Does my Child has Developmental delay
Dr. Adil Hamamsy
Medcare Sharjah
Every child is unique and develops differently. Here is some important information on key developmental milestones that parents can use to help monitor their child’s development and identify any red flags
Signs and Symptoms of Developmental Delays:
In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that identify the behavioral or developmental markers suggesting the need for further evaluation.
For a parent, these “red flags” should serve as a catalyst prompting developmental screening to ensure that the child is on the right developmental path.
If your child shows two or more of these signs, please ask your pediatric healthcare provider for an immediate evaluation. It is also highly recommended that whenever a parent suspects that there may be such concerns that you go through a Referral Process to ensure that your child gets the help he or she needs.
Doctors used to (and some still do) take a “wait and see” approach, but today it is clear that early intervention is the key to the greatest possible outcomes for children with such issues.
The Red Flags Early Identification Guide will:
• Assist with early identification of developmental concerns in a child’s developmental domains (social/emotional;
communication; fine motor/cognition/self-care; and gross motor) that are impacting on their day-to-day functioning.
• Assist with clinical decision making when used in conjunction with other evidence-based screening tools,
such as the Parents Evaluation of Developmental Status (PEDS) and/or Ages and Stages Questionnaire (ASQ).
The guide is not a standardised screening tool and should not replace standardised assessment.
• Facilitate conversation with parents/carers around their child’s development and the benefits of early identification
and early intervention in particular when a parent may not be concerned about their child’s development.
• Facilitate conversation about a plan of action and where to obtain a more detailed developmental screen
and/or assessment.
• It is recommended that this resource be used in discussions with parents/carers about typical development and parental understanding/expectations of development.
This process facilitates identification of parental concerns/questions about a child’s growth, development and activities of daily living.
• A single red flag is not always an indication for concern or referral, rather the functional impact of one or more
red flags on the child’s everyday functioning and participation, should be taken into consideration.
• The negative statements of ‘does not…’ and ‘not able to…’ have been used to highlight a delay/lack of acquisition of skills.
The red flags have been linked to the absence or delay of skill/s which lie at the boundary of the typical developmental range.
Therefore the guide should not be used as a ‘milestones’ screener, as the red flags are not developmental milestones.
• This second edition includes revised red flags and directions for appropriate use.
Stimulate your child’s development with PLAY!
Partner: be your child’s partner in play.
Follow their lead and wait for them to take their turn.
Look and listen: adjust the play to your child’s level and follow their instructions.
Add: introduce new ideas to guide, support and expand on the play your child is leading.
You and your child together: get down on their level and enjoy being together.
Ways to PLAY?
• Use your senses: touch, listen and look at objects (e.g. sand, leaves and toys)
• Move about: help your child move, push and pull objects
• Out and about: go to libraries, talk about books; visit parks – climb, throw
and kick balls, ride a bike
• Talk and problem solve, e.g. with puzzles
• Use imagination: play out simple ideas and gradually introduce different scenarios or roles; play with dolls/teddies/figurines; creatively use boxes or containers as play objects (e.g. as a car)
• Explore: use a variety of things for your child to explore and play with e.g. bubbles, pots and pans, play doh. Your cupboards are full of exciting things!
Normal Developmenal milstones By age
1-4 months:
Physical Development:
Makes jerky, quivering arm thrusts
Brings hands within range of eyes and mouth
Moves head from side to side while lying on stomach
Head flops backward if unsupported
Keeps hands in tight fists
Strong reflex movements
Visual & Hearing Development:
Focuses 8 to 12 inches (20.3 to 30.4 cm) away
Eyes wander and occasionally cross
Prefers black-and-white or high-contrast patterns
Prefers the human face to all other patterns
Hearing is fully mature
Recognizes some sounds
May turn toward familiar sounds and voices
Sensory Development:
Prefers sweet smells
Avoids bitter or acidic smells
Recognizes the scent of his own mother’s breastmilk
Prefers soft to coarse sensations
Dislikes rough or abrupt handling
Red Flags:
Sucks poorly and feeds slowly
Doesn’t blink when shown a bright light
Doesn’t focus and follow a nearby object moving side to side
Rarely moves arms and legs; seems stiff
Seems excessively loose in the limbs, or floppy
Lower jaw trembles constantly, even when not crying or excited
Doesn’t respond to loud sounds
4-7 mo:
Physical Development:
Raises head and chest when lying on stomach
Supports upper body with arms when lying on stomach
Stretches legs out and kicks when lying on stomach or back
Opens and shuts hands
Pushes down on legs when feet are placed on a firm surface
Brings hand to mouth
Takes swipes at dangling objects with hands
Grasps and shakes hand toys
Visual & Hearing Development:
Watches faces intently
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
Smiles at the sound of your voice
Begins to babble
Begins to imitate some sounds
Turns head toward direction of sound
Social & Emotional Development:
Begins to develop a social smile
Enjoys playing with other people and may cry when playing stops
Becomes more communicative and expressive with face and body
Imitates some movements and facial expressions
Red Flags:
Doesn’t seem to respond to loud sounds
Doesn’t notice her hands by two months
Doesn’t smile at the sound of your voice by two months
Doesn’t follow moving objects with her eyes by two to three months
Doesn’t grasp and hold objects by three months
Doesn’t smile at people by three months
Cannot support her head well at three months
Doesn’t reach for and grasp toys by three to four months
Doesn’t babble by three to four months
Doesn’t bring objects to her mouth by four months
Begins babbling, but doesn’t try to imitate any of your sounds by four months
Doesn’t push down with her legs when her feet are placed on a firm surface by four months
Has trouble moving one or both eyes in all directions
Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
Still has the tonic neck reflex at four to five months
7-12 mo:
Physical Development:
Rolls both ways (front to back, back to front)
Sits with, and then without, support of her hands
Supports her whole weight on her legs
Reaches with one hand
Transfers object from hand to hand
Uses raking grasp (not pincer)
Visual Development:
Develops full color vision
Distance vision matures
Ability to track moving objects improves
Language Development:
Responds to own name
Begins to respond to “no”
Distinguishes emotions by tone of voice
Responds to sound by making sounds
Uses voice to express joy and displeasure
Babbles chains of consonants
Cognitive Development:
Finds partially hidden object
Explores with hands and mouth
Struggles to get objects that are out of reach
Social & Emotional Development:
Enjoys social play
Interested in mirror images
Responds to other people’s expressions of emotion and appears joyful often
Red Flags:
Seems very stiff, with tight muscles
Seems very floppy, like a rag doll
Head still flops back when body is pulled up to a sitting position
Reaches with one hand only
Refuses to cuddle
Shows no affection for the person who cares for him
Doesn’t seem to enjoy being around people
One or both eyes consistently turn in or out
Persistent tearing, eye drainage, or sensitivity to light
Does not respond to sounds around him
Has difficulty getting objects to his mouth
Does not turn his head to locate sounds by four months
Doesn’t roll over in either direction (front to back or back to front) by five months
Seems inconsolable at night after five months
Doesn’t smile spontaneously by five months
Cannot sit with help by six months
Does not laugh or make squealing sounds by six months
Does not actively reach for objects by six to seven months
Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
Does not bear some weight on legs by seven months
Does not try to attract attention through actions by seven months
Does not babble by eight months
Shows no interest in games of peekaboo by eight months
1-2 years
Physical Development:
Gets to sitting position without assistance
Crawls forward on belly by pulling with arms and pushing with legs
Assumes hands-and-knees position
Creeps on hands and knees supporting trunk on hands and knees
Gets from sitting to crawling or prone (lying on stomach) position
Pulls self up to stand
Walks holding on to furniture
Stands momentarily without support
May walk two or three steps without support
Hand & Finger Skills Development:
Uses pincer grasp
Bangs two cubes together
Puts objects into container
Takes objects out of container
Lets objects go voluntarily
Pokes with index finger
Tries to imitate scribbling
Language Development:
Pays increasing attention to speech
Responds to simple verbal requests
Responds to “no”
Uses simple gestures, such as shaking head for “no”
Babbles with inflection
Says “dada” and “mama”
Uses exclamations, such as “oh-oh!”
Tries to imitate words
Cognitive Development:
Explores objects in many different ways (shaking, banging, throwing, dropping)
Finds hidden objects easily
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
Social & Emotional Development:
Shy or anxious with strangers
Cries when mother or father leaves
Enjoys imitating people in play
Shows specific preferences for certain people and toys
Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
May be fearful in some situations
Prefers mother and/or regular caregiver over all others
Repeats sounds or gestures for attention
Finger-feeds himself
Extends arm or leg to help when being dressed
Red Flags:
Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he watches
Says no single words (“mama” or “dada”)
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures
2-3 years
Physical Development:
Walks alone
Pulls toys behind her while walking
Carries large toy or several toys while walking
Begins to run
Stands on tiptoe
Kicks a ball
Climbs onto and down from furniture unassisted
Walks up and down stairs holding on to support
Milestones in hand and finger skills
Scribbles spontaneously
Turns over container to pour out contents
Builds tower of four blocks or more
Might use one hand more frequently than the other
Language Development:
Points to object or picture when it’s named for him
Recognizes names of familiar people, objects, and body parts
Says several single words (by fifteen to eighteen months)
Uses simple phrases (by eighteen to twenty-four months)
Uses two- to four-word sentences
Follows simple instructions
Repeats words overheard in conversation
Cognitive Development:
Finds objects even when hidden under two or three covers
Begins to sort by shapes and colors
Begins make-believe play
Social and emotional milestones
Imitates behavior of others, especially adults and older children
Increasingly aware of herself as separate from others
Increasingly enthusiastic about company of other children
Increasingly enthusiastic about company of other children
Demonstrates increasing independence
Begins to show defiant behavior
Increasing episodes of separation anxiety toward midyear, then they fade
Red Flags:
Cannot walk by eighteen months
Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
Does not speak at least fifteen words by eighteen months
Does not use two-word sentences by age two
Does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon) by fifteen months
Does not imitate actions or words by the end of this period
Does not follow simple instructions by age two
Cannot push a wheeled toy by age two
4-5 years
Physical Development:
Hops and stands on one foot up to five seconds
Goes upstairs and downstairs without support
Kicks ball forward
Throws ball overhand
Catches bounced ball most of the time
Moves forward and backward with agility
Hand & Finger Skills Development:
Copies square shapes
Draws a person with two to four body parts
Uses scissors
Draws circles and squares
Begins to copy some capital letters
Language Development:
Understands the concepts of “same” and “different”
Has mastered some basic rules of grammar
Speaks in sentences of five to six words
Speaks clearly enough for strangers to understand
Tells stories
Cognitive Development:
Correctly names some colors
Understands the concept of counting and may know a few numbers
Approaches problems from a single point of view
Begins to have a clearer sense of time
Follows three-part commands
Recalls parts of a story
Understands the concept of same/different
Engages in fantasy play
Social & Emotional Development:
Interested in new experiences
Cooperates with other children
Plays “Mom” or “Dad”
Increasingly inventive in fantasy play
Dresses and undresses
Negotiates solutions to conflicts
More independent
Imagines that many unfamiliar images may be “monsters”
Views self as a whole person involving body, mind, and feelings
Often cannot distinguish between fantasy and reality
Red Flags:
Cannot throw a ball overhand
Cannot jump in place
Cannot ride a tricycle
Cannot grasp a crayon between thumb and fingers
Has difficulty scribbling
Cannot stack four blocks
Still clings or cries whenever his parents leave him
Shows no interest in interactive games
Ignores other children
Doesn’t respond to people outside the family
Doesn’t engage in fantasy play
Resists dressing, sleeping, using the toilet
Lashes out without any self-control when angry or upset
Cannot copy a circle
Doesn’t use sentences of more than three words
Doesn’t use “me” and “you” appropriately
5 years
Physical Development:
Stands on one foot for ten seconds or longer
Hops, somersaults
Swings, climbs
May be able to skip
Hand & Finger skills Development:
Copies triangle and other geometric patterns
Draws person with body
Prints some letters
Dresses and undresses without assistance
Uses fork, spoon, and (sometimes) a table knife
Usually cares for own toilet needs
Language Development:
Recalls part of a story
Speaks sentences of more than five words
Uses future tense
Tells longer stories
Says name and address
Cognitive Development:
Can count ten or more objects
Correctly names at least four colors
Better understands the concept of time
Knows about things used every day in the home (money, food, appliances)
Social & Emotional Development:
Wants to please friends
Wants to be like her friends
More likely to agree to rules
Likes to sing, dance, and act
Shows more independence and may even visit a next-door neighbor by herself
Aware of sexuality
Able to distinguish fantasy from reality
Sometimes demanding, sometimes eagerly cooperative
Red Flags:
Exhibits extremely fearful or timid behavior
Exhibits extremely aggressive behavior
Is unable to separate from parents without major protest
Is easily distracted and unable to concentrate on any single activity for more than five minutes
Shows little interest in playing with other children
Refuses to respond to people in general, or responds only superficially
Rarely uses fantasy or imitation in play
Seems unhappy or sad much of the time
Doesn’t engage in a variety of activities
Avoids or seems aloof with other children and adults
Doesn’t express a wide range of emotions
Has trouble eating, sleeping, or using the toilet
Can’t differentiate between fantasy and reality
Seems unusually passive
Cannot understand two-part commands using prepositions (“Put the cup on the table”; “Get the ball under the couch.”)
Can’t correctly give her first and last name
Doesn’t use plurals or past tense properly when speaking
Doesn’t talk about her daily activities and experiences
Cannot build a tower of six to eight blocks
Seems uncomfortable holding a crayon
Has trouble taking off her clothing
Cannot brush her teeth efficiently
Cannot wash and dry her hands