Developmental Delay in Young Children:  What the Signs Are, What to Do

What can you do to help your child that’s (for the most part) free, painless, generally not controversial, certainly not hazardous, and even fun? It’s developmental screening, and it’s an essential part of ensuring your child’s overall good health. It’s been well established that discovering delays in your child’s milestones and helping her overcome them makes things go better later on, both at school and at home. Here we’ll talk about some of the ways to accomplish a screening and what to do if it’s not normal.

Screening Begins at Home

“Development” refers to the process of children, particularly infants and younger children, acquiring new skills and abilities as they get older. Although we’ll examine the role of your pediatric provider and of specialists in looking at your child’s development, one caveat here: you, the parent, are likely the best judge! You may just have a parent’s “sixth sense” that something is not right. Perhaps your baby’s is not doing the same things as his siblings when they were his age, or seems behind others at the daycare. While this doesn’t mean there is necessarily a problem, it’s a question worth raising with your child’s provider.

Infants do develop at different rates, and missing a single milestone for a month or two isn’t necessarily cause for alarm. There are great resources for tracking what your child does online but following is a sampling of reasons to think about some additional screening:

  • Your child does not walk by 18 months.
  • Your child is not saying any spontaneous words by 18 months. (It’s important to note that the presence of multiple languages in the home should not slow down speech development! The words she acquires may be in different languages, but she should get them at the same rate.)
  • Hand preference (left- or right-handed) before 18 months. Both sides should be used equally before then. Similarly, any asymmetry (say, in crawling) warrants a referral.
  • Unusual, “funny” walking, talking or other activity that isn’t seen in other children his age.
  • Your child stops doing something that she was previously doing, unless it’s replaced by a more age appropriate activity. (For example, a baby that can get into a sitting position will usually not roll over very often.)
  • Certain risk factors, even without obvious delays. Prematurity is a common one; your provider can discuss others with you.

Screening in the Office

Many people think that those periodic pediatric visits are “just for the shots” (or for the daycare form!). Fact is, many other things are addressed at these visits. Pediatricians will generally do at least a simple developmental screen of a few questions at every visit. They’re looking for progress in motor (movement), speech and personal/social (how the child interacts with others and how she’s progressing on other necessary activities, such as feeding herself).

Usually every few visits, a more comprehensive screen is done, usually in the form of a written parent questionnaire. There are many out there, but some of the more popular ones include the Ages and Stages Questionnaire (which checks all the major areas of development from infancy to age 5 years) and the M-CHAT screen (one more geared toward autism). Again, these are just screens and don’t necessarily signify an issue. But in most cases a result that falls outside the normal range means the child should have at least a repeat screening, with a referral for more comprehensive testing if results remain abnormal. (Some preschool and daycare programs also administer these or similar tests.)

Referral to a Specialist

If your child does need a little more evaluation, there are a couple of choices. More information can be obtained through your state’s early intervention program. This is a federally funded program that will evaluate and treat children up to age 3. Although each state runs its program a little differently, what they also have in common is that you can access the program without a doctor’s referral at no cost. (For children whose delays are discovered after age 3, your school system would perform this function.)

Another option is to see a developmental pediatrician—a medical doctor with special training in child development. Although a referral is sometimes needed, your provider may prefer that you go this route if there are additional medical concerns (say, a genetic disease or extreme prematurity) or if the delay is particularly severe. If so, it’s likely your local early intervention program (or school system, depending on age) will be involved for therapy to help your child catch up.

Although we don’t have the answers for every child’s delays, there is overwhelming evidence that we can make things go better for the great majority. In terms of giving kids their best shot at achieving their milestones, there are three lessons here: (1) continue to follow up with your child’s provider for regular pediatric care; (2) address any concerns you have about your child’s development with the provider; and (3) know that you have the right to get more information on your child from your state’s early intervention program.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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