Developmental Concerns

All children grow and develop differently. Some issues that initially cause concern turn out to be normal development. This guide helps you recognise common issues you might see but which don’t indicate a specific problem that requires treatment.

Concerns about speech

The following areas often worry parents, carers and teachers. But they’re all perfectly normal and don’t need treatment by a Speech and Language Therapist.

  • Lisping in children under seven, when a “th” sound replaces the letter “s”, usually disappears as children get older – lost teeth or braces might also cause lisping; this is perfectly normal
  • Saying “w” instead of “r” can persist up until the age of seven, although most children will have acquired the “r” sound by the age of five
  • Leaving out the “t” in the middle and at the end of words isn’t a problem unless your child is showing other speech problems – leaving out “t” is often caused by an accent, rather than a problem with talking
  • Replacing “th” with “f” (in words such as “thing”) and “th” with “v” (in words such as “that”) is usually caused by accent, rather than speech difficulties

If you notice any of these in your child after the age of seven, and they seem to be causing difficulties, consider contacting your GP or our HealthHub for advice.

Concerns about using their left or right hand

From about the age of four or five, children tend to prefer using either their left or right hand when picking up small items and performing delicate tasks such as writing and drawing. They establish a definite hand dominance at around seven or eight.

It’s common for some children to use one hand for writing but choose the other hand for fine motor tasks such as cutting paper. Quite often, children who write with their left hand find it easier when cutting to hold the scissors in their right hand and the paper in the left. This allows the action (left) hand to move the paper while the scissors remain fairly still, needing only to open and close. This isn’t a cause for concern.

Concerns about getting dressed

Some children take longer than others to learn how to dress themselves, especially if they’re not given the chance to try. Parents sometimes find it easier and quicker to dress their child but it’s important to allow your child some time to try it for themselves.

Concerns about walking

The following areas often seem a cause for concern but they’re all normal and don’t require treatment.

  • Flat feet: all children are born with flat feet; the arch of the foot develops gradually over the first 10 years of life and 20 per cent of six year olds still have flat feet. There’s no evidence that insoles will help an arch to develop in the foot but they might be useful if your child is experiencing foot and/or ankle pain when walking
  • In-toeing: this is where the knee and foot turn in when your child is standing. This is common, especially in girls, and will usually improve gradually and stop by the age of seven or eight. Physiotherapy assessment is not required unless your child is having difficulty walking or running. Encourage your child to exercise and sit cross legged. Don’t try to correct the walking, or tell your child to walk normally
  • Bow legs: this is when there is a larger gap between the knees than the ankles when standing and will usually disappear by the age of three. Assessment by a physiotherapist is only required if only one leg appears bowed and the other straight, or if the gap is very large (greater than 10cm)
  • Knock knees: this is when there is a larger gap between the ankles than the knees when standing. It’s common in children aged three to eight and usually improves over time without treatment. Assessment by a physiotherapist is only required if one leg appears more bent than the other or if the gap is very large (greater than 10cm). Knock knees that first become apparent during the teen years need to be assessed by a physiotherapist
  • Curly toes: this is common in young children and often runs in families. No treatment is required unless there is pain or changes to the skin or nails
  • Toe walking: this is where a child walks on their tip toes. There are several reasons why this might occur and it often runs in families. If this impacts on a child or young person’s ability, e.g. frequent tripping, contact Children and Young People’s Integrated Therapies (CYPIT) services for advice

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