A child between 0-3 months of age should startles to loud noise, awakens to sounds, blinks or widens eyes in response (reflex) to noises.

A high index of suspicion needs to be maintained if there is history of difficult labour, low birth weight, need of NICU care. A normal baby should have good neck holding by 3 months, sitting by 6 months and walking by 1.5 years. Any child with deviations from these milestone should be investigated.

Cerebral palsy cannot be totally prevented as there are multiple causes. Good maternal and child care can reduce the incidence.

Physiotherapy and medical management in early stages. Surgery at a later stage.

No. There is some injury to brain and hence some deficit always remains.

As soon as a delay in milestone is observed physiotherapy should be started.

A physiotherapist improves the development of large muscles of the body which helps the child to stand and walk. An occupational therapist help in development of fine motor skills and activities of daily living like eating, writing, wearing clothes.

Ideally it should be done life long, minimum till the height of the child is growing (around 15-17 years).

It should be done daily 2-3 times per day in divided programmes by parents so that the child does not get tired. A trained therapist should be involved atleast 3 times a week.

Early intervention takes advantage of ongoing process of myelination and neural plasticity of brain 6months to 3 years. Valuable time is lost in “wait & watch policy” attitude adopted by parents, grand parents and even medical specialists.

The approach is unique by the virtue that it looks at the child as a ‘whole’. That means the treatment is directed not only towards physical independence, but it also targets child’s emotional, social, sensory, perceptual aspects so that he or she becomes an active member of the society and can fulfil his duties like any other individual. Treatment by the approach does not stop at achieving physical improvement; but assures that the child is able to use the same to accomplish his age-appropriate roles.

Handedness is usually decided around 2 years of age. Till then a child should use both hands equally. If one hand is weak then the child learns to use the better hand and hence it is very difficult to break the habit at a later stage. The child should however be encouraged to use the weak hand otherwise the weakness and wasting will progress.

Specially designed spoons and forks with long handles or straps are available. Use of Velcro straps instead of buttons are some of the examples. Use of books with pictures are also good tools for communication.

Children with poor sitting balance should be given a belt to support them and help them sit upright. The child hence learns to understand the surroundings and becomes more interactive.

Wheelchairs, walkers, elbow crutches, tripod sticks are some of the mobility devices to be used according to the mobility of the child.

A wheelchair will increase the mobility of the child and will make him independent. His social interactions and interactions with the surroundings will improve and hence will bring the overall development of the child.

Dislocated hips tend to be painful in later life and also impair sitting and toilet care. Hence operative reduction is the treatment of choice.

From an early age scissoring posture and ‘W’ sitting should be avoided. Hip radiographs should be performed every year to diagnose early dislocation.

Consult your doctor. The child will need radiographs and use of belts. In severe cases surgery may be required.

The child has tight hamstring muscles and weak quadriceps muscles. Physiotherapy, strengthening exercises and surgery may be required.

His tendoachillis muscle (heel cord) is tight. It needs regular physiotherapy, plasters, botulinum toxin A treatment or surgery.

They are seen in most of the children with cerebral palsy. A tight heel cord leads to midfoot break. Ankle Foot Orthosis should be used to prevent progression. Surgery of the foot may be required.

Yes. If surgery is advised by your doctor then it must be performed. It will increase the mobility of the child.

Muscle lengthening surgery should be avoided before 7 years of age. In some conditions however surgery may be required at an earlier age.

Ideally Physiotherapy will be required life long or atleast till the height of the child is growing.

Generalised spasticity can be reduced by oral medications like tab. Baclofen. Localised spasticity can be reduced by Botulinum Toxin A, Baclofen pump, Selective dorsal rhizotomy or by specific tendon lengthening procedures.

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. It acts on the nerve terminals and prevents release of Acetylcholine, which in turn causes temporary paralysis of muscles. It is commercially available as Botox, Dysport.

It causes relaxation of the spastic muscles and improves joint range of motion. This will help the physiotherapist to train the opposite group of muscles and trunk muscles. This will ultimately result in improvement in gait and function of the child.

The duration of action is 3-6 months. Results in the injected muscle can be prolonged by use of splints and physiotherapy.

It can be given 5-6 times with a minimum gap of 4-6 months.

There are no know major side effects. It causes some weakness in muscles which is reversible. Other side effect could be allergic reaction.

In children with minor involvement and single muscle involvement surgery can be prevented. However repeated injections may be required. In all other cases surgery may be required once the child grows older.

Generally, children utter their first meaningful, spontaneous, single words around 12 to 14 months of age, though the upper limit of this milestone can be extended to nearly 24 months. However, it is advisable to first consult a developmental paediatrician by 15 months of age or earlier, in case of any doubt.

The important point to remember here is that a child will begin to speak only after a certain minimum amount of comprehension (understanding) capacity has developed, as comprehension precedes expression. If a child is delayed in speech and language, a paediatrician or speech therapist would search for reasons related to a possible hearing impairment, developmental or learning concerns, autistic spectrum disorder, visual impairment, cerebral palsy, multiple special needs, or other syndromes.

The doctor may refer the child for different tests, before coming to any definite conclusion. In case medical or surgical intervention is required, the doctor would make the necessary suggestions. Simultaneously, the child would be referred for therapies such as speech and language, physio, occupational, remedial education and behavioural therapies, depending on the age and special needs of the child.

No child begins speaking in an absolutely clear way. As part and parcel of natural speech development, speech may be unclear or there may be natural repetitions. A therapist would judge whether the speech is within range for age, or whether direct or indirect interventions are required.

The therapist would also take a detailed case-history to ascertain whether the child may have special needs, a tongue-tie, poor quality environmental input, or other issues. Accordingly, referrals would be made, parental counselling would begin, or therapeutic intervention would commence.

Actually, more appropriate terms would be “communication therapy” or “speech and language therapy”. Our job is to help the child/adult communicate his/her needs, wants, ideas, fears and thoughts, as per the capacity of the individual. Speech is only one method of communication.

These would include use of gestures, pointing, body language, facial expressions, voice intonations, picture or word communication boards/books, alphabet boards, or technology-assisted devices, among others. The methods chosen would depend on the physical and mental capacities of the individual.

Further, a speech therapist also deals with improving reading, writing and number skills. Problems related to chewing and/or swallowing are also looked into. Team efforts are often required.

Basically, a child needs a very stimulating environment in order to develop comprehension and communication. Lots of interaction is required, using songs, poems, stories, toys, art, craft, outings and outdoor activities. Giving of one's personal time is extremely essential.

Park-play and a chance to mix with children of the same age-group are also important. A happy, healthy home-environment for the child will go a long way in helping speech and language development. In case of any doubt, please contact a developmental paediatrician as early as possible.

This would depend on several factors. Depending on the age of the child and the severity of the condition, therapy will be direct or indirect. For very small children, initially more time would be spent with the parents, guiding them how to interact with the child and how to increase the child's comprehension skills.

Initially, two sessions (minimum) may be required per week. However, therapy will not help unless all suggestions are practically implemented by the parents at home. After all, communication is a 24-hour process.

Developmental Delay is a term used when children have not reached milestones they are expected to achieve by their chronological age. Developmental delays can occur in gross motor, fine motor, speech, social interaction and activities of daily living, or in one or more of these areas.

Before four years, if a child has delay in more than two areas of development it is called global developmental delay. Doctors generally use age-appropriate developmental and cognitive assessments to understand a child's developmental profile.

This is a clinical estimation of the child's performance. It is used up to 2½ years of age. Developmental quotient (DQ) is expressed as: DQ = Developmental age / Chronological age × 100.

Intelligence is defined as a composite of maturity of motor, adaptive, language and personal social behaviour. Intelligence tests calculate an IQ or intelligence quotient that is an index of the intellectual abilities of the child.

Types of tests mentioned on the original website include the Wechsler Intelligence Scale for Children and Stanford-Binet/Binet-Kamat testing.

Currently there are no medications available to improve intelligence scores. A child's performance can be supported by early intervention, appropriate stimulation, family support, school environment and therapies targeted to specific areas of need.

In a child with irritability, one needs to assess the child in all areas of development. In young infants, feeding difficulties, poor suck-swallow coordination, reflux or colic may contribute. If irritability is associated with fever and refusal of feeds, a paediatric evaluation is important to look for the cause.

Not listening or noncompliance can be part of normal developmental behaviour, particularly in preschool-age children and adolescents. In some cases, behaviour may be developmentally inappropriate and require effective intervention. Parent training and appropriate behavioural strategies may help.

Attention deficit hyperactivity disorder (ADHD) is characterised by hyperactivity, impulsivity and inattention. Diagnosis requires assessment by appropriate professionals and consideration of other possible causes of similar symptoms. Treatment can include behavioural interventions and, when appropriate, medication.