Developmental Delay in children is dreaded by parents, as it can mean some serious disorders are involved, mostly incurable. Delays occur when your child does not reach their developmental milestones at the expected times. Delay can occur in one or many areas—for example, gross or fine motor, language, social, or thinking skills. Developmental Delay is most often a diagnosis made by a doctor based on strict guidelines. Usually though, parents are the first to notice that their child is not progressing at the same rate as other children the same age.
When it comes to reaching fine-motor and gross-motor milestones, there is a wide range of normal for toddlers. When a child takes too long to be able to handle a spoon, say, or to take that first step, she may have fine-motor delays or gross-motor delays. Children with fine-motor delays have difficulty using their small muscles, so that tasks like grasping crayons with their fingers are tricky. When it comes to gross-motor delays, the trouble is instead with large muscles and mastering skills like walking, kicking, hopping, and climbing stairs.
Recently, doctors in Switzerland, led by Dr. Joel Fluss at the Geneva Children’s Hospital reported on a case of motor delay in a four-year-old boy from Ghana.
The parents noted that the child could not keep up with his peers during outdoor activities, could not run very far, and was easily tired. Physical exam showed lower extremity weakness and an abnormal waddling walk. A slew of expensive tests were all negative. Finally, a vitamin D level and alkaline phosphatase showed the child’s vitamin D level was undetectable and his alkaline phosphatase was about ten times higher than the upper range.
The doctors diagnosed rickets and started him on calcium 1000 mg/day and vitamin D, 5,000 IU/day. After four months of treatment, the child began to run and hop, the fatigue disappeared and he could keep up with his peers. The dreaded Developmental Delay disappeared.
The authors note that
“Interestingly, despite being well described for almost 50 years, the muscle weakness associated with rickets is rarely mentioned in the differential diagnosis muscle weakness occurring in childhood. Vitamin D deficiency should be considered in the differential diagnosis of any child with delayed motor milestones and/or muscle weakness, especially in minorities at risk. This case highlights an unusual and unexpected cause of proximal muscle weakness that not only could have been more easily diagnosed with simple laboratory tests but is fully reversible when properly treated.”
How unusual is it? I doubt it is that unusual. What is unusual is that the doctors properly diagnosed it.