Children may show early delay in the acquisition of motor milestones, with a failure to crawl or sit unsupported at the appropriate age. A child who is not walking at the age of 18mths should be referred for a further opinion, and may need to see a physiotherapist or a specialist paediatri-cian. It is important to exclude the following conditions:
· Cerebral palsy.
· Duchenne muscular dystrophy (DMD) or other muscular disorders.
· Global neurodevelopmental delay as part of a syndrome or other unidentified cause.
Delayed speech may be an isolated finding, either in the production of actual sounds or in the use of language. Language is divided into receptive language (language comprehension) and expressive language (speech to communicate). A speech and language therapist should assess language delay. A hearing test should be considered especially if the child has not had their hearing screened as a neonate or there are other concerns.
The causes of delayed speech development are shown in Box 15.3.
· Familial: a family history of language delay where parents have been late in developing language skills or have had speech therapy
· Hearing impairment: chronic otitis media (glue ear) is a common cause for delayed or poor clarity of speech in the pre-school age
· Environmental: poor social interaction/deprivation
· global developmental delay
· autistic spectrum disorder
Global developmental delay indicates a delay in all skill areas. Often it is more pronounced in fine motor, speech, and social skills. The degree of gross motor deficit is variable. There are many causes of developmen-tal delay, although in some cases the cause will remain unknown. If the delay is severe or profound then it is more likely that a cause will be found.