What Is a Developmental Delay?
A developmental delay is when your child falls behind their peers in one or more areas of emotional, mental, or physical growth. If your child' development is delayed, early treatment is the best way to help them make progress or even to catch up.
There are many 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, there is a significant delay 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 delays are different from developmental disabilities, which include such conditions as cerebral palsy, hearing loss, and autism spectrum disorder, which usually last for life.
Developmental Delay Causes
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
- A mother's alcohol or drug use during pregnancy
- Physical abuse or neglect
- Lack of oxygen during delivery
Speech and Language Delays
These aren't unusual delays in toddlers. Language and speech problems are the most common 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 happen in children who have severe middle ear infections or 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. 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 ages shown. Also, watch for any loss of skills that have already been learned.
By 3 to 4 months, contact the doctor if your child:
- Doesn't respond to loud noises
- Doesn't babble
- Begins babbling but doesn't try to imitate sounds (by 4 months)
By 7 months, contact the doctor if your child:
- Doesn't respond to sounds
- Doesn't take turns making sounds with you
By 1 year, contact the doctor if your child doesn't:
- Use any single words (like "mama")
- Understand words like "bye-bye" or "no"
By 2 years, contact the doctor if your child:
- Can't speak at least 15 words
- Doesn't use two-word phrases without repetition; can only imitate speech
- Doesn't use speech to express more than immediate needs
- Doesn't use more movements other than waving or pointing, like shaking their head "yes" or "no"
- Can't point to two or more body parts when asked
Vision Developmental Delays
Newborn baby vision is normally blurry. Then it improves by about 3 months of age as your child's eyes begin to work together to track and focus on things. But sometimes, this doesn't 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 ages shown. Also, watch for any loss of skills that have already been learned.
By 3 months, contact the doctor if your child:
- Doesn't follow moving objects with their eyes
- Doesn't 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
- Has constant tearing or eye drainage
- Doesn't follow near objects (1 foot away) or far objects (6 feet away) with both eyes
- Doesn't look at and/or touch the image of themselves in the mirror
If your child's doctor notes any problems, the doctor may refer your child to an ophthalmologist for further evaluation.
Motor Skill Delays
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 ages shown. Also, watch for any loss of skills that have already been learned.
By 3 to 4 months, contact the doctor if your child doesn't:
- Reach for, grasp, or hold objects
- Support their head well
- Bring objects and hands to their mouth (by 4 months)
- Use arms to swing at toys
- Push onto forearms or elbows while on their stomach
- 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)
- Doesn't bear weight on their legs when you pull them up to a standing position
- Doesn't use straight arms to push up when on their stomach (by 6 months)
- Doesn't bear weight on hands for support when sitting (by 6 months)
By 1 year, contact the doctor if your child:
- Can't get to sitting position by themselves and sit without help (9 months)
- Doesn't crawl
- Drags one side of their body while crawling
- Can't stand when supported
- Doesn't walk while holding on to furniture
By 2 years, contact the doctor if your child:
- Can't walk (by 18 months)
- Doesn't develop a heel-to-toe walking pattern or walks only on toes
- Can't push a wheeled toy
- Doesn't run
- Can't go up a few steps without help
- Can't use a spoon
Social and Emotional Delays
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, like living in an orphanage, 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 for 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 problem behaviors
As with most types of delays, early treatment can make a big difference in the progress your child makes. Depending on the diagnosis, treatment may also include play therapy or steps to help with 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 ages shown. Also, watch for any loss of skills that have already been learned.
By 3 to 4 months, contact the doctor if your child doesn't:
- Smile at people
- Make a small laugh when you try to make them laugh
- Look at you, make sounds, or make movements to get your attention
- 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
- Can't be comforted at night (after 5 months)
- Doesn't smile without prompting (by 5 months)
- Doesn't laugh or squeal (by 6 months)
- Shows no interest in games of peekaboo (by 8 months)
- Doesn't like to look at self in mirror (by 6 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
- Interest in playing games like patty-cake
Cognitive Delays
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. Other potential causes of cognitive delays include:
- A wide range of learning disabilities
- Exposure to alcohol or toxins before birth or afterward, including lead poisoning
- Living in an institution, like an orphanage or a children's home, 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 ages shown. Also, watch for any loss of skills that have already been learned.
By 1 year, contact the doctor if your child doesn't:
- Search for objects that are hidden while they watch
- Use gestures, such as waving
- Point to objects or pictures
- Put things into a container, like a small toy into a cup
By 2 years, contact the doctor if your child doesn't:
- Know the function of common objects, such as a hairbrush, telephone, or spoon
- Follow simple instructions
- Imitate actions or words
- Hold an object in one hand while using the other hand, like taking a top off a bottle
- Play with more than one toy at a time
- Use buttons, knobs, or other parts on a toy
How to Help a Child With Developmental Delays
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 step in early. The Individuals with Disabilities Education Act (IDEA) says eligible infants and toddlers should get services such as speech or physical therapy, social services, and dietary guidance. IDEA also says children younger than 3 years old who are at risk of developmental delay should be eligible for certain early intervention services without a confirmed diagnosis.
And children until age 21 can receive special public education specially made for their developmental delays.