When a toddler isn’t meeting key milestones, like combining words or showing social engagement, parents may wonder whether to wait or seek help. While every child develops at their own pace, early intervention for developmental delays offers the best chance to support growth and prevent long-term challenges.
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A 2-year-old child is not yet combining two words and has limited pointing or social referencing. Motor development is on track. Hearing and vision screens are normal. The pediatrician recommends early intervention, but the parents are hesitant and believe the child is simply “a late bloomer.”
Key takeaways about approaching early intervention for developmental delays:
Pediatrics
"I tend to send young children for early intervention whenever they start to fall behind in development. I explain to the parents that if we refer them now, they may be able to catch up more quickly. Waiting generally puts them further behind before they can be seen. I even tell them that if we refer them, they may actually improve before they start any therapy, and the therapist can discharge them."
Pediatrics
"Refer early; the earlier the better, but take a careful family history and look for subtle signs of possible genetic syndromes. Hand flapping or other stereotypical behaviors, rocking, etc, should send up red flags. As with all decision-making, it should be shared decision-making with advice and suggestions to reevaluate within a certain timeframe if no improvement. Ultimately, all we can do is offer our best advice in a nonjudgmental way."
Family Practice
"By the age of 2, I would check hearing first, and if there is a history of ear infections, I would recommend an ENT consult. Concerns for autism could be a lack of eye contact, repetitive behavior, or non-verbal. Hesitant parents could be counseled that earlier intervention reduces issues later, for example, if ear tubes are needed, then follow-up. It's easy to arrange if speech therapy is needed, the sooner the better, as this is best for their child. If autism is suspected, there are support groups for the parents."
Family Practice
"In Chicago, we refer to early intervention before age 3, and after age 3, the Chicago Board of Education does the evaluation. I would screen for lead poisoning, which is common in Chicago. I would also try to convince the parents, and if they still refuse, recommend they read to the child and try to interact with the child daily through interactive play. I would bring the child back for another evaluation in a month."
Oncology/Hematology
"1. Refer early. The data is clear that EARLY intervention is best. Parents are often embarrassed or fearful of having a child that is different, but they should be encouraged to follow the recommendations. Case examples of other children may help to convince them.
2. The typical signs in the diagnostic criteria include making unusual hand movements near the eye.
3. Gentle encouragement, but find out what their hesitation is and allow them to voice their thoughts. Explain that the delay in diagnosis may cause her to have more significant delays. Educate respectfully about ASD."
We'd love to hear your opinion. If you have experience with implementing early intervention for developmental delays, visit the full case on Healthcasts to share your suggestions.