Overview

A child who is very slow to achieve all milestones or lags behind on a specific developmental domain may have underlying pathology.

• If <30 weeks, correct for gestational age, this is used until child is 2 years old.

• Global Developmental Delay → slow in all developmental domains. May indicate underlying diagnosis such as down’s syndrome, fragile x syndrome, fetal alcohol syndrome, rett syndrome, metabolic disorders.

• Gross Motor Delay → cerebral palsy, ataxia, myopathy, spina bifida, visual impairment.

  • Developmental Gross Motor Milestones

• Fine Motor Delay → dyspraxia, cerebral palsy, muscular dystrophy, visual impairment, congenital ataxia.

  • Developmental Fine Motor Milestones

• Language Delay → hearing impairment, learning disability, neglect, autism, cerebral palsy.

  • Developmental Speech and Hearing Milestones

• Personal and Social Delay → emotional/social neglect, parenting issues, autism.

  • Developmental Social Milestones

  Median Age (age at which half the population achieves a skill) and Limit Age (age at which 95% of the population develop a certain skill).

• Hearing Testing

  • Newborn → otoacoustic emission test (part of newborn hearing screening programme).
    • If Abnormal (Newborn + Infants) → auditory brainstem response test.
  • 6-9 Months → distraction test.

  • 3 Years → pure tone audiometry.

• Child with delayed speech → organise hearing assessment before making an onward referral to speech and language therapy.

Making Diagnosis

Clinical Features

Investigations

• Global Development Delay:
  • 1st Line → Genetic Karyotyping.

Management Plan