What is Developmental Delay?
Developmental delay means slowness in acquiring milestones. It can be global or selective developmental domains, such as gross or fine motor development, expressive speech, or comprehension of language development.
It is important to define if the developmental delay is abnormal from a neurological perspective, or is a normal motor developmental variants (i.e. in neurological normal children’.)
What are the common Normal Developmental Variants?
‘Bobby preferred supine lying; he sat late; when lifted off the floor, he flexed his hips and extended his knees. He loves bottom-shuffling and scooting! He seems to walk much later compared to the others.’
Bobby has a typical history of a bottom-shuffler, and this often runs in families.
Some bottom-shufflers have very rapid motor development with almost no floor locomotion before independent walking! Typical bottom-shuffler has no other developmental or cognitive impairments. He has a normal neurological assessment and no investigation or treatment is recommended.
There are also other ‘physiological’ causes for developmental variants, such as familial delay, ligamentous laxity (loose ligaments of upper and lower limbs), and prematurity with development not corrected for gestational age.
What is Global Developmental Delay (GDD)?
GDD is defined as developmental delay or impairment in more than 2 of the developmental domains:
- Gross Motor skills
- Fine Motor skills
- Speech and Language skills
- Cognition, emotional and social skills
When shall I see a Paediatric Neurologist?
The goals of clinical evaluation by a paediatric neurologist or Dr Yeo are:
- To establish a causation of developmental delay so a treatable condition is not missed
- To personalise investigation testing (if indicated)
- To personalised management strategies (if indicated)
- To provide prognosis and risk of recurrence
The appointment will involve a detailed evaluation by our paediatric neurologist, Dr Yeo, including a medical history, physical examination, and neurological assessment.
When dealing with developmental delay, it can be challenging to decide whether to conduct testing or not. One crucial factor to consider is whether the development pattern is a normal variant or neurologically abnormal. If the answer is uncertain, it may be necessary to proceed with certain baseline investigations.
Recommended investigations may include Blood, Urine or Cerebrospinal Fluid (CSF) analysis for special chemical or mineral levels, audiological testing and ophthalmological evaluation. MRI brain is recommended as it is more sensitive in picking up abnormal changes in the brain. Electroencephalogram (EEG) tests maybe requested to analyse your child’s brain wave signals/ pattern. Genetic testing may be suggested depending on initial investigations.
Please click ‘Blood Tests & Metabolic Testing’ and ‘Genetic Testing’ for details.
