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    Move Forward Guide

    Physical Therapist's Guide to Developmental Delay

    Developmental delay describes the behavior of young children whose development in moving, talking, or playing is slower than other children of the same age. The delay can be in any area(s) of development, such as movement (motor), speech, thinking, or self-care skills. About 10% of all toddlers and preschoolers in the United States are classified as having developmental delay.


     

    What is Developmental Delay?

    The term "developmental delay" may be used to describe any type of delay dealing with motor, speech, or thinking abilities that may or may not result from a specific condition. A child with Down syndrome, for example, would be identified at birth as having the syndrome (or even before birth with prenatal tests) and also, as it becomes apparent, with having developmental delay in several areas, including motor, speech, and thinking skills. Similarly, a child with autism could be described as having autism and developmental delay, meaning that the child’s behaviors can be described as autistic, but the child also exhibits delays in developmental skills. Other children have developmental delay without having a specific diagnosis.

    Although all states provide early intervention services for children with developmental delay, each state individually defines “developmental delay” (see Resources). Thus, the term may mean different things to different people and can result in differing services to help a family with a child who has developmental delay.

     

    Signs and Symptoms

    If a child has developmental delay, he or she might play with toys for younger children or interact with people like a younger child. When children's motor skills are delayed, they might not run, skip, or jump with other children because they have not yet developed age-appropriate skills and cannot keep up with their peers.

    Because the term is such a broad and general one, developmental delay often looks different from one child to the next.

    In infancy, a child is first suspected to have developmental delay if common milestones are delayed, such as:

    • Holding the head steadily up by 4 months
    • Sitting by about 6 months
    • Walking by about 12 months

    A child who has a general lack of movement or does not move in a lot of different ways to explore movement, might have a motor developmental delay. Some infants with a motor developmental delay have hypotonia, or low muscle tone, which contributes to their movement difficulties.

    Although delays in motor milestones often are the most obvious behavior that caregivers notice, other delays might be related to a child not moving. For example, learning about objects or producing speech sounds can be affected if a child does not learn to sit or change positions. In infancy, all developmental areas are closely connected and influence each other's progress.

    Some children have sensory problems adding to movement difficulty, such as hypersensitivity to touch or an inability to plan and problem-solve movement activities. Children who have some or all of these problems also might develop social or emotional problems, such as a fear of trying new motor skills.

     

    How Is It Diagnosed?

    You first should talk to your pediatrician about any concerns you have regarding your child's development. Medical problems can have an impact on overall development that your doctor can identify, such as chronic ear infections that reduce hearing and affect the child’s speech development or balance.

    Developmental delay is diagnosed by using tests designed to score a child's movement, communication, play, and other behaviors compared with those of other children of the same age. These tests are standardized, or scored on hundreds of children, in order to determine a normal range of scores for each age. If children score far below the average score for their age, they are at risk for developmental delay.

    A pediatrician usually will perform a screening test during infancy to determine if a child is progressing normally, often at the request of a parent who suspects the child is not performing the same skills as other children of the same age. A screening test helps to identify which children would benefit from a more in-depth evaluation. A physical therapist, who has knowledge of movement development, coordination, and medical conditions, will perform an in-depth examination to determine if a child’s motor skills are delayed and, if so, by how much they are delayed.

     

    How Can a Physical Therapist Help?

    A physical therapist will first evaluate your child, including having a conversation with you and conducting an appropriate and detailed test to determine the child's specific strengths and weaknesses. If the child has developmental delay, the therapist will problem-solve with you about your family's routines and environment to find ways to enhance and build your child's developmental skills.

    In addition to evaluating your child and the environment in which the child moves, the physical therapist can give detailed guidance on building motor skills 1 step at a time to reach established goals. The therapist may guide the child’s movements or provide cues to help the child learn a new way to move. For example, if a child is having a hard time learning to pull herself up to a standing position, the therapist might show the child how to lean forward and push off her feet; or if a child cannot balance while standing, the therapist may experiment with various means of support so the child can safely learn ways to stand.

    The therapist will also teach the family what they can do to help the child practice skills during the child’s everyday activities. The most important influence on the child is the family, because they can make sure the child has the opportunities needed to achieve each new skill.

    The therapist will explain how much practice is needed to help achieve a particular milestone. A child learning how to walk, for example, covers a lot of ground during the day, and the therapist can provide specific advice on the amount and type of activities appropriate for your child at his/her stage of development.

     

    Can this Injury or Condition be Prevented?

    Once developmental delay has been diagnosed, there are steps to take to prevent further delay or to help the child "catch up." However, because this diagnosis has so much variability, the outcomes of intervention vary quite a bit. The important thing to remember is that the earlier you intervene, the more likely it will be that your child can improve and not continue to fall behind.

    CAUTION: Babies who have little or no active "tummy time" play may be prone to developmental delay. The American Academy of Pediatrics (AAP) has recommended that all infants sleep on their backs to reduce the incidence of sudden infant death syndrome (SIDS). As a precaution, many parents have avoided placing infants on their tummies altogether. However, research has shown that avoiding tummy time can slow the rate of accomplishment of motor-skill (movement) milestones. Evidence also indicates that infants who are kept in baby equipment (infant chairs, carriers, sling seats at activity centers) for long periods of time are at a higher risk of motor delays than infants who have sufficient opportunities for active movement.

    AAP's new recommendation, "Back to Sleep, Tummy to Play" (see Resources), encourages parents to let a child be on the floor to play in many different positions. This allows the child to learn how to move, and stimulates the brain and muscles so that rolling, reaching, crawling, and eventually walking can be achieved. Experiencing lots of different positions allows children to experiment with their bodies and build new movements. And exploring new movements helps them learn to think differently, and may even stimulate speech and social skills.

     

    Real Life Experiences

    When Sam was 10 months old, his parents were concerned that he was not sitting or crawling like the other children in his daycare center. Their pediatrician administered a Denver Developmental Screening Test, which rated Sam's larger movement (gross motor) skills and hand (fine motor) skills, as well as his communication skills, as developing more slowly than expected.

    The doctor referred Sam for early-intervention therapy. His early-intervention team—an early childhood special education teacher, an occupational therapist, and a physical therapist—assessed Sam's skills in his home. They determined that he qualified for services based on a diagnosis of developmental delay. At the Individualized Family Service Plan meeting with the early-intervention team, the family stated they thought Sam was weak and they most wanted to improve his gross motor (larger movement) skills. Physical therapy was therefore identified as the primary services provider to address those concerns as well as the concerns about fine motor and communication skills, with consultation from the occupational therapist and speech-language pathologist.

    Over the next 6 months, the physical therapist worked with Sam, his family, and his daycare provider to develop ways that Sam could work on his strength and balance in sitting, on his ability to move and explore on the floor, and his ability to get in and out of sitting safely. The therapist modified Sam's toys and changed the way his play space was arranged. He quickly learned that being upright was fun, where his hands were free to explore new toys!

    Moving on the floor was difficult for Sam. He did not like being on his tummy; he was content to play on his back, and he had not discovered that rolling was a means to get to objects of interest. Again, with simple modifications of his play environment and gentle guidance, such as placing items just out of reach and providing gentle touch or verbal cues, the physical therapist encouraged Sam to begin to explore. He first rolled, then commando-crawled, and then learned he could scoot quickly on his bottom to get to his toys!

    By age three, Sam was prepared to move to a preschool program. By now, his gross motor skills were no longer the area of primary concern. Sam was running, moving on ride-on toys, and beginning to explore playground equipment. He still had difficulty with climbing stairs and jumping without support, but overall, he could keep pace with his age group in a play setting. The plans for Sam's preschool program were based on his specific needs.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat a wide variety of conditions and injuries.  For children with developmental delay, you may want to consider:

    • A physical therapist who is experienced in treating children with developmental delay.
    • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to this condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • Ask about the physical therapists' experience in helping children with developmental delay and their families.
    • During your first visit with the physical therapist, be prepared to describe your concerns in as much detail as possible.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence related to physical therapy treatment of developmental delay. The articles report recent research and give an overview of the standards of practice for treatment of developmental delay both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Adolph KE, Berger SE. Physical and motor development. In: Bornstein MH, Lamb ME, eds. Developmental Science: An Advanced Textbook. 6th ed. East Sussex, United Kingdom: Psychology Press; 2011:241–302.  Product Description.

    Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics. 2008;121:e1503–e1509. Free Article.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored byRegina Harbourne, PT, PhD, PCS, and Sandra Willett, PT, PCS. Reviewed by the MoveForwardPT.com editorial board. B

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