Developmental delay refers to a slower than expected progression in reaching developmental milestones. This delay can be either global, affecting multiple areas of development, or selective, impacting specific domains such as gross motor skills, fine motor skills, expressive speech, or language comprehension.
It’s essential to determine whether the developmental delay is abnormal from a neurological standpoint or if it falls within the range of normal motor developmental variations, particularly in neurologically typical children.
‘Bobby preferred lying on his back; he sat up later than others and, when lifted off the floor, he flexed his hips and extended his knees. He enjoys bottom-shuffling and scooting! Compared to his peers, he seems to walk much later.’
Bobby’s experience is typical for a bottom-shuffler, a pattern often seen in families. Some bottom-shufflers may have rapid motor development with little to no floor locomotion before they start walking independently. A typical bottom-shuffler does not exhibit any other developmental or cognitive impairments. His neurological assessment is normal, and no investigations or treatments are recommended.
There are also other physiological reasons for developmental variants, including familial delay, ligamentous laxity (which refers to loose ligaments in the upper and lower limbs), and prematurity where development is not adjusted for gestational age.wer limbs), and prematurity with development not corrected for gestational age.
What is Global Developmental Delay (GDD)?
GDD is defined as developmental delay or impairment in more than 2 of the developmental domains:
- Gross Motor domain
- Fine Motor domain
- Speech and Language domain
- Cognition, emotional and social domain
When shall I see a Paediatric Neurologist?
The clinical evaluation conducted by Dr Yeo has several vital objectives:
- To accurately identify the underlying cause of developmental delay, ensuring that no treatable condition is overlooked.
- To customise investigation tests, when necessary, for a more targeted approach.
- To develop personalised management strategies to suit your child’s specific needs.
- To provide a clear prognosis and evaluate the risk of recurrence for a comprehensive understanding of your child’s condition.
During your appointment, Dr. Yeo will perform an in-depth evaluation that includes a thorough medical history review, a physical examination, and a neurological assessment.
Navigating the complexities of developmental delay can be challenging, especially when deciding whether a developmental pattern is a normal variant or a sign of a neurological issue. In cases of uncertainty, it is imperative to conduct baseline investigations to clarify the clinical situation.
Dr Yeo may recommend targeted investigations, which may include blood, urine, or cerebrospinal fluid (CSF) analysis to assess specific chemical or mineral levels, as well as audiological and ophthalmological evaluations. If indicated, MRI of the brain is recommended for its superior sensitivity in detecting abnormal changes. Additionally, an electroencephalogram (EEG) may be requested to provide insights into your child’s brain wave patterns. Depending on the initial investigation results, genetic testing could also be a valuable step in understanding your child’s condition.
This thorough and thoughtful evaluation process is to ensure that your child receives the best possible care tailored to their unique situation. Your concerns matter, and we are dedicated to providing clarity and direction.
Please click ‘Blood Tests & Metabolic Testing’ and ‘Genetic Testing’ for details.
If you have any further questions, you can schedule an appointment today with Dr Yeo.
Dr Yeo’s recent peer-group review journal publications and abstracts regarding Neurometabolic disorders:
Cheng, Duo-Tong, Yeo, Tong Hong, Seng, Michaela Su-Fern, Teoh, Oon Hoe, Lee, Sumin; Koh, Ai Ling. Genomic sequencing: ending the diagnostic odyssey for a child with microcephaly and dystonia with a perioperative challenge. Singapore Medical Journal ():10.4103/singaporemedj.SMJ-2023-134, June 28, 2024. | DOI: 10.4103/singaporemedj.SMJ-2023-134
Leow, XYJ & Tan, JTC & Yeo, Tong & Wong, Kenneth & Mahadev, Arjandas & Ang, Bixia & Vasanwala, Rashida & Ng, Zhi Min. (2021). Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition. Singapore Medical Journal. 64. 10.11622/smedj.2021124.
Hamilton R, Yeo TH, et al. Sensitivity and specificity of the light-adapted ERG in suspected neuronal ceroid lipofuscinoses (NCLs). Documenta Ophthalmologica, Aug 2016;133 (1S).
Yeo TH, Vassallo G, Judge M, Laycock N, Kelsey A, Crow YJ. Infantile neurological Degos disease. Eur J Paediatr Neurol. 2011 Mar;15(2):167-70.
Yeo TH, De Goede C, Crow Y. Biotin non-responsive familial infantile bilateral striatal necrosis associated with primary Influenzae A infection. Eur J Paediatr Neurol. 2011 May:15(1):S117-S118.
Yeo TH, et al. Coexistence of Krabbe’s disease and multiple chromosomal abnormalities: a case report. Poster presentation. Eur J Paediatr Neurol. Eur J Paediatr Neurol. 2011 May:15(1): S52-S53.
Yeo TH, et al. The value of CT brain in undiagnosed neurological disorders. Eur J Paediatr Neurol. 2009 Sept: 13(1):S124.
