Spot the development delays early so that your child can enjoy a more fulfilling life.

Dr Lian Wee Bin, Consultant, Neonatal and Developmental Medicine, at Singapore General Hospital, sheds  light on what developmental delays are really about.

Many parents have the impression that boys may often be slower in terms of development. While not all children develop the same way, it is, however, important to note the various developmental milestones and patterns.

Speech Boys may be slower for speech. However, all children should speak prior to turning 18 months. This means being able to use at least three words (besides ‘Papa’ and ‘Mama’) meaningfully. Accompanying this should be concomitant language and communication development.

Language is the use of words to express our needs, interest and feelings and involves both receptive (receiving and understanding) and expressive (output and response) components.

Communication involves both verbal and non-verbal modes, including gestures, facial expressions, tone and pitch of voice and language interpretation and construction.


Why it is important: Speech and language concerns make up about two-thirds of referrals  in most developmental clinics. This includes children with pronounciation disorder (unclear speech), oral dyspraxia (difficulty with speech control, often also affecting language), receptive and expressive language disorders and communication disorders (such as Autistic Spectrum Disorder [ASD]).

What should be considered: Doctors find out more about a child’s developmental history to decide if early intervention is needed. Hearing screening is also sometimes recommended even if parents don’t think a child is deaf, because mild hearing impairment may not be clinically apparent. Children with receptive deficits often have associated learning difficulties later. Conditions such as ASD (with impairments in social communication, impaired social interaction and play and atypical, stereotypic behaviours) are life-long conditions that have great impact on the child and the family. This is because up to 70% of them have some degree of mental delay. The first few years can be particularly traumatic if appropriate intervention is not put into place.

Gross Motor Skills

Why it is important: Sometimes, a child may not walk on time. As a general guideline, paediatricians like to see children sit by 8 months and walk by 15 months. When these are not achieved, the child may have gross motor delay.

What should be considered: We get worried when we don’t see that happening: we ask if the child’s tone is normal and whether there is any limb weakness. With gross motor delay and poor tone (hypotonia), a wider scope of disorders must be considered: muscle disorders, hypothyroidism (low thyroid function) and other syndromes. Specific limb weakness may indicate a cranial cause warranting a scan. In most instances, these children will require physiotherapy.

Fine Motor Skills

Why it is important: Other motor difficulties may surface later such as poor block stacking, pen grasp, threading, writing and drawing or handwriting skills, termed fine motor delays and may be isolated or occur with other disorders, e.g. with oral dyspraxia, under a wider umbrella of  Developmental Co-ordination Disorder.

What should be considered: These are usually children who seem clumsy, not great at physical activities, are slow with writing and sometimes in learning as well. Occupational Therapy is an important intervention that can help these children.

Play Patterns

Why it is important: Play comes naturally to most children They develop parallel play by 2 and interactive play by 3, with good pretend play between 2-4 years, However, there are some who do not know how to play. Some may not be able to stack blocks: They might never have been exposed are they might have some fine motor difficulties. Perhaps your child its not interested in playing; he only wants to stare at the fan, the spinning car wheels or the blinking lights of the elevator. These interests are considered atypical play patterns.

What should be considered:  If your child is attracted to these repeated motions, a red flag has to be raised because these atypical play patterns are often seen in the the child with ASD. Ask yourself if your child is generally alone or enjoys peer-company. Perhaps, he is fantastic in recollecting the alphabet and numbers, yet does not speak a word (hyperlexia) – another feature of ASD. Sometimes, parents rejoice when they proudly declare that their child is very good – ‘can read’, yet admit that he can only say a couple of words. To doctors, that isn’t a regular developmental pattern – in other words, one does not scale walls before he can walk.

Learning Disability

Why it is an important: Learning disability (discrepancy between cognitive ability and achievement or school performance) is known to occur in two or three of untreated children with ADHD, but it also stands alone. The child, often of normal intelligence, gets increasingly frustrated with academic learning and demands.

What should be considered:  Dyslexia is one such condition, where the written form poses a challenge for the affected child. Proper diagnosis is required, often possible only when a child is about six or seven years old, and intervention critical to allow the child to achieve his optimal ability.


Why it is an important:  Sometimes, a child may not have good attention, a feature that becomes significant around the age of 5 years, before which it is normal to have some degree of hyperactivity. Is poor attention a cause or a result of poor understanding, often related to poor speech and language skills – the chicken and egg question?

What should be considered: If your child has poor attention, is hyperactive or impulsive, doctors would consider Attention Deficit/Hyperactivity Disorder (ADHD), for which the cornerstone of treatment is medication, a fact that needs to be emphasised despite reservation from parents. Medical literature clearly documents best outcomes in medicated children, with reduction in risks towards co-morbid disorders such as Opposition Defiant Disorder, Conduct Disorder and other psychiatric disorders. It also lessens the risk of future behaviour like substance abuse, dropping out of school and traffic offences.

With raised parental expectations, increased learning hours with enrichment classes and school, sometimes, these delays may be missed. Early indentification and intervention are essential in helping the child achieve his optimum potential. When in doubt, it is good to consult a peadiatrician.

Article courtesy of Singapore General Hospital.