Developmental Delay

Question 1

What is the definition of developmental delay?

Answer 1

Child has not acquired a particular skill by an age more than 2 standard deviations from the average age at which the skill is usually acquired.

Question 2

What is the definition of a global developmental delay?

Answer 2

Significant delay in at least 2 of the 4 developmental domains.

Question 3

What are the causes of a global developmental delay?

Answer 3

1. Genetic - Down’s, fragile X, metabolic
2. Congenital brain abnormalities - hydrocephalus, microcephaly
3. Prenatal - drugs, alcohol, congenital infection
4. Perinatal - IVH, birth asphyxia, kernicterus, hypoglycaemia
5. Postnatal - head injury, meningitis, encephalitis, hypoglycaemia

Question 4

What are the conditions causing a gross motor delay?

Answer 4

1. Cerebral palsy

2. Muscular dystrophy

Question 5

What are the conditions causing a fine motor and vision delay?

Answer 5

1. Squint
2. Congenital cataract
3. Retinopathy of prematurity

Question 6

What are the conditions causing a speech and language delay?

Answer 6

1. Hearing impairment - sensorineural or conductive (glue ear)
2. Global developmental delay
3. Autism

Question 7

What are the conditions causing a social skills delay?

Answer 7

1. Autism

2. Child abuse and neglect

Question 8

What are the general clinical features of a developmental delay?

Answer 8

1. Failure to reach specific milestones (red flag)
2. Mild learning difficulties may not be apparent until school age
3. Disruptive behaviour, struggling to keep up in class.
4. Family history of delay, genetic disorders, consanguinity.

Question 9

How is a developmental delay investigated?

Answer 9

1. FBC, ferritin, B12, CK, TFTs, urine metabolic screen, FISH/aCGH.
2. Hearing test
3. Developmental exam
4. Neurological exam
5. MRI, EEG, EMG

Question 10

What is the management of a developmental delay?

Answer 10

1. MDT
2. Educational psychologist
3. Special schools

Question 11

What are the causes of a language delay?

Answer 11

1. Familial - family history of late speech development
2. Hearing impairment - chronic otitis media
3. Environmental - deprivation, poor social interaction, abuse
4. Neuropsychological - global delay, cerebral palsy, autism

Question 12

What is the treatment for a language delay?

Answer 12

Refer early for speech therapy and treat underlying issue.

Question 13

How is a delay in walking investigated?

Answer 13

Hip x-ray, CK, TFTs, vitamin D, calcium.