When your child is missing their milestones

Young children who have problems with both speaking and understanding speech might have GDD. — Positive Parenting

Your child is already three years old, but his speech development appears to be slower than his peers.

You notice that he has a limited vocabulary and hasn’t started speaking in phrases.

He seems to be a bit slower in meeting his major motor milestones too.

Is this a concern? What should you do?

Affected areas

Before we proceed, there are two important terms parents should know:

• Developmental milestones

  These are important skills that babies and toddlers learn as they grow up (e.g. sitting up, rolling over, crawling, walking, babbling, talking, etc), which typically occur in a certain sequence and at a certain age range.

• Developmental delay

  This is when a child reaches one or more of these milestones much later than expected, as compared with peers of the same age.

Developmental delays can be transient or persistent, and classified as mild, moderate or severe.

Now, there are many terms used to describe different patterns of developmental delay and atypical development.

Global developmental delay (GDD) is one such term.

When there are significant delays in two or more developmental domains in children under the age of five years, we describe this as GDD.

These domains include:

• Gross motor (locomotor) skills, e.g. sitting up, crawling, walking and running.
• Fine motor (hand manipulative) skills, e.g. handling tiny objects, stacking blocks, drawing and writing.
• Expressive language and speech, e.g. babbling, imitating speech sounds, putting words together to form phrases and sentences, and learning to converse.
• Receptive language and comprehension, e.g. identifying sounds, responding to names of objects and people, and taking verbal instructions.
• Cognitive skills, e.g. ability to learn new things, processing information to solve problems, organising thoughts and remembering things.
• Social and emotional skills, e.g. interacting with others, development of personal traits and feelings, and understanding and responding to the needs and feelings of others.

Causes and diagnosis

GDD may be caused by various factors or conditions such as the following:

• Prenatal (during pregnancy), e.g. genetic disorders (like Down syndrome and fragile X syndrome), problems with brain or spinal cord development, exposure to drugs/toxic substances (like alcohol and smoking) and maternal infections (like rubella, toxoplasmosis, malaria and HIV).
• Perinatal (during or immediately after birth), e.g. premature birth, complications during delivery and neonatal hypoglycaemia (low blood sugar).
• Postnatal (after birth), e.g. childhood infections (like meningitis and encephalitis), metabolic diseases (like inborn errors of metabolism and hypothyroidism) and accidents (like suffocation, near-drowning and head injury).
• Others, e.g. psychosocial issues (like significant and prolonged under-stimulation, severe emotional deprivation, maltreatment and malnutrition).

During early childhood, children’s growth and development will be monitored periodically during scheduled visits to health clinics.

Parents or caregivers can raise any concerns to the doctor during these visits.

The doctor will conduct a thorough physical examination, ask the parents specific questions regarding the child’s development, and perform a quick developmental screen.

If there are significant concerns, your child may be referred to specialists, who often include paediatricians, psychologists, speech-language therapists or occupational therapists.

Additional assessments and/or medical and genetic tests may be needed to identify the cause or ascertain a diagnosis.

Evaluations by these healthcare professionals can also help us understand your child’s developmental needs, as well as individual strengths.

Individualised therapy

Some children with GDD may catch up to their peers with timely intervention and continue to develop without problems.

Other children may need more specific and longer-term support.

Every child is different, hence, intervention or therapy needs to be tailored to each child’s unique strengths and difficulties.

Possible interventions or supports include physiotherapy, speech and language therapy, and occupational therapy.

Some children benefit from early intervention programs that are more intensive and incorporate multi-disciplinary supports.

A definite diagnosis may not always be clear when a child is very young. In these instances, the doctor may advise for the child to undergo a reevaluation when they are older.

In the meantime, pre-emptive intervention and supportive therapy should not be delayed.

Early intervention is important to provide appropriate support for a child with developmental delays.

With timely and accurate support that is based on your child’s strengths and vulnerabilities, your child will have a better chance of narrowing the developmental gaps and achieve their best potential.

Dr Cindy Chan Su Huay is a consultant developmental paediatrician. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.