What are the red flags in the development milestone?

Every one of us wants to ensure that our children are on the right path of development. If the child behaves differently than other children, it is natural for us to be concerned about it. To clear our doubts and fear of delayed milestones and other serious problems, we have Dr Sargam Setia to enlighten us about the red flags associated with developmental milestones.

1. Tell me some about yourself –

Hello everyone, I am Dr Sargam Setia. I am a physiotherapist and I have done my bachelors in physiotherapy from Dolphin PG Institute of Biomedical & Natural Sciences, Dehradun. As we go into the collaboration with Ezyschooling, I wanted to mention that I have an experience of working with the kids at a paediatric-physiotherapeutic Clinic, Physio Sparsh. So, that was my journey with the kids. 

2. Why did you choose this topic? 

Before starting, I want to request the parents to not to freak out because there are ways to find out solutions and after this conversation, they should not feel that there are some symptoms or there are things we need to focus on but no, you don’t need to worry. All you need to do is find the exact person or the health care provider if you feel such things are happening 

3. What are the delayed milestones that parents usually come across?

Delayed milestones are basically childhood development milestones that automatically transforms into delayed milestones if they get missed in an expected age. Milestones are the periods in a child’s development. It starts from when the baby is born till 2 years. We find that after 3  months when the baby is grasping, crawling, walking, such milestones occur – speech milestone, then the walking milestone and these are the milestones that occur during a child’s development and growth which indicates us if the child is growing normally or abnormally or if there are any issues with the child.

Like for example, the child babbles, the child gazes, the child responses to the name you have given to the child and the sounds created, so all these moments like baby grasping your fingers, crawling and doing tummy times or rotating themselves, all these are known as the development milestones and when these milestones are delayed or these milestones are altered they are known as delayed milestones. 

For example, if speech is delayed in some children, with delayed speech the parents get worried that the child is not speaking or the child is not responding but it is not something to be worried about. Talking about the red flags, for example, the child is always gazing at you or the child is always gazing at the fan, the child is not responding to his or her name and the child is not grasping or doing the tummy times. So, all these red flags tell us that there are some issues and I want to mention that the parents need not be worried about all these things because you can’t say if one milestone is missed it’s a delayed milestone and the child is suffering from some issues. It is the spectrum of symptoms that cause issues in a child.

If your child is responding to what you say, or the child is babbling but the child is not speaking so the speak milestone can be delayed, and in some children, it develops later. So, there is no need to worry about this thing as it doesn’t indicate that there is some abnormality in the child. It’s the spectrum of all abnormal behaviours that you should be concerned about. Like, if the child is not responding, not gazing, not babbling, and not even speaking then you can say that something is abnormal. 

If there are some neurological conditions, then you should worry about it. If you find that there is a speech delayed or delayed in walking then there is nothing to worry, consult Medicare or a health care specialist, a physiotherapist or an occupational therapist for that and your paediatrician because in some children it is delayed automatically thus parents should not worry about that.

4. Ma’am, we also have some questions from our audience regarding autism and cerebral palsy so it would be helpful if you could just throw some light on these to aspects. 

Autism is basically a communication disorder that occurs in the early year of childhood and in autism you find that the babies or children are not responding or communicating. In autism, the child doesn’t speak or gaze and like that there are all delayed milestones. There are so many cognitive issues like the child doesn’t respond, there are no environmental factors involved, and you find that the child is isolated, whenever you gaze at your baby or whenever to talk to your baby and you find that the baby is not babbling.

In these cases, we usually require a psychiatrist or we go to a counsellor for the children and we usually go for a physiotherapist and also take the help of a paediatrician if the symptoms are detected at an early age. With the help of a paediatrician, you consult a physiotherapist. Parents directly approach us, or they are sent by the paediatricians to the therapist. So, that’s the way of consultancy and the health care provider should be the first choice and you need to understand how to consult the apt health care provider for your baby.  

There are several causes of autism, genetic as well as adaptive, theories are going on for the causes as causes are yet unknown. So for the child, I would suggest a behavioural therapy, occupational therapy, physical therapy, and biomedical therapy. All these therapies are the first line of treatment for babies suffering from autism. 

Talking about cerebral palsy, we all need to know that cerebral palsy is different from autism because cerebral palsy is a movement disorder where the muscles of the child are stiff, it is also detected in the early age of the childhood like from 0-2 years or in the first three years. Cerebral palsy is a movement disorder where you find muscle stiffness, movement stiffness, muscle weakness and there are also cognitive issues, behavioural issues in the child. This goes for a prolonged period. The first line of treatment for that is physical therapy and some parents also go for orthopaedic surgery, and various techniques are involved to treat a child who is suffering from cerebral palsy.

5. When do we understand that we really need to consult someone? 

As I said, 0-2 years is the age where you find out that the child is not responding. If you find that there is only one symptom, then you don’t need to worry, you need to wait because like I told you before that there are delayed milestones. Like I told you it is the spectrum of symptoms that you need to notice like if your kid is not speaking, grasping, and not even walking, not responding or is not even socially interactive.

If you find all these things are going together then you should consult a physiotherapist or a paediatrician. Unless you find all this spectrum of disorders then you should not worry and you should wait because in some babies it gets delayed like, suppose, a baby is not gazing at parents, parents may notice this behaviour in the babies in 3 months and some parents may find this later.

All I want to share is that when you find these symptoms then you should consult a health care provider, your physiotherapist, or your paediatrician to know how to proceed further. Mothers don’t need to worry about this because some babies walk later, some babies walk at the age of 2.5 years, and some babies walk at the age of 3 years. 

If only one milestone is missing that is walking but other milestones are proper, then you don’t need to worry as there is not a spectrum of these symptoms and your child is not suffering from any disorder. It may be due to some muscle weakness or maybe it is due to some nutritional deficiency, you should find the reasons behind that rather than googling about the symptoms. You need to find the reason behind that one milestone that being is missed.

Whether it is a speech milestone, do consult a speech therapist. Suppose, the child is not walking, crawling, turning over tummy times, gazing, not even grasping if you find all these things missing then you should worry about your baby then you should try to consult your specialist, or your physiotherapist or your paediatrician.

6. How does this delay in development affect the child adversely? 

See the delayed milestones affect the child in the later age but when I talk about cerebral palsy or autism when you find them at the early age that some milestones are delayed and you get the assessment and the diagnostics of the baby done, you can find that these occur due to some neurological conditions. If you find out that there are cognitive issues, gross motor issues or there is no development in the child, your child is not socially interactive and your child is not even babbling, when you find all these things and there is a delay in all the milestones then you should consult a therapist because there can be other reasons as I have mentioned. 

There can be some genetic reasons, there can be some difficulty during the time of delivery or it was a difficult pregnancy so all these factors involved causes delayed milestones and in some children, the growth is also postponed so all these factors involved causes adverse effect on the child. If the parents find out that there are some symptoms at an early age and consult a paediatric and find out that the child is suffering from autism or the child is suffering from down syndrome because all these symptoms are similar to such conditions.
So, the early years are very crucial for babies so every mother should be attentive and if the mother is not able to understand what is happening with the child then she need not worry about this because your child is not abnormal some people think in this way but we should not think in this way rather we should seek for help.

7. What is the solution to all this and how do you deal with such children?

If a parent approaches us directly or is referred through a paediatrician, we take the previous history of the child, do the diagnostics and basic assessments of the child’s issues. When we find that the child is suffering through all these disorders then we try to engage the child is some physical therapy, we create a positive environment for the child. Like if a baby isn’t walking at a certain age then we try to engage the baby with other kids, we give few tasks to strengthen the muscles as the main problem lies in the weakness or the stiffness of the muscles so we try to strengthen the muscles.

So that the strengthening of muscles could lead to proper walking as there may be muscle weakness and, in some babies, the muscle tone is less so we are trying to improve that in babies. We take out all those factors and work upon those factors that are causing delayed milestone. If it is speech then we try to work in the speech issues and we set up some of the props like the Lego games or somethings and we try to engage the child in audios or music so that the child tries to speak. If the child is 3-4 years and is having a delayed milestone in speech, so the speech therapist uses ice cream sticks and other methods in their own way to engage the child and break down the words so the child can try to speak.

We also find other issues as well which are related to neurological conditions or some disorders so that is like a long process as we work on various things. First, we do a proper assessment and diagnostics and then we go for proper treatment. The treatment protocol is decided according to the child’s history only. Like for example, in case of autism in children, there are 60% of children who are suffering from autism and have some kind of nutritional deficiencies so we try to engage a nutritionist with us so that we can help the parents with the nutritional issues that the autistic child is facing.

When we work with a child, we need everyone that can help the child in various ways, we need a paediatrician, physiotherapist, occupational therapist, a child educationalist and help of a dietitian. This is like a joint effort as we need to consult different people to find every way to deal with the spectrum that is involved and that is causing delayed milestone or some behavioural issues like cognitive issues that hamper the skill development in the child. So, we need to find out every reason behind that then only we proceed with our treatment. 

Biomedical therapy is very important in this, we go for physical therapy, behavioural therapy, functional therapy, tapping is also involved when children have some early postural issues. We try to engage the child in various games, and we try to change the environment of the child. So, there are various things we try to do. In case of walking, we try to improve the muscle weakness and muscle tone, we try to find if there is any vitamin deficiency like vitamin D, Calcium deficiency or some mineral deficiency so we try to work upon them with the help of a dietician and when we find that the child’s fine motor skills are not developed like the child isn’t grasping or gazing then we try to improve the fine motor skills and the gross motor skills.

In my profession, I always advise that if you want to improve the fine motor skills of a child then you must engage the child into various things like catching papers can be one of the game, if we want to improve the sensations in the child’ finger or movement of child’s fingers then we go for various techniques that involve transferring or touching and feeling and there are various DIYs that the mothers can do at home just to improve child’s fine motor and gross motor skills, children can be engaged in swimming at the house using a kid’s pool, children can be engaged in the activities such as hurdles, hurdles can be made at the home on the floor like floor hurdles, there are also treasure hurdles, games like Lego, all these things can help the child to improve.  

Also Read | Handling Kids With Autism

8. What is the role of nutrition?

Nutrition plays a very vital role in this. In the early years, mother feed is very essential. Babies must take the mother feed in the early years. When there is some vitamin or mineral deficiency then that it leads to some disorders in the later years, for example, Rickets due to deficiency in vitamin D, bone deficiency due to the calcium deficiency so food plays a very important role. Parents must know what the right age is to feed their child and what things to be given to your child. If the child is lacking the exposure to vitamin D then yoghurt can be given, the mushroom can be given, etc. Knowing all these things is very important because food plays a very important role in the development of your child.

9. Is there any possibility to avoid such condition? 

Like I told you it can be avoided if there is early detection of some abnormality and parents consult the specialists like a physiotherapist and/or a paediatrician and a chain of rehabilitation and a chain of treatment starts at an early age. Proper assessment of the child from an early age is the vital factor to stop these disorders to proceed and there we can bring a positive change in the child. 

We should not let it affect the whole body if your child is having a severe muscle stiffness in the arms or the upper limbs or there has been some increase in the muscle tone or the child has some abnormal tone and you consult a physio. If strengthening, muscle manipulation and mobilisation are done in an early period, then it will stop at some certain age, but when you notice them in the later changes or you don’t do anything about the symptoms you observed earlier and don’t consult a specialist, then in the later stage the child may suffer. Muscles and bones will get weak, he or she will have difficulty in walking, the kid’s behavioural pattern will be abnormal, the child will not interact with other kids, there will be some environmental issues, so the social development in the child will stop at a certain age. So, to avoid that whenever you come across an abnormal symptom consult your health care provider or the paediatrician of your child or a physiotherapist at an early stage.

10. Lastly, do you have any message for our viewers?

Yes, I want to tell all the parents out there is no need to freak out or worry about if you see some of the milestones are getting delayed. You should consult a specialist and most importantly, you should not compare your baby with other babies because every baby has a different pace for growth. All the babies do not start walking at the same age, some might start at a later age so there is nothing to be worried about. 

The growth span is different in every baby. Go for ways to improve your babies growth like you can go for good baby massages, try to improve the strengthening, go for good mobilisation, and if you want then you can approach a physio and arrange a home exercising programme, go for some vitamin D exposure, engage your child in a swimming pool and see that he or she is kicking the water or not, engage your child in the activities when you think there will be an improvement in the child’s walking skills and later on you will find positive changes in that. So, like that try to find out some things, try to think something out of the box, try to do some DIYs if you are not able to go out and consult a physio or consult a paediatrician. But when you first detect a symptom then to get the first line of treatment you should consult a paediatrician and proceed further to a physiotherapist and then an occupational therapist or a speech therapist.