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Causes
Delayed milestones can manifest as early as infancy and develop later in early school years. Many factors contribute to delayed milestone such as medications, trauma, environmental, genetics, and metabolic.

Anti-Epileptic Medications
One cause of delayed milestone is the use of anti-epileptic medications such as valproate during pregnancy. According to the study, there is an association between prenatal exposure to valproate and delayed milestones and intellectual disabilities. The risk of children having delayed developmental milestones is significantly higher compared to children without valproate exposure. Pregnant women taking higher doses of valproate have a higher risk of intellectual disabilities and delayed milestones compared to lower doses.

Other anti-epileptic medications such as carbamazepine, clonazepam, and oxcarbazepine have been associated with an increased risk of developmental milestones in children while exposed prenatally.

Parental Violence and Psychological Distress
Children exposed to intimate partner violence have been associated with delayed milestones along with long term physical and mental health adverse effects. Trauma and toxic stress that stems from intimate partner violence interferes with the normal developmental processes of the brain.

Parental psychological distress such (PPD) as anxiety and depression have been associated with delayed milestones. PPD interferes with healthy attachment between parent and child which increases the risk of the child having behavioral and cognitive problems.

The Child Health Improvement through Computer Automation (CHICA) system measured developmental milestones under 4 domains: personal-social, language, fine motor-adaptive, and gross motor. According to the study, children exposed to intimate partner violence and parental psychological distress within the first 6 years of a child's life failed all 4 developmental domains of developmental milestones.

Micronutrient Deficiency
Micronutrient Deficiency in children below 2 years old have been associated with delayed milestones. Specifically, vitamin B12, folate and iron deficiency have been associated with negative effects on development. According to studies, vitamin B12 has the most negative effect on developmental delays followed by iron and folic acid deficiency. Children with vitamin B12 deficiency have shown to have delay in gross motor development and children with iron deficiency are shown to have poor cognitive and motor development as well as behavioral issues. In the study, children were not presented with folate deficiency as folate concentration is high in breastmilk.

Antidepressants
Women taking antidepressants while pregnant may lead to delayed milestones in their child as well as reversible or permanent effects on fetal development. The occurrence of delayed milestone in children depends on the timing of exposure to antidepressants during pregnancy. Studies shown that children who were exposed to antidepressants during the second or third trimester of pregnancy were able to sit and walk later than children that were not exposed to antidepressants, however were still in the normal range of development. Fewer children took as long as 6 months to sit without support while some took even 19 months to support themselves.