A child’s brain develops in response to both genes and the environment. Early environments.
There is no more important period in human development than conception through early childhood in maximising the potential for living fully.
Concerns: Shubham (name changed) is a nine month old baby. His mother is worried that he is not yet rolling over. He tries to hold objects but does not transfer them from one hand to the other. He responds to his name and babbles. He was born premature.
matter and nurturing relationships are essential for optimal child development.
What is a developmental delay?
Child development happens on a continuum. The process in which children go through changes in skill development during predictable time periods is called developmental milestones. Developmental delay occurs when a child exhibits a significant delay in the acquisition of milestones in one or more domains of development (i.e., gross motor, fine motor, speech/ language, cognitive, personal/social, or activities of daily living). Knowing what behaviours a child should exhibit and what constitutes normal development can help parents to determine if their child is developing normally or has a developmental delay.
Some red flags for development:
|Gross Motor||Age||Fine Motor||Age|
|No roll over||6 months||Not holding rattle||4-5 months|
|Not walking||15 months||No transfer from hand to hand||5-6 months|
|Not climbing stairs||4 years||Not Feeding self with spoon||3 years|
|Not pedaling a cycle||4 years||Not tying shoe laces||7 years|
|Language||Age||Social and self help||Age|
|Not turning to sound||6 months||Not smiling on seeing face||3 months|
|Not locating objects||15 months||No response to name||9 months|
|No gesture for need||12 months||No showing, sharing||18 months|
|No three words||15 months||No pretend play||3 years|
|No joining words||2 ½ years||No team games||7 years|
|No sentences||3 years||Not eating a meal||4 years|
|Speech unclear||4 years||Night time bedwetting||4 years|
Loss of skills: e.g. he used to sit now he cannot; is a red flag at any age.
All parents worry about their child and their development at some point in their life. The most important thing you can do for your child is to ask for advice or help as soon as you notice the above red flags. If there is suspicion, the child should undergo a complete developmental evaluation to assess the child’s developmental profile. A developmental assessment is a process designed to deepen the understanding of a child’s strengths, skills, and resources. Ideally, it will also provide some insight into the care giving and learning environments that are most likely to help a child make fullest use of his or her developmental potential.
The necessary investigations are done and early treatment (Intervention) is started. If intervention is started at age less than 3 years; we may optimise outcomes.
Evaluation: Shubham was found to have a mild tone abnormality due to being born preterm. He was cognitively doing age appropriate tasks. He was commenced on exercises with a therapist on regular basis. He is now 15 months old. He comes to stand, tries to eat finger foods and progressing well. He is on a regular follow up of his development.
Concerns: Arav (name changed) is a four year old boy. He was referred by his school because he has difficulty sitting in his seat. He disturbs others in class and sometimes gets aggressive. He had spoken late i.e. words after 2 years of age.
Behavioural Issues in Children
Behaviour issues faced by children in school, at play or at home can be distressing for parents. They cause stress and could hamper with the functioning of the child in social settings or interfere with their learning.
Red Flags for behaviour issues
|Feeding- excess fussiness, using the bottle or mashed foods for too long, vomiting|
|Sleep- light sleepers, sleeping too late|
|Difficulty concentrating- fidgety, falling often|
|Difficulty making friends- left out of games, hitting friends|
|School refusal- crying to go to school|
|Worries a lot- fear of separation from parents, obsessive behaviours|
|Primary bedwetting after 5 years or potty staining on underwear after 5 years|
A single symptom in a child does not necessarily mean the child has a disorder. The child needs a detailed evaluation and a behavioural assessment. A behaviour and environmental modification goes a long way in modifying the behaviour before it escalates.
ADHD (Attention Deficit Hyperactivity Disorder)
It is characterized by a pattern of behavior present in multiple settings (e.g., school and home) that can result in performance issues in social, educational, or work settings. Symptoms: It could manifest between 3 to 7 years of age. In earlier childhood, the child may run about in class, have tantrums and could have speech delay. In the primary school years, attention may interfere with academics; there could be hand writing difficulties and difficulty making friends. In adolescence, the attention issue may manifest as difficulty with academic grades, difficulty in sustaining relationships, risk taking behaviours and maintaining a stable job.
Evaluation: Arav underwent a detailed evaluation. He was found to be a bright boy with attention issues. Arav engaged in attention seeking behaviours. He was one year ahead in school and had some issues with eye hand coordination.
Treatment: His parents were counselled. A structured routine was initiated with activities to channelize his attention. Certain modifications were implemented in school. He was started on occupational therapy for prewriting skills. He did need some medication temporarily at age 5 for about a year.
Now: At 7 years now; Arav is a bright boy who was repeated a year and benefitted from it. He currently faces some difficulties with reading and spelling. An evaluation revealed high average intelligence and early specific learning difficulty in reading and spelling. He is commenced on remediation for the same and accesses necessary concessions. He loves going to school and is a swimming champ at school. He is currently not on medication.
Evaluation: When the child is brought with such concerns it is essential to take a detailed history and do a developmental and behavioural assessment. Information is obtained from all settings of the child: home, school and play area. The diagnosis is purely a clinical diagnosis. Investigations and treatment plan is individualized. The primary step is to share the concerns with the family. Treatment: This consists of ensuring structured routine, educating parents about behaviour handling and initiating therapies if needed. A diet modification may also be beneficial. Even if diagnosed later, it helps parents understand their child better and be vigilant about modifying future possible difficulties. In certain situations medications may be needed in addition to holistic intervention. However the use of medication is not life long and can gradually be weaned if the correct structured routine is provided.
A Specific learning difficulty difficulty is an unexpected, specific, persistent failure to acquire efficient academic skills despite conventional instruction, adequate intelligence and socio cultural opportunity. It may be seen independently or along with ADHD.
Red flags for Dyslexia or dyscalculia
- Normal children with impairment in learning to read and write or maths
- Family history of reading delay.
- Delayed speech.
- Pronunciation difficulties especially after 5-6 years.
- Letter and number reversals especially after 6 years.
- Difficulty attending to sound of words trouble playing rhyming games words or confusing words that sound alike.
Early intervention goes a long way in reducing the impact of behavioral disorders on children’s performance and thereby helps better holistic development. The need of the day is to sensitise parents, teachers and create more awareness. Some children may need slight modifications of the environment provided in school. Also there are certain provisions that are provided as rights to differently abled children. Sensitivity to the needs of differently abled children goes a long way in ensuring a better future and helps these children blossom to their best potential.
Dr. Archana Kadam, MD. DNB., Paediatrics is a Developmental Paediatrician who specialises in developmental and behaviour issues among children. Her work involves early diagnosis and intervention, to help children get the right start for a better future.
Dr. Kadam has been practising in Pune for 13 years. She consults at KEM Hospital and Jehangir Hospital in Pune.