infants & toddlers
 
Developmental Delays:
What Parents Should Know

A baby's rate of development is determined largely before birth, primarily as a result of genetic make-up. A child who walks early most likely has a parent who walked early. Few babies develop at a uniform rate; most develop quickly in some areas and slower in others. Some babies reach most or all developmental milestones slightly later than "average." As long as a child's development falls within the broad range that is considered normal, reaching one or more milestones late is generally not a cause for concern. When a child consistently reaches developmental milestones much later than other children, a professional consultation is usually warranted.

Several developmental areas are of interest: gross motor skills (e.g., crawling, walking), fine motor skills (e.g., grasping and manipulating objects), receptive (understanding) and expressive (speaking) language, self-help (e.g., feeding, dressing), and social and play skills. While it is important to consider each of these areas, some are more important predictors of developmental difficulties than others.

Gross motor skills tend to be of particular importance to parents. They are readily observable and easy to compare from one child to the next. The timing of concrete achievements such as first steps is usually easier to pinpoint than that of more ambiguous accomplishments in other areas of development (e.g., baby recognizing his own name). While steady progress in the development of motor skills is important, a particular achievement such as early walking bears little relationship to later intelligence and is most likely an inherited trait, much like early or late teething.

Communication and social skills are generally more import in understanding a child's developmental progress. During the first half of the first year, baby's communication skills are largely nonverbal. Smiling, making eye contact and turning in the direction of a familiar voice, are all signs that baby is connecting with and relating to his social environment. Later in the first year, babbling begins and words may start to appear. In most cases, baby's vocabulary will continue to grow by leaps and bounds as he moves through the second year. Again, however, it is the ability to use language to communicate and relate to the social world that is most important. A child who has a limited speaking vocabulary late into the second year, but is able to communicate needs through gestures, point to named objects in books, and follow simple directions, is most likely not exhibiting significant developmental delay.

The nature of a child's play also pro-vides important information about intellectual development. Very young children tend to play alongside, rather than with, other children. Early play consists largely of using body and senses to interact with the environment. During the toddler years there is a move toward pretend play and increasingly interactive play with other children. Flexibility and creativity become more evident as a child begins to engage in symbolic play (e.g., using a block to represent a car) and role-playing (e.g., "I'll be the mommy and you be the baby"). Steady progression toward more social and complex play suggests that development in this area is on track.

As the most important observers of a child's development, parents should be aware of the behaviors that are typical at a given age as well as the developmental "red flags." Some warning signs that a child's development may not be on track:

Infants (0-2 years):

  • Little interest in surroundings and caregivers
  • Absence or minimal eye-contact or smiling
  • Lack of responsiveness to sound
  • Absence of babbling by end of first year
  • Failure to walk by 15 months of age
  • Failure to use hands to manipulate and explore objects.

Toddlers (2-3 years):

  • Little interest in other children
  • Limited use of words or gestures to communicate needs
  • Repetitive non-communicative or parrot-like speech
  • Very repetitive, non-purposeful play (e.g., focuses only on parts of objects such a wheels, knobs; obsessively turns pages of book without attending to or recognizing content).

Pre-schoolers (3-5 years):

  • Speech that is very difficult to under-stand
  • Little or no pretend or imaginary play
  • Little interest in social interaction
  • Difficulties with balance, running
  • Difficulty using crayons or scissors, manipulating small objects.

What should concerned parents do?
Consult your child's pediatrician and obtain a complete physical exam, including vision and hearing checks. Some apparent delays in a child's development can be attributed to a health condition such as frequent ear infections or impaired vision. Make a list of your questions and provide details and examples of areas that concern you. In many cases your child's doctor will be able to provide answers and information to relieve your anxiety and will continue to monitor your child's progress. Keep asking questions; get a second opinion.

If you continue to have concerns, you may wish to seek a formal developmental assessment by qualified professionals. Often a child psychologist or developmental pediatrician will conduct an evaluation in collaboration with other professionals depending upon the particular areas of concern. A comprehensive evaluation will provide a clear description of your child's needs as well as his strengths and will facilitate the development of educational or treatment plans if needed. With early intervention, most children will make a successful transition to school.

Resources:
Connecticut Birth to Three (0-3 years of age): 1-800-505-7000 or www.birth23.org; Local school system (3 years of age and above)

Elizabeth L. Hart, Ph.D is a Clinical Child Psychologist in private practice; Assistant Clinical Professor of Psychiatry, Yale School of Medicine; and mother of two young daughters.

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