Better Health sits down with Nouf Ali Alnoon, Specialist Family Medicine, Fellowship in Maternal and Child health, at Dubai Health Authority’s (DHA) Primary Health Care Sector, to answer questions about developmental delays in infants, when to seek medical advice and when to expect your child to start the taking tiny steps towards walking.
How common is it for infants to suffer from developmental delays with mobility (crawling, standing and walking) and what are the factors or causes that can increase the risk of this?
As children grow, they develop or gain new skills that are called developmental milestones, such as the ability to smile, wave “bye-bye,” sit, or walk.
The developmental milestones assess normal children’s development in four main domains - language or communication, cognitive (learning, thinking), social and physical or movement.
A developmental delay is when a child is behind in obtaining a skill that is expected for their age.
Developmental delays are common in children. In 2006, a study conducted in the UAE reported that the prevalence of developmental delays was 8.6 per cent. Worldwide the prevalence varies between 7 and 16 per cent. One in six children are at risk of a developmental delay.
Gross motor delay is when the child is not reaching an age-specific motor milestone such as rolling, crawling, and walking. It’s not as common as speech or language delay.
Motor delay can be due to many reasons such as a problem during pregnancy, issues at childbirth, an infection or due to genetic problem that affects the child muscles, joints or nervous system.
What ages generally should parents expect their child to start crawling, standing and walking?
A child is expected to start to crawl backward as early as 6 months, but at 9 months all children should be able to crawl.
Some children may not crawl and skip to the next skill such as pulling themselves to stand around nine months of age or cruising (waking by holding to furniture) at 12 months of age. Children start to take their first few steps at 12 months of age but by 18 months of age, all children should be able to stand from sitting and walk independently.
Should parents encourage their child’s mobility development and how should they do this?
It’s a natural skill that all children will develop eventually - the child will walk when they are ready.
Yet, you can promote this skill and encourage your child to walk, by holding your child by both hands and encouraging them to take a few steps when they are ready, and able to stand.
It’s very important that parents should not use a baby walker as it can cause serious problems for the child such as falling, tripping, and injury by reaching hazardous objects. Not only that but they can cause long term hip and joint problems.
Moreover, baby walkers don’t help your child to walk earlier or encourage them to move. So, instead you can use stationery walker that has no wheels, which is considered safe and actually encourages the child to bounce and walk.
Another thing parents may use to encourage the child to walk is a stable push-type baby walker - making sure that the child can stand on their own with both feet flat on the floor and under supervision.
When should parents seek medical advice and what signs should they look for if they think there is an issue?
If parents have any concerns about their child’s development, they should not hesitate to seek medical advice whether it’s the child’s tone, coordination, strength and ambulation, as well as poor or slow feeding.
Even a trivial thing parents notice when compared to other children of the same age is considered important to address.
Parents should seek medical advice when:
- A child can’t hold his head up at four months of age.
- A child is not sitting without support by seven months.
- A child is not standing at one year of age.
- A child is not walking by 15 months of age and a maximum of 18 months of age.
How does DHA treat infants who are struggling with mobility?
At DHA we have child health services that offer free vaccinations for all children and during each visit the child is continuously screened for developmental delays.
Moreover, surveillance is provided by a standard questionnaire called Baraem, which is used to screen for developmental delays in children. It’s available through the DHA application.
It’s generated automatically for children starting at nine months of age to 72 months of age and an SMS is sent to parents as a reminder. In the case that any abnormality is reported or a parent is concerned about a child, an appointment will be arranged for a visit to a child health doctor for further assessment and evaluation by default.
DHA also has a centre called the Early Intervention Centre that has a multidisciplinary team for rehabilitation such as physiotherapy, occupational therapy, speech therapy, and psychology for all children below six years of age.