Developmental Delay

When doing a developmental assessment of a child it is important to appreciate that children develop at different rates, and there is flexibility in the milestones. However, a child who is very slow to achieve all milestones or lags behind on a specific developmental domain may have underlying pathology.


Global Developmental Delay

Global developmental delay refers to a child displaying slow development in all developmental domains. This could indicate an underlying diagnosis such as:

  • Down’s syndrome
  • Fragile X syndrome
  • Fetal alcohol syndrome
  • Rett syndrome
  • Metabolic disorders


Gross Motor Delay

A delay that is specific to the gross motor domain may indicate underlying:

  • Cerebral palsy
  • Ataxia
  • Myopathy
  • Spina bifida
  • Visual impairment


Fine Motor Delay

A delay that is specific to the fine motor domain may indicate underlying:

  • Dyspraxia
  • Cerebral palsy
  • Muscular dystrophy
  • Visual impairment
  • Congenital ataxia (rare)


Language Delay

A delay that is specific to the speech and language domain may indicate underlying:

  • Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
  • Hearing impairment
  • Learning disability
  • Neglect
  • Autism
  • Cerebral palsy

Management of language delay involves a referral to speech and language, audiology and the health visitor. Referral to safeguarding is required if neglect is a concern.


Personal and Social Delay

A delay that is specific to the personal and social domain may indicate underlying:

  • Emotional and social neglect
  • Parenting issues
  • Autism


Last updated January 2020
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