The delay in the development of the child. Child developmental delay

Without a doubt, every parent is worried about the health of his child. And if something in its development goes wrong, this, of course, makes you wonder. Many parents begin to take their children to doctors and, more often, not without reason. The sooner you pay attention to the problem, the greater the likelihood that this problem can be eliminated. Of course, you can refer to the factors of individuality and say that “my baby is not the same as everyone and he has his own way”, but in this case nobody canceled the medical norms.

It is time to sound the alarm if you notice that your child behaves indifferently among his peers or cannot join the game. For people without medical education, it is easier to determine such factors as developmental delays by comparing children of the same age.

In medicine, there are certain guidelines and alarming signals for children of a certain age. They are needed so that parents can know for sure that their baby is developing properly, according to all medical standards.

Landmarks for speech development:

• Up to 4 months, the baby utters vowels;
• Up to 5-6 months babbles, can pronounce consonants;
• From 6 months the syllable “ma” begins to form;
• Up to 12 learns to pronounce short simple words;
• Up to 1.5 years a speech understandable to an adult develops;
• By 2 years old he utters whole sentences and knows many words.

Landmarks of motor development:

• Up to 3 months can hold the head;

• Up to 4 months learning to grab small objects with handles;
• Up to 5 months, he turns himself from back to flank;
• Up to 6 months, he already knows how to roll over from his back to his stomach and back;
• Up to 7 months to keep oneself seated;
• Till 10 months creeps, up to 11 - stands with a support, in 13 already goes.

Alarms (from 0 to 4 months):

• The kid hardly reacts even to loud noises;
• There are not enough objects and in general almost does not move hands;
• When a mother appears, the baby does not smile and does not react at all positively;
• Does not hold the head;
• Do not try to imitate the sounds heard.

Alarms (7.5-8 months):

• The child does not pull objects into his mouth;
• Does not make joyful sounds;
• He does not sit by himself, has very hard or, on the contrary, too soft muscles;
• At the sight of mother does not feel joyful feelings.

Alarms (from 11 months to 1 year):

• The child cannot speak words at all;
• Does not walk, do not stand without help, crawls poorly or uses only hands when crawling;
• Does not use non-verbal communication at all.

Disturbing signals of deviations of speech and hearing development (2 years):

• In the lexicon, less than 15 words;
• Does not fulfill basic requests;
• Large objects are no different from small ones;
• Does not make proposals at all.
• Alarms (3 years):

  If it does, it is very vague;

• It is very unstable on his feet;
• The child is not interested in toys, games with other children;
• Does not support eye contact. Alarms (4 years):
• It has a bad memory; Cannot distinguish colors;

It avoids communication with peers, if it chooses a company for itself, then it consists of young children.

The reasons why the child is lagging behind

Prerequisites for improper development of the child, most often are negative factors affecting the fetus during the period of intrauterine formation of the nervous system. These factors may include bad habits of parents, stress or chronic pathologies of the mother.

  What can cause problems in the development of the child? According to experts, the care of parents greatly affects the normal development of the baby. Without proper attention (fairy tales before bedtime, walks, activities with the child, hugs, just conversations with the baby), one cannot count on the normal formation of children.

Even the most expensive and good toys will not replace dad and mom. Body contact, touch, kind words, all this is so important for its development. But do not overdo it: there is a big difference between taking care of hyper care. Do not rush from one extreme to another, give the child the opportunity to express himself, and do not do everything for him.

Also an important reason for the appearance of developmental delays can be diseases that the mother of the future baby had had during the pregnancy. Any, even the most minor infections, can affect the process of formation of the cerebral cortex, and in case of deviations, unpleasant consequences may arise in the period of active growth of the child after birth. A mother who has had any illness at the very beginning of pregnancy puts the fetus at greater risk than if she had had the disease in the last trimester of pregnancy.

Undoubtedly, such bad habits as smoking, drug use, alcohol abuse impose their indelible mark. The poor ecological condition of the area where the parents live, the proximity of factories, factories, and contacts with various harmful chemicals also have a negative effect. Sometimes it happens that the baby does not have enough air in the womb (maybe with toxicosis, wrapping the umbilical cord around the baby’s neck), which leads to the death of nerve cells. Premature babies are also at risk, as their development in the womb is not fully completed and they need to "catch up" with their peers. As you can see, there are many reasons for this.

Required diagnostics

To prevent developmental problems in children, it is necessary to take this issue with full responsibility at the planning stage of pregnancy. Genetic reconciliation of mother and father analyzes will prevent the development of chromosomal abnormalities. A full history of parents will give an appropriate understanding of which of the diseases can be transmitted genetically, and which pathologies will be transmitted to the baby during the period of intrauterine development.

The sooner the disease is detected, the easier it is to cure it later, everyone knows it, experts will tell you the same thing. Never neglect checks, testing and other procedures, although even in this case, doctors are not immediately suspicious. It is possible to check the child for congenital abnormalities right there in the maternity hospital, when the baby is given blood for analysis of five serious genetic diseases.

Try still at an early stage to give yourself an attitude that it is necessary for a child to be checked, even if you are one of those people who do not really trust doctors.

Next, the child is periodically checked by a pediatrician who monitors the overall condition of the baby. Of course, no one here cancels the human factor, so if there is an opportunity, check with different specialists in different clinics, this will help reduce the likelihood of errors. For prophylaxis, you can contact a neurologist at least once every two months, this will give you an additional opportunity to make sure that the baby is all right.

Solution to the problem

It is important to remember that the presence of diseases provoking the fact that the baby is lagging behind in development is not yet a sentence for leading them to a normal lifestyle in the future. Often the attentive attitude of parents and the timely appeal to a child psychologist allows you to grow an absolutely full member of society.

If during the checks it turned out that the child has some kind of developmental delay, then first of all you need to understand: no final and irrevocable verdicts! Until a certain age, doctors cannot make a diagnosis, since the individual characteristics of the brain and nervous system of a particular person can sometimes slow down certain processes, but sometimes with the passage of time everything can return to normal.

Another conversation, if this did not happen and the child lags behind his peers in some parameters of speech or physical development. There are so-called reference dates, determined by doctors all over the world. The norms of motor or mental skill are established, and if a child does not fit into these norms (for each age, their dates), then this problem should be taken more seriously. Of course, there are exceptions everywhere. For example, in medical practice more than once met with the fact that a child who uttered only elementary sounds, begins to speak sharply with whole words and sentences.

Do not let things take their course, write down your observations of the child, talk about your concern to the doctors. If we start treating such developmental delays in time, then through the efforts of doctors and parents it can be done so that in the future the child will be no worse than their peers. Sometimes, after all, this does not go without a trace: children with backwardness in speech later vaguely speak, and if there were problems with fine motor skills, their fingers do not obey, it turns out to be worse to take objects. The child's adaptation is deteriorating in society. However, with due diligence and work with the child, improvements can be made.

Do not try to deny the disease and pretend that nothing is happening. Some parents hope that “it will resolve itself somehow,” but more often it is not the case.

It is necessary to wait a little with trips to psychologists at such an early age, since until 3-4 years a child should be better trained by such specialists as a neurologist, speech therapist, pediatrician, defectologist, orthopedist. Do not be afraid to once again show the baby to the doctor: often, if the parents feel that the child is lagging behind in some way, then this has a basis. Remember that it is the parents who spend most of their time with the child and very much depends on them.

During pregnancy, the mother must protect herself from the factors that harm her. Toys purchased for a child must carry a developmental focus. Care, care, due attention - and the child will be protected almost one hundred percent of the problems associated with adaptation in society in the future.

It is in infancy and early childhood that the rapid development of the brain occurs and the formation of the nervous system is completed. Each child is, of course, an independent personality, which develops according to an individual schedule. However, all children go through the same stages of development - someone a little earlier, someone a little later. These age stages allow you to judge the mental and motor development of the child. Simply put, pediatricians need to know if a child has a set of skills characteristic of children of his age. Delay in the development of the child can be the first symptom of any disease, and that is why doctors will monitor the baby up to a year each month, checking what he can do.

The delay in the development of a child up to a year

How does the development of infants? There are rules that the baby must meet. So, in the month he smiles for the first time when he saw an adult. He briefly lifts his head when lying on his stomach, reacts to the voice of mom and dad, can follow his gaze for smoothly moving objects, briefly focuses his gaze on large objects.

At two months, the baby is able to hold his gaze on the subject for a long time, confidently holds the head, begins to slowly shake, smiles at adults and turns his head, trying to see the source of the sound. With a delay in the development of a child already at this age, deviations from the norm may be observed - for example, if the baby does not hold its head well. Parents should be wary if the baby’s muscles are sluggish or vice versa, they are always in good shape.

By three months, some of the newborn's reflexes disappear - for example, the so-called “automatic walking”. But there are many other skills - and above all, it is active communication with adults. The kid happily smiles at them and even laughs, and his crying becomes different in intonations. In fact, these are really the first attempts at verbal communication. Mom easily guesses why the baby is crying - whether he wants to eat, sleep, or if he has a tummy ache. The baby turns over on his tummy, begins to make the first attempts to touch the rattle. If there is a delay in the development of a child up to one year old, at this age the child cannot roll over on his own, does not have grasping reflexes, does not try to roar. By the age of four months, skills develop, and the child can already concentrate on the toy he has taken in his hand. It accurately localizes the sound source in the room and the faces of adults.

By five months, all reflexes of the newborn, except for sucking, disappear completely. The baby is actively turning over and standing with support. And by half a year he already sits down independently, eats from a spoon or from a bottle, actively picks up objects and swings them. Some babies already at this age begin to babble the first syllables.

At seven months, the child gets up on all fours, and at eight is already actively crawling. These are extremely important stages of motor development. With a delay in the development of a child up to a year, these skills may linger - the child will later begin to sit, stand on all fours and crawl. But all deviations from the norm should be considered only in the aggregate - if in all other respects the child at this age is not inferior to his peers, then it is quite possible that these are his individual characteristics.

At nine and ten months, the child confidently stands and walks holding the support, but the main thing is that he begins to interact with his parents and other adults. He shows objects with his finger, plays finger games, knows his name, responds to the call, actively babbles syllables. And by the year he takes his first steps, learns to collect pyramids, and even tries to comb by himself, actively imitating adults.

Age up to two years

What can indicate a delay in the development of a child at 2 years old, if up to a year he developed, fully complying with the norms? We repeat once again that it is impossible to speak with confidence about developmental delay if the baby first crawled not at eight months, but at nine or ten. There are children who generally pass this stage, immediately getting up on their feet. But if deviations were observed at each of the stages of development, then it is necessary to closely monitor the further development of the child.

In the period from one to two years, mastering the elementary skills of a child and the development of his speech come to the fore. This is a huge leap, because in two years, the baby normally can do the following things:

• He understands the stories of adults, and already has an idea about time;
• Enjoys adjectives (red, beautiful) and pronouns (mostly “he”, “they”);
• Can pick up similar items (for example, round) or, on the contrary, contrasting;
• Already partially can independently put on - for example, put on pants, a cap and boots.

When can we talk about the delay in the development of a child in 2 years? It should be alerted if the child does not fulfill the instructions of adults - it is at this age that children are ready to actively cooperate and readily fulfill simple requests, rejoicing in their achievements. It is very important to follow the child's speech: at this age the vocabulary is enriched with great speed, and the child tends to repeat new unfamiliar words. If this does not happen, we can assume a lag in speech development, which will only intensify in the future without correction.

The cult of individuality has been raised to a superlative degree in our society. The desire to stand out, to be not like everyone else, has already become a sign of good taste and a true sign of creative nature. Children, too, began to win their right to be extraordinary: modern parents are ready to consider not only the needs of the child, but also his wishes. However, it is not necessary to try on the philosophy of individualism to the pace of development of the baby: they are verified by the course of evolution and have their own terms.

The first signaling system is the reflex reactions of our body to stimuli from the outside and inside, which help us to experience different physical sensations (pain, cold, heat) and to realize instincts. But people and animals also have these abilities. At the summit of the food and hierarchical pyramid of the animal world of man, speech was raised — the product of the second signal system, inherent only to higher beings. Today, scientists can, with an impressive degree of probability, assert: the monkey became a man at the moment when it straightened its back and firmly stood on its feet. Without verticalization (the ability to assume a sedentary and standing position) speech, and after it, intelligence, we would never have developed. “The doctors have long been convinced of this,” confirms Vladimir Studenikin, Chief Researcher of the Department of Psychoneurology and Psychosomatic Pathology at the NCHS, RAMS. - If after a stroke the patient is completely immobilized and cannot walk, his cognitive abilities, including memory and attention, begin to fade away rapidly. For the same reason, babies with cerebral palsy are artificially placed in a sitting position. ”

Normally, verticalization begins after six months when the child learns to sit. Speech develops in children only by the end of the first year of life, that is, by the time they rise from their knees. But preparation for an important metamorphosis starts even earlier. Motor (otherwise - motor) development starts immediately after the birth. Gradually, the muscles become stronger, and the child develops key skills: first he learns to hold his head, then grab a toy with his hand, later begins to crawl, then sit, and finally gets up and goes. At the same time, the child’s mental development flows: as the child matures, the cerebral cortex ripens, and the actions become conscious.

For example, if a 7–8-month-old child is offered a piece of apple, he will be able not only to grab and hold it in his hand (which is a sign of stronger coordination), but he will also try a tooth, because at this age he already understands: an apple is food, and the most suitable place for it is the mouth. In this gesture, the shoots of social maturation are already outlined, because here there is an attempt to feed oneself. On the other hand, the allocation of motor, mental, intellectual, emotional and social development is very conditional: all these aspects are too intricately intertwined. “Nevertheless, problems always begin precisely with motor development,” explains Vladimir Studenikin. - If the cause of the motor delay is serious enough, in the next stage, the psychomotor may become stratified, and then speech. When verticalization passes late, the cerebral cortex matures in slow motion. If the baby later raised his head, later crawled, later he sat down and stood up, there is a high probability that he will start talking a little later. ”

Artificial barrier

Parents play an important role in the development of the child. “Children have their own needs: they must not only be fed and bathed,” recalls Vladimir Studenikin. - They need to communicate with mom no less. Easy wellness (non-therapeutic) massage, which she does to the baby herself every day, does not just improve blood circulation through the vessels, which in itself is very useful for the brain. Body contact stimulates the development of the child, even if it is an ordinary stroking. ”

If there is no interaction with parents, one cannot count on the normal development of the child. For at least 2 years, the baby and the mother are connected to each other by an “invisible placenta”. If this “placenta” is torn apart, the child will be artificially deprived, will not be able to manifest all the abilities inherent in it. Developmental toys and games will never be a full replacement. Amazingly, the lack of parental attention can not only lead to a delay in psychomotor, speech, and emotional development. “Children from home babies eat fully, but at the same time they are not gaining weight well,” adds Studenkin. “So the power of parental heat cannot be overestimated.”

In rare cases, the reason for the delay is purely mechanical. “For example, if a baby has a dislocated hip joint during childbirth, doctors immobilize it for some time with the help of special tires,” explains Vladimir Studenikin. “If the“ treatment ”is delayed for 8 months (more often due to the ignorance of the orthopedist or the negligence of the parents), verticalization will not be able to pass on time: to sit down, the child needs to move a lot and strengthen the muscles.” Fortunately, artificially caused developmental delays can almost always be corrected.

Unfavorable background

Lagging behind the schedule may occur for other, more serious reasons, and then the forecast for the baby is ambiguous. Often failures occur during pregnancy. “The cerebral cortex begins to form during the prenatal development of a child,” explains the children's neurologist Elena Gladkova. - In the first trimester, all organs and tissues are laid down, including a special motor zone in the frontal lobe, which is responsible for motor functions. Any negative impact during this period can interfere with the proper formation of brain cells. " Such an obstacle could be infections that a woman had had during pregnancy, birth injuries, a mother’s profession, which involves contact with hazardous substances, poor ecology, electromagnetic radiation from computers and household appliances, bad habits: cigarettes and alcohol. The damage often leads to the so-called perinatal lesions of the nervous system, which translate into delays in motor, mental and speech development.

According to the Scientific Center for Children's Health, Russian Academy of Medical Sciences, in the first year of life more than 80% of children are at risk. By the way, until 1998 another term was used - “perinatal encephalopathy” (some doctors still use it). Perinatal lesions of the nervous system - an extensive concept. These include almost innocuous syndromes such as unilateral violation of muscle tone, and the three most severe scenarios - epilepsy, hydrocephalus (cerebral edema), cerebral palsy. The severity of such lesions depends primarily on what caused them and when the failure occurred: getting infected with the flu in the first trimester is much more dangerous than in II or III.

Most often, perinatal lesions are caused by chronic or acute hypoxia (lack of air) of the fetus during pregnancy. In such conditions, the nerve cells of the brain of the baby no longer receive enough oxygen and glucose, which serve them as food, and die. Chronic hypoxia usually develops during toxicosis or preeclampsia, acute - in childbirth due to various complications, for example, if the umbilical cord is wrapped around the baby’s neck and it becomes difficult to breathe.

Test

All experts are unanimous: it is very important to detect a delay as early as possible, then the child will have much more chances to overcome it. But it often happens that doctors fail to suspect that something is wrong in time, despite the numerous examinations that begin during pregnancy. Immediately after birth, the baby’s condition is assessed on the Apgar scale - this measure allows to detect hypoxia at an early stage. Inadvertent oversights are not uncommon at this stage. In the maternity hospital, a blood test is also taken from a child for 5 serious genetic diseases that must be treated from the first days: (hypothyroidism, cystic fibrosis, phenylketonuria, adrenogenital syndrome, galactosemia).

This study excludes congenital abnormalities, the benefit of laboratory results can be trusted. Then the baby falls into the care of a pediatrician, who, noticing the delay, sends him to a neurologist. However, sometimes the pediatrician does not pay attention to the warning signs only because the crumb gains weight well and withstands great need by the hours. Or does not take seriously the concern of parents, pre-writing it to suspiciousness. That is why the doctor needs to be changed, if his competence raises doubts, and be sure to show the kid to the neurologist (at 1 month, 3 months, 6 months and a year) for the sake of prevention. This is the only way to detect a hitch in time.

“The brain encephalogram makes it possible to see whether the development of the cerebral cortex corresponds to the age of the child or not,” says Elena Gladkova. - Ultrasound of the brain shows the presence of hemorrhages, damaged areas due to hypoxia, hydrocephalus, and so on. These two studies are prescribed for suspected perinatal damage to the nervous system and hereditary pathologies. ”

In growth

Doctors can not always make the final verdict immediately. For example, they give the diagnosis “cerebral palsy” not earlier than a year, “autism” - only after three years (at the age of 3, the child must be seen by a child psychiatrist). Up to 3 years, doctors use the term “delayed speech development,” and after 3 years they speak of “general speech underdevelopment” (in the first case, the baby has a much better chance of recovery). This ambiguity is caused by the fact that the anatomical maturation of the brain and nervous system, which is responsible for the development of motor and mental functions, is parallel, but does not coincide completely. With the individual characteristics of the body also have to be considered, because someone starts walking in a year, and someone - in one and a half.

In order to make the prognosis objective, doctors are forced to wait for a certain period, by the end of which a healthy child must acquire one or another motor or mental skill. The norms were derived empirically as a result of many years of observations, but still these are not constant constants. Thanks to new discoveries in medicine, the reference dates continue to float, and conflicting information appears in the popular science literature. “Doctors rely only on officially recognized averages,” explains Vladimir Studenikin. - And it is important for parents to remember the upper and lower bounds of each “standard”. It is not necessary to think that a child who did not laugh at 3 months is certainly sick, but if he did not laugh at 6 months, this is already a clear sign of mental retardation. Individual rates of development certainly exist, but they never go beyond the age limits. ”

Although exceptions to the rules are still there. “For large children, some terms are shifted for natural reasons, and there is nothing wrong with that,” says Elena Gladkova. - If at 3 months the baby weighs 9 kilograms, it is more difficult for him to roll over on his side, stand on all fours and so on. Some children do develop according to a personal program that does not fit into the usual frame. They do not sit down or crawl, but at some point they immediately stand up and start walking. ” But only additional research will help to establish the true reason for being late.

Action plan

In most cases, perinatal lesions are for a child without a trace or almost without a trace, but only if treatment is started without delay. According to statistics, in 30–40% of cases, the common efforts of the doctors and parents can be restored to the baby’s health, so that in the future it will not be any different from peers. “But there are still“ relatively favorable ”outcomes, - continues Vladimir Studenikin. - Not so long ago, at such a turn, doctors used the term “minimal brain dysfunction,” but it no longer appears in the latest international register of diseases. Doctors correct the violations, but not to the end: such children may have behavioral difficulties and minor problems with motor skills - they walk, but not firmly, they take objects, but it is awkward, they say, but it is unclean. ”

If doctors have discovered a developmental delay in a baby, it is important not to lose time. “It is imperative to treat perinatal lesions of the nervous system,” says Vladimir Studenikin. - Sometimes it is enough vitamins, massage and light vascular drugs. In more serious situations, intensive actions and nootropics are necessary - drugs that nourish brain cells. ”

Rehabilitation centers and psychologists should be treated with caution. “Up to 2.5 years, children are not able to communicate with their own kind,” warns Vladimir Studenikin. - Stress that they experience in the classroom, can cause tics, urinary incontinence, stuttering. By the way, the same thing happens in today's fashionable development centers for healthy kids. ” Children are taken to serious rehabilitation institutions from 2–3 years old. Special programs for the restoration are educators, pathologists and psychologists. Up to 2−3 years to correct developmental delays will be a neurologist, orthopedist and speech therapist.

Landmarks of speech development

• Till 3–4 months - “gulification”: pronounces vowels
• 4−6 months - babbling: pronounces consonants (“gu-g-gy”)
• From 6 months - a syllable is formed ("ma")
• From 6 to 12 months - a set of short words ("give", "on", "woman") appears
• To 1.5 years - says short phrases ("Mom, give")
• By 2 years - uses a large set of words, builds sentences with predicate, subject and addition

Landmarks motor development

• From 1 month up to 3 months - holds the head
• 3−3.5 months - captures objects by hand (having mastered this trick, after 2-2.5 weeks the baby firmly shifts the toy from one hand to the other)
• Up to 4−4.5 months. - turns from back to side
• From 4.5 to 5.5 months. - turns from back to belly
• Up to 6 months - turns from belly to back
• From 5.5 to 7 months. - sitting
• From 5.5 to 11 months. - creeps
• From 6.5 to 10 months. - stands with support
• From 10 to 13 months. - starts walking

Alarms

From 0 to 4 months

• Pupils are inactive or mowed their eyes;
• does not respond to loud noises;
• does not notice his pens (by 2 months);
• not enough items (by 3 months);
• does not smile to mum (by 3 months);
• does not hold the head (by 3 months);
• does not walk and does not try to imitate sounds;
• does not fall on the heels, if you put it on a hard surface (by 4 months).

in 7 months

• Muscles to the touch very hard or weak, like a rag doll;
• constantly watery eyes, there is an increased sensitivity to light;
• the head sinks back when the child is sitting;
• pulls only one pen;
• does not like to caress;
• shows no signs of attachment to the person who cares about him;
• does not pull objects in the mouth;
• does not make joyful sounds (by 5.5 months);
• does not roll from back to stomach in both directions (by 6 months);
• does not sit by itself (by 7 months).

in 1 year

• Does not crawl or crawl, but drags at the same time legs;
• do not stand without support;
• does not look for objects when he sees that they have been hidden;
• does not say a single word;
• does not use gestures (for example, does not shake his head in disagreement);
• does not stick a finger on objects and pictures;
• does not go (maximum to 18 months).

in 2 years

• Speaks less than 15 words;
• does not use two-word sentences;
• does not imitate the behavior of adults, their gestures, new words;
• does not follow simple instructions (“come up”, “look”);
• does not distinguish a large object from a small one.

in 3 years

• Often falls or with difficulty overcomes the steps;
• fuzzy words;
• does not use the pot (good or bad);
• cannot build a tower of 4 cubes;
• handles small items poorly;
• cannot draw a semblance of a circle;
• cannot speak in short phrases;
• does not come into play;
• no interest in other babies;
• rarely looks into eyes;
• little interested in toys.

The reason for the delay in development may be the health of the child or the influence of environmental factors. Both cases are based on inadequate nutrition. Treatment should be aimed at restoring proper nutrition.

Causes of developmental delay in a child

The physiological basis for the delay in the development of any etiology is malnutrition. Currently emit:

• organic developmental delays;
• inorganic developmental delays.

Organic developmental delay. Growth inhibition is the result of an acute or chronic disease that interferes with the consumption of nutrients, their absorption, metabolism or excretion, or increases the need for energy (Table 305-2). The disease of any organ or organ system can cause a delay in development.

Inorganic developmental delays. Up to 80% of children with dysplasia do not have obvious disorders causing growth retardation (organic); growth impairment occurs due to external causes (eg, lack of food), behavioral abnormalities, or a combination of these.

Power shortages can be caused by:

• insufficient income;
• poor understanding of feeding methods;
• improperly prepared mixtures (for example, if they are too diluted to prolong their use due to financial difficulties);
• inadequate breastfeeding (for example, because the mother is under stress, exhausted or malnourished).

Sometimes the psychological basis of inorganic developmental delay seems to be similar to that in hospitalism (sublethal form of anacletic depression), a syndrome observed in infants who have secondary depression with behavioral deviations in the stimulus.

In the absence of motivation (stimulus), the child becomes depressed, apathetic, and eventually anorexia develops. Stimulation may be absent, because the parent / carer:

• is depressed or apathetic;
• has poor parenting skills;
• concerned about the role of the caregiver or not fulfilling it;
• feels hostility towards the child;
• responds to real or perceived external stressors (for example, the requirements of other children in large or asocial families, family dysfunctions, significant losses, financial difficulties).

Poor care does not fully explain all variants of inorganic developmental delays. The temperament of the child, his capabilities and responses help the caregiver understand the model of education. The general scenario of engaging in inappropriate parent-child relationships is the inability to meet the needs of the child (even non-pathological), while the parents may relate well to a child with differing needs, or to the same child in other circumstances.

Mixed developmental delays. With mixed developmental delays, organic and inorganic causes may overlap; children with organic disorders may also have a disturbing environment. In addition, children with severe malnutrition caused by inorganic developmental delays may develop organic medical problems.

Diagnosis of developmental delay in a child

• Frequent mass control.
• Careful collection of medical, family and social history.
• Anamnesis of nutrition.
• Laboratory research.

Children with organic developmental delay can be detected at any age, depending on the underlying disease. Most children with inorganic developmental delay have growth retardation under the age of 1 year, and many by 6 months. Age should be related to weight, height, head size according to standards and growth scales, such as those recommended by the WHO and the Centers for Disease Control (CDC) (for children about 0 to 2 years old, see WHO growth scales for children 2 years old and older are the growth scales of the Centers for Disease Control). Until premature babies reach 2 years of age, the age should be adjusted for gestational.

Mass is the most sensitive indicator of nutritional status. When developmental delays are associated with inadequate calorie intake, weight drops below the base percentile faster than growth. Decreases in linear growth usually indicate severe long-term malnutrition. Simultaneous reduction of length and weight implies a primary growth disorder. Since the brain is predominantly protected from protein-energy malnutrition, a decrease in the increase in head circumference occurs late and indicates severe malnutrition.

Children who are underweight may have a smaller height than their peers, as well as symptoms such as fussiness or crying, lethargy or drowsiness, or constipation. Delay in physical development is associated with a delay in motor development (for example, a delay in the ability to sit, walk), social delays (for example, interaction, learning), and also if there is in older children, with a delay in puberty.

Usually, when a growth delay is detected, anamnesis is collected (including a nutritional history), nutrition is discussed, and the child’s weight is often monitored. In case of insufficient weight gain, despite monitoring and treatment in an outpatient setting, the child is usually hospitalized for observation and emergency diagnosis. Without evidence obtained through the collection of anamnesis and physical examination, no single clinical sign or test can reliably distinguish between organic and inorganic etiology of developmental delay. Since inorganic developmental delays are not a diagnosis of exclusion, the physician must simultaneously look for a basic organic problem and personal, family circumstances, as well as features of the interaction between the child and the family, which can support the psychosocial etiology of the disorder. Optimally, the assessment should be interdisciplinary with the involvement of a doctor, nurse, social worker, nutritionist, child development specialist, and often a psychiatrist or psychologist. It is necessary to observe the behavior of the child when feeding by medical staff and parents both in the hospital and on an outpatient basis.

Involving parents as co-investigators is important. This fosters self-esteem and avoids accusations to those who may already feel frustrated or consider themselves incapable of raising their child. Families should be encouraged to visit the child as often and as long as possible. Employees should welcome them, support their efforts to feed the child, and provide toys and ideas that encourage parents to play with children and other interactions. Medical staff should welcome parents, support their efforts to feed the child, and provide. toys and ideas that will help parents interact with children in the form of a game. Employees should avoid any comments that suggest inadequacy, irresponsibility, or other parental errors as a cause of developmental delays. However, the adequacy of parents and their sense of responsibility must be assessed. Parents suspected of neglecting or abusing the child should be reported to the social authorities. But in many cases, preventive measures aimed at satisfying the family’s needs for support and education (for example, extra coupons for food, more affordable childcare, parent classes) are more appropriate.

During hospitalization, one should carefully observe how the child interacts with people in his environment, and note evidence of self-stimulating behavior (for example, rocking, beating his head). Some children with inorganic developmental delays were described as very vigilant, fearing close contact with people, preferring to interact with inanimate objects, in front of everyone. And although the cause of the inorganic delay in the development of a child is more often scornful than his forced upbringing, nevertheless, the child must be carefully examined for possible violence. A screening test should be carried out on the level of development and, if indicated, the following more complex evaluations. Hospitalized children who are beginning to gain weight well with proper feeding methods, preparation of mixtures and calorie intake are more likely to have inorganic developmental delays.

Testing. Numerous laboratory tests are usually unproductive. If a thorough history or physical examination does not indicate a specific reason, most experts recommend limiting screening tests:

• complete blood count, ESR;
• urea or creatinine level, serum electrolytes;
• urinalysis (including the ability to concentrate and acidification), urine culture;
• determination of pH and blood gases;
• scatology.

Depending on the prevalence of certain diseases in society, testing for blood lead levels, diagnosis of HIV, and tuberculosis may be justified.

Other tests sometimes include determining thyroxine levels if growth is damaged more strongly than weight gain, or when height and weight decrease at the same time (in this case, growth hormone deficiency should also be suspected) and sweat testing, a very strong appetite, smelling abundant stools. Studies on infectious diseases are required to be conducted in children with signs of infection (for example, fever, vomiting, cough, diarrhea), but urine culture may be useful because some children with developmental delays due to UTI do not have other symptoms and signs. If an endocrine cause is suspected, bone age is sometimes determined.

Child developmental delay forecast

The prognosis for organic developmental delay depends on the cause. Children who develop developmental delays under the age of 1 year have a high risk of mental retardation, especially verbal and math skills. Children diagnosed with developmental delay at the age of less than 6 months, when the growth rate of the brain is at its maximum, are most at risk. Problems, especially related to food (for example, pickyness, sluggishness) or elimination, as a rule, occur in the same percentage of children as with other behavioral or personality disorders.

Treatment of developmental delay in a child

Treatment is aimed at providing sufficient health and environmental resources to promote satisfactory growth. A nutritious diet that contains an adequate amount of calories for catching-up growth (about 150% of the normal calorie needs) and support is usually necessary. The ability to gain weight in the hospital does not always allow differentiating children with inorganic and organic developmental delays; All children grow up with adequate nutrition.

In children with organic or mixed developmental delay, the underlying disease must be cured quickly. For children with an apparent inorganic or mixed form of developmental delay, assistance includes the mandatory provision of an educational program and emotional support in order to eliminate problems that interfere with normal child-parent relationships. An overall problem assessment team can initially identify the needs of the family, provide initial training and support, and issue the appropriate referral to public institutions. Parents should understand why these areas are being issued, and if there is such an opportunity, they should be involved in deciding which institutions will be involved. If the child is hospitalized in a specialized care center, the attending physician is obliged to advise on the available local authorities and on the level of expertise available in the community.

Areas of responsibility and accountability should be clearly defined, preferably in writing, and distributed to all participants. Parents should be invited to take stock after the conference so that they can meet with social workers, ask them questions, and also systematize subsequent appointments.

In some cases, the child must be placed in a foster family. If the child is expected to eventually return to the biological parents, an educational program and psychological counseling skills should be provided for them. The successes of the child should be carefully monitored. The return of the child to the biological parents should be based on the parents demonstrating the ability to adequately care for the child.

The development and development of speech in children always takes place in different ways and depends on many factors. Each child is individual, so it is hardly necessary to compare one baby with another. However, it is necessary for parents to know the difference between the norm and pathology.

There are generally accepted, approximate norms by which one can trace the development of the speech of his child. And, in the presence of alarm signals indicating its delay, a specialist should be promptly consulted for correction and, if necessary, for adequate treatment.

Today we are talking about the causes of speech delay in the development of children 3 years. Also say about what to do, treatment. It is about this important issue that we will talk today with you on the Popular Health website:

General norms of speech development

In practice, experts use certain regulatory boundaries, through which parents can focus on the correct development of the speech of their baby.

As for the three-year-old child, at this age his vocabulary should be at the level of 1000 words. His speech is already well understood by parents and everyone with whom he communicates daily. He understands well what you are saying to him and knows how to respond.

The kid at this age is usually quite familiar with the home environment, knows the name of most items. He remembers the names of all family members and his own. Many children know and can give their home address.

He understands the meaning of the questions and can answer them. The questions “Why?” And “For what?” Can give an extended answer.

By the age of four, he can speak quite freely on various, non-complex topics. Of course, it is still not quite coherent, and the sentences themselves are usually monosyllabic, short. However, the baby can easily build a simple phrase from several words.

If there are significant deviations from the above standards, we can suspect a delay in speech development in children.

Causes of delayed speech development

This problem has two main reasons: physiological, associated with the health of the child and social, arising from its environment and features of education. Consider both causes of delay development in more detail:

Physiological causes

Problems with hearing and vision, insufficient development of articulation organs (lips, tongue and soft palate).

Lesions of various degrees of the brain, serious diseases, pathologies caused by intrauterine injuries.

Congenital pathologies and features: Cerebral palsy, Down syndrome, as well as autism and hyperactivity.

Problems during pregnancy, serious illness, transferred by mother
during this period, as well as its use of alcohol, when carrying a baby. Difficult or premature labor.

Heredity.

The treatment in this case is more complex and lengthy than in the presence of social factors and requires the involvement of different specialists.

Social factors

The reasons for children include attention deficit when the child simply has no one to talk with, slurred speech, “lisping” of parents and other people, as well as excessive care for relatives, when the child simply has no motivation to start talking.

Emotional stress, fear.

Constantly working TV, constant loud extraneous sounds surrounding the baby.

Communication of relatives in the family in other languages.

What to do with speech delay?

In children at this age, articulation organs are still being formed. Therefore, the work of narrow specialists is usually effective and successful, especially when a problem with speech is identified in a timely manner. It is very important for parents to carefully observe the baby at this age and, if necessary, show it to a specialist.

If you have problems with speech development, you should contact a defectologist, a neurologist or a psychologist. It is too early to go to a speech therapist, since his field is the formulation of the correct pronunciation of sounds. Therefore, the help of this specialist should be addressed after 4-5 years.

Parents should understand that if there are problems with speech, they should contact a specialist as soon as possible. By the age of 7, time may be lost and it will take a lot of effort so that the child can fully communicate with adults and peers.

Speech delay treatment methods

If necessary, therapy, use two main methods. Let us dwell on them in more detail:

Drug treatment of speech delay

Use of funds aimed at enhancing the function of speech zones. With their help, neurons of the brain are activated. Such drugs are prescribed by a pediatric neuropathologist, individually, after a thorough examination and diagnosis.

Physiotherapy

For the correction used methods of magnetic and electroreflexotherapy. With the help of a course of procedures, the functioning of those areas of the brain that are responsible for mental abilities, diction and vocabulary is normalized.

Usually in therapy use both methods that complement each other. At the same time, classes with a teacher of a correctionologist are needed. Without it, both methods will not bring the desired effect.

With the timely start of complex therapy, it is possible to effectively correct developmental defects, reduce the risk of speech inhibition. The participation of specialists helps the child to cope with the difficulties with the help of individual lessons in the form of a game.

A specialist should be contacted if the speech of a three-year-old child is incomprehensible even to close people. If he does not understand what is being said to him, even a three-word phrase cannot be constructed. Either speaks too fast or vice versa, too slowly. If the symptoms described are accompanied by increased salivation, there are difficulties in swallowing or chewing food, the doctor should be marked immediately.

The main thing to remember is that the sooner speech correction measures are started, and, if necessary, medical treatment of children is carried out, the faster a positive result will be achieved.