A child with developmental delay is a child who is not achieving
certain skills as quickly as expected. In otherwords, the child is
not reaching developmental landmarks at the usual age.
One subset of children with developmental delay includes those
with very early onset of their disorder. These children have delay in
walking and other motor skills and their motor difficulties do not
get worse over time. This is often referred to as "cerebral palsy."
Conditions that are genetic (inherited) are not usually included in
this category. Very low birth weight infants account for many, but
not all, children who meet the criteria for "cerebral palsy."
Causes
There are numerous causes of developmental delay. One of the goals
of the Pediatric Neurologist is to identify the cause of a child's
neurologic or develomental problem. Sometimes this task is easy (for
example, if a child had obvious brain injury from a severe brain
infection), but more often it is difficult and may require a variety
of different tests. The tests we recommend are based on the
information we gather from parents and the findings on physical
examination. It often takes more than one clinic visit to identify a
specific disease, condition or syndrome. Children are constantly
changing. As we follow this pattern of change, new diagnoses may be
considered. Often, despite the tests and several clinic visits, we
are unable to identify a specific diagnosis.
There are at least two major reasons for trying to arrive at a
specific diagnosis for your child.
- We need to know what caused the developmental delay to tell
parents, siblings and other family members whether another child
with developmental delay is likely to be born in this family. Some
causes of developmental delay are inherited and others are chance
events that are unlikely to recur.
- Assigning a specific diagnosis allows us to better predict the
outcome for a given child and to anticipate any other problems
that might arise.
Outcome
Parents often wonder what developmental delay will mean for the
child as he or she gets older. This depends in part on the cause of
the developmental delay, but some generalizations are useful.
Sometimes, mildly delayed children will catch up during early
childhood. Often, however, children who are delayed continue to have
problems in adulthood. These problems may affect primarily the motor
system and lead to difficulty walking, or even the inability to walk.
Sometimes developmental delay affects primarily language or ability
to learn. Some children with developmental delay will have other
associated problems, such as abnormalities of vision or hearing,
behavioral problems, or seizures. In many children all systems are
affected. Most children who are delayed have strengths and weaknesses
and parents are often the first ones to recognize their child’s
strengths.
One way to think about the long term outcome is shown in the graph
below.
This graph illustrates the steady developmental progress from
birth through 18 years of age in the average child. At 18 years of
age, this child is expected to graduate from high school, be able to
run, read and is planning a life independent from his or her parents.
The lines labelled A, B, and C demonstrate possible patterns of
development. Each line shows a different degree of developmental
delay. Line (A) illustrates mildde lay that joins the normal line
during childhood. Lines (B) and (C) illustrate developmental delay
that never joins with the normal line. There are two important points
illustrated by this graph.
- The children in each situation make steady developmental
progress, but the rates of progress vary. Children with
developmental delay usually make steady developmental progress,
but they do things at a different age than other children.
- The end point of achievements for a child who is
developmentally delayed is often different from that of the
average child. Exactly what will be achieved in adulthood can vary
dramatically within the developmentally delayed population as it
does within the "average" population. Rate of progress during the
first 5-7 years of life generally provides a good deal of
information about approximately where a child fits in on this
illustrative graph.
Management
There is almost never a specific medicine or surgical procedure
that will correct developmental delay. The most important thing a
parent can do for a delayed child is provide a loving and stimulating
environment. We often recommend contact with the physical or
occupational therapist to assist you in providing appropriate
exercises and stimulation for your child. This is usually through the
AEA (Area Educational Agency) for families in Iowa. We may also refer
your child to other specialists for management of specific problems
such as tight muscles or abnormalities of vision. The goal of
treatment is to maximize abilities while preventing new problems as
much as is possible.
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