When a baby is born, there's usually a moment when everyone in the delivery room collectively holds their breath - at least metaphorically.
The relief that is felt upon hearing that first cry does not mean that all is necessarily well, however. Poor vital signs may raise any alarms and a physical examination revealing any obvious deformity or abnormality would be cause for concern.
But if all appears well, does this mean the pregnancy has gone according to plan? Unfortunately, no. Some birth injuries - whether they are sustained in utero, during labour and delivery, or in the critical first few weeks after birth - may not reveal themselves until long after a child is born.
In this blog post I examine how a child's failure to meet certain developmental milestones in the first months and years of life can indicate a possible birth injury. First, I define development milestones and outline some of the major markers a child is expected to reach. Next, I explain the types of birth injuries that can cause some types of developmental delays. Finally, I provide details about what you can do if you believe your loved one may have suffered from a birth injury.
Meeting Milestones.
Humans grow and develop with age. But while growth refers to physical size, development encompasses certain functional skills and the process of learning how to do specific tasks. Child development milestones are age markers when most children have obtained these skills or are able to perform these tasks.
A variety of scientific fields, including neurology, physiology, sociology, and psychology have produced theories and frameworks which seek to explain why children tend to develop skills at certain ages and stages of life. The modern concept of child development milestones encompasses five skills categories: gross motor, fine motor, cognitive, language, and behavioural.
- Gross motor skills require the coordinated use of large groups of muscles
- Fine motor skills require the coordinated use of specific muscle groups to perform more delicate or intricate tasks
- Cognitive skills are used to learn, remember, understand, reason, and solve problems
- Language skills are necessary to communicate through speech and body language, and to process the speech and movement of others
- Social skills are developed as we learn how to interact with others, what is necessary to build strong relationships, and how to empathise and respond to the needs and feelings of other people
Examples of Age-Specific Development Milestones.
The Canadian Paediatric Society suggests a child generally develops the following skills at these ages:
Age | Gross Motor | Fine Motor | Cognitive | Language/Social |
3 months | -roll from front to back -control head and neck while seated -raise head and chest when lying face down -push down on legs when feet are on a firm surface | -bring hands together -open and shut their hands -bring hands to their mouth -take swipes at a hanging object | -watch faces closely -follow moving objects -recognize familiar objects and people | -smile on their own and when smiled at -demonstrate expression with face and body -copy some body movements and facial expressions |
8 months | -roll from front to back and back to front -remain in a seated position -support all their weight on their legs -control upper body | -hold and shake an object -move an object from one hand to another -use their hands to examine an object | -track moving objects -struggle to get objects that are out of reach -look from one object to another -watch a falling object | -reach for a familiar person -smile at themselves in a mirror -respond to emotions of others -copy speech sounds |
12 to 14 months | -sit up independently -crawl on hands and knees or scoot while seated -pull up to a standing position -stand briefly without support and perhaps take a step or two -walk holding an adult’s hand, -start to climb stairs with help | -pincer grasp with thumb and forefinger -put objects into and take objects out of a container -poke with an index finger -push a toy -begin to drink from a cup -scribble with a crayon -begin to use a spoon | -use shaking, throwing, dropping and banging to explore objects -recognize names of familiar objects -respond to music -begin to explore cause and effect | -exhibit shyness or anxiety around strangers -have favourite toys and people -extend a limb to help when being dressed -pull off socks -respond to their name -pair “mama” or “dada” with one or more meaningful words -stop when they hear “no” |
18 months | -climb onto chairs -walk without assistance -climb individual stairs with help | -use a spoon well -turn a few board-book pages at a time -pour out a container -easily drink from a cup | -use objects as tools -sort and fit shapes together | -vocabulary of at least 20 words -follow a simple instruction -point to familiar objects when asked -help with simple tasks |
2 years | -walk while pulling a toy or carrying a large toy -begin to run -kick and/or throw a ball -climb onto and off of chairs independently -walk up and down stairs with help | -build a tower with four or more blocks -complete a simple shape-matching puzzle -turn board-book pages easily, one at a time | -start to put two words together -copy behaviour of others -play alongside other children -demonstrate more independence and/or defiance | -begin “make-believe” or imaginary play |
3 years | -run easily -jump in place -throw a ball overhead -walk up and down stairs with alternating feet on each step | -control certain movements with a crayon -hold a pencil in writing position -build a tower of more than 6 blocks -unscrew jar lids or big nuts and bolts -string big beads -work latches and hooks -snip with children’s scissors | -match objects with pictures of objects -use toys, animals, and people in imaginary play -sort easily by shape and colour -understand the difference between 1 and 2 -name body parts and colours | -know their full name -speak in sentences -ask for help -ask many questions -show spontaneous affection for playmates they know -begin to take turns -anticipate activities and object to changes in routine -put toys away |
4 years | -hop and stand on 1 foot for a few seconds -kick a ball forward -catch a bouncing ball | -draw a person with 2 to 4 body parts -draw circles and squares | -understand counting -follow a 3-part instruction -make up and tell simple stories -understand “same” and “different” -know their address | -anticipate new experiences -cooperate with others -play “family” -dress and undress -develop solutions to conflicts |
If your child struggles to reach some or all of these developmental markers, it may indicate they have a condition that requires investigation by your medical practitioner.
Surveillance Versus Screening.
Paediatricians conduct surveillance (or observation) of development progress to ensure a child is generally aligned with anticipated milestones. However, children in Canada are not necessarily screened for developmental disorders unless they are deemed to be at high-risk or a parent brings forward concerns about delays. Development screening uses tools such as questionnaires to systematically search and monitor for delays.
The Canadian Paediatric Society has recommended universal screening based on the Ontario model which provides a general screener at the enhanced 18-month well-baby visit. The American Academy of Pediatrics (AAP) has recommended more frequent screening, even in the absence of concerns. The AAP notes that subtle delays may not generally be evident from clinical observation, yet early intervention into developmental delays results in better long-term outcomes. It recommends developmental and behavioural screening for all children during regular well-child visits at 9 months, 18 months and 30 months, and specific screening for autism spectrum disorder (ASD) during regular well-child visits at 18 months and 24 months.
However, the Canadian Task Force on Preventive Health Care, which was established by the Public Health Agency of Canada (PHAC) to develop clinical practice guidelines that support primary care providers in delivering preventive health care, has recommended against universal screening before the age of four if a child's parents have not expressed concerns.
The task force cited poor accuracy of screening tools based on randomised trials. False positives in screens could dilute resources available to help children who are in greater need of early interventions. Moreover, studies of specific groups of children have suggested that social and cultural factors may reveal disparities in milestone achievement that do not result in any long-term developmental deficits.
Although there is natural variation amongst children and failure to meet a specific milestone is not necessarily cause for concern in itself, parental screening can help to identify potential signs of problems that you can discuss with your paediatrician or medical practitioner during routine appointments.
Delays as Evidence of Birth Injuries.
If you or your child's doctor does identify certain delays that are concerning, they may conduct additional assessments or refer you to a specialist for treatment or to confirm a diagnosis.
Birth injuries which may not be identifiable during or immediately following a pregnancy, but which may become apparent due to development delays, include:
- Cerebral Palsy - brain damage occurring in utero, during delivery, or in the first weeks after birth can cause a group of neurological disorders that affect movement, balance, and sometimes resulting in cognitive impairment
- Traumatic Brain Injuries - brain damage from a traumatic force or sudden movement
- Ischemic/Hemorrhagic Strokes - brain damage can result from a blockage that stops blood flow to the brain or when a burst blood vessel causes bleeding in the brain.
- Spinal Cord Injuries - damage to nerves in the spinal column resulting in reduced or lost function in the body
- Nerve Damage - stretched, ripped or torn nerves in the neck, shoulders and extremities that affect muscle function
Development delays caused by these injuries are not necessarily evidence of medical malpractice on the part of a paediatrician, general physician, or midwife. However, it is worth your time to speak with a knowledgeable and experienced birth injury lawyer to determine if there are grounds to investigate further.
How We Help.
Our team of Ontario birth injury lawyers have helped many people just like you who are discovering your loved one has a condition causing developmental delays. Although certain treatments and early intervention may produce better outcomes for your child, navigating life with a serious debilitating injury or disability can be very challenging. If someone's negligent actions or inaction caused this injury, you may be able to access funds to compensate for the harm done and to help you and your loved one as you look to the future.
When you contact us for a free, no obligation initial consultation, we'll attentively listen as you explain what's happened. After we inform you of your rights and options, we'll answer any questions you may have. If we believe we can negotiate a fair settlement for you or achieve an award from the court, we will gladly offer to represent you in legal proceedings.
As a firm committed to full-circle care, we treat our clients as we would treat our own families. You deserve a legal team who not only provides excellent legal service, but also one whose empathy, compassion, and tireless work ethic demonstrates our full support in seeing you through to better days. Contact us today to learn more about how we can help.