Document Type : Original Article
Authors
- . Neha Sharma
- . Jamal Masood 1
- . S. N. Singh 2
- . Naim Ahmad 3
- . Prabhaker Mishra 4
- . Shikhar Singh 5
- . Sudip Bhattacharya
1 Department of Community Medicine and Public Health, King George’s Medical University
2 Department of Paediatrics, King George’s Medical University
3 Department of Community Medicine and Public Health, King Geo
4 Department of Biostatistics and Health Informatics, SGPGI
5 Department of Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
Abstract
BACKGROUND: Initial formative years in every children’s life are critical for their optimal development,
as these frame the foundation of future well‑being. With a varied prevalence of developmental
delays (DDs) in the world and most of the studies representing the hospital‑based data. The present
study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged
2 months to 6 years in the rural area of North India.
METHODS: This was a cross‑sectional study in which a multistage random sampling technique was
used. From 30 Anganwadi centers, 450 children aged 2 months–6 years were taken in the study.
Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family
Welfare, India, was used for developmental screening. Binary logistic regression analysis was done
to identify the predictors for DDs (domain wise).
RESULTS: Seventy‑three (16.2%) children were found to have DDs and 60 (13.3%) children had
the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%)
children who had delay in speech and language area. About 17/190 (8.9%) children had social
delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was
seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational
age (adjusted odds ratio [AOR] – 13.30), complications during delivery (AOR – 25.79), meconium
aspiration (AOR – 12.81), and child never breastfed (AOR – 8.34) were strong predictors for the
delay in different domains of developmental milestones.
CONCLUSION: Socio-economic, ante-natal, natal and post-natal factors should be considered for
prompt identification and initiation of intervention for DDs.
RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding
the achievement of developmental milestones according to the age. A multipronged approach to the
holistic treatment of developmentally delayed children for early intervention is required.
Keywords
- David D, Toppo KJ, Saini K. Research article a study to assess
the knowledge of mothers’ regarding developmental milestones
of infants. Vol. 6, Issue, 07, pp. 7524‑7528, July, 2014Available
from: http://www.gmferd.com/journalcra.com/sites/default/
files/5791_1.pdf. .
2. Eldred K, Darrah J. Using cluster analysis to interpret the
variability of gross motor scores of children with typical
development. Phys Ther 2010;90:1510‑8.
3. Tervo RC. Identifying patterns of developmental delays can help
diagnose neurodevelopmental disorders. Clin Pediatr (Phila)
2006;45:509‑17.
4. Walter F, Wrester F. Early childhood development. J Child Dev
2009;23:23.
5. Kerstjens JM, de Winter AF, Bocca‑Tjeertes IF, ten Vergert EMJ,
Reijneveld SA, Bos AF: Developmental delay in moderately
perterm‑born children at school entry. J Pediatr 2011;159:92‑8.
6. Koch R. Institute: Results of the child and youth health survey.
Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz
2007;50:529‑908.
7. Wohlfeil A. Developmental delays in children starting school
with the resultant performance deficits. Öffentl Gesundhwes
1991;53:175‑80.
8. The Developmental Disabilities Services and Facilities
Construction Act of 1970. p. 91‑517. Available from: http://
www.mn.gov/mnddc/dd_act/documents/FEDREG/90DDALEGLISLATIVEHISTORY.pdf. [Last accessed on 2019 Jan
02].
9. Landgren M, Pettersson R, Kjellman B, Gillberg C. ADHD,
DAMP and other neurodevelopmental/psychiatric disorders in
6‑year‑old children: Epidemiology and co‑morbidity. Dev Med
Child Neurol 1996;38:891‑906. - 10. Tirosh E, Berger J, Cohen‑Ophir M, Davidovitch M, Cohen A.
Learning disabilities with and without attention‑deficit
hyperactivity disorder: Parents’ and teachers’ perspectives.
J Child Neurol 1998;13:270‑6.
11. Bishop DV. Handedness, clumsiness and developmental language
disorders. Neuropsychologia 1990;28:681‑90.
12. Nicolson RI, Fawcett AJ. Comparison of deficits in cognitive
and motor skills among children with dyslexia. Ann Dyslexia
1994;44:147‑64.
13. Ministry of Health and Family Welfare Government of India.
Rashtriya Bal Swasthya Karyakram (RBSK) Child Health
Screening and Early Intervention Services under NRHM. Oper
Guidelines; 2013.
14. Mukherjee SB, Aneja S, Krishnamurthy V, Srinivasan R.
Incorporating Developmental Screening and Surveillance of
Young Children in Office Practice [Internet]. Vol. 627, INDIAN
PEDIATRICS. 2014 [cited 2019 Feb 1]. Available from: https://
www.indianpediatrics.net/aug2014/627.pdf.
15. Cioni G, Inguaggiato E, Sgandurra G. Early intervention in
neurodevelopmental disorders: Underlying neural mechanisms.
Dev Med Child Neurol 2016;58 Suppl 4:61‑6.
16. Campbell F, Conti G, Heckman JJ, Moon SH, Pinto R, Pungello E,
et al. Early childhood investments substantially boost adult health.
Science 2014;343:1478‑85.
17. Rosenberg SA, Zhang D, Robinson CC. Prevalence of
developmental delays and participation in early intervention
services for young children. Pediatrics 2008;121:e1503‑9.
18. Agarwal PK, Shi L, Daniel LM, Yang PH, Khoo PC, Quek BH,
et al. Prospective evaluation of the ages and stages questionnaire
3rd edition in very‑low‑birthweight infants. Dev Med Child Neurol
2017;59:484‑9.
19. Kerstjens JM, Bos AF, ten Vergert EM, de Meer G, Butcher PR,
Reijneveld SA, et al. Support for the global feasibility of the ages
and stages questionnaire as developmental screener. Early Hum
Dev 2009;85:443‑7.
20. Flamant C, Branger B, Nguyen The Tich S, de la Rochebrochard E,
Savagner C, Berlie I, et al. Parent‑completed developmental
screening in premature children: A valid tool for follow‑up
programs. PLoS One 2011;6:e20004.
21. Torabi F, Akbari SAA, Amiri S, Soleimani F, Majd HA. Correlation
between high-risk pregnancy and developmental delay in
children aged 4-60 months. Libyan J Med. 2012;7(1):0–6.
22. Vora H, Shah P, Mansuri SH. A study on developmental
delay among children less than 2 year attending well baby
clinic – Prevalence and antecedents factors. Int J Med Sci Public
Health 2013;462037:1084-7.
23. Meenai Z, Longia S. A study on prevalence & antecedents of
developmental delay among children less than 2 years attending
well baby clinic: Peoples J Sci Res 2009;2:462037.
24. Ali SS, Pa B, Dhaded SM, Goudar SS. Assessment of growth and
global developmental delay: A study among young children
in a rural community of India. International Multidisciplinary
Research Journal 2011, 1(7):31-34.
25. Séguin L, Xu Q, Gauvin L, Zunzunegui MV, Potvin L, Frohlich KL,
et al. Understanding the dimensions of socioeconomic status
that influence toddlers’ health: unique impact of lack of money
for basic needs in Quebec’s birth cohort. Epidemiol Community
Health 2005;59:42‑8. Available from: https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1763364/pdf/v059p00042.pdf. [Last
accessed on 2017 Sep 05].
26. Binu A, Sunil R, Baburaj S, MohandasMK.Socio demographic
profile of speech and language delay up to six years of age in
Indian children. Int J Med Res Health Sci. 2014;3(1):98.
27. Devi UL, Professor A, Resident S. Assessment of speech and
language delay using language evaluation scale Trivandrum(LEST
0‑3). Chettinad Health City Med J 2015;4:70‑4. Available from:
http://www.chcmj.ac.in/journal/pdf/vol4_no2/Assessment.
pdf. [Last accessed on 2017 Aug 27].
28. Mondal N, Bhat BV, Plakkal N, Thulasingam M, Ajayan P,
Poorna DR. Prevalence and risk factors of speech and language
delay in children less than three years of age. J Compr Pediatr
2016;7:e33173.
29. Venketraman Kondekar S, Shree VS, Kondekar SV. Assessment
of speech and language delay among 0-3 years old children
attending well-baby clinics using Language Evaluation Scale
Trivandrum. Indian J Child Health 2016;3:220-4. Available
from: https://www.atharvapub.net/index.php/IJCH/article/
viewFile/551/337. [Last accessed on 2017 Aug 25].
30. Sidhu M, Malhi P, Jerath J. Early language development in Indian
children: A population‑based pilot study. Ann Indian Acad
Neurol 2013;16:371‑5.
31. Dharmalingam A, Raghupathy NS, Belgin R, Kumar P. Cross
sectional study on language assessment of speech delay in
children 0 to 6 years. IOSR J Dent Med Sci 2015;14:2279‑861.
Available from: http://www.iosrjournals.org. [Last accessed on
2018, Oct 6].
32. Gupta A, Kalaivani M, Gupta SK, Rai SK, Nongkynrih B. The
study on achievement of motor milestones and associated factors
among children in rural North India. J Family Med Prim Care
2016;5:378‑82.
33. Sajedi F, Vameghi R, Kraskian Mujembari A. Prevalence of
undetected developmental delays in Iranian children. Child Care
Health Dev 2014;40:379‑88.
34. Bello AI, Quartey JN, Appiah LA. Screening for developmental
delay among children attending a rural community welfare clinic
in Ghana. BMC Pediatr 2013;13:119.
35. DabarD, DasR, NageshS, YadavV, MangalA. Acommunity‑based
study on growth and development of under‑five children in an
urbanized village of South Delhi. J Trop Pediatr 2016;62:446‑56.
36. Soleimani F, Vameghi R, Biglarian A, Rahgozar M. Prevalence of
motor developmental disorders in children in Alborz province,
Iran in 2010. Iran Red Crescent Med J 2014;16:e16711.
37. Kerstjens JM, de Winter AF, Bocca‑Tjeertes IF, ten Vergert EM,
Reijneveld SA, Bos AF, et al. Developmental delay in moderately
preterm‑born children at school entry. J Pediatr 2011;159:92‑8.
38. Bhattacharya T, Ray S, Das DK. Developmental delay among
children below two years of age : A cross- sectional study in a
community development block of Burdwan district, West Bengal.
International Journal of Community Medicine and Public Health
2017;4:1762-67.
39. Sheelamma JK, Kumari KS. Developmental profile of children
under two years in the coastal area of Kochi, Kerala. Int J Adv
Res J 2013;1:870‑4. Available from: http://www.journalijar.
com/uploads/2013‑12‑04_031544_778.pdf. [Last accessed on
2017 Sep 05].
40. Valla L, Wentzel‑Larsen T, Hofoss D, Slinning K. Prevalence of
suspected developmental delays in early infancy: Results from
a regional population‑based longitudinal study. BMC Pediatr
2015;15:215.
41. Hediger ML, Overpeck MD, Ruan WJ, Troendle JF. Birthweight
and gestational age effects on motor and social development.
Paediatr Perinat Epidemiol 2002;16:33‑46.
42. Handal AJ, Lozoff B, Breilh J, Harlow SD. Sociodemographic and
nutritional correlates of neurobehavioral development: A study
of young children in a rural region of Ecuador. Rev Panam Salud
Publica 2007;21:292‑300.
43. Richter J, Janson H. A validation study of the Norwegian
version of the ages and stages questionnaires. Acta Paediatr
2007;96:748‑52.
44. Potijk MR, Kerstjens JM, Bos AF, Reijneveld SA, de Winter AF.
Developmental delay in moderately preterm‑born children
with low socioeconomic status: Risks multiply. J Pediatr
2013;163:1289‑95.
45. Schady N. Parents’ education, mothers’ vocabulary, and cognitive development in early childhood: Longitudinal evidence from
Ecuador. Am J Public Health 2011;101:2299‑307.
46. Comuk‑Balci N, Bayoglu B, Tekindal A, Kerem‑Gunel M, Anlar B.
Screening preschool children for fine motor skills: Environmental
influence. J Phys Ther Sci 2016;28:1026‑31.
47. Alvik A, Grøholt B. Examination of the cut-off scores determined
by the Ages and Stages Questionnaire in a population-based
sample of 6 month-old Norwegian infants [Internet]. 2011
[cited 2019 Feb 1]. Available from: http://www.biomedcentral.
com/1471-2431/11/117.
48. Charan GS, Vagha J. Study of perinatal factors in children with
developmental delay. International Journal of Contemporary
Pediatrics 2017;4:182-90.
49. Nguefack S, Kamga KK, Moifo B, Chiabi A, Mah E, Mbonda E.
Causes of developmental delay in children of 5 to 72 months old
at the child neurology unit of Yaounde Gynaeco‑obstetric and
paediatric hospital (Cameroon). Open J Pediatr 2013;3:279‑85.
Available from: http://www.dx.doi.org/10.4236/ojped.
2013.33050. [Last accessed on 2017 Aug 27].
50. Sachdeva S, Amir A, Alam S, Khan Z, Khalique N, Ansari MA,
et al. Global developmental delay and its determinants among
urban infants and toddlers: A cross sectional study. Indian J
Pediatr 2010;77:975‑80.
51. Tikaria A, Kabra M, Gupta N, Sapra S, Balakrishnan P, Gulati S,
et al. Aetiology of global developmental delay in young children:
Experience from a tertiary care centre in India. Natl Med J India
2010;23:324‑9.
52. El Marroun H, Zeegers M, Steegers EA, van der Ende J, Schenk JJ,
Hofman A, et al. Post‑term birth and the risk of behavioural
and emotional problems in early childhood. Int J Epidemiol
2012;41:773‑81.
53. Olesen AW, Olsen J, Zhu JL. Developmental milestones in children
born post‑term in the Danish national birth cohort: A main
research article. BJOG 2015;122:1331‑9.
54. Beligere N, Rao R. Neurodevelopmental outcome of infants with
meconium aspiration syndrome: Report of a study and literature
review. J Perinatol 2008;28 Suppl 3:S93‑101.
55. Wiswell TE, Bent RC. Meconium staining and the meconium
aspiration syndrome. Unresolved issues. Pediatr Clin North Am
1993;40:955‑81.
56. Vidyasagar D, Harris V, Pildes RS. Assisted ventilation in infants
with meconium aspiration syndrome. Pediatrics 1975;56:208‑13.
57. Koul R, Al‑Yahmedy M, Al‑Futaisi A. Evaluation children with
global developmental delay: A prospective study at Sultan
Qaboos university hospital, Oman. Oman Med J 2012;27:310‑3.
58. Thomaidis L, Zantopoulos GZ, Fouzas S, Mantagou L,
Bakoula C, Konstantopoulos A, et al. Predictors of severity
and outcome of global developmental delay without definitive
etiologic yield: A prospective observational study. BMC Pediatr
2014;14:40.
59. Juneja M, Mohanty M, Jain R, Ramji S. Ages and stages
questionnaire as a screening tool for developmental delay in
Indian children. Indian Pediatr 2012;49:457‑61.
60. de Kieviet JF, Piek JP, Aarnoudse‑Moens CS, Oosterlaan J. Motor
development in very preterm and very low‑birth‑weight children
from birth to adolescence: Ameta‑analysis. JAMA 2009;302:2235‑42.
61. Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in
very low birth weight neonates in a public sector hospital in
Johannesburg. BMC Pediatr 2010;10:30.
62. Chattopadhyay N, Mitra K. Neurodevelopmental outcome of
high risk newborns discharged from special care baby units in a
rural district in India. J Public Health Res 2015;4:318.
63. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW,
Matush L, et al. Breastfeeding and child cognitive development:
New evidence from a large randomized trial. Arch Gen Psychiatry
2008;65:578‑84.
64. Jedrychowski W, Perera F, Jankowski J, Butscher M, Mroz E,
Flak E, et al. Effect of exclusive breastfeeding on the development
of children’s cognitive function in the Krakow prospective birth
cohort study. Eur J Pediatr 2012;171:151‑8.
65. Lundqvist‑Persson C, Lau G, Nordin P, Strandvik B, Sabel KG.
Early behaviour and development in breast‑fed premature infants
are influenced by omega‑6 and omega‑3 fatty acid status. Early
Hum Dev 2010;86:407‑12.
66. Pérez‑Escamilla R. Influence of Breastfeeding on Psychosocial
Development; 2008 Available from: http://www.childencyclopedia.com/sites/default/files/textes‑experts/en/545/
influence-of-breastfeeding‑on‑psychosocial‑development.
pdf. [Last accessed on 2018 Aug 31].
67. Walfisch A, Sermer C, Cressman A, Koren G. Breast milk and
cognitive development – The role of confounders: A systematic
review. BMJ Open 2013;3:e003259.
68. Bernard JY, Armand M, Peyre H, Garcia C, Forhan A,
De Agostini M, et al. Breastfeeding, polyunsaturated fatty acid
levels in colostrum and child intelligence quotient at age 5‑6 years.
J Pediatr 2017;183:43‑50.e3.