Developmental Delay/Speech or Language Delay

General Information

Most parents are very familiar with big milestones, like rolling, sitting, crawling, and walking, and saying first words.  Meeting milestones is good evidence that development is going well and according to plan.  If your baby is falling behind or not meeting milestones, it can be very distressing.  It is important to examine why delays are occurring and to not delay a therapy evaluation and treatment if delays are noted.  Some babies are more at risk for development delay, including those born prematurely, with a muscle tone abnormality (high or low muscle tone), or who demonstrate early feeding difficulties.

If therapy is started early, it may prevent current problems from worsening.  Babies learn by repetition, and it can be very hard to “un-do” patterns of movement if they have had a long time using them.  The job of an early intervention therapist is to teach parents strategies to carry over to boost their child’s development.  Early intervention can give you many tools to help your child!

At Pediatric Therapy, we strongly value a proactive approach to developmental issues with babies and toddlers.  Parents should not accept “wait and see” if they have concerns about development!  If you are unsure about whether your child might need an evaluation, the therapists at PTLC provide free phone consults, in which you can call and discuss your child’s developmental profile to make a guided  decision about whether or not an evaluation is necessary.  In some cases, developmental difficulties may be resolved on a consultative basis alone.

Red Flags that may warrant an evaluation

The following are a few “red flags” for developmental delay that warrant discussing an evaluation with a therapist:

At any age

  • Baby’s muscles feel “stiff” or “floppy”
  • Limited interest in external environment or limited desire to explore environment
  • Movement does not seem as fluid or coordinated as expected for age

By 3 Months

  • Problems following objects/tracking with his eyes
  • Limited movement of the arms or legs
  • Trouble lifting head off the ground when on belly or head lags heavily when baby is pulled to sit
  • Keeps head turned to one side primarily, or head appears “tilted” when looking at you.  (Click here for more information).
  • Baby does not seem calm and alert
  • Does not show brief reciprocal interaction with caregivers (ex: imitating your mouth movements when you hold him/her close to you)

By 4-6 Months

  • Not reaching to midline or to feet/knees when lying on back with hands
  • Uses one side of body more than other
  • Not rolling from tummy to back or arches back when rolling from back to tummy
  • Not bearing weight through legs if placed in standing
  • Baby does not respond to you with smiles or other facial expressions; does not seem to get pleasure from interaction with familiar  caregivers

By 6-9 Months

  • Baby not interested in exploring environment
  • Not sitting independently
  • Unable to move in/out of different positions independently (back to sitting, sitting to all fours)
  • No babbling (babbling should consist of sounds that have patterns, like “ba-ba” or “da-da”) 

By 9-12 Months

  • Baby not crawling or crawls by “bunny hopping” (bringing both arms out first, then scoots both legs in together); crawls with one knee “up” or in unusual way
  • Baby does not attempt to pull to stand or “cruise” (take steps) along furniture
  • Baby does not clap or appear to grasp objects well with fingers
  • Does not consistently pay attention to name when called

By 12-15 Months

  • No first words
  • Baby does not seem to understand you
  • Not walking independently
  • Doesn’t attempt to scribble with crayon

By 15-18 Months

  • No consistent words
  • No use of words in a meaningful way (not just imitation of words)
  • Not attempting to walk up stairs with hand held or crawl down stairs
  • Does not look to caregiver for safety, admiration, or approval
  • Does not use gestures (ex: waving “hi” and “bye”, pointing with index finger to something)
  • Play appears very repetitive with little variety

By 18-24 Months

  • No consistent words or word combinations (by 24 months) (words and word combinations should be mostly meaningful, not just reciting common phrases from TV shows)
  • Cannot kick or throw ball
  • Unable to run, squat, or climb over simple obstacles
  • Does not imitate adults or other children for simple pretend play (i.e. brushing hair, feeding a doll, etc)
  • Does not appear to notice or express interest in peers
  • Play is very repetitive with little variety




What services do you offer to babies and toddlers with a developmental delay?

We offer Occupational Therapy and Speech Therapy services (OT and ST), both on an ongoing basis (i.e. weekly or bi-weekly, sometimes more) and on a consultative basis.

It is important to know that if your baby receives additional early intervention services by another program (like Early Steps of Louisiana), he or she can also receive services at our clinic, but services cannot be billed on the same day.  For example, if your child gets speech therapy with Early Steps on Tuesday, he/she cannot have an ST session in our clinic on Tuesday but they could attend any other day in the week.  Supplementing or adding clinic services in addition to receiving Early Steps services is beneficial for many babies and toddlers to increased intensity of therapy for faster progress.

What happens during a therapy evaluation?

Your therapist will call you prior to your appointment to gather information about your concerns regarding your child’s development, and the office will also send you paperwork ahead of time.  This may consist of a medical history and developmental or sensory questionnaires.  Please bring this to your appointment.  During the evaluation, your therapist will likely use a combination of standardized testing and clinical observations of many areas of development, including motor skills, sensory processing, play skills, etc.  Our observations of your child playing can give us information about numerous areas of development.

More information on play coming soon!

What does therapy for infants and toddlers look like?

Therapy sessions in our clinic last 40 minutes, during which time your therapist will address specific goals targeted to your child’s individual needs through play.  You are encouraged and welcomed to attend sessions with your child.  The therapist will discuss ways you can incorporate different strategies at home to work on progress outside of the clinic setting.  Our speech therapists utilize research based programs, like Hanen’s It Takes Two To Talk®, a specialized parent training program for children with language delays, as well as parent training techniques and approaches supported by the DIR/Floortime® model.