Delayed and Regressive milestone

Children develop in the domains of cognition, speech and language, motor, personal skills, social skills and activities of daily living in a predictable and organized manner. Milestones are the predicted points for when a child reaches a significant stage in their development such as walking or talking. A delayed milestone is when the child has not reached a significant stage at a certain predicated age. There can be many different causes of delayed milestones such as genetic problems, problems during pregnancy or birth and premature birth. Problems during early infancy or childhood such as infection or head injury can also cause delayed milestones.  In most cases there is no identifiable cause of the delayed milestone.

Developmental regression is when a child who has reached a certain developmental stage begins to lose previously acquired milestones.   Developmental regression is a common response to hospitalization. It involves the loss of developmental milestones during and after hospitalization.   

Development timeline

6 months

When on front, lift head and chest and use extended arms to support themselves. Use hands to grasp small objects. Turns and listens to familiar voice.

12 months

Crawls or shuffles, using pincer grip with thumb and index finger and responds to own name.

18 months

Walks with feet slightly apart and stops and starts safely, can build tower of three blocks after demonstration and can hold spoon and get food to mouth.

2 years

• Can run and stop and start and avoid obstacles.
• Can pick up and place tiny objects accurately and quickly.
• Can lift cup and drink and replace cup on table with no spillage.

3 years

• Can walk alone on stairs with one foot to each step.
• Can cut with toy scissors.
• Joins in active play with other children.

4 years

• Can walk or run up and down stairs alone.
• Can touch each finger with thumb on imitation.
• Can use spoon and fork easily and can spread butter with a knife.

Causes of Developmental Delay

There is not one cause for delays in development. Factors that may contribute can occur before a child is born, during the birth process, and after birth. The causes may be prenatal, postnatal and neonatal.

• Prenatal risk factors include chronic maternal illness, certain maternal infections (HIV, Syphilis), toxin exposures (smoking, alcohol, drugs/environmental toxics) and nutritional deficiencies. Other risk factors in the perinatal period include pregnancy-related complications, prematurity and low birth weight, and infection exposure during pregnancy or at time of birth.
• Preconception factors-developmental disability relate predominantly to genetic disorders or malformation syndromes. This include Genetic or hereditary conditions like Down syndrome.
• Maternal chronic illness- Diseases such as diabetes, hypertension, renal disease and autoimmune disorders are associated with complications to pregnancy that can adversely affect a fetus or newborn child.
• Postnatal causes- Hypoxic ischemic injury, Traumatic brain injury, Infections, Demyelinating disorders, Seizure disorders (e.g., infantile spasms), Severe and chronic social deprivation, Toxic metabolic syndromes and intoxications (e.g., lead, mercury)
• Developmental Delay Causes may also include premature births, prolonged labour, asphyxia (insufficient oxygen supply),Metabolic disorders, Deprivation of food or environment

In some cases, it may not be possible to find the cause of the developmental delay.

   NEONATAL REFLEXES

Neonatal reflexes are inborn reflexes, which are present at birth and occur in a predictable fashion. A normally developing newborn should respond to certain stimuli with these reflexes, which eventually become inhibited as the child matures. Most primitive reflexes begin to occur in utero through the early months of the child’s postnatal life. These reflexes are then replaced by voluntary motor skills. When the reflexes are not inhibited, there is usually a neurological problem at hand. In those individuals with cerebral palsy and neurogenic dysphagia, the presence of primitive reflexes is a characteristic. The following are some of the normal reflexes seen in newborn babies:

Moro reflex

- occurs from birth until about 3 months of age.

- When the baby is held in the supine position and the head is suddenly allowed to fall back, there is symmetrical opening of the arms before they close again (extension then flexion of the limbs).

Rooting reflex

- occurs from birth until about 4 months of age.

- When the baby is touched near the corner of the mouth, the baby will turn his head towards the stimulus. This is one of the baby milestones that is useful for getting babies to latch onto the breast - the baby will turn to the nipple if it is brushed on the baby's cheek.

Sucking reflex

-occurs from birth until about 4 months of age. When an object is placed in the mouth, the baby will start sucking. This is one of the baby milestones that is vital for survival. Babies don't have to learn how to feed after birth, it is a natural reflex.

Palmar Grasp reflex

-occurs from birth until about 3 months of age. The baby will close his hand if an object is placed in the palm.

Asymmetric Tonic Neck Reflex

• The child is placed on their back and will:

– make fists

– turn their head to the right.

• This reflex is present at 18 weeks in utero

• Disappears by 6 months after birth

Tonic Labyrinthine Reflex

• Arms and legs extend when head moves backward (away from spine), and will curl in when the head moves forward.

• Emerges in utero until approximately four months post-natal.

Galant Reflex

• The neonates back is stimulated– their trunk and hips should move toward the side of the stimulus.

• This reflex emerges 20 weeks in utero and is inhibited by 9 months.

• This turning of the torso aides in neonatal and toddler movement, such as crawling and walking.

• However, if the reflex persists, it can affect walking posture.

Landau’s Reflex

• When neonate is placed on stomach, their back arches and head raises.

• Emerges at 3 months post-natal and lasts until the child is 12 months old.

• If this reflex does not occur, it is an indication of a motor development issue

– generalized intellectual impairment

– Cerebral palsy

Normally Persisting Reflexes

Although it is important that many of these reflexes become inhibited as a child matures, there are also those reflexes that remain throughout a healthy person’s life.

– The ‘knee-jerk’ reflex,

• stimulated by a tap on the tendon located just below the knee while person is sitting

• An involuntary upward swinging of the lower leg and foot is a response.

– The acoustic reflex,

• stimulated by loud noise.

• The stapedius muscle contracts in response to this stimulus to protect the ear from possible trauma caused by loud sounds.

– The pharyngeal reflex, or ‘gag’ reflex

 What Do Abnormal or Persistent Primitive Reflexes Indicate?

 The normal emergence and inhibition of primitive reflexes is extremely important in neonates.

However, these reflexes should disappear and allow for voluntary skills to replace them.

Those children who exhibit abnormal reflex patterns most likely suffer from a neurological problem which can result in;

– Dysphagia,

– delayed speech

– reading problems

• The reemergence of primitive reflexes in adults with a formally mature and healthy neurological system can indicate a problem in the central and/or peripheral nervous systems.

• Thus, testing for the presence of primitive reflexes in adults can determine if there may be neurological breakdown.

Physiotherapy management of children with delayed milestone

Physiotherapy treatment aims to promote a child’s independence and ability to reach physical milestones. Treatment will be specific to a child’s needs, age and abilities and our team of specialist physiotherapists will often use fun games and activities to help promote normal development. We liaise closely with parents, care givers and teachers to help them understand the child’s needs and how they can help promote future independence.

The benefits of physiotherapy are:

• Achievement of physical milestones such as sitting, crawling and standing
• Improved independence in activities of daily living
• Improved posture, muscle strength, balance and coordination
• Improved confidence

Delayed and regressive milestones can severely affect a child’s development so it is vital that treatment is used to help a child to reach the right milestones at the right times. Physiotherapy management speed up paediatric delayed milestones.

To book an appointment or for more information about paediatric delayed milestones contact us or call 0798079039.