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• What Is Developmental Delay?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Developmental Delay?

When a child is more than "a little behind" in everyday skills for their age, they may have a developmental delay. Developmental delay is a significant lag in one or more of the following five skill areas:

• Fine and gross motor (movement)
• Cognitive (thinking)
• Social and emotional
• Speech and language.
• Activities of daily living.

Delays may result from conditions such as Down syndrome, autism spectrum disorder, or cerebral palsy. Children without a specific medical condition also can have a developmental delay. Early assessment is key to a positive treatment outcome. It is important to share any concerns with your child's pediatrician or physical therapist.

Signs and Symptoms

Parents are often the first to notice their child is not meeting developmental milestones. While lagging on one milestone may cause concern, it does not always mean a child has developmental delay. That diagnosis occurs if a child has a significant delay in multiple areas.

Motor developmental delay may be suspected in children who do not explore moving in various ways or meet typical milestones, such as:

• Holding the head up by 4 months.
• Sitting by about 6 months.
• Walking while holding onto furniture by about 12 months.

Children with a motor delay also may have another condition, such as hypotonia (low muscle tone). Hypotonia and other conditions can contribute to movement problems.

Movement delays may be the first area of concern noticed. In infants and young children, all areas of development are connected. A delay in one area affects progress in another. A child who does not learn to sit or change positions to explore or reach toys also may have delayed babbling and talking. Other problems that may contribute to movement delays include being:

• Overly sensitive to touch.
• Unable to plan how to move.

Children with these problems also may develop a fear of trying new motor skills. This can lead to social or emotional challenges. For example, the child may avoid playing with others, exploring the playground, or taking part in creative activities, such as a music class.

How Is It Diagnosed?

Doctors and physical therapists can identify a child's developmental delay. Parents should talk to a pediatrician or physical therapist about any concerns.

During wellness visits throughout early childhood, pediatricians assess whether a child is progressing at an age-appropriate pace. Screening identifies children who will benefit from a more in-depth evaluation. Your child's doctor can identify any medical problems that may affect overall development. For example, chronic ear infections that reduce hearing can affect speech development and balance.

A physical therapist can perform tests to determine if a motor delay is present or of concern. Physical therapists have advanced knowledge of movement development and coordination. They also understand other conditions that may cause movement problems.

Diagnosing developmental delay requires standardized tests by age for each area of development. These tests score a child's movement and other behaviors compared with the expected range for children of the same age. The tests cover skills such as:

• Communication.
• Play.
• Thinking.
• Feeding.

If a child scores below average for their age, they are at risk for or have a developmental delay.

Parents can call their state's early intervention program to have their child's skills evaluated thoroughly. Early intervention programs provide services to help eligible children from birth to age 3.

How Can a Physical Therapist Help?

A physical therapist will conduct a detailed assessment to determine your child's specific strengths and needs. They also will ask about any concerns you have. Questions may include asking about your family's routines and environment. Your child's physical therapist will work with you to find ways to build your child's developmental skills.

Physical therapists help children build motor skills one step at a time to reach specific goals. They will guide your child's movement during visits and work with you to help them learn new ways to move at home by:

• Coaching you on how to aid and encourage movement.
• Teaching you verbal and visual cues.
• Recommending changes to your home environment.

Your physical therapist will teach you and your family how to help your child practice everyday skills. Family who can practice daily with a child have the greatest impact on that child's development toward achieving each new skill.

Your physical therapist will explain how much your child should practice toward achieving specific milestones. They can advise you on the amount and type of activities that are right for your child at each stage of development. It is practical and beneficial to link these activities to daily routines during early development.

Early intervention programs are available in all 50 states and territories. They provide needed therapy services and support for children from birth to 3 years who have developmental delays and disabilities. These programs are free or offered at a reduced cost for eligible children. Each state defines "developmental delay" differently, and services can vary from state to state. A pediatrician or physical therapist can help parents learn what services their state offers. They also can help with the referral process.

Can This Injury or Condition Be Prevented?

It is not always possible to prevent developmental delay. The cause in some cases may be unclear. However, addressing it as soon as it is identified can help children "catch up" or prevent further delay.

All children develop at different speeds. If you notice your child is not progressing at the same pace as their peers, talk to their doctor or a physical therapist. The symptoms of developmental delay vary greatly. The outcomes of treatment also vary. Early identification and treatment are key to positive outcomes.

Note: Babies who do not have enough wakeful "tummy time" play may be more at risk for developmental delay. The American Academy of Pediatrics recommends all infants sleep on their backs to reduce sudden infant death syndrome, or SIDS. This sleep practice has led many parents to avoid placing infants on their tummies altogether, even when awake and supervised. Research shows avoiding tummy time can slow the rate of achieving movement milestones.

Evidence also shows that infants who spend too much time in baby equipment (chairs, carriers, swings) are at a higher risk for motor delays than those with supervised opportunities for unrestricted, active movement.

The "Back to Sleep, Tummy to Play" campaign encourages parents to let babies play on the floor in many different positions. This allows them to learn how to move. It also stimulates the brain and muscles so babies can achieve rolling, reaching, crawling, and walking. Experiencing many different positions allows children to build new movements. Experimenting and exploring new movements help babies learn and think. It may even stimulate speech and social skills.

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 the following:

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

You can search for physical therapists in your area who have these and other credentials by using Find a PT, a tool built by the American Physical Therapy Association.

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

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience helping infants and children with developmental delay.
• Be prepared to describe your child's symptoms and development history in as much detail as possible.

The APTA Academy of Pediatric Physical Therapy contributed to this consumer resource. It is for informational purposes only and is not intended to represent the position of APTA Pediatrics.