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Healthy Outlook

If You Wonder About Your Child, Don't Put Off Screening for Developmental Delays

By Dr. Cathy Huang

Wednesday, August 14, 2013

Is my child normal?

As a pediatrician, I often hear this question. Parents are often concerned about what it means if a young child does not stand, walk, talk or show other signs of development when expected.

Usually, everything is fine. When it is not, a screening for developmental delay may detect the issue and intervention can help the child.

The trouble is, for all the questions we field from worried parents, developmental delay often goes undiagnosed. Sometimes we miss the signs because of a lack of resources, either in detection or intervention. Sometimes it's parental misperception, or even denial.

I recommend that any parent with concerns about the development of their child ask their doctor about formal screening – as early as possible, but hopefully before the child starts school. Intervention works better with malleable young minds, and the more preparation a child with delays receives, the better they will acclimate socially and perform academically.

The American Academy of Pediatrics previously reported that children with more pronounced forms of developmental delay, such as autism, were typically diagnosed at age 5 and were not even assessed before reaching 48 months.

Their parents, meanwhile, recalled concerns about development, on average, by the time their children reached 18 months. This lag is likely even longer in cases of milder developmental delays.

It's easy to understand why. Sometimes the evidence of a delay is hard to notice in a young child. And, quite often, social stigma about having a delay is a barrier.

I once suspected that a toddler, who we'll call Bobby, had a developmental delay. Whenever I asked Bobby's parents if they had any concerns about his development, they said he was "smart."

When I suggested a more formal screening test for developmental delays, both seemed uncomfortable. They were worried that if I diagnosed Bobby with a delay, he would no longer be seen as "smart."

The father worried that kids would pick on Bobby when he got older. Then it came out that the father had a similar, hurtful experience in childhood.

But, as I explained to Bobby's father, those experiences are precisely why we now screen children and intervene with developmental delays much earlier than in the past. Kids with delays can be just as "smart" as anyone else, but they often do need more help to prepare for school and socialization with peers.

Early diagnosis can profoundly affect the quality of a child's life. Our minds have the greatest capacity for change and growth in the early years, so that is the period when intervention will have the greatest impact.

Bobby turned out to have mild delays in his speech, so we gave his parents activities to do at home, such as reading to him daily. We follow his progress closely at the clinic, and continue to see improvements.

We believe so strongly in the value of early detection and intervention that we are working closely with community partners, such as First 5, to standardize our screening practices across Contra Costa County.

With the help of early screening and early intervention, our hope is that fewer children will ever feel less than "smart."

Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at For more health information, go to
About the Author

Dr. Huang practices pediatrics at the Brentwood Health Center and Contra Costa Regional Medical Center in Martinez.