Developmental Delays

Children develop at their own pace, and the timescale over which milestones are achieved can be quite wide. During their early years, children develop gross motor skills such as rolling, sitting, transferring from one sitting position to the other, crawling, standing, and walking as the brain develops. These are known as gross motor milestones which are achieved at particular stages during development.
Children experiencing delays might reach their developmental milestones at a much later stage in comparison to their peers. For example, children usually sit independently around 7 months of age. If they are not sitting independently around 9 months, it means there is a delay in achievement of this skill. This will have a cascading effect on other skills, such as crawling, supported kneeling, pulling to stand, and walking. When there is a significant delay in two or more developmental domains - motor, speech, and cognition – it is referred to as global developmental delay.

What Are the Causes?

The conditions that cause developmental delay could be genetic, neurologic, metabolic, musculoskeletal, perinatal, postnatal, pre-maturity, or sensory. In some cases, the cause of delay remains undiagnosed.

How Do You Distinguish Developmental Delay from Learning Disability?

Children with developmental delay will continue to acquire skills, just at a slower rate. The gap between them and their peers should become narrower or eventually close over time. However, with learning disability, you will note that the skill gap between them and their age group widens with time.

How Do You Recognise a Delay in Gross Motor Skills?

Between 6 to 8 weeks, you should seek advice if your child:

  • Is not observed to bring their hands to the mouth when lying on their back.
  • Is not observed to symmetrically move their arms.
  • Is unable to kick legs in a rhythmical fashion when lying on their back.
  • Is unable to follow a toy in 180 degrees arc when on their back.
  • Is not observed to give eye contact or smile.

Between 3 to 4 months, you should seek advice if your child:

  • Is not able to support his or her head.
  • Is unable to bring both hands towards the midline when on their back.
  • Is not able to roll from lying on their back to lying on their side.
  • Is not observed to reach for a toy.
  • Has their hands fisted or closed most of the time.

Between 6 to 7 months of age, your child should be able to:

  • Roll from lying on their tummy to lying on their back.
  • Push up while on his or her tummy to lift their chest off the surface.
  • Sit independently for approximately 8 to 10 seconds, or sit with minimal support.
  • Sit independently, or with support, and reach for toys with one arm at a time.
  • Grasp a small object (might not be able to use the thumb as yet).

By approximately 9 to 10 months of age, your child should be able to:

  • Sit steadily unsupported.
  • Maintain sitting balance by extending arms to the side when balance is challenged.
  • Transfer from crawling position to sitting on their bottom.
  • Crawl forwards using alternating upper and lower limb movements.
  • Stand supported/holding furniture with a wide base of support.
  • Grasp objects between thumb and side of index finger.

By 12 months of age, most babies can:

  • Pull themselves up to standing.
  • Use one hand for supporting themselves in standing while reaching with the other.
  • Walk with the support of furniture.
  • Pick up objects using pincer grasp (thumb and index finger).
  • Clap hands.

How Will Physiotherapy Help?

On your first visit, a comprehensive initial assessment will be undertaken for finding whether the cause of the delay is neuromuscular, musculoskeletal, or due to other anomalies. Your child will be observed while playing in the environment and will also be engaged in a variety of activities for assessment purposes. This assessment will display at which stage of development they are and, most probably, the reason for the delay. This is also the first step towards management and treatment planning as well as determining the prognosis.

The assessment findings and management will be thoroughly discussed with you and goals will be jointly formed. Depending on the cause of delay, your child might also benefit from occupational therapy or speech and language therapy. A holistic approach will be applied in meeting their needs.

An exercise programme in the form of play, which can be easily incorporated into your child’s daily routine, will be provided to progress their gross motor skills and refine their existing skills. The programme will be explained and you will be supervised implementing the same. The changes in their level of abilities will be measured on a regular basis, and the treatment plan will be modified accordingly. Liaison will regularly take place with all members of the multi-disciplinary team to ensure we all are working towards the same goals. A visit to the educational setting can be undertaken for demonstrating the programme as well as training staff to implement it correctly.

You will notice a massive improvement in your child’s endurance, muscle strength, flexibility, balance, motor coordination, attention span, and interaction with the environment, which will have a tremendously positive effect on their confidence. This will lead to an increase in participation as well as engagement with peers.

What You Can Do

As early intervention is very important, please seek advice as soon as you observe any signs of delay. This will help minimise the cascading effect on other developmental milestones. It would be of great benefit if the exercise programme could be incorporated into their daily routine, rather than just being performed 1 hour a day. This will not only accelerate the rehabilitation process but also help in motor learning.

Repeated practice is essential as children learn by exploring their environment and through constant feedback gained by trial and error. Once they master skills at a certain level, they get the confidence to move on to the next level. For example, in the initial stages when the child is learning to sit, they use their hands to support themselves. After a few weeks, they use their hands to reach for toys as they have realised they can play while sitting independently.

Prognosis

The prognosis varies according to the cause of the delay. In the absence of any pathology, children tend to catch up with their peers, and the gap between skill levels is gradually bridged.

References

Majnemer A, Shevell M I, 1995. Diagnostic yield of the neurologic assessment of the developmentally delayed child. Journal of Pediatrics, 127, pp.193–199.

Contact us now, in Wellingborough, Northamptonshire, for more information about the benefits our paediatric physiotherapy has on children with delayed development.