Warning signs of a developmental delay

Children develop at different rates, but most follow a general timeline. Most of the time, babies reach each developmental milestone (like rolling over, sitting, walking, and talking) right around the expected age, and if not, they catch up soon. If your child doesn't seem to be meeting milestones within several weeks of the average, ask their doctor about it.

Keep in mind that if your child was born prematurely, they might sometimes need a bit more time than other kids their age to reach the various developmental stages. Doctors may track a premature baby's development using their due date rather than their actual birth date until age 2 or 3.

As a general rule, trust your instincts. If something seems odd or wrong to you about the way your baby or child moves or acts, ask about it. After all, you know your little one best.

Signs of a development delay in babies, toddlers, and kids

The following are possible warning signs of a problem:

By 2 months

• Doesn't respond to loud sounds
• Doesn't watch things as they move
• Can't hold their head up when on their tummy
• Doesn't smile at people
• Doesn't bring hands to mouth

By 4 months

• Doesn't watch things as they move
• Doesn't smile at people
• Can't hold head steady
• Doesn't coo or make sounds
• Doesn't bring things to mouth
• Doesn't push down with legs when feet are placed on a hard surface
• Has trouble moving one or both eyes in all directions

By 6 months

• Doesn't try to grasp things within reach
• Shows no affection for caregivers
• Doesn't respond to sounds around them
• Has trouble bringing things to mouth
• Doesn't make vowel sounds
• Doesn't roll over in either direction (back to front or front to back)
• Doesn't laugh or squeal
• Seems very stiff, with tight muscles
• Seems very floppy, like a rag doll

By 9 months

• Doesn't bear weight on legs when supported
• Doesn't sit with help
• Doesn't babble
• Doesn't play games involving back-and-forth play
• Doesn't respond to own name
• Doesn't seem to recognize familiar people
• Doesn't look where you point
• Doesn't transfer toys from one hand to the other

By 12 months

• Doesn't crawl
• Can't stand with support
• Doesn't say single words like "mama" or "dada"
• Doesn't use gestures such as waving or shaking their head
• Doesn't point to things
• Doesn't search for things that they see you hide
• Loses skills they once had

By 18 months

• Doesn't point to show things to others
• Can't walk
• Doesn't know what familiar things are for
• Doesn't copy others
• Doesn't gain new words
• Doesn't have at least 6 words
• Doesn't notice or mind when a caregiver leaves or returns
• Loses skills they once had

By 2 years

• Doesn't use 2-word phrases (such as "drink milk")
• Doesn't know what to do with common items, like a brush or fork
• Doesn't copy actions and words
• Doesn't follow simple instructions
• Doesn't walk steadily
• Loses skills they once had

By 3 years

• Falls down a lot or has trouble with stairs
• Drools or has very unclear speech
• Can't manipulate simple toys
• Doesn't speak in sentences
• Doesn't understand simple instructions
• Doesn't play pretend or make-believe
• Doesn't want to play with other children or with toys
• Doesn't make eye contact
• Loses skills they once had

By 4 years

• Can't jump in place
• Has trouble scribbling
• Shows no interest in interactive games or make-believe
• Ignores other children or doesn't respond to people outside the family
• Resists dressing, sleeping, and using the bathroom
• Can't retell a favorite story
• Doesn't follow 3-part instructions
• Doesn't understand "same" and "different"
• Doesn't use "me" and "you" correctly
• Speaks unclearly
• Loses skills they once had

By 5 years

• Doesn't show a wide range of emotions
• Shows extreme behavior (unusually fearful, aggressive, shy, or sad)
• Unusually withdrawn and not active
• Is easily distracted, has trouble focusing on one activity for more than 5 minutes
• Doesn't respond to people, or responds only superficially
• Doesn't play a variety of games and activities
• Can't give first and last name
• Doesn't use plurals or past tense properly
• Doesn't talk about daily activities or experiences
• Doesn't draw pictures
• Can't brush teeth, wash and dry hands, or get undressed without help
• Loses skills they once had

What does "developmental delay" mean?

Doctors use this term when a child doesn't reach developmental milestones within the broad range of what's considered normal. The delay might be in one or more areas: Gross motor skills such as sitting up and fine motor skills such as grasping and manipulating objects, communication and language skills (both understanding language and speaking), self-help skills (like toilet training and dressing), and social skills (such as making eye contact and playing with others).

What are the chances that my child has a developmental delay?

Various studies have reported that 10 to 15 percent of children under the age of 3 had a developmental delay, such as difficulty learning, communicating, playing, or performing physical activities or practical skills.

Early intervention can make a huge difference for many children with developmental delays, yet one study found that only about 3 percent of kids were getting appropriate attention. That's why it's important for you to speak up if you suspect your child has a developmental delay.

Some delays disappear by the time a child heads to school, while other problems won't be identified until later. About 14 percent of children under the age of 17 have issues such as speech and language impairments, an intellectual disability, learning disabilities, or emotional and behavioral problems.

Among children with developmental delays, about 40 percent have more than one developmental issue, and less than 2 percent have three or more.

If my child does have a delay, what could be causing it?

Sometimes delayed development has a medical cause, such as complications of a premature birth or a genetic condition like Down syndrome. Or it could be the result of a serious illness or accident.

Speech and language delay might stem from a hearing impairment or a problem with the larynx, throat, or nasal or oral cavity. Difficulties with communication might be related to a problem with the central nervous system.

Most often, though, no specific medical cause can be found to explain developmental delays.

Will my child's doctor check for developmental delays?

Yes, they should. The American Academy of Pediatrics recommends that babies and children be informally screened during visits for any potential delays and be given a formal, structured developmental screening at 9, 18, and 24 or 30 months. Plus, screenings can be done whenever a parent or provider has a concern.

The AAP also recommends that children be screened for autism at 18 and 24 months.

Your child's doctor should ask you about any concerns you have. Using standard developmental assessment tests, the doctor will look for specific motor skills, communication and language skills, and cognitive ability.

If they find anything of concern, they may do a more detailed test or refer you to a specialist in developmental issues. Your child will then have a developmental evaluation, which is a more in-depth assessment of their skills. Or, if your child seems to have a language or communication delay, the doctor may send them to a speech pathologist for an evaluation.

Vision and hearing problems – which may affect development in other areas – can be hard to spot unless you're a professional. Eye and ear checkups should also be part of every checkup for your child, beginning with their first doctor visits as a newborn. If your child's doctor suspects a problem, they may recommend more thorough hearing or vision tests.

If you're worried about your child's development between regular well-child visits, don't wait until the next one. Call the doctor and explain your concern. They may be able to calm your fears quickly, or they may want to schedule an appointment for a developmental screening right away.

If your child has been evaluated by their doctor and you're still concerned, don't hesitate to get another opinion. (It's a good idea to keep your child's primary care provider informed about visits to other doctors and their findings.)

Look for a specialist in developmental issues, or consult a speech pathologist if you're concerned about your child's language delay. In addition, most communities have early intervention programs that provide free developmental evaluations and screenings to those who qualify.