PE3.1-3 | Developmental Delay — Summary & Reflection

KEY TAKEAWAYS

Developmental delay is failure to achieve developmental milestones for chronological age, classified as global (≥2 domains, in children <5 yr) or domain-specific. Intellectual disability is confirmed at ≥5 years with IQ <70 and adaptive function deficits.

Aetiology spans prenatal (chromosomal: Down syndrome/Fragile X; structural; TORCH; teratogenic: fetal alcohol syndrome; metabolic: PKU/hypothyroidism), perinatal (HIE, prematurity/PVL, kernicterus), and postnatal (meningitis, lead toxicity, malnutrition) causes. ~30–50% remain unidentified.

Approach: History (perinatal, developmental, family, social) → Examination (dysmorphic features, anthropometry, neurology) → Standardised assessment (DASII for Indian children; DDST-II) → Targeted investigations (first-line: TFT, lead level, hearing assessment; then guided by findings).

Red flag requiring urgent evaluation: any developmental regression (loss of skills).

Management: Treat the cause (thyroxine, low-phenylalanine diet, chelation, hearing aids) + early intervention (physiotherapy, speech therapy, OT, special education) + government entitlements (RBSK, RPWD Act 2016, National Trust Act 1999).

Counselling key points: Compassionate communication, parental role in home stimulation, early therapy without waiting for complete investigation results, educational inclusion, peer support.

REFLECT

Think about the case of Arjun in the opening scenario — the 3-year-old with delayed speech, unsteady gait, and a traumatic delivery history. Having studied this module, what would your next steps be? Which domain-specific delays would you formally assess? What investigations would be most informative given the birth history? And when you sit with his mother — who is frightened, perhaps blaming herself, and watching other children run and talk while her son struggles — what would you say first, and how would you frame what comes next? Reflect on the emotional labour of this conversation, and what resources or support you would need to do it well.