Developmental delay in children

Movement: doesn't hold the head up at 4 months; doesn't sit without support at 9 months; isn't walking at 18 months; uses one side less than the other; muscles are very loose (a “floppy baby”) or very stiff; walks on tiptoes all the time.

Speech: no babbling and no pointing at 12 months; no meaningful words at 18 months; doesn't combine two words at 24 months; strangers can't understand the child's speech at 3 years; has lost words they used to say.

Social and cognitive: doesn't turn to their name, doesn't make eye contact, doesn't look at what you point to, doesn't play with toys in the way they are meant to be used, doesn't understand simple instructions.

The most important sign: losing skills the child used to have (regression). In this case the exam is not postponed.

Often there is more than one cause, and a cause is not found in every child. The main groups are: perinatal factors (preterm birth, low birth weight, lack of oxygen at birth, severe newborn jaundice), genetic and metabolic conditions, malformations of brain development, hearing and vision problems, nutritional deficiencies (including iron), severe chronic illness, and an under-stimulating environment. For “late talkers” whose delay is only in speech, the outcome is most strongly shaped by vocabulary size at toddler age, language comprehension, and the family environment; sex and a family history of speech delay are not proven predictors.

1. Detailed history: pregnancy, birth, birth weight, the first months, developmental problems in the family, and when the child gained each skill.
2. Neurological exam: muscle tone, reflexes, symmetry, head circumference over time, skin findings, dysmorphic features.
3. Standardized developmental assessment with an age-appropriate scale; autism screening at 18–24 months.
4. Hearing check, for every child with delayed speech.
5. Additional tests when indicated: blood tests (including iron and thyroid), genetic testing, MRI, and EEG (only if there are seizures or regression).

The goal is twofold: to find a treatable cause (for example, hearing loss, hypothyroidism, iron deficiency) and to start a support program without delay, even if the cause is not yet clear.

The brain is most plastic in the first years, so early intervention brings the greatest benefit. The program is built around the child's profile: physical therapy and occupational therapy for motor delay, a speech-language therapist and a language-rich home for speech delay, developmental-behavioral programs for social-communication delay, and a combined approach when several areas are delayed. The neurologist builds the plan, follows progress, and re-assesses when needed. In babies with suspected cerebral palsy, the diagnosis can be made with modern tools before 6 months; more here: cerebral palsy.