Developmental Delay

What developmental delay means

Doctors track development in five main areas, called domains:

• Gross motor: rolling, sitting, crawling, walking, running
• Fine motor: grasping, pincer grip, stacking blocks, drawing
• Speech and language: understanding words, babbling, talking
• Cognitive: problem solving, play, learning
• Social and emotional: smiling, eye contact, playing with others, managing feelings

A delay can affect one area (for example, a speech delay) or several. When a child under 5 is significantly delayed in two or more areas, doctors call it global developmental delay. The causes, evaluation and support for this are explained on our developmental delays page.

Milestones have a range. For example, most children walk between 9 and 15 months. Being toward the end of a range is common. A delay is a sign to look more closely, not a diagnosis.

Signs of developmental delay by age

These red flags are based on CDC and American Academy of Pediatrics milestone guidance. They mark skills that most children (about 75 percent or more) have by that age.

Children born more than 3 weeks early are judged by their corrected age (age from their due date) until about 2 years.

Causes of developmental delay

Common and often temporary

• Prematurity: many preterm babies catch up by age 2 or 3.
• Hearing loss, including fluid in the ears, which can delay speech. Every child with a speech delay needs a hearing test.
• Limited opportunity: little floor time, excess screen time or few chances to talk and play can slow skills.
• Chronic illness or long hospital stays.
• Bilingual homes: may mix languages but should reach overall milestones on time.

Conditions that cause lasting delays

• Autism spectrum disorder: delays in social communication, limited eye contact and pointing, repetitive behaviors
• Cerebral palsy: motor delays with stiff or floppy muscles
• Genetic conditions such as Down syndrome and fragile X syndrome
• Intellectual disability
• Developmental coordination disorder (dyspraxia): clumsiness and fine motor difficulty
• Fetal alcohol spectrum disorder
• Hypothyroidism, lead exposure, malnutrition and iron deficiency
• Vision impairment
• Rare metabolic and neuromuscular diseases, more likely when skills are lost

When to worry about developmental delay

Ask for an evaluation if:

• your child misses one or more milestones for their age in the table above
• your child loses skills they had
• you, your child's caregiver or teacher have concerns, even if you are unsure
• your child had risk factors such as very premature birth or a known genetic condition

Trust your instincts. Parents often notice problems first, and research shows parent concerns are a good predictor of real delays.

How developmental delay is checked

The American Academy of Pediatrics recommends developmental surveillance at every well-child visit and formal screening questionnaires at 9, 18 and 30 months, with autism screening at 18 and 24 months. Common tools include the Ages and Stages Questionnaire (ASQ) and the M-CHAT-R/F for autism.

If screening shows a concern, the next step is a full developmental evaluation by a developmental pediatrician, child neurologist, psychologist or early intervention team, plus:

• hearing and vision tests
• physical and neurological exam, head size and growth
• blood or genetic tests if indicated

What helps

• Early intervention (birth to 3): in the US, every state offers free or low-cost evaluation and services under federal law (IDEA Part C). You can contact them directly without a doctor's referral.
• Preschool special education (3 to 5): through your local public school district.
• Therapies: speech and language therapy, physical therapy, occupational therapy and behavioral therapy as needed.
• At home: talk, read and sing to your child every day, name objects, take turns in play, limit screen time for young children, and give plenty of floor time for movement.

Do not wait to "see if they grow out of it". Early support helps whether or not the delay turns out to be temporary.

Frequently asked questions

What are the first signs of developmental delay?

Early signs include not smiling at people by 2 to 3 months, poor head control by 4 months, not rolling or reaching by 6 months, no babbling or sitting by 9 months, and no pointing, waving or response to name by 12 months. Losing any skill is always a warning sign.

Can a child catch up from developmental delay?

Many do, especially when the delay is mild, affects one area, or is due to prematurity, hearing problems or limited opportunity. Early intervention improves catch-up. Delays caused by conditions such as autism or intellectual disability usually continue in some form but improve with support.

Is developmental delay the same as autism?

No. Developmental delay means skills are behind for age and can have many causes. Autism is one specific cause, marked by differences in social communication and repetitive behaviors. Many children with delays do not have autism, and screening helps tell them apart.

How do I get my child evaluated for developmental delay?

Tell your pediatrician about your concerns and ask for a developmental screening. In the US, you can also contact your state's early intervention program for children under 3, or your local school district for children 3 and older, to request a free evaluation.

Should I worry if my baby is late for one milestone?

Being a little late on a single milestone is common and often normal, especially if other skills are on track. Mention it to your pediatrician. Worry more if several milestones are missed, if a milestone is well past the expected range, or if skills are lost.