caused by brain damage before birth
• Cognitive delays
• Myopathy, a type of muscle disease
• Spina bifida, a genetic condition causing partial or complete paralysis of the lower body

Social and Emotional Development Delay in Children

Children may have difficulties interacting with adults or other children, known as social and/or emotional developmental delay. These issues typically emerge before school age. Causes include:

• Parental neglect
• Issues with ineffective caregiving or attachment
• Cognitive delays
• Unknown causes

Cognitive Development Delay in Children

Cognitive delays may be caused by one or more of the following:

• Various learning disabilities
• Exposure to alcohol or toxins before or after birth, including lead poisoning
• Neglect during infancy or early childhood
• Down syndrome or other genetic disorders
• Autism spectrum disorder
• Severe medical conditions in newborns
• Idiopathic causes

Risk Factor

Several factors can lead to developmental delays, occurring before, during, or after birth. Contributing factors include:

• Genetic or congenital abnormalities, such as Down syndrome
• Metabolic disorders, such as phenylketonuria (PKU)
• Brain trauma, such as shaken baby syndrome
• Severe psychosocial trauma, such as post-traumatic stress disorder (PTSD)
• Exposure to certain toxic substances during pregnancy, such as alcohol or lead poisoning
• Severe infections
• Malnutrition
• Premature birth
• Poor vision or hearing
• Physical abuse or neglect
• Oxygen deprivation during birth

Symptoms

Language and Speech Development Delay

• Age 3-4 months: No response to loud noises, no babbling, or attempts to imitate sounds (4 months).
• Age 7 months: No response to sound.
• Age 1 year: Cannot say single words like "mama", does not understand words like "bye-bye" or "no".
• Age 2 years: Cannot speak at least 15 words, cannot use two-word phrases without repetition, and uses speech only for immediate needs.

Visual Development Delay

• Age 3 months: Does not follow moving objects with eyes, does not notice hands (2 months), has difficulty moving one or both eyes in all directions, and eyes frequently bulge.
• Age 6 months: One or both eyes turn inward or outward constantly, eyes are constantly watery, and does not follow objects at close (30 cm) or far distances (180 cm) with both eyes.

Motor Skill Development Delay in Children

• Age 3-4 months: Cannot reach, grasp, or hold objects; cannot support head well; cannot bring objects close to mouth (4 months); cannot push down with legs when placed on a hard surface (4 months).
• Age 7 months: Has stiff or very floppy muscles, head falls back when pulled to a sitting position, reaches with one hand only or not at all, has difficulty bringing objects to mouth, does not roll over in either direction (5 months), and cannot sit without help (6 months).
• Age 1 year: Cannot crawl, drags one side of body while crawling, and cannot stand when supported.
• Age 2 years: Cannot walk (18 months), does not develop a heel-to-toe walking pattern or walks only on tiptoes, and cannot push a wheeled toy.

Social and Emotional Development Delay in Children

• Age 3 months: Does not smile at people, does not seem to notice, or appears fearful of new faces.
• Age 7 months: Refuses to be cuddled, shows no affection for parents or caregivers, cannot be comforted at night (after 5 months), does not smile spontaneously (5 months), does not laugh (6 months), and does not show interest in games like "peek-a-boo" (8 months).
• Age 1 year: Does not share sounds, smiles, or facial expressions (9 months); does not show back-and-forth gestures like waving, reaching, or pointing.

Cognitive Development Delay in Children

• Age 1 year: Does not search for hidden objects while watching, does not use gestures like waving, and cannot point to objects or pictures.
• Age 2 years: Does not know the function of common objects like a brush, phone, or spoon; does not follow simple instructions; cannot imitate actions or words.

Diagnosis

To diagnose developmental delay, doctors begin by interviewing the child's parents or caregivers to discuss symptoms, complaints, and the child's growth and developmental milestones. Doctors will also consider potential risk factors that may have contributed to the delay.

A physical examination will be conducted from head to toe to assess the child's growth and developmental status, observing the child's behavior. In some cases, additional tests may be required to check for underlying conditions, such as blood tests, urine tests, cerebrospinal fluid analysis, genetic testing, EEG (electroencephalogram) to assess electrical activity in the brain, and MRI scans.

Management

Language and Speech Development Delay

Management typically involves a doctor and a speech therapist. The doctor may recommend speech therapy for the child. If symptoms are mild, the doctor might suggest:

• Communicating more with your child, including talking, singing, and repeating words.
• Reading to your child daily
• Reinforcing speech and language throughout the day
• Treating any middle ear infections if present

Visual Development Delay

Early intervention can help correct many vision problems. Depending on the child's eye condition, treatments may include:

• Glasses or contact lenses
• Surgery
• Eye patches

Motor Skill Development Delay in Children

The doctor may advise taking certain steps at home to encourage more physical activity for the child. Physical therapy may be needed for delays in gross motor skills. Specific occupational or physical therapies can help with fine motor skills or sensory processing disorders, which occur when the brain has difficulty receiving and responding to information from the senses.

Social and Emotional Development Delay in Children

No specific treatments are known for this condition. However, management may include:

• Specialized behavior therapy focused on skill development
• Certain medications that can help manage some problematic behaviors

Cognitive Development Delay in Children

Educational interventions can help your child develop certain cognitive skills. Educators and therapists may use play therapy or behavioral therapy and recommend specific steps you can take at home to support your child's development.

Complications

Most developmental delays can improve without complications, provided that early intervention and management are implemented. Delayed intervention may result in long-term effects that could hinder the child's future daily activities related to the delayed skill.

Prevention

There is no specific way to prevent developmental delays in children. The key is to avoid risk factors that may increase the likelihood of developmental delays, especially during pregnancy.

When to See a Doctor?

If your child's growth and development are not on par with their peers, consult with a doctor. If your child also shows symptoms of delay appropriate for their age, seek further evaluation from a healthcare professional.