General Health & Wellness • Sep 27, 2011

Recognizing developmental delay

The first three years of a child’s life are an amazing time of development – and what happens during those years stays with the child for a lifetime. That’s why it’s so important to watch for signs of developmental delays, and to get help if you suspect problems. The sooner a delayed child gets early intervention, the better the outcome will be. So if you have concerns act early, act now!

Children develop at different rates, but most follow a general timeline (though preemies may be off schedule by a few weeks or months). If your child doesn’t seem to be meeting milestones within several weeks of the average, ask his pediatrician about it. It may be nothing, but if your child does have a delay, you’ll want to catch it early so you can get a diagnosis and begin treatment.

Developmental delay can have many different causes, such as genetic causes (like Down syndrome), or complications of pregnancy and birth (like prematurity or infections). Often, however, the specific cause is unknown. Some causes can be easily reversed if caught early enough, such as failure to thrive, hearing loss from chronic ear infections or lead poisoning.

If you think your child may be delayed, you should take them to their primary care provider, or to a developmental pediatrician or pediatric neurologist. You can also get help through your local school system. If your child seems to be losing milestones, in other words, starts to not be able to do things they could do in the past—you should have them seen right away. The sooner you get a diagnosis, the sooner you can begin connecting to resources and develop a medical plan if needed— the better your child’s progress will be.

The five major areas of development in a child are-

  • Gross motor skills, such as crawling and walking
  • Fine motor skills, such as stacking blocks or coloring
  • Language skills, including speech and comprehension
  • Thinking skills
  • Social interaction

Using input from the CDC and the American Academy of Pediatrics, the following is a rough timeline of milestones in the above areas. Remember, a child can stray from this timeline and still be within the range of normal, but it’s best to discuss any concerns with your pediatrician. The following list should only be used as an adjunct to developmental assessment done regularly at your pediatrician’s office during the well child visits. 

 Timeline of Childhood Milestones

2 Months Begins to smiles at the sound of your voiceTurns head towards sound
3 Months Raises head and chest when lying on stomach
Grasps objects
Smiles at other people
4 Months Smiles spontaneously, especially at peopleBegins to babble

Holds head steady, Reaches for toy with one hand

6 Months Knows familiar faces, likes to look at self in mirrorResponds to sounds by making sounds

Rolls from back to stomach and stomach to back
Starts to move objects from hand to hand

7 Months Responds to own name
Finds partially hidden objects
9 Months Beginning of ‘stranger anxiety’, understands ‘no’Sits without support
Stands holding on, Crawls
12 Months Walks with or without support
Says single words like “mama” or “dada”
Enjoys imitating people
18 Months Walks independently
Drinks from a cup
Says at least 15 words
2 Years Runs
Speaks in two-word sentences
Follows simple instructions
Begins make-believe play
3 Years Climbs well
Speaks in multiword sentences
Sorts objects by shape and colorRides a tricycle
4 Years Gets along with people outside the familySings from a song or poem from memory
Draws circles and squares

Hops and stands on one foot up to 2 sec

5 Years Gender identity, Tells name and address
Jumps, hops, and skips
Gets dressed
Counts 10 or more objectsUses a fork and spoon, copies a triangle

 Ask your school system for an evaluation of your child, even if your child is a baby, toddler or preschooler. They are required to provide it at no cost to you. The purpose of an evaluation is to find out why your child is not meeting her developmental milestones or not doing well in school. A team of professionals will work with you to evaluate your child. If they do not find a problem, you can ask the school system to pay for an Independent Educational Evaluation (IEE). There are strict rules about this, so not everybody is approved. You can also have your child tested again privately, and pay for it yourself. But check with your school district first to make sure they will accept the private test results. By law, the school system must consider the results of the second evaluation when deciding if your child can get special services

As a general rule, trust your instincts. If something seems odd or wrong to you about the way your baby moves or interacts, ask about it. After all, you know your child best.

Here are some additional resources regarding developmental delay in children:


  1. As a mother of triplets, I had what I call “age matched controls”. When my pediatrician told me I was “over-reacting”, I thought he knew what he was talking about. That child is autistic. We could have started intervention so much earlier if I had pushed.
    I recognized a problem at 18 mos. Intervention didn’t start untill well after age 2. I’m still angry. (Note that I changed pediatricians.) He’s 17 and doing well.
    Great article. Points out lots of stuff I wish I had known.

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