Developmental Delay - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Developmental delay is a broad term referring to a delay in any of the four developmental areas. These are: Gross motor Fine motor Speech and language Social and emotional Global developmental delay refers to a delay in two or more of the above areas simultaneously. By TeachMeSeries Ltd (2026) Figure 1. Developmental delay in different domains Risk factors/Causes Developmental delay has many different causes, including (1): Table 1: Causes of developmental delay Category Examples Neurological Congenital – antenatal vascular event, spina bifida Acquired: hypoxic ischaemic encephalopathy (HIE), intraventricular haemorrhage, prolonged hypoglycaemia, traumatic brain injury, stroke, epilepsy Infection Congenital infections – e.g. TORCH infections (toxoplasmosis, rubella, cytomegalovirus/CMV, herpes/HSV) HIV Meningitis – e.g. meningococcus Encephalitis – e.g. herpes virus Neuromuscular disorders Duchenne muscular dystrophy, Spinal muscular atrophy Hypothyroidism Genetic disorders Down syndrome Pervasive developmental disorders Autism Metabolic disorders Hurle syndrome, Krabbe’s disease, Phenylketonuria Prematurity Idiopathic (no obvious cause) By TeachMeSeries Ltd (2026) Figure 2. Graphic depicting early development signs of autism, one cause of developmental delay Clinical features Parents might bring a child to see you because: A child is not hitting the expected milestones – in any of the four developmental areas Referred by a Health Visitor as part of regular routine development checks Concerns raised by their early education setting or school Routinely followed-up more closely – for example children born extremely prematurely placing them at higher risk of developmental delay. There might be concerns in a single area of development such as an 18 month old not yet walking but otherwise hitting milestones, or there might be a more generalised delay, such as a 2 year old who is not walking steadily, only uses one word sentences and is not able to imitate scribbles. It is important to look for key red flags, such as: Table 2: Red flags in developmental domains Developmental domain Red flag Social Not smiling by 10 weeks Gross motor Not sitting unsupported by 12 months Not walking by 18 months Fine motor Showing hand preference before 12 months of age Speech and Language Not knowing 2-6 words by 18 months If any of the above red flags are detected, the child should be referred for paediatric specialist assessment or investigated further. By TeachMeSeries Ltd (2026) Figure 3. Photo of a child with motor delay requiring support to sit after 12 months Investigations The aim of investigations is three-fold. That is to determine: The cause of the delay The likely prognosis Possible treatments. First-line investigations for global developmental delay are as follows (1): Table 3: First-line investigations in global developmental delay Investigation Reason Full blood count and haematinics Iron deficiency and folate/B12 deficiency can cause developmental delay Urea and Electrolytes Renal failure and hyponatraemia can cause poor growth Creatinine kinase Duchenne Muscular Dystrophy Thyroid function tests Congenital hypothyroidism Liver function tests Metabolic disorders Vitamin D Deficiency can cause motor delay Hearing test Isolated speech and language delay is commonly due to a hearing impairment Second-line investigations may be helpful as directed by first line investigations or if the cause still unclear. Examples include karyotyping or DNA analysis, more detailed metabolic screens, MRI and EEG. Management If any child is suspected to have a developmental delay, they should be referred to a community paediatrician who will perform a detailed developmental assessment, as well as holistic assessment of the child and family. Community paediatricians often use a standardised developmental assessment such as the Griffiths Scales of Child Development or the Schedule of Growing Skills, to assess the child across the developmental domains. Management is multi-disciplinary and involves referral to specialist therapists to support the child and family. These include speech and language therapists, occupational therapists, portage practitioners and orthoptists. Referral to a hospital paediatrician or specialist might also be indicated. If a reversible underlying cause is found, treatment for this should be instituted. Complications Only a few causes of developmental delay are reversible, most will result in chronic morbidity with the child requiring specialist support for many years. Do you think you’re ready? Take the quiz below Pro Feature - Quiz Developmental Delay Question 1 of 3 Submitting... Skip Next Rate question: You scored 0% Skipped: 0/3 1000+ More Questions Available Upgrade to TeachMePaediatrics Pro Challenge yourself with over 1000 multiple-choice questions to reinforce learning Learn More Frequent questions What is developmental delay? Developmental delay refers to a lag in reaching expected milestones in one or more of the four key developmental areas: gross motor, fine motor, speech and language, and social and emotional skills. When a child experiences delays in two or more areas, it is termed global developmental delay. What are the common causes of developmental delay? Developmental delay can arise from various factors, including neurological issues like congenital conditions, infections, neuromuscular disorders, genetic disorders, metabolic disorders, and prematurity. Each category encompasses specific conditions that may contribute to a child's developmental challenges. What are the red flags indicating potential developmental delay? Red flags for developmental delay include not smiling by 10 weeks, not sitting unsupported by 12 months, not walking by 18 months, showing hand preference before 12 months, and not knowing 2-6 words by 18 months. Identifying these signs early is crucial for timely referral and intervention. What investigations are conducted for suspected developmental delay? First-line investigations for global developmental delay aim to identify the cause, prognosis, and possible treatments. These typically include blood tests, renal function tests, thyroid function tests, and hearing assessments to rule out deficiencies or underlying conditions. How is developmental delay managed? Management of developmental delay involves a referral to a community paediatrician for a comprehensive assessment and the use of standardised developmental tools. A multidisciplinary approach is essential, often involving various specialists such as speech and language therapists, occupational therapists, and others to support the child and family. Rate This Article