Assessing Developmental Delays in Infants: Milestones and Testing

Regarding infant intelligence testing!

Hello, Dr.
Hsiao! My brother is now nine months and five days old.
Today, we took him to see a neurologist who assessed his development and said, "His development is only at the level of a seven-month-old." I looked at the developmental milestones for 9-10 months in the child health handbook, and aside from not being able to crawl on hands and knees (but he can scoot on his belly), not being able to pull himself up to stand, and not being able to clap his hands or wave goodbye, everything else seems normal! However, because he is lacking in these three areas, the neurologist became quite anxious! When the nurse saw this situation, she quickly told the doctor, "He just turned nine months, so it's okay if he can't do these three things yet, right!?" The doctor then revised his statement to say, "Well, his development is about one month behind." He kept recommending that I take him to a rehabilitation specialist! He also asked me, "Did the pediatrician mention anything about his development during his vaccinations?" I replied, "The pediatrician said that aside from a slight weakness in his back, everything else is normal!" After that, he asked me to return in a month for an intelligence test for my brother.
I would like to know what kind of intelligence test will be conducted when he is almost 10 months old, and how it will be done.
Also, since my brother is only nine months and five days old and he still cannot crawl on hands and knees (but can scoot on his belly), cannot pull himself up to stand, and cannot clap his hands or wave goodbye, while everything else is normal, does this indicate developmental delay?

Zhuang Tai Tai, 20~29 year old female. Ask Date: 2012/11/29

Dr. Xiao Kaiwen reply Pediatrics

The development of parental records in the child health handbook does not necessarily require full compliance to be considered normal.
There is considerable variability in the neurological development of infants and young children of the same age, and such variability can still be regarded as normal.
What pediatricians aim to identify are cases of significant developmental delays that warrant prompt referral for further evaluation or rehabilitation, known as "developmental delays." It appears that your child does not exhibit significant developmental delays at this time.
To my knowledge, infants should only undergo growth and developmental assessments as outlined in the child health handbook, and there should not be any infant intelligence testing.
It is best for infants to be evaluated by a pediatric neurologist rather than an internist.

Reply Date: 2012/11/29

More Info

Assessing developmental milestones in infants is crucial for identifying potential delays and ensuring that children receive the appropriate support and interventions. In your case, your brother is currently nine months and five days old, and you have noted some concerns regarding his development, particularly in areas such as crawling, standing, and responding to social cues like waving goodbye or clapping hands.

Developmental milestones are generally categorized into several domains, including gross motor skills, fine motor skills, language development, and social-emotional development. For a nine-month-old, typical milestones include:
1. Gross Motor Skills: Most infants at this age can sit without support, crawl on hands and knees, and may begin to pull themselves up to stand while holding onto furniture.

2. Fine Motor Skills: Infants should be able to use their hands to grasp objects, transfer toys from one hand to the other, and may start to use a pincer grasp (using thumb and forefinger) to pick up small items.

3. Language Development: By nine months, babies often babble and may say simple words like "mama" or "dada." They also respond to their names and may understand simple commands.

4. Social-Emotional Development: Infants should show interest in social interactions, such as smiling at familiar faces, waving goodbye, and engaging in simple games like peek-a-boo.

In your brother's case, he is exhibiting some delays in gross motor skills (not crawling on hands and knees or pulling up to stand) and fine motor skills (not clapping hands). While it is true that every child develops at their own pace, the concerns raised by the neurologist regarding his development being at a seven-month level warrant further investigation. The fact that he is not meeting several key milestones could indicate a developmental delay, but it is essential to consider the whole picture.

The neurologist's recommendation for a follow-up visit in a month for cognitive testing is a standard approach to assess developmental delays. The specific tests may vary, but they often include standardized assessments that evaluate cognitive abilities, problem-solving skills, and adaptive behaviors. Common assessments for infants include the Bayley Scales of Infant and Toddler Development and the Denver Developmental Screening Test. These tests are designed to provide a comprehensive overview of a child's developmental status and can help identify areas where support may be needed.

In the meantime, it is essential to continue monitoring your brother's development and provide opportunities for him to practice his motor skills. Engaging him in play that encourages movement, such as tummy time, reaching for toys, and providing safe spaces for him to explore, can be beneficial. Additionally, if there are concerns about his muscle strength, especially in his back, physical therapy may be recommended to help him build strength and coordination.

Lastly, it is important to maintain open communication with your pediatrician and any specialists involved in your brother's care. They can provide guidance on appropriate interventions, resources, and support for your family as you navigate this process. Early intervention is key in addressing developmental delays, and the sooner support is provided, the better the outcomes for your brother's overall development.

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