Paeds Development Unit

If you notice that your child is not developing or progressing when compared to children of his or her age; or when your child is growing slowly, sluggishly or seems to be lagging behind in growth – then you should consult a Paediatric neurologist.

The following are the developmental milestones for a child according to their age:

• Rolling at four months
• Sitting at six months
• Crawling at nine months
• Pulling to stand at ten months
• Walking at twelve months

• Movement difficulties – delay in the development of motor skills
• Cognitive skills developmental delay
• Social and emotional skills developmental delays
• Language or speaking skills delay

The most common causes of developmental delay include premature birth, Autism spectrum disorders, genetic disorders like Down’s syndrome, complications during pregnancy, chronic infections, Fragile X chromosome – an inherited type of cognitive impairment and foetal alcohol syndrome – which may result due to drinking excessive alcohol during pregnancy.

Prenatal infections environmental toxins exposure – mercury, lead and arsenic; head trauma; pregnancy-related complications; prenatal exposure to toxins – drugs, alcohol and smoking; nutritional deficiencies and maternal illnesses like autoimmune disorders, renal disease, high blood pressure and diabetes may increase the risk.

The potential causes for speech or language delays include trauma, genetic disorders, use of certain types of medicines, middle ear infections, hearing loss, speech disorder (dysarthria), child abuse, autism spectrum disorders and other learning disabilities. The cause may be unknown (idiopathic).

The potential causes for cognitive skills developmental delay include Autism spectrum disorders, Down syndrome, medical health issues before birth, premature birth, parenteral neglect and exposure to environmental toxins – such as mercury, arsenic and lead. Cognitive skills developmental delay cause learning difficulties.

Walking, movement and crawling difficulties come under gross motor skills developmental delays. Difficulties in using fingers to grasp pencil, spoon, pen and other objects come under fine motor skills developmental delays. Most children have problems with dexterity in using fingers and gripping objects.
Muscular disorders like myopathy, ataxia and other disorders like cerebral palsy and spina bifida cause these types of delays.

Autism is a neurodevelopmental condition which is usually diagnosed in the first three years of life. Generally, parents become concerned when their child has delays in speech development, limited social relatedness, and restricted interests and activities. The child may avoid direct eye contact and exhibit odd behaviors such as focusing on parts of objects (e.g. the spinning wheel of a toy car). There may be unusual motor movements such as hand flapping, self-stimulation or walking on toes.

Parents and relatives should be concerned about their infant or toddler if they notice any of the following developmental delays or behavioral problems and discuss concerns with their child’s paediatrician to obtain appropriate referrals for evaluation:

• Lack of or delay in development of spoken language
• Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
• Little or no eye contact
• Lack of interest in peer relationships
• Lack of spontaneous or make-believe play
• Persistent fixation on parts of objects