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By Kathy
Mathews, M.D.
A child with developmental delay is a child who is not achieving certain
skills as quickly as expected. In other words, 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
developmental 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.
1. 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.
2. 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 labeled A, B, and C
demonstrate possible patterns of development. Each line shows a different
degree of developmental delay. Line (A) illustrates mild developmental delay
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. 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
Copyright protected material used with permission of the author and the
University of Iowa's Virtual Hospital,
www.vh.org
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