This is a question I am asked by many parents when they bring their children in to see me for physical therapy services. It is important to look at many factors to make this determination, for instance, underlying medical issues, prematurity, personality and size of the child and most importantly opportunity for movement unhindered.
To take each in turn, there are many medical reasons that can contribute to a developmental delay. Rather than listing them all, it would suffice to say that certain patterns will begin to emerge to indicate a problem. A parent will notice multiple areas that are “not quite right” across the spectrum of fine motor, gross motor, feeding, sleeping, etc. that occur over time as the child develops in the first year. Most children who I treat with the diagnosis cerebral palsy receive the actual diagnosis anywhere from 8 months of age to 18 months of age. It follows an observance by the doctor and the parents of multiple issues with the child. Prematurity is technically considered a medical condition which also influences when a child will develop certain skills. We establish an adjusted age on evaluation. What this means is if your child was born 8 weeks premature, you could possibly see a 2 month delay in skill acquisition up to about three years old. By three years, children are typically all doing about the same thing.
Personality and size play a huge role in how fast a child develops. In my experience, the smaller and lighter an infant is, the easier it is for him or her to progress through skills. In contrast, the heavier and bigger an infant is, a slower progression is more often observed. This is just physics. It is more difficult to lift a heavy head with weak muscles than it is a light one. It is more difficult to roll a heavy body than a light one. (No, you don’t need to put your baby on a diet! It is simply genetics.) On topic with personality, a very curious, active baby will likely develop faster than a baby with a laid back personality. My second son is a perfect example. He was very content to just sit and observe as an infant. There was nothing he needed bad enough to move for. We nick named him “The Rock” because wherever you placed him would be where he remained until you moved him again. He eventually did everything he was supposed to, he just took his sweet time about it. To this day, he is a more laid back individual who doesn’t really get ruffled about much in life.
The most important factor that you as the parent can directly influence is how much opportunity for movement your child receives. It stands to reason that the more opportunity a child receives to explore the use of his or her muscles, the faster he or she will develop. Conversely, the less opportunity the child has for movement, the slower he or she is likely to develop. For example, a mother has been bringing her infant son in for treatment of developmental delay for a few months now. He was six months old when I first evaluated him, in the higher percentile of weight and height- a big baby boy- with a laid back personality and who spent most of his time confined in a car seat, bouncer or high chair in a day care setting. With this combination of size, personality and limited opportunity for movement, it was no surprise he was not moving. I was not alarmed, nor did I detect any medical reason for the delay, but it was much more difficult to explain to the mother who was panicked that he wasn’t doing the things other children his age were doing. Even though I have been encouraging her endlessly to give him opportunity for movement and to get him out of the car seat, she consistently tells me she doesn’t have time to work with him on his exercises because she never sees him (he is in day care and she works 40-50 hours a week) and brings him in for every treatment strapped in his car seat. (Just a side note here, there comes a point when you have to boldly and blatantly say to a mother, “Leave the car seat in the car and carry your baby around!”) The simple act of actually carrying your baby gives him much opportunity to use his muscles, his balance, his eyes and many other systems in the body. So, if you are like this mother who does not have enough hours in the day to get it all done, just carry your baby around on your hip. This will help.
In conclusion, I must remind you all that medical professionals look for patterns over time and for skills to be mastered in certain ranges of time. With the advent of car seats and bouncers, etc. this range of skill acquisition is slowly ebbing towards later months for accomplishment. Observe your baby for personality and size; observe yourself and how much you are carrying your baby in your arms as opposed to pushing a stroller or carrying a car seat. Take a look at how much opportunity for movement your baby gets during the day. All of these factors, medical, prematurity, personality, size and opportunity for movement will more accurately answer the question, “Is my baby developmentally delayed?”
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