Developmental Delay

  • Core 1 (Pre-Clerkship)
    • Biomedical Science
      • Anatomy and Imaging
      • POCUS
  • Core 2 (Clerkship)
    • Pediatric Clerkship - Development Didactic
  • Core 3 (Post-Clerkship)
    • Electives that may further knowledge 

  • Autism Spectrum Disorder 
  • Cerebral Palsy or Neurologic Disorders (e.g., epilepsy) 
  • Genetic Disorders 
  • Psychosocial Factors 
  • ADHD 
  • Cognitive Disorders (e.g., learning disabilities) 

A 2-year-old child presents for their routine well-child visit. The parent expresses concerns that their child is significantly delayed in speech development. The child only has three intelligible words (e.g., "mama," "ball," and "no") and does not point or gesture to communicate. The parent reports that the child does not respond consistently to their name and rarely engages in joint attention, such as following a point or looking at objects the parent is showing them.  

The parent mentions that their child is generally quiet and prefers to play alone rather than engage with adults or peers. They do not imitate actions or words during play. The parent denies any recent illnesses or significant medical history but shares that their child had frequent ear infections between 6 and 12 months of age. The child’s milestones for gross motor and fine motor development were reportedly achieved on time, but there is concern about delayed communication and social engagement.

History  

Birth History:  

  • Was the child born full-term or preterm?  
  • Any complications during pregnancy, delivery, or neonatal period (e.g., advanced maternal age, exposures to substances in utero, low birth weight, NICU stay, etc.)?  

Medical History:  

  • Any history of recurrent ear infections, hearing problems, or other conditions that could impact language development?  
  • Any hospitalizations, surgeries, or chronic illnesses?  

Developmental History:  

  • When did the child achieve key milestones (e.g., sitting, crawling, walking)?  
  • Was babbling present during infancy? If so, when did it decline or stop? 
  • Is there any regression in language or social skills (e.g., loss of previously acquired words)?  

Family History:  

  • Any family history of speech or language delays, autism spectrum disorder (ASD), learning disabilities, or genetic conditions?  

Social and Environmental Factors:  

  • What is the child’s home environment like?  
  • Are they exposed to consistent language stimulation (e.g., reading, talking, singing)?  
  • Does the child attend daycare or have exposure to peers? 

Physical Exam 

Growth Parameters: 

  • Plot weight, height, and head circumference on a growth chart to check for abnormalities that could suggest an underlying condition. 

General Observations: 

  • Observe behavior during the visit. Does the child make eye contact, respond to their name, or show curiosity about their surroundings? 

Hearing Assessment: 

  • Perform a basic hearing screen (e.g., response to sounds like clapping or a soft bell). 

Neurologic Examination: 

  • Assess muscle tone, reflexes, and coordination to rule out any neurologic abnormalities. 

Other 

  • Examine the mouth and throat for structural abnormalities (e.g., cleft palate, tongue-tie) that could impact speech. 
  • Look for dysmorphic features or signs of syndromes 

  • Primary developmental delays (e.g., speech delay, motor delay) 
  • Autism Spectrum Disorder 
  • Intellectual disability (genetic or environmental causes) 
  • Hearing or vision impairment 
  • Obstructive sleep apnea/other sleep difficulties 
  • Metabolic or endocrine disorders 
  • Neurologic conditions (e.g., cerebral palsy, epilepsy) 
  • Psychosocial factors (e.g., neglect, lack of stimulation) 

Evaluation/Management

  • Developmental screening tools: ASQ-3, M-CHAT-R, Vanderbilt (for > 6 years of age) 
  • Audiology testing 
  • Vision testing (if school-aged child) 
  • Consider genetic testing or referral to genetics if syndromic features are present 
  • Referral to early intervention services or developmental pediatrics 
  • Therapies: speech, occupational, or physical therapy 
  • Parental support/education: for example, parents should narrate daily activities 

Anticipatory Guidance for Parents on Development 

Parents can foster an environment that supports their child's development. They can encourage a variety of engaging activities that promote physical, social, and cognitive skills. For example, reading daily to their child helps build language skills, and programs like Reach Out and Read promote early literacy by providing parents with books and guidance on how to read interactively with their children. This initiative helps improve language development and school readiness. Additionally, limiting screen time can ensure children have ample opportunities for hands-on experiences and real-life interactions.  

The Bright Futures Guidelines by the American Academy of Pediatrics (AAP) emphasizes the importance of regular well-child visits to monitor developmental milestones and provide anticipatory guidance tailored to your child's needs. For more resources, parents can explore the CDC’s Developmental Milestones Checklist to track their child’s progress and recognize areas for improvement. Parents should communicate any concerns with their healthcare provider. Remember, every child develops at their own pace and Early Intervention (EI) programs can make a significant difference if developmental delays are identified. 

  • Early intervention is critical for improved outcomes in developmental delays. 
  • Speech delays alone may indicate hearing impairment—always assess hearing. 
  • Regression of milestones warrants urgent evaluation for neurologic or metabolic conditions.