Developmental Delays: Signs and Early Help

Maybe your toddler is not talking as much as other kids at the park. Maybe your baby is not sitting up yet and a relative made a comment. It is natural to worry, and it is also natural for children to grow at different speeds. A developmental delay means a child is behind what most children can do at their age. The most important thing to know is this: if your child does have a delay, getting help early makes a real difference, and help for young children in Texas is easier to start than many parents think.

Types of developmental delay

Doctors usually look at five areas of development. A child may be behind in one area or in several.

• Gross motor: using large muscles to roll, sit, crawl, walk, run and climb
• Fine motor: using hands and fingers to grab, pick up small things, scribble and feed themselves
• Speech and language: understanding words and using sounds, gestures and words to communicate
• Thinking and learning: exploring, solving simple problems, remembering and playing pretend
• Social and emotional: connecting with people, sharing attention, showing feelings and playing with others

When a young child is behind in two or more areas, doctors may call it a global developmental delay. Some delays are short term and catch up with a little support. Others are an early sign of a longer-term condition, such as hearing loss, autism, cerebral palsy or an intellectual disability. Finding out early helps either way.

Signs to watch for

Each age has its own milestones. The CDC's Learn the Signs. Act Early. milestone checklists list skills most children have by each age. Some signs that are worth raising with your pediatrician include:

• Losing skills your child once had, such as words, babbling or eye contact. This is important at any age.
• Not smiling at people or looking at faces by about 2 to 3 months
• Not reaching for toys or rolling by about 6 months
• Not sitting without help or not babbling by about 9 months
• Not pointing, waving or responding to their name by about 12 months
• Not walking or not saying any single words by about 18 months
• Not putting two words together by about 2 years
• Very stiff or very floppy muscles, or strongly using one side of the body
• Not seeming to hear well, or not following simple directions by age 2

Children born early are usually measured by their adjusted age, so ask your pediatrician which age to use.

How screening works

At every well visit your pediatrician asks about your child's development. The American Academy of Pediatrics also recommends a formal developmental screening at 9, 18 and 30 months, and autism screening at 18 and 24 months. Screening is usually a short questionnaire you fill out about what your child can do.

A screening does not give a diagnosis. It helps show whether a closer look is needed. If it raises a concern, your pediatrician may check hearing and vision, order tests, or refer your child for a full evaluation by specialists such as a speech therapist, developmental pediatrician or neurologist. You can ask for a screening at any visit, even if one is not due.

Early Childhood Intervention in Texas (birth to 3)

Texas has a statewide program called Early Childhood Intervention, or ECI, run by Texas Health and Human Services. It serves children from birth up to their third birthday who have a developmental delay, certain medical diagnoses, or hearing or vision loss.

Here is what families should know:

• You do not have to wait for a diagnosis. A child can qualify based on how far behind they are in one or more areas.
• Your pediatrician can refer your child, and you can also contact your local ECI program yourself.
• The evaluation is free. Families share in the cost of some ongoing services based on income, and no family is turned away because they cannot pay.
• Services happen where your child already spends time, such as your home or child care, and focus on teaching you ways to help during everyday routines.
• The team may include speech, physical and occupational therapists and early intervention specialists.

You can find your local program and eligibility details on the Texas HHS Early Childhood Intervention page.

Help from age 3: your school district

When a child turns 3, ECI services end. Public school districts provide special education services for eligible children starting at age 3, even before kindergarten. If your child is in ECI, the team will help you plan this move before the third birthday. If your child is 3 or older and was never in ECI, contact your local school district's special education office and ask for an evaluation. Put the request in writing and keep a copy.

What you can do at home

• Talk, sing and read with your child every day, and give them time to respond
• Give plenty of floor time and safe space to move
• Keep a short list of what your child can and cannot do yet, with dates
• Take videos of anything that worries you to show at the visit

Waiting to see if a child "grows out of it" can mean losing time when the brain learns fastest. If you have a concern, it is always fine to ask.

When to call us

Call your A thru Z Pediatrics office if your child loses skills, is missing several milestones, does not seem to hear, or you simply have a feeling something is not right. We can talk through it, do a screening, and help with referrals.

Call 911 or go to the ER if your child has a seizure, trouble breathing, or suddenly becomes very weak or hard to wake.

Want to talk about your child's development? You can request a visit.