Developmental Delays and Infant Brain Injury

Children grow and develop at their own pace. You have to have a long time horizon when raising children or you will quickly go crazy.  Still, it is good to be on watch for red flags. In most serious cases, developmental delays can be symptoms of cerebral palsy and other birth injuries where prompt treatment can make a difference.

First, you have to understand that a lot of people, and even some physicians, use the phrases "developmental disabilities" and "developmental delays" interchangeably although they have very different meanings. While children can make progress, they cannot outgrow developmental disabilities. Developmental disabilities can be caused by Down syndrome, Angelman syndrome, Autism, Fetal Alcohol Spectrum Disorders, and brain injuries.

Developmental delays, on the other hand, can in many cases be outgrown and are often, but not always, caused by more short-lived issues such as something like a speech delay as a result of temporary hearing loss from an ear infection or impaired physical abilities from a long hospital stay.

Developmental delays can be signs of learning and attention issues that may come to light as the child ages, so if you think your infant or child may not be catching up as quickly as others at a similar age, it is very important to consider having a professional evaluation done to get a better idea of what specifically could be going on and how to meet your child's needs.

Developmental Milestones are physical skills and behaviors that are seen in infants and children as they progress in growth and development. For each age range, there are different milestones to look for. Listed below are milestones you should see at a given age range, however, these milestones may occur earlier or later in some children. If your child fails entirely to reach one of these milestones or is slow in doing so, it is important to consult with your physician to make sure nothing more serious is going on.

• Infant-Birth to 1 year:
  • Babbles, displays social smile, able to drink from a cup, able to sit alone, gets first tooth, plays peek-a-boo, puts self in standing position, rolls over, says "mama" and "dada" appropriately, understands no, walks while holding on to some type of support
• Toddler-1to 3 years:
  • able to feed themselves, draw line, run and walk backwards, say first and last name, walk up and down stairs, ride tricycle, name pictures of common objects and point to body parts, dress self primarily on own, imitates speech, share toys, knows difference between male and female, use words, masters walking
• Preschooler-3 to 6 years:
  • Able to draw circle, square, stick figures, able to skip, balance, potentially ride a bike, recognize words, start of reading skills, do things independently, and understand size and time concepts
• Child-6 to 12 years:
  • able to begin to play sports, lose baby teeth and get permanent teeth, signs of puberty, menarche, peer recognition starts to be important, further developed reading skills, and develop daily routines
• Adolescent-12 to 18 years:
  • adult size-height and weight, sexual maturity, growth of body hair, voice and genital changes in males, girls experience breast development and menarche if it has not already occurred, peer acceptance and recognition becomes very important, and ability to understand abstract concepts

There are five primary areas where developmental delays can occur, including cognitive skills, social and emotional skills, speech and language skills, fine and gross motor skills, and activities of daily living. Delays can also occur between two or more of the areas, which is referred to as a "global developmental delay." The five areas are described in detail below.

• Cognitive Developmental Delays: A child's intellectual functioning may be affected by cognitive delays, which can cause an interference with awareness and learning difficulties. They can also make it difficult for a child to communicate and play with other children. These symptoms usually do not become apparent until the child begins school. Cognitive delays can be caused by, among other, genetic defects/disorders, medical problems prior to birth, neglect, and learning disabilities, exposure to alcohol or toxins before and/or after birth, and lead poisoning. Signs to look for in infants and young children include loss of skills that were already learned, not searching for objects that were hidden while the child watched, failing to use gestures like waving, not pointing to objects or pictures, failing to learn the use of common objects like a spoon or hairbrush, failing to follow simple instructions, and failing to copy actions or words. Treatment for cognitive delays includes educational intervention and therapy. Treatment is most effective and can make a substantial difference in your child's progress when caught early.
• Social and Emotional Developmental Delays: Social and emotional skills encompass the ability to relate to other people through expressing and controlling emotions. This can include infants communicating by smiling and making sounds or for older children, such as preschoolers, being able to ask for help, express feelings, and get along with others. These delays are best understood as problems or an inability to interact and communicate with other children and adults. Most often, these issues will become apparent before a child starts school. Social and emotional delays can be caused by neglect, attachment problems, ineffective parenting, cognitive delays, and commonly autism. Signs to look for in your infant or child include loss of skills already learned, little to no smiling at others, failure to pay attention to new faces or becoming frightened by them, failing to cuddle, little or no signs of affection, no signs of enjoyment around others, being uncomfortable at night, little to no laughing, and little to no waving/back-and-forth gestures. There is not a cure for these types of delays, but treatment such as behavioral and skill-oriented therapy, play therapy, steps to aid attachment between the child and parent, as well as medication can make a big difference in your child's progress, especially when caught early.
• Speech and Language Development Delays: Speech and language delays encompass issues where the ability to use and understand language is affected. This can include cooing and babbling in infants as well as understanding what is said and responding in a way so that others can understand in older children. These delays can be caused by a number of problems including exposure to multiple languages, learning disabilities, child abuse or neglect, dysarthria- a problem with the muscles controlling speech, hearing loss- resulting from severe middle ear infections or due to certain medications, trauma, or genetic disorders, and autism. Signs to look for in infants and babies include no response to loud noises, no babbling, not imitating sounds, little to any response to sounds, not using single words such as "dada", and not understanding words such as "no." In children at age two or older, the inability to speak at least 15 words, imitating speech by not being able to use two-word phrase without repeating it, and the failure to use speech for other purposes than immediate needs are all signs to pay attention to. Treatments include seeing a speech-language pathologist where speech therapy may be implemented. In less serious cases, it may be recommended to verbally engage more with your child, read to them regularly, and reinforce speech daily.
• Fine and Gross Motor Developmental Delays: These delays include fine motor skills, the ability to use small muscles particularly in the hands and gross motor skills, the ability to use larger muscles. In infants and young children, this includes the ability to use fine motor skills to hold objects like utensils or a pen/pencil and the ability to use gross motor skills to sit up, roll over, and begin to walk. These delays can be caused by premature birth, ataxia- a defect impairing muscle coordination, cerebral palsy-caused by brain damage before or after birth, cognitive delays, vision problems, myopathy- muscle disease, and spina bifida. Signs to look for, among others, include not reaching for or holding objects, not supporting the head, not bringing objects to their mouth, stiff and tight or very floppy muscles, not rolling over in either direction, inability to sit up without help, not crawling, dragging one side of the body while crawling, and the inability to walk by 2 years. Treatments for motor delays include encouraging more physical activity and physical therapy for more serious cases.
• Activities of Daily Living: These delays affect an infant's/child's ability and progress in learning to eat, dress, and bathe.

Developmental delays are not caused by one thing. One very common cause, however, is birth complications. Complications may include premature birth, low birth weight, and deprivation of oxygen at birth. In the most severe cases, birth complications may result in brain damage that has caused cerebral palsy that is the underlying reason for your child's developmental delays. Environmental issues such as lead poisoning, poor nutrition, and exposure to drugs and/or alcohol can also increase the risk.

Developmental delays are commonly seen in infants and children with cerebral palsy as a result of brain damage during or soon after birth due to birth complications. It is most noticed by the failure of the child in meeting some of the milestones, discussed above, at all or within a reasonable time. Physical delays often lead to cerebral palsy diagnoses when babies show delay or inability in being able to hold their head up when laying on their stomach, being able to lift their head up unsupported after 4 months, roll over, grasp toys, bring their hands to their mouth, or later after six months being unable to stand and bounce, sit without help, and crawl.

Cognitive delays are also sometimes seen in children with cerebral palsy but not always. These delays may include the failure to react to faces and follow movements with their eyes, the failure to respond to affection and reach for toys, the failure to play peek-a-boo, failure to demonstrate emotions, search for hidden items, use objects for their intended purpose, copy gestures, and follow simple directions. Social and emotional delays are also less common, but can be symptoms of cerebral palsy. These delays can include the failure to smile at people, play with people, recognize people, and respond to emotions. Additionally, the failure to have favorite people, show fear, become upset when a parent leaves, and share with others can also be symptoms of social and emotional delays resulting from cerebral palsy.

Lastly, language and communication delays are also seen in children with cerebral palsy and could result from cognitive or physical impairments. There can also be physical impairments that cause issues with vision and hearing. Symptoms can include a baby failing to coo and gurgle and turn at sound, failing to develop distinct consonant sounds, understand simples words like "no" or "mama", and respond to simple request and make gestures like waiving.