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Here are some of the most common developmental problems that children experience.

Teachers identify some of the most common developmental problems they deal with in their classrooms.

Fine motor skills

One of the most common developmental problems involves the small muscle movements in the hands and fingers. Hands and fingers are are used to perform functions like grasping, writing, doing up buttons or cutting. Joburg occupational therapist (OT) Cheryl Bennie says children with fine motor skill difficulties, or related developmental problems, may avoid tasks requiring small muscle movement, such as building puzzles and cutting with scissors.

Other indications include:

  • difficulty sitting still to draw or colour
  • swapping hands during fine motor work
  • rushed and poorly controlled colouring or drawing
  • avoidance of grasping objects with isolated finger movements.

Children should be developing skills like beading and using an inferior pencil grip by the age of three. However, problems may only be identified in Grades 0 or 1, when there is greater expectation on children to perform fine motor activities. Therapy often depends on the cause of the problem. It could be as simple as engaging children in age-appropriate fine motor games. Or, if there is low muscle tone or poor motor planning, an OT will advise on the best course of remediation.

Gross motor skills

This relates to large body movements. Every child is programmed to go through the same sequence of developmental milestones. A development delay or non-acquisition of these milestones result in the inadequate use of the body, says Joburg OT Jennifer Lewkowski. A child may have poor head and neck control and poor posture control. They may slouch, prop their head up while sitting or use support when standing. Their hands won’t meet or cross the midline. They may often bump into things. And, they struggle to listen and will fiddle. They fall behind because they can’t sit and focus on what the teacher is saying.

Gross motor problems are noticeable at birth. At school age, you will observe problems with your child’s language, academic work, social behaviour, emotional resolution and decision-making.

Who to consult

A paediatrician will identify if there is motor skill dysfunction and refer you to an OT or a neurodevelopmental physiotherapist.

Muscle tone

Loose, floppy muscles are signs of low muscle tone. Typically, it will only be noticeable from about three years old. Children may also have motor skill problems and poor co-ordination. They may struggle to maintain their posture and will tire easily. Often, you will notice that they  slump, have poor head control and struggle to sit still. Low muscle tone can lead to problems like delays in developing motor skills, speech difficulties and concentration problems.

Children can sometimes grow out of low muscle tone if it is mild and if they participate in suitable physical activities. OT or physical therapy includes activities that help to develop more tone and muscle strength.

Sensory integration

This is when the brain does not interpret information from the senses correctly. Lewkowski says: “Imagine going through your day wearing gardening gloves against thorns. Or every time someone hugs or kisses or touches you, the sensation is like scraping chalk on the blackboard.”

Signs include being overly sensitive to touch, movement, sight, sound, taste and smell. Children will react with irritability or withdraw when touched, and avoid certain textures. They may be easily distracted or fearful of simple movement activities. They may also suffer from motion sickness. Some children may seek out intense sensory experiences as they may seem oblivious to pain or unaware of where their body is or its movement in space. Sometimes there is fluctuation between the extremes of over- and under-responsiveness.

Dysfunction can be noticed in the co-ordination of the large muscles – stability and movement in the torso, body or trunk or with fine motor co-ordination – using scissors, crayons, buttons, laces, knives and forks. Children may appear lazy, bored, or unmotivated. They find ways to avoid tasks at which they fail.

Sensory integration can be recognised immediately after birth. However, it is sometimes mistaken for severe colic and restlessness. If not dealt with early, it will continue until the child becomes extremely distressed.

Who to consult

An evaluation can be carried out by a qualified OT. The therapist might informally observe spontaneous play and ask you to provide information about your child’s development and/or your child’s typical behaviour patterns.

Ability to concentrate

An inability to focus on a set task could be a concentration problem says Durban-based psychologist Claudette Jordan. Underlying causes may include:

  • hearing or vision difficulties
  • problems with processing information
  • cognitive or developmental problems and delays
  • emotional concerns
  • nutritional or physiological deficiencies

Children may be easily distracted, struggle to focus on a task, or sustain that focus, and battle to follow instructions.

Other signs include hyperfocus and hyperactivity, says Jordan. Poor concentration usually becomes apparent during the preschool years, when there is a structured, formal learning environment. “Determining if a child has concentration difficulty can be a complex process of multidisciplinary assessment, as each child differs.”

A psychiatrist may prescribe medication. Brain training is a popular treatment and uses focused and repeated exercises to change cognitive functioning. Nutritional supplements, commonly omega-3 and -6 oils, and a low-GI diet can also be used. Supportive therapies include OT or speech therapy to improve information processing. Effective management often needs parents to work on behavioural strategies at home, consult a kinesiologist for this.


Speaking with a lisp is a common speech impediment. It involves either a substitution or a distortion of certain sounds. Joburg-based speech therapist Karen Levin says children sometimes substitute sounds, for example, using “w” instead of “r”. This is normal for younger children, especially with the “s” sound, so it shouldn’t be a concern until Grade 0. Therapy from the second half of Grade 0 is recommended. Lisps that involve a distortion of sounds should be treated with therapy as soon as possible.

A speech therapist can assess and treat a lisp. Articulation therapy shows children where to position the tongue, and uses listening, mirror therapy and home programmes. Lisps can be caused by a tongue thrust, an immature swallowing pattern or low muscle tone, says Levin. In these cases, a speech therapist could recommend additional treatment, such as oral motor exercises.

With delayed language development, and developmental problems, a child’s ability to use language doesn’t develop as it should. Critical language development milestones start from 9–10 months of age. This is when children’s babbling sounds should sound like speech. By age two, children should be putting together simple sentences and asking for or telling you things. By Grade 1, children should have a concept of time, space and relationships. They should pick up words easily and seldom make grammatical errors.

Who to consult

If you suspect a problem, or there are other risk factors such as your child was premature or has hearing difficulties, consult a speech therapist.


Three out of four children have had at least one ear infection before the age of three. Symptoms include pain, fluid leaking from the ear, irritability and difficulty sleeping. Muffled sounds due to temporary hearing loss are a common symptom of middle-ear infection. Bacteria in water causes swimmer’s ear – an infection of the outer-ear structures. Fortunately, this doesn’t cause lasting hearing problems.

Consult a doctor or specialist if there is persistent pain, a high fever or fluid leaking from the ear. Treatment may involve antibiotics. In  severe cases, grommets will be inserted in a surgical procedure.

Central auditory processing disorder (CAPD) can also affect hearing. CAPD refers to the communication between what the ear hears and how the brain interprets the information. When a child’s auditory processing skills are weak, they may experience “auditory overload”. This makes communication and learning a challenge. It impacts their ability to listen, speak, read, write and do certain tasks. Children may behave as if they have hearing loss, even though a hearing assessment indicates normal hearing thresholds. They will have difficulty learning songs and rhymes, battle to read, write and spell, and may mishear words. The auditory system only fully matures from around eight years of age. So, it is only possible to establish an auditory disorder then.

Who to consult

An audiologist is the only person who can correctly diagnose your child with CAPD. CAPD can be improved with treatment from speech therapists, audiologists, educational psychologists, teachers, doctors and parents.

Child magazine