Developmental Delay in Children: Don’t Wait and Watch, Act Early, Says Paediatric Neurologist

Speech delay, late walking or poor social interaction can leave parents worried. But experts say the first step is not panic—it is timely assessment. In an interview with Sakshi Life, Consultant Paediatric Neurologist Dr Ramya Bandi explained how parents can identify developmental delays, distinguish them from autism, understand the role of screen time and recognise why early intervention matters.

For many parents, watching a child take the first steps, say the first word or respond to familiar faces is an exciting milestone. But what happens when these milestones do not appear at the expected age?

Is the child simply a late bloomer, or could it indicate a developmental delay?

According to Dr Ramya Bandi, Consultant Paediatric Neurologist, child development happens gradually and across several areas—not just walking and talking. Parents need to observe these milestones carefully and seek medical advice whenever they have concerns.

What Exactly Is Developmental Delay?

Development refers to the gradual acquisition of skills as a child grows. Babies first learn to hold their heads up, roll over, sit, crawl, stand and eventually walk. These skills generally develop in a sequence.

But development is not restricted to physical movement. It also includes:

Thinking and learning
Speech and language
Vision
Hearing
Understanding
Social interaction
Use of hands and other motor skills

When a child is significantly behind the expected age range in one or more of these areas, it may be described as developmental delay.

Developmental Milestones Have a Range

Parents should also remember that children do not all develop at exactly the same pace.

Dr Bandi explained that milestones have a range rather than a single fixed deadline. For example, children may begin walking around one year of age, but there can be some variation. Similarly, speech and other skills develop over a range of ages.

Around six months, a baby is generally expected to show skills such as rolling over, responding socially and smiling at familiar people. Around nine to 10 months, crawling and babbling may emerge. Walking generally develops around the one-year period, although some children may take longer.

By around 18 to 20 months, children are expected to acquire more words, while by around two years, many children begin combining words into simple two-word sentences.

The important point is that parents should look at the overall pattern rather than compare their child with another child of the same age.

Speech Delay Is One of the Most Common Developmental Concerns

One of the most frequent concerns seen today is speech delay.

Some children may achieve their physical and other developmental milestones but continue to have difficulty speaking. This can sometimes be an isolated speech delay, where other areas of development are progressing normally.

Speech and language develop through repeated exposure and interaction. Children listen to people around them, process what they hear and gradually learn to communicate. The more meaningful exposure they receive, the more opportunities they have to develop language skills.

Could Excessive Screen Time Affect Speech?

The growing use of mobile phones, tablets and other screens has become an important concern for parents.

Dr Bandi explained that when screens replace human interaction, children lose opportunities to communicate directly with people. A screen provides largely one-way stimulation, whereas human communication involves listening, responding, observing facial expressions and body language and taking turns.

Reduced interaction can therefore affect opportunities for speech development. Screen use can also reduce physical activity, outdoor play and interaction with other children.
The doctor also cautioned parents against assuming that a child is learning language simply because they can repeat material from a mobile phone.

Hearing Problems Can Sometimes Be Missed

Another important cause to consider in a child with speech delay is hearing difficulty.

Parents may assume that a child can hear normally because the child responds to loud sounds. However, according to Dr Bandi, some children with hearing problems may still respond to certain sounds while having difficulty hearing particular frequencies or understanding speech clearly.

As a result, hearing problems can sometimes go unnoticed and delay appropriate intervention.

Is Speech Delay Always Autism?

Not necessarily.

Speech delay can occur for several reasons, and autism is a specific developmental condition rather than simply another name for speech delay.

Dr Bandi explained that autism primarily involves difficulties with social communication and interaction. Communication is not limited to speech—it also includes gestures, facial expressions, body language and the ability to engage socially.

Children with autism may also show restricted interests or repetitive behaviours. Therefore, speech delay alone is not enough to diagnose autism.

Early Signs of Autism Parents Should Watch For

Parents may notice certain early signs, although these signs should not be used for self-diagnosis.

These can include:

• Reduced eye contact
• Limited social interaction
• Less interest in responding to people
• Differences in interaction with parents
• Delayed or unusual speech
• Repetitive movements such as rocking or jumping
• Repetitive ways of playing with toys
• Reduced pointing or sharing attention
• Failure to look towards something when a parent points it out

Dr Bandi stressed that parents who notice such concerns should consult a doctor rather than trying to reach a diagnosis themselves.

When a Child Loses an Already-Learned Skill

A particularly important warning sign is developmental regression.

There is a difference between a child temporarily losing interest in an activity and actually losing an established developmental skill.

For example, if a child previously used meaningful words and interacted normally but then stops using those words and becomes less interactive, it can represent developmental regression.

Dr Bandi described regression as a serious concern that requires evaluation to determine what has changed, which skills have been lost and over what period.

How Do Doctors Diagnose Developmental Delay?

Doctors assess development by looking at the child's age and the milestones expected at that stage.

The evaluation generally involves detailed discussions with parents about when different skills appeared, followed by examination of the child.

Doctors may assess:

• Movement
• Vision
• Hearing
• Social interaction
• Hand movements and ability to pick up objects
• Speech and understanding
• Other age-specific developmental skills

Formal, age-specific developmental assessments may also be used when required. Paediatricians can play an important role because developmental milestones are often checked during routine visits and vaccinations.

Are MRI, Blood Tests or Genetic Tests Always Needed?

Not every child with developmental delay needs the same investigations.

According to Dr Bandi, the need for MRI scans, blood tests or genetic testing depends on the child's clinical presentation and the suspected cause.

The child's symptoms and examination help doctors decide which investigations, if any, are appropriate.

What Causes Developmental Delay?

Developmental problems can originate at different stages—from pregnancy through early childhood.

Possible factors discussed in the interview include genetic causes, problems affecting brain development during pregnancy, maternal infections and certain pregnancy-related complications such as high blood pressure, high blood sugar or thyroid problems.

Birth Complications Can Also Matter

Dr Bandi highlighted complications around delivery as another important factor.

When a baby experiences problems around birth that affect oxygen supply to the brain, brain injury can occur. She also stressed the importance of the first few days after birth, particularly when feeding difficulties or low blood sugar occur.

Other problems after birth, including severe infections affecting the developing brain, can also contribute to developmental difficulties.

Children who experience significant seizures may also develop delays because of their effect on the brain.

Developmental Delay vs Autism: What Is the Difference?

Developmental delay is a broad term covering delays in different developmental areas.

Autism, on the other hand, is a specific condition characterised particularly by differences in social communication and interaction, along with restricted or repetitive patterns of behaviour.

A child with developmental delay may primarily have difficulty in one developmental area, such as speech. Autism involves a broader pattern of social-communication and behavioural differences.

Boys May Talk Slightly Later—but Don't Ignore Delays

A common belief among families is that boys naturally speak much later than girls.

Dr Bandi said there is some evidence that girls may acquire language slightly earlier. However, the difference should not be exaggerated.

Parents should not assume that a boy who is significantly delayed in speech will automatically catch up simply because he is a boy. If a child is approaching 18 or 19 months without meaningful speech, the concern should be assessed rather than dismissed. Understanding, interaction and the child's ability to communicate should also be considered.

What Counts as Meaningful Speech?

Simply repeating a word does not necessarily mean a child is using language meaningfully.

For example, if a child says "grandfather" while looking at or referring specifically to the grandfather, that word is being used meaningfully. But if the child simply repeats the word without understanding or connecting it to a person or situation, it may not represent meaningful language.

Context and communication are therefore important when assessing speech development.

Two Languages Do Not Automatically Cause Speech Delay

Another common misconception is that children exposed to two languages become confused and therefore develop speech delay.

Dr Bandi said there is no scientific evidence in the interview to support the idea that simply being exposed to two languages causes speech delay.

Children can learn more than one language. They may initially mix words from different languages, but this does not necessarily mean they have a developmental problem.

Treatment Depends on the Cause

The outlook for a child with developmental delay depends heavily on the underlying cause.

If the delay is linked to a relatively simple and treatable problem such as a vitamin deficiency or thyroid deficiency, addressing that problem may lead to significant improvement.

When there is a more substantial neurological problem, progress may depend on the nature and severity of that condition.

Therapies Can Make a Major Difference

Once the cause and developmental needs are understood, therapy can become an important part of management.

Depending on the child's difficulties, therapies may include:

• Physiotherapy
• Speech therapy
• Occupational therapy
• Behavioural therapy

Dr Bandi stressed that developmental intervention is not the responsibility of one person alone. It often requires a coordinated team involving doctors, therapists and parents, with consistent effort over time.

Why Early Intervention Matters

One of the strongest messages from the interview was the importance of early intervention.

Early intervention means beginning appropriate support as soon as a developmental problem is identified, rather than waiting for the condition to become more obvious.

For example, babies born prematurely, those who spend significant time in intensive care or those who experience complications may already be considered at higher risk for developmental difficulties. In such cases, intervention may begin before a major delay becomes obvious.

Similarly, if a child is known to have developmental delay but the exact diagnosis has not yet been established, therapy need not always wait until every diagnostic question is resolved.

Why "Wait and Watch" May Not Always Be the Right Approach

Parents are sometimes advised by relatives or neighbours to simply wait because "the child will start talking later" or "children develop at different speeds."

Dr Bandi's message was clear: when parents have a genuine concern, they should get it assessed instead of relying on informal reassurance.

Early childhood is an important period for learning and development, and unnecessary delays in seeking help can mean losing valuable time for intervention.

What Can Parents Do at Home?

Parents play a crucial role in a child's development and therapy.

They should:

• Follow the doctor's advice consistently
• Continue recommended exercises and therapies at home
• Give prescribed medicines on time
• Increase meaningful human interaction
• Reduce excessive screen exposure
• Spend time playing with the child
• Encourage interaction with other people and children
• Provide opportunities for outdoor activity

For children with speech concerns, direct interaction and play with another person can be particularly valuable.

Grandparents can also provide useful support when they are actively involved in the child's life. Their presence can increase human interaction and provide opportunities for play and bonding, especially when parents are busy.

Can Developmental Delay Be Completely Treated?

There is no single answer because the outcome depends on the cause.

Dr Bandi explained that children with less severe or treatable causes can show significant improvement. The broader goal is to help children overcome their difficulties as much as possible, participate in school and daily life and become as independent as they can.

Therapy and sustained support can play an important role in achieving these goals.

Don't Mistake Stubbornness for Autism

Another misconception is that a stubborn or difficult child automatically has autism.

Dr Bandi stressed that autism is completely different from ordinary stubbornness. A child's behaviour can be influenced by several factors, including temperament and environment.

A single behaviour—such as not making eye contact—should not be used on its own to diagnose autism. A proper assessment requires looking at the child's overall developmental and behavioural pattern.

A Case That Shows Why Screening Matters

Dr Bandi shared the example of a six-month-old baby who was brought in because the baby was not holding the head properly.

During routine assessment, the child was found to have very low thyroid levels. Thyroid supplementation was started, after which the child's development improved. The baby subsequently began rolling over, holding the head and later sitting.

However, the child remained slightly behind peers because valuable early developmental time had already passed before the problem was identified.

The doctor therefore highlighted the importance of newborn screening, including screening for thyroid problems, so that treatable conditions can be identified early.

Pregnancy Health and Baby's Brain Development

The interview also touched on the importance of maternal health during pregnancy and the early years of a child's life.

Dr Bandi advised mothers to maintain a balanced diet during pregnancy. She also mentioned foods containing omega-3 fatty acids as potentially helpful and stressed that a healthy pregnancy supports healthy brain development.

Can Children Learn Speech From Mobile Phones?

A child may watch videos and repeat alphabets, numbers, songs or rhymes perfectly. But that does not necessarily mean the child has developed functional language.

Dr Bandi explained that true communication involves interacting with other people—not simply reproducing something memorised from a screen.

A child who can recite A to Z, count from one to 20 or repeat rhymes may still have difficulty communicating needs, responding socially or engaging in meaningful conversation. Repetition alone should therefore not reassure parents that speech development is normal.

Can Children With Developmental Delay Lead Independent Lives?

A developmental delay does not automatically mean that a child will remain dependent throughout life.

Dr Bandi noted that many children improve significantly and go on to lead their own lives. The objective is to identify the difficulties, provide appropriate support and help the child overcome as many challenges as possible.

With the right support, the focus should be on helping the child participate in school, society and everyday life and achieve maximum independence.

Hyperactivity: When Should Parents Seek Help?

Some children are naturally energetic, and a certain degree of activity can depend on temperament and personality.

However, very high levels of hyperactivity may require professional assessment, particularly when a child is constantly climbing or jumping, knocking things over, failing to listen, or repeatedly struggling to follow simple instructions.

Dr Bandi also pointed out that hyperactivity can occur alongside autism, so doctors need to understand whether it is occurring independently or as part of a broader developmental condition.

The Bottom Line for Parents

The central message from Dr Ramya Bandi's interview is simple: do not ignore developmental concerns and do not rely solely on "wait and watch."

Every child develops at an individual pace, but there are developmental ranges that parents and paediatricians can monitor. A delay in walking, speech, interaction, understanding or other skills deserves attention—particularly when parents themselves feel that something is not right.

And if a child loses a skill they had already acquired, the concern becomes even more important.

Rather than relying on advice from neighbours, relatives or comparisons with other children, parents should seek professional medical assessment. Early identification can open the door to timely therapy and support.