What is ZPR and what are the options?
The development of a child occurs in stages: each skill appears in a certain age interval. Timelines differ slightly for different children, so a slight delay in one area does not mean a delay. The doctor speaks of mental retardation when the child is noticeably outside the age range in one or more areas. Isolated delay, for example only speech, differs from general delay, in which movement, speech, and cognitive skills lag behind. As people grow older and the cause becomes clearer, the conclusion is usually revised and replaced with a more accurate diagnosis.
- Delayed motor development - head, sitting, crawling, walking
- Delayed speech development
- Delayed cognitive development
- Delayed social-emotional development
- General developmental delay - delays in several areas
Causes and risk factors
The causes of mental retardation are numerous, and in some children it is not possible to determine the exact cause. Often the delay is associated with prematurity and immaturity of the nervous system, suffered from hypoxia, cerebral hemorrhages, and intrauterine infections. Genetic causes include chromosomal syndromes and inherited metabolic diseases. Hearing loss interferes with speech development, and visual impairment interferes with motor skills and cognition. Congenital hypothyroidism without timely treatment leads to delays, so it is detected during screening of newborns. Social conditions also matter: lack of communication, vivid impressions and games with adults.
- Prematurity and low birth weight
- Hypoxia and birth trauma
- Intrauterine infections
- Genetic and chromosomal syndromes
- Hearing and vision impairment
- Congenital hypothyroidism
- Epilepsy and cerebral palsy
- Lack of communication and developmental environment
Signs to watch out for
It is useful for parents to know the main milestones of development and note when new skills emerge. It is alarming if the baby is lethargic or, on the contrary, is too tense, does not follow the toy with his eyes well, does not smile in response to communication, does not roll over, or does not reach for objects. In the second year of life, alarming signs are considered to be the absence of words, pointing gestures, interest in games, and the inability to fulfill simple requests. The loss of previously mastered skills requires special attention: this is a reason to consult a doctor without delay.
- Doesn't smile back by 2–3 months
- Can't hold his head up by 3-4 months
- Does not sit independently by 9–10 months
- No babbling or pointing by 12 months
- Does not walk by 18 months
- No simple two-word phrases by age 2
- Loss of previously mastered skills at any age
Diagnostics
The pediatric neurologist asks about the course of pregnancy and childbirth, the timing of the appearance of skills, examines the child, evaluates muscle tone, reflexes, and development according to age scales. Hearing and vision must be checked, as their impairments are often hidden behind developmental delays. Further examination is selected individually: analysis of thyroid hormones, neurosonography in babies with an open fontanel, EEG if seizures are suspected, MRI of the brain, genetic studies. A speech therapist, speech pathologist, psychologist, and, if necessary, a child psychiatrist are involved in the assessment.
- Examination by a pediatric neurologist and assessment using developmental scales
- Hearing and vision testing
- TSH and other tests as indicated
- Neurosonography
- Electroencephalography
- MRI of the brain
- Genetic testing, including karyotype
Treatment and assistance for the child
Early comprehensive intervention, not pills, is the cornerstone of care. Specialists work with the baby: a physical therapy instructor and a massage therapist develop movements, a speech therapist develops speech and understanding, a speech pathologist and a psychologist develop cognitive and social skills. The main role belongs to parents: daily games, reading, talking and repeating exercises at home have a greater effect than rare courses. If a cause is identified, it is treated, for example, replacement therapy for hypothyroidism or treatment of epilepsy. Drugs to “improve cerebral circulation” have no proven effectiveness in treating mental retardation and do not replace exercise.
- Early help immediately after a delay is identified
- Therapeutic exercise and massage
- Classes with a speech therapist and defectologist
- Daily educational games at home
- Regular monitoring by a pediatric neurologist
- Correction of hearing and vision impairments, if identified
- Consultation with a geneticist if a hereditary cause is suspected