When should you be worried about delayed milestones?

When we have a new baby in the family, we expect the baby to meet certain milestones at certain times. And when that doesn’t happen, it becomes a cause for concern.

Some delays are OK, and should not be a reason to get into a frenzy, but other times, it could point to a bigger underlying issue. 

“There is a range of normal when you’re looking at developmental milestones. Every baby does not roll over exactly at four months. Every baby is a little different”, says Dr Suan Buttross, a paediatrician.

“We don’t become concerned unless a child falls outside the range when 95 per cent of children should be doing that particular skill, whether it’s saying first words or crawling or standing.” Although it can be quite nerve-racking to observe other children achieving milestones before yours, some delays are not necessarily a reason to panic. Sometimes, all a baby needs is monitoring and company of other children so that they may know how to put words together or socialise.

A child is considered to have an unusual development when:

When there is a delay. This is when a child attains milestones at a slower pace than expected for a particular age range.

When there is a deviation. This is when a child develops differently or opposite from the expected.

When there is dissociation. This is when a child lacks the normal integration of thoughts, feelings and experiences where consciousness and memory is concerned.

When there is regression. This is when a child loses previously gained skills or fails to acquire new ones.

Other than biological factors, what else can cause delays?

In addition to biological factors, caregiver’s responsiveness and parent-child interactions seem to have been found to contribute to child development. Studies have found that better parent-child relation, higher education and lower levels of maternal depression seem to have a positive impact on a child’s development. With many Kenyan households having both parents working, and homes under the care of domestic managers, handling and engagement with children has shifted to be the responsibility of the latter. In fact, a study done in Kariobangi and Kangemi in 2018 highlighted insights from teachers and nurses providing appropriate parenting for school going children when caregivers were unable to. This is attributed to family level barriers such as lack of parenting skills, financial constraints, domestic violence and lack of social support that affect children’s mental health challenges.

Published research points to a 10 – 15 per cent occurrence of developmental delays in pre-school children globally. There are four main areas/domains where development delays may manifest:

Motor development; unusual motor movement or coordination

Speech and language development; stuttering, unclear speech, poor vocabulary, late speaking and dyslexia.

Social and emotional development including hyperactivity and behavioural disorder

Cognitive and problem-solving capabilities- profound, severe, moderate or mild intellectual disability.

Developmental delays can be based on a single delay or a significant delay in tow or more domains—global developmental delay. Some children may lose already acquired skills or maybe impaired to develop any new skills. However, not all children will manifest severe lifelong disabilities even after diagnosis.

Causes of development delays

1.  Before birth

The common causes of developmental delays in children occurring in the prenatal stage include:

·         Toxins such as alcohol, cigarette smoke, and cytotoxic drugs consumed by the mother.

·         Maternal infections early in pregnancy such as toxoplasmosis, cytomegalovirus or rubella.

·         Malaria or HIV infection late in pregnancy.

·         Genetic disorders including Down syndrome, fragile X syndrome and other chromosomal deletions or duplications.

·         Abnormal brain development.

2.    Shortly after birth

·         Premature birth due to intrauterine growth retardation or bleeding.

·         Metabolic disorders such as hypoglycemia or bilirubin-induced neurological dysfunction.

3.    Six weeks after birth (Postnatal period)

·         Meningitis and encephalitis infection.

·         Dehydration and hypoglycemia.

·         Accidental or non-accidental trauma to the head.

·         Near drowning experience or suffocation.

·         Stroke.

·         Malnutrition and mineral deficiencies.

·         Mental disorder in the mother.