How to keep an eye out for developmental delays (without turning into a neurotic lunatic)
Is your baby's milestones on track? Do you think your child is keeping up with age-appropriate skills? Or do you secretly think there may be a problem? We spoke to Cape Town based physiotherapist, Julia Lee-Sylvester, who explains what developmental delays look like at different stages, and what parents can do.
Are you worried your child might have a developmental delay? Here's when to get professional help and when to just let them be. (iStock)
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Children reach developmental milestones in their own time. But as a parent we all want the best for our kids and it can be difficult to relax and trust that they are on track. Especially when comparing your kids to other, sometimes more advanced, children.  

No-one wants to be that over-anxious parent tracking their child’s every movement, and the chances are that your baby or toddler is just following their own developmental path. But how would you know if your child really is facing a developmental delay, and when should you intervene? 

We asked Julia Lee-Sylvester, a Cape Town based physiotherapist who is trained in neurodevelopmental therapy, for her expert insight. She spent two years working at a local state school for children with special needs before entering private practice, where she assists children with a variety of developmental delays from birth to adolescence.  

How do I know there's a developmental delay? 

“I think it is important to note that when looking at your child’s development, one needs to look at the whole picture,” Lee-Sylvester advises. “In other words, how is your child developing in all aspects of their development: motor, speech and language, sensory, cognitive, emotional and social, physical, and then daily functioning?

"If a child is slightly behind in one area it is less of a concern than if there is either a severe delay or delays in multiple areas.”  

When tracking your child’s development, Lee-Sylvester recommends looking at the normal age range when certain skills are attained as opposed to looking at a finite age or month. For example, parents read or are told that their baby should be able to sit up by themselves when they are 6 months of age, but Lee-Sylvester says it is more helpful to know that a baby should be able to sit independently between the ages of 5 and 7 months.  

“It is important to note that, if one milestone is delayed or attained later in the normal range, a parent can expect that the subsequent milestones may also be delayed. For example, if your baby was able to sit independently at 7 and a half months, expecting them to start crawling at 9 months would be placing unnecessary pressure on them and may evoke anxiety in the mother. 

Babies:

“As soon as you notice your baby starting to crawl in an asymmetrical way or bum shuffling instead of crawling, I would recommend seeking intervention,” she says. Once your baby chooses that way of moving it is very difficult to get them crawling in the typical fashion. 

“That is not to say that there is anything 'wrong' with your child, but it would be a good idea to let a therapist do an assessment to check for any asymmetries or underlying reasons that may be making it difficult for them to move. And there are many reasons why we think crawling is more beneficial over sailing on their tummy or bum shuffling.”  

If your baby is not walking independently by 16 months, Lee-Sylvester suggests seeking intervention, although she notes that literature and some paediatricians would say 18 months is also within the normal range.

Toddlers:

Toddlers will explore different ways of sitting, walking and running and may momentarily go up onto their toes or sit with their legs in a W pattern. A child who spends a large portion of time on their toes or in W-sitting would need intervention as there could be long-term repercussions.

Children:    

For older, school-going-aged children, parents needs to not only look at their motor performance, but also at their ability to cope with the demands of their everyday life. Consider how they are coping at school, extra-murals, with activities of daily living such as dressing and eating. 

“What you as the parent want to foster is a healthy balance between all aspects of their development and lives. Luckily once your child goes to school, you have an extra set of eyes on them in the form of their class teacher and most educators from grade pre-R upwards will be able to identify a significant delay and let the parents know,” she says.

I suspect a delay, what should I do?

If you suspect a delay, Lee-Sylvester says the first point of call would be to do your own research and then monitor for change. “If your baby is under 2, any parent will tell you how rapid development is and how things change on a weekly basis. If you think you do not see any progress from week to week, I would then recommend seeking professional input.” 

Which professional you need to visit would depend on the age of your child and the type of delay.

  • For a young baby under one you could visit your local clinic for a variety of concerns, from feeding to motor development.
  • For an older child you could visit your paediatrician or seek out a therapist such as a physiotherapist or occupational therapist who has a special interest in paediatrics.

Also read: 0-18 months development milestones

I'm convinced of a delay, what now? 

Lee-Sylvester advocates for early intervention as there is strong evidence to suggest that the early years are extremely vital and formative for every child’s future. A young developing brain has potential to be shaped and the input a child receives in those early years has a huge impact. 

“Seek out a physiotherapist or occupational therapist (OT) that has a special interest in paediatrics and has done postgraduate training and experience in treating infants and children with developmental delays,” she advises.

The therapist should do a full in-depth assessment to ascertain how your child is developing for their age and will then give hands-on intervention as well as lots of education and advice for you to follow through with at home. The therapist can, where necessary, refer you to other specialists, from an eye or ear test to play therapy.

What are the risks of undiagnosed developmental delays?

Research has shown that there is no real correlation between a baby's intelligence and when a baby reaches his developmental milestones. “In other words, if a baby reaches their milestones earlier than another it does not mean that baby is a ‘clever’ baby,” Lee-Sylvester explained. 

However, there is a common school of thought among paediatric therapists that skipping a milestone may result in difficulties later in life.

“For example, there is research to show that there is a link between shoulder control when lying on their tummies and hand coordination, so a child who dislikes lying on their tummy is at risk for hand coordination difficulties later in life,” Lee-Sylvester shared. “Children who bum-shuffled as a baby have been shown to have worse handwriting and score lower in perceptual tests than those who crawl in the typical manner.”  

She says there is generally an underlying reason why your baby would struggle or skip a milestone that would again cause difficulties later in life, so it is best to keep an eye out for delays and seek the appropriate treatment in good time. 

Did you suspect your baby or child had a developmental delay? How did you approach the situation? Tell us by emailing chatback@parent24.com and we may publish your comments on the site.

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