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When Should You Be Concerned About Your Child's Development?



Do you find yourself frequently wondering whether your child is developing as they should? Pathfinder Health is here to help!


Although worrying is a part of parenting, stressing over your child's development doesn't have to be. We can help you understand typical developmental patterns so you can more easily notice any developmental concerns.


In this article, we'll explore the common red flags for developmental disabilities, disorders, and delays, so that you can act promptly if needed and feel reassured that you are doing everything you can to help your child thrive.


In this article:

How do we measure child development?

Developmental milestones

The 4 developmental domains

When to be concerned about your child’s development

What are developmental delays?

Motor delays

Speech and language delays

Social and emotional delays

Cognitive delays

Global delays

A note about autism

What should you do if you are concerned about your child’s development?

Talk to your healthcare provider

Self-refer to Early Intervention Services

The importance of early identification

How Pathfinder Health Can Help



How do we measure child development?

Developmental milestones

Developmental milestones are tasks or skills that most children can do by a certain age. Generally, children achieve developmental milestones in a set pattern: for example, they crawl, then stand, then walk. Monitoring milestones is a way of tracking a child's development and making sure that they are progressing neurotypically. For more information about milestones and why they're important, check out Pathfinder Health's Milestones Matter.


The 4 developmental domains

Pathfinder Health divides child milestones into four major developmental domains:

(1) motor/movement,

(2) social and emotional,

(3) speech and language,

(4) cognitive.


Each one of these areas is equally important in helping your child reach full developmental maturity.





When to be concerned about your child’s development

Developmental delays can manifest themselves in a multitude of ways. Parents should be aware of the many different indicators of concern so they can promptly discuss them with their healthcare provider.


The following may be indicators of a developmental concern:

  • Poor eye contact or social skills

  • Lack of interest in toys or playing with others

  • Very floppy or stiff and tight muscles

  • Hyperactivity, impulsivity, or aggressive behavior

  • Regression of skills your child already reached

However, the primary indicator of a developmental concern is that your child does not meet a developmental milestone when expected, known as a developmental delay.


We discuss developmental delays in more detail below.




What are developmental delays?

For some of the most significant developmental milestones, failure to achieve the milestone by a certain age range is a cause for concern and warrants further evaluation.


Note that there is a difference between a developmental delay and simply being late to achieve a milestone.


For all milestones, there is an age range where the majority of children will achieve the milestone, so being at the later end of the typical range is not concerning in itself.


For example, most children walk between 12 and 15 months, so not walking at 15 months should not cause concern. However, by 18 months nearly all late walkers will have taken their first steps if there is no underlying developmental delay.


Types of developmental delay

Developmental delays are categorized based on the four developmental domains listed above. A child with a delay in a particular domain will likely have difficulty reaching the milestones in that category and will take longer to achieve them or struggle to do them correctly or at all.

We'll discuss each category of developmental delay and give examples of what a delay in each category might look like. For more information about development delays, see Understanding Developmental Delays: How Parents Can Optimize Their Child's Outcome.


Motor delays

Motor (also known as movement) delays can affect a child’s gross or fine motor skills.


Gross motor delays involve the large muscles in the body, such as those in the arms, legs, and torso. Examples of gross motor delays include:

  • A baby struggles to hold up their head, roll, or crawl

  • An older child doesn't walk, climb stairs, or throw a ball

Fine motor delays affect the small muscles in the hands and fingers as well as the mouth, tongue, and jaw. Examples of fine motor delays include:

  • A child has trouble grasping small objects, using a spoon, or writing

  • An older baby doesn't bang two objects together

Motor delays also affect a child’s ability to process sensory information and can manifest in a child’s inability to track an object with both eyes or respond to loud sounds.


Speech and language delays

Speech and language delays can affect a child’s ability to both communicate with and understand other people.


A language delay might involve challenges with receptive language and/or expressive language.

  • Receptive language means understanding words and concepts. A child with a delay might not respond to their name or be able to follow simple spoken instructions.

  • Expressive language refers to the ability to communicate one's thoughts. A child with a delay might struggle to combine words to make phrases or speak in sentences by the expected age.


A speech delay is trouble articulating words and being understood by others. A child with a delay might not babble, say their first words, or speak intelligibly by the expected age.



Social and emotional delays

Social and emotional delays affect how a child interacts with other people, interprets others’ emotions, and manages their own emotions. Signs of social and emotional delay might include:

  • Trouble reading social cues or maintaining conversations

  • Indifference to other people

  • Failure to point or return gestures such as waves and smiles

  • Difficulty regulating emotions, sometimes leading to extended tantrums when faced with a socially or emotionally demanding situation


Cognitive delays

Cognitive delays are delays in a child's ability to think, learn, and remember. Signs of cognitive delay might include:

  • Difficulty following simple instructions, solving problems, paying attention, and sitting still

  • A delay in any other developmental category--for example, late crawling, trouble speaking, and weak listening skills can all be signs of cognitive delay

  • A lack of age-appropriate self-help skills, such as using the toilet


Global delays

Global delay” is used in reference to children under age five to describe a significant delay in two or more of the developmental domains discussed above. Because it refers to delays in multiple areas of functioning, global delay does not have its own specific set of symptoms.



A note about autism

It is important to understand that autism spectrum disorder (ASD) is not the same as a developmental delay. Most children with ASD do show some degree of developmental delay in at least one area.


For example, they might not smile or interact with others (social and emotional delay) or have difficulty communicating (speech and language delay). However, not every child with a developmental delay has ASD.




What should you do if you are concerned about your child’s development?


Talk to your healthcare provider

The short answer: Anytime you have a concern about your child's development (or any aspect of their health!) you should discuss it with your healthcare provider as soon as possible. They can perform a developmental screening to determine if your child is meeting the expected milestones and may refer you to a specialist for additional evaluation.


Self-refer to Early Intervention Services

Parents can self-refer to Early Intervention Services (EIS), free programs provided by the states. A doctor's referral is not required for EIS. You can even seek EIS before your child receives a diagnosis--it is available to any child with a certain degree of developmental delay, as defined by the particular state.

You can find more information and links to EIS on the Pathfinder Health app or the CDC website.


The importance of early identification

The first five years after your child’s birth are particularly crucial to their health, well-being, and the overall trajectory of their life.


In fact, 90% of your child's brain develops by age five. This is the time when it has the highest neuroplasticity (the brain’s ability to essentially "rewire" itself to function in a different way). This flexibility means that treatments and interventions have the greatest impact during the early years, especially birth to age three.


So if you have any developmental concerns about your child, don't wait! The earlier any issues are detected, the earlier your child can begin treatment and the more effective that treatment is likely to be.


Early intervention services can help your young child learn the skills they need to be successful in school and life, reducing the need for more costly special education and related services later on, and can even change your child's developmental path. The key is to identify concerns at the earliest possible age.




How Pathfinder Health Can Help

By regularly using the Pathfinder Health app, you can feel reassured that you are keeping track of your child's milestones--when they happen, how frequently they occur, and what else to look for.


When it comes to developmental health, it’s often the absence of something normal vs. the presence of something abnormal that indicate red flags.


So knowing where your child stands, and what may be missing (which can happen at any age), is important in identifying developmental delays.


When you know what your child has achieved, you can help them where they need it and follow up more quickly on any concerns, which provides invaluable peace of mind for parents.





Sources:

1. Choo YY, Agarwal P, How CH. Developmental delay: identification and management at primary care level. Singapore Med J. 2019 Mar; 60(3): 119–123.

2. Habibullah H, Albradie R, Bashir S. Identifying pattern in global developmental delay children: A retrospective study at King Fahad specialist hospital, Dammam (Saudi Arabia). Pediatr Rep. 2019 Dec 2; 11(4): 8251.

3. Vitrikas K, Savard D, Bucaj M. Developmental Delay: When and How to Screen. Am Fam Physician. 2017;96(1):36-43.





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