What Is a Developmental Delay in Young Children?
Developmental delay is when your child lags behind their peers in one or more areas of emotional, mental, or physical growth. If your child is delayed, early treatment is the best way to help them make progress or even to catch up.
There are many different types of developmental delays in infants and young children. They include problems with:
- Language or speech
- Vision
- Movement -- motor skills
- Social and emotional skills
- Thinking -- cognitive skills
Sometimes, a significant delay occurs in two or more of these areas. When that happens, it’s called "global developmental delay." It refers to infants and preschoolers up to age 5 who show delays lasting at least 6 months.
Developmental delay is different from developmental disabilities, which include such conditions as cerebral palsy, hearing loss, and autism spectrum disorder and which usually last for life.
Developmental Delay Causes and Risk Factors
Little children learn to crawl, talk, or use the toilet at different speeds. But sometimes a child may reach those milestones much later than other kids. There are many reasons for such delays, including:
- Being born prematurely
- Genetic conditions like Down syndrome or muscular dystrophy
- Poor eyesight or hearing
- Malnutrition
- Alcohol or drug use during pregnancy
- Physical abuse or neglect
- Lack of oxygen during delivery
Here are some warning signs for different types of delays that may show up from infancy to age 2.
Language and Speech Developmental Delays
These are not unusual delays in toddlers. Language and speech problems are the most common type of developmental delays. Speech refers to verbal expression, including the way words are formed. Language is a broader system of expressing and receiving information, such as being able to understand gestures.
Possible causes. A variety of problems may cause language and speech delays, including:
- Exposure to more than one language -- which can cause mild delays in toddlers but not delays by the time they reach school age
- A learning disability
- Child abuse or neglect
- A problem with the muscles controlling speech -- a disorder called dysarthria
- Hearing loss, which may occur in children who have severe middle ear infections or occur as a result of certain medications, trauma, or genetic disorders
- Autism spectrum disorders -- a group of neurological disorders that may involve impaired communication as well as impaired social interaction and cognitive skills
- No cause can be found
Types of treatment. If you or your child’s doctor suspects a speech delay, a referral will be placed for an evaluation by a speech-language pathologist. This specialist may test your child’s hearing, assess your child’s receptive and expressive language, and then plan for speech therapy sessions with your child. If the delay is mild, the specialist or doctor may suggest that you:
- Communicate more with your child -- talk, sing, and encourage repetition.
- Read daily to your child.
- Reinforce speech and language throughout the day.
- Get treatment for middle ear infections.
Warning signs of speech or language delays. Contact your child's doctor if your child has any of the following signs at the age that's indicated. In addition, watch for any loss of skills that have already been learned.
By 3 to 4 months, contact the doctor if your child:
- Does not respond to loud noises
- Does not babble
- Begins babbling but does not try to imitate sounds (by 4 months)
By 7 months, contact the doctor if your child:
- Does not respond to sounds
By 1 year, contact the doctor if your child does not:
- Use any single words (like "mama")
- Understand words like "bye-bye" or "no"
By 2 years, contact the doctor if your child:
- Cannot speak at least 15 words
- Does not use two-word phrases without repetition; can only imitate speech
- Does not use speech to communicate more than immediate needs
Vision Developmental Delays
Until 6 months, a newborn's vision is normally blurry. Then it improves as the child begins to coordinate sight in both eyes. But sometimes, this does not happen or other vision problems show up.
Possible causes of vision delays. Refractive errors, such as nearsightedness and farsightedness, are common in children. Other eye problems include:
- Amblyopia (lazy eye), poor vision in one eye that may also appear to turn outward
- Infantile cataracts -- a clouding of the eye's lens -- or another inherited problem (these problems are rare)
- Retinopathy of prematurity, an eye disease that sometimes affects premature infants
- Strabismus -- also called cross eyes -- eyes that turn in, out, up, or down
Types of treatment for vision delays. Early treatment can help correct many vision problems. Depending on the eye problem your child has, they may need:
- Glasses or contact lenses
- Special glasses
- Surgery
- An eye patch
Warning signs of vision problems. Contact your child's doctor if your child has any of the following signs at the age that’s indicated. In addition, watch for any loss of skills that have already been learned.
By 3 months, contact the doctor if your child:
- Does not follow moving objects with their eyes
- Does not notice hands (by 2 months)
- Has trouble moving one or both eyes in all directions
- Crosses eyes most of the time
By 6 months, contact the doctor if your child:
- Has one or both eyes turning in or out all the time
- Experiences constant tearing or eye drainage
- Does not follow near objects (1 foot away) or far objects (6 feet away) with both eyes
If your child's doctor notes any problems, the doctor may refer your child to an ophthalmologist for further evaluation.
Motor Skill Developmental Delays in Children
Motor skill developmental delays may be related to problems with gross motor skills, such as crawling or walking, or fine motor skills, such as using fingers to grasp a spoon.
Possible causes of motor skill delays. Children who are born prematurely may not develop muscles at the same rate as other children.
Other possible causes of motor delays include:
- Ataxia, a defect that impairs muscle coordination
- Cerebral palsy, a condition caused by brain damage before birth
- Cognitive delays
- Myopathy, a disease of the muscles
- Problems with vision
- Spina bifida, a genetic condition causing partial or total paralysis of the lower part of the body
Types of treatment for motor skill delays. Your child's doctor may suggest taking certain steps at home to encourage more physical activity. Your child may also need physical therapy for gross motor delays. Certain types of physical or occupational therapy may help with fine motor problems or with sensory processing disorder, which happens when the brain has trouble receiving and responding to information that comes in through the senses.
Warning signs of motor skill delays. Contact your child's doctor if your child has any of the following signs at the age that's indicated. In addition, watch for any loss of skills that have already been learned.
By 3 to 4 months, contact the doctor if your child does not:
- Reach for, grasp, or hold objects
- Support their head well
- Bring objects to their mouth (by 4 months)
- Push down with legs when their feet are placed on a firm surface (by 4 months)
By 7 months, contact the doctor if your child:
- Has stiff and tight or very floppy muscles
- Flops their head when pulled into a sitting position
- Reaches with one hand only or does not actively reach for objects
- Has trouble getting objects to their mouth
- Doesn't roll over in either direction (by 5 months)
- Cannot sit up without help (by 6 months)
- Does not bear weight on their legs when you pull them up to a standing position
By 1 year, contact the doctor if your child:
- Does not crawl
- Drags one side of their body while crawling
- Cannot stand when supported
By 2 years, contact the doctor if your child:
- Cannot walk (by 18 months)
- Does not develop a heel-to-toe walking pattern or walks only on toes
- Cannot push a wheeled toy
Social and Emotional Developmental Delays in Children
Children may have problems interacting with adults or other children, called social and/or emotional developmental delays. Usually these problems show up before a child begins school.
Possible causes. Some causes of social and emotional delays include:
- Neglect from early institutionalization or parental neglect
- Ineffective parenting or attachment problems
- Cognitive delays
- An unknown cause
Another common cause of social and emotional developmental delays falls under the umbrella diagnosis autism spectrum disorder (ASD). This was previously referred to as pervasive developmental disorder (PDD), autism, Asperger's, and other names. ASD includes disorders that can cause a child to have a hard time communicating, have repetitive behaviors, and have language problems.
Types of treatment. There is no known cure for these conditions. But treatment may include:
- Special types of behavioral and skill-oriented therapy
- Medication that may help with some problematic behaviors
As with most types of delays, early treatment can make a big difference in the progress your child makes. Depending upon the diagnosis, treatment may also include play therapy or steps to aid attachment between parent and child.
Warning signs of social or emotional delays. Contact your child's doctor if your child has any of the following signs at the age that’s indicated. In addition, watch for any loss of skills that have already been learned.
By 3 months, contact the doctor if your child does not:
- Smile at people
- Pay attention to new faces, or seems frightened by them
By 7 months, contact the doctor if your child:
- Refuses to cuddle
- Shows no affection for parents or caregivers
- Shows no enjoyment around people
- Cannot be comforted at night (after 5 months)
- Does not smile without prompting (by 5 months)
- Does not laugh or squeal (by 6 months)
- Shows no interest in games of peek-a-boo (by 8 months)
By 1 year, contact the doctor if your child shows no:
- Back-and-forth sharing of sounds, smiles, or facial expressions (at 9 months)
- Back-and-forth gestures, such as waving, reaching, or pointing
Cognitive Developmental Delays in Children
Problems with thinking, or cognitive delays, may be due to one or more of these reasons:
- Genetic defects
- Significant medical problems before birth
- Exposure to something harmful in the environment, such as a toxin
- Neglect
Possible causes. Causes of cognitive delays include:
- A wide range of different learning disabilities
- Exposure to alcohol or toxins before birth or afterward, including lead poisoning
- Institutionalization or neglect during infancy or early childhood
- Down syndrome and other genetic disorders
- Autism spectrum disorder
- Severe newborn medical problems
- No known cause
Types of treatment for cognitive delays. As with most types of developmental delays, early treatment can make a big difference in the progress your child makes. Educational intervention can help your child develop specific cognitive skills. Educators and therapists may use play therapy or behavioral therapy and may also recommend specific steps you can take at home to help your child.
Warning signs of cognitive delays. Contact your child's doctor if your child has any of the following signs at the age that's indicated. In addition, watch for any loss of skills that have already been learned.
By 1 year, contact the doctor if your child does not:
- Search for objects that are hidden while they watch
- Use gestures, such as waving
- Point to objects or pictures
By 2 years, contact the doctor if your child does not:
- Know the function of common objects, such as a hairbrush, telephone, or spoon
- Follow simple instructions
- Imitate actions or words
What to Do if You Suspect a Developmental Delay in Your Child
Remember: There is a wide range of normal development in children. Most developmental delays in children are not serious, and children eventually catch up. Even children who do have serious delays can make big improvements when treatment begins as early as possible.
The key is to intervene early. The federal Individuals With Disabilities Act entitles eligible infants and toddlers to services such as speech or physical therapy, social services, and dietary guidance. And children until age 21 can receive special public education tailored for their developmental delays.