Developmental Delays & Red Flags in Children


All children develop and grow at their own pace, achieving milestones such as talking, sitting up, crawling and walking. While children are consistently taking in their surroundings and learning from their interactions, there are specific age-appropriate developmental milestones that most children can do as compared to others of the same age. When the child’s development milestones are delayed, it can raise concerns that may require attention and intervention, called red flags. If these concerns are not addressed early on, they may develop into specific special needs conditions as the child grows.

In this article, we will discuss developmental delays and red flags in children with Dr. Iram Javed – Pediatric Neurologist. She will brief us about the developmental milestones, the causes of delays, the signs, and types of developmental delays and what are the treatments available.

What is a Developmental Delay?

A developmental delay is when a child is slow to reach one or more developmental milestones compared to others of the same age. Not reaching those by a certain age is a developmental warning sign or red flag. According to Dr. Iram, “There is a normal pattern to a child’s development. If the child is behind this timeline, then they may have delayed milestones. If they do, they will have difficulty learning new skills and/or performing a skill.” Delays may occur in the areas of motor function, speech, and language, cognitive, play, and social skills. Global developmental delay means a young child has significant delays in two or more of these areas of development.

Developmental milestones for infants include skills such as:

▪ Smiling for the first time

▪ Rolling over

▪ Sitting without support

▪ Waving bye-bye

▪ Taking a first step

▪ Moving objects from one hand to the other

▪ Transitioning from crawling to taking steps

However, developmental delay is different from developmental disabilities. Dr. Iram says, “A developmental delay may occur in any child with or without cause. A child may be diagnosed with a developmental delay when he or she does not meet expected developmental milestones.”

Whereas, a developmental disability is a long-term, chronic problem that results from physical or intellectual/mental challenges which may include such conditions as cerebral palsy, hearing loss, and autism spectrum disorder.

Types of Developmental Delays 

The types of developmental delays found in children are:

1. Cognitive (thinking) skills: Cognitive skills include thinking, learning, and understanding information. A child with a cognitive delay may have trouble following directions or solving a problem. There are significant delays in recognizing parents, smiling, and establishing eye contact. Learning difficulties are usually apparent when the child starts going to school. Children with cognitive delays may also have difficulty communicating and playing with others. 

 2. Social and emotional skills: These skills include interacting with others, expressing feelings and the ability to communicate needs. The delay can impact a child's ability to learn, communicate, and interact with others. Such children will be unable to communicate, strike up a conversation, would not understand properly, or avoid mingling with other children. Usually, these problems show up before a child begins school or daycare. 

3. Speech and language skills: Speech and language problems are the most common type of developmental delay. A child with speech and language delays may have difficulty speaking words or understanding what others say. Children with speech delays may have trouble identifying colours, body parts or shapes. Such children will have reduced vocabulary, and will not be able to form sentences. 

4. Gross and Fine Motor Skills: Gross motor skills include crawling, sitting, balancing, or walking. Fine motor skills include using fingers to grasp a spoon such as eating, writing, and playing. A child with a fine motor delay may have trouble holding an object in their hands or have trouble with colouring and writing. Motor delays happen commonly due to cerebral palsy or muscular dystrophy or sometimes genetic conditions. 

What are the Developmental Red Flags?

To identify red flags or warning signs, parents need to be aware of normal patterns in children. If they know the normal pattern, it will be easy to identify the abnormal/red flags. Once identified, parents should refer to the child’s pediatrician. These child developmental red flags are certain indicators of potential developmental problems that may require interventions. 

According to Dr. Iram, parents should consult their child's-paediatrician in the below situations:

1. If a child is not smiling back to parents by 3 months 

2. If a child is unable to steadily hold their neck by 4 months

3. If a child is unable to sit momentarily without support by 7 to 8 months 

4. If a child is not standing momentarily without support by 12 to 13 months 

5. If a child is not walking independently by 18 months

6. If a child is not speaking a single meaningful word by 12 months 


Factors that may contribute to the developmental delay can occur before a child is born, during the birth process, and after birth. 

Dr. Iram elaborates on the factors as follows: 

▪ Genetic or hereditary conditions like Down syndrome or Muscular Dystrophy

▪ Exposure to toxins before birth, such as alcohol

▪ Exposure to toxins after birth, such as lead poisoning

▪ Premature birth

▪ Low birth weight

▪ Lack of oxygen during delivery

▪ Poor nutrition

▪ Brain injury

▪ Health conditions such as chronic ear infections and vision issues

▪ Severe trauma, including child abuse

▪ Early screen exposure

▪ Missed/skipped vaccination

▪ Cousin marriages

Signs and Symptoms 

Some of the most common symptoms of developmental delays may include:

▪ Delays in rolling over, sitting up, crawling and walking

▪ Trouble with fine motor skills

▪ Problems understanding what others say

▪ Trouble with problem-solving

▪ Issues with social skills

▪ Problems talking or talking late

▪ Difficulty remembering things

▪ Inability to connect actions with consequences

▪ Inability to do everyday tasks like getting dressed or using the restroom without help

If there is an underlying medical reason that causes the developmental delay, identification and treatment of that condition may improve the child’s developmental skills.


Although there is no cure for developmental delay, therapies directed to the specific area of delay are very effective in helping children catch up to their peers. These types of therapies may include:

1. Physical Therapy: It is often helpful for children with delays in physical or gross motor skills.

2. Occupational Therapy: It guides children through exercises that make it easier for them to perform everyday activities such as scribbling or drawing, feed themselves, and get dressed. 

3. Speech and Language Therapy: It is typically used to address problems in the areas of understanding and producing language and speech sounds, often through play activities.

4. Behavioral therapy: This may be needed in some children for behavioural difficulties that affect socially appropriate behaviours.


Developmental delays can be challenging and can severely affect a child’s development. The early the intervention, the better it will be for the child’s development to help him reach the right milestones at the right times. As a parent, it is important to be watchful for delays in development and to remain consistent with the therapies for their child’s development.

To book an appointment with Pediatric Neurologist Dr. Iram Javed at the Shifaam Online Clinic, click, download the Shifaam Health App or call us at 021-37132273. You can also message us on WhatsApp: 0347-7222273. 

Visit our Paeds Neurology Clinic in collaboration with Hashmanis Medical Centre on Main Shaheed e Millat Road, Karachi for any Pediatric Neurology concerns. 

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If you suspect your child has a developmental delay, you should see a pediatric neurologist in Karachi immediately. For more information on Pediatric Neurologist in Karachi or an appointment with experienced pediatricians contact shifaam today and click on the links below:


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