Child Development Concerns

Back to:  Therapist Questions & Answers - Developmental Concerns

We have a neighbor who's 19-month old seems to be having quite a bit of delay in a few areas. We've mentioned it to the parents and they are certain they just need to be patient and she will eventually learn to crawl and walk. I spent 3 hours with her recently. I have an 18-month old who was with us. They are drastically different developmental wise.

 Some of the things I observed during her 3 hour visit. � still has newborn reflexes, clinched fists � sits in one spot, doesn't point and play with toys she's surrounded with � crawls on bottom, scooting, using bent knee to move � didn't try to pull to stand � didn't try to hold the toy that my daughter (18 month) brought to her several times. She would just cover her eyes. � fell backwards while sitting up when given a gentle hug, didn't stop herself with her hands. These are just a few things. I then mentioned it to the mom. She said she took her to the pediatrician and they said she was doing just fine.

With such an obvious delay in lots of areas, why wouldn't it flag the pediatrician to order PT or therapy of some sort? Could the pediatrician really be okay with where she's at? Also, I question if she was really seen or not. I know there is such a small window of time to help with these things, but my neighbor has just labeled her daughter "an observer" and a "mellow" baby. I have just never met a 19-month old that sits in one place and doesn't play with things they are surrounded by. How can that be normal? It was only 3 hours, but I would think that their impulse would make them get up and play with toys. Also, what are some risks with not dealing with this at an early age? Learning disabilities? Special needs?

From your description of this child, she is already exhibiting significant developmental delays in her gross and fine motor skills, which would lead me to believe she is probably also experiencing some delays in other areas of development (self-feeding, cognitive/play skills and language). A pediatrician should certainly be concerned if a 19 month old child is not pulling to stand yet or is crawling in an atypical or unsymmetrical pattern (though some children do crawl atypically and do not have delays.

But, sometimes, pediatricians only see a child briefly and the child is crying during the visit and they go by parent report, so if Mom is reporting she has no concerns and the child is healthy, perhaps the pediatrician did not recommend anything. The retention of primitive reflexes, fisted hands and lack of protective balance reactions in sitting would be concerning to me even if she were a 12 month old, so as a 19 month old this is very concerning. Perhaps the pediatrician did recommend something, but the parent's are afraid to follow through? If you have a good relationship with this family perhaps you can direct them to our website to look at the developmental milestones for children ages 12-24 months

For example, motor-wise most 18-month olds can:

• Walk alone
• Walk downstairs holding rail, one step at a time
• Run in a hurried walk
• Walk into a large ball to kick
• Throw underhand in sitting
• Pull toy behind while walking
• Stand on one leg with help

This child should have a full team evaluation with a developmentalist, PT, OT and speech therapist because from your description it sounds like she would definitely qualify for PT & OT at the very least. Even if this child had been a preemie (and you didn't mention that), it would still be concerning that she seems to be quite behind in her motor skills.

If her pediatrician has not given her the information for early intervention in your area, perhaps you can give it to her? This is the link for services in your area.

You can make a referral for her if the parent's give you permission. Early Intervention is voluntary, and of course it is so very hard to hear that your child has a developmental delay, so some parent's are simply in denial with the hopes that their child will catch up. Children who start therapy before age 3 have a much greater chance of catching up then those who wait until preschool or school age for needs to be met. I hope this family will follow through and get this child the help she needs before she turns two.

Back to:  Therapist Questions & Answers - Developmental Concerns