Many parents watch their children closely for any signs that deviate or differ from what is considered "normal". Whether it be a delay in speech or reactions to stimuli, any sign that they are lagging behind their peers can be cause for anxiety. But are these unfounded fears?
Every child is unique, this is true. That is what makes each individual a delight to watch grow and develop. But according to Dayal Nandwani, Executive Director for the Center for Excellence in Special Education (Stepping Stone) Foundation, Inc., there are many factors that cause developmental delays.
"In this day and age when our food, environment, and social norms are quite toxic, it is important for parents to be very watchful. It is best for parents always to observe the milestones and consult with professionals," he shares in an interview with Smart Parenting.
A study published in the Singapore Medical Journal in 2019 cited that, among children under five years old, 10-15% experience developmental delays and 1-3% are diagnosed with Global Development Delay (GDD). Some delays can be diagnosed as autism, intellectual delay, Down syndrome, cerebral palsy, ADHD, to name a few.
Recognizing the developmental delay
"Children below 6 years old are usually diagnosed with GDD, as it cannot be determined for sure whether or not the child has autism or intellectual delay," says Nandwani.
He adds that, "Autism is diagnosed in one out of every 59 children, according to a study conducted in 2019; Down syndrome, in one out of 800 births. Autism cannot be diagnosed at birth, [but this can be done in the case of] Down syndrome. However, certain milestones of the child can and should be monitored closely as early as three months old."
Below is a developmental milestones checklist, courtesy of Autism Society of the Philippines, that you can use as reference to monitor your child.
Developmental milestones checklist (zero to 3 years old)
At three months
• Begins to develop a social smile
• Becomes more expressive and communicates more with face and body
• Raises head and chest when lying on stomach
• Brings hand to mouth
• Takes swipes at dangling objects with hands
• Grasps and shakes hand toys
• Watches faces intently
• Follows moving objects
• Recognizes familiar objects and people at a distance
• Smiles at the sound of your voice
• Begins to babble
• Begins to imitate some sounds
• Turns head toward direction of sound
At seven months
• Enjoys social play
• Is interested in mirror images
• Struggles to get objects that are out of reach
• Responds to own name
• Begins to respond to "no"
• Babbles chains of sounds
• Rolls both ways (front to back, back to front)
• Sits with, and then without, support on hands
• Reaches with one hand
• Transfers object from hand to hand
At one year (or 12 months)
• Is shy or anxious with strangers
• Cries when mother or father leaves
• Enjoys imitating people in play
• Repeats sounds or gestures for attention
• Is able to finger-feed
• Finds hidden objects easily
• Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
• Responds to "no"
• Uses simple gestures such as shaking head for "no"
• Babbles with inflection (changes in tone)
• Says "dada" and "mama"
• Uses exclamations, such as "oh-oh!"
• Tries to imitate words
• Crawls forward on belly
• Pulls self up to stand
• Walks holding onto furniture
• Bangs two objects together
• Puts objects into and takes objects out of container
• Pokes with index finger
• Answers to name when called
At two years (or 24 months)
• Imitates behavior of others, especially adults and older children
• Is more excited about company of other children
• Demonstrates increasing independence
• Begins to show defiant behavior
• Finds objects even when hidden under two or three covers
• Begins to sort by shapes and colors
• Begins make-believe play
• Points to object or picture when it's named
• Says several single words (by 15-18 months)
• Uses simple phrases (by 18-24 months)
• Uses two- to four-word sentences
• Follows simple instructions
• Repeats words overheard in conversation
• Walks alone
• Pulls toys behind him or her while walking
• Scribbles on own
At three years (or 36 months)
• Imitates adults and playmates
• Spontaneously shows affection for familiar playmates
• Takes turns in games
• Understands concept of "mine" and "his/hers"
• Expresses affection openly
• Expresses a wide range of emotions
• Separates easily from parents by 3
• Makes mechanical toys work
• Plays make-believe with dolls, animals and people
• Sorts objects by shape and color
• Completes puzzles with three or four pieces
• Understands most sentences
• Uses four- to five-word sentences
• Can say name, age and sex
• Walks up and down stairs, alternating feet (one foot per stair step)
• Runs easily
• Pedals tricycle
• Holds a pencil in writing position
When should I be concerned?
To be clear, there is no need to panic. Nandwani advises, though, that parents consult a developmental pediatrician as early as possible to get a diagnosis on their child, if the child does not meet the suggested milestones. "[Parents] need to bring in their child as soon as they suspect something is not right and never relax."
In addition, he says "it is best to already engage the child in stimulating activities focused on social norms, cognitive, and motor skills [early on]."
What if I do not have access to a developmental physician?
Nandwani acknowledges that there is a dearth in developmental pediatricians, licensed speech therapists, occupational therapists, and physical therapists in the Philippines. This is one of the reasons—a deterrent, really—that many parents are unable to obtain a timely diagnosis for their children.
Facilities like Stepping Stone Center, located in Sucat, Parañaque, has professionals who are able to conduct assessments on whether a child is meeting the suggested milestones. The said assessments are conducted by a multidisciplinary team composed of the Academics Head, SpEd teacher, and therapists. It is still best, however, to consult your trusted developmental pediatricians or licensed therapists.
After the assessment, the team prepares an Individualized Education Plan (IEP). They then discuss the content of the IEP with the child's parents. This plan consists of goals that the child should reach at certain periods of time (e.g., monthly, quarterly). The child's progress is noted and documented and, if and when necessary, adjusted accordingly. In turn, the school is fully equipped with therapy centers, Special Education classes, and even vocational courses for children and adults with developmental issues.
"Every child is different so we stress more on their abilities rather than their disabilities," says Nandwani.