Questions?What Are HIE Developmental Delays?
An HIE developmental delay is a sign that a baby’s brain injury is affecting how they grow, move, or learn.
Neonatal hypoxic-ischemic encephalopathy is a type of brain injury that happens when a baby’s brain doesn’t get enough oxygen supply or blood flow around the time of birth.
This kind of oxygen deprivation, also known as hypoxia or ischemia, can damage areas of the brain that control speech, movement, problem-solving, and other important skills.
Delays caused by HIE may show up in the first months or years of life. Some babies may struggle to hold their head up, sit, crawl, or speak on time. Others may need extra support in learning or daily activities as they get older.
Every child is different, but HIE developmental delays are one of the most common signs that something is wrong. Recognizing these early symptoms of HIE can help families get answers — and support — sooner.
An experienced birth injury lawyer can fight for the money your family deserves. The experienced attorneys in our network have helped families recover over $1 billion, including for cases involving hypoxic ischemic encephalopathy.
We can help families in all 50 states. Find out if we can help you — get a free case review right now.
How Does Hypoxic Ischemic Encephalopathy Cause Developmental Delays?
HIE can damage brain cells that control how a child moves, learns, speaks, and interacts with the world. When the brain is deprived of oxygen and blood flow, even for a short time, the affected areas may not develop as they should.
This lack of oxygen, also called birth asphyxia or perinatal asphyxia, can lead to permanent brain dysfunction and significantly impact a child’s HIE prognosis.
For example, if the damage is in areas that control movement, the child may struggle with sitting, crawling, or walking.
If injury occurs in regions responsible for speech or learning, the child may have trouble speaking, understanding language, or solving problems as they grow.
Some children with moderate HIE may experience only slight delays, while others with severe HIE may face long-term developmental challenges.
In many cases, developmental delays don’t become clear until a child starts missing key milestones during infancy or toddlerhood.
Types of HIE Developmental Delays
Children with hypoxic-ischemic encephalopathy may experience different types of developmental delays depending on which areas of the brain were affected.
In many cases, developmental delays appear alongside other early HIE symptoms, like seizures, low muscle tone, or poor feeding.
As the child grows, delays in reaching milestones may become more noticeable. An HIE developmental delay can involve physical, cognitive, and social skills.
- Cognitive delays: Challenges with thinking, learning, memory, or problem-solving
- Motor delays: Trouble with movement and coordination, such as rolling over, sitting, crawling, or walking later than expected
- Sensory processing issues: Over- or under-reacting to sounds, lights, textures, or other sensory input
- Social and emotional delays: Problems interacting with others, managing emotions, or forming relationships
- Speech and language delays: Difficulty making sounds, using words, or understanding language
Early intervention services — like physical, occupational, or speech therapy — can make a meaningful difference in how a child develops after HIE.
Early Signs of an HIE Developmental Delay
Every child develops on their own timeline, but consistently missing key milestones may be an early sign of brain damage.
HIE can damage areas of the brain responsible for movement, coordination, speech, and learning. Some signs may appear in the first few weeks or months, while others become easier to notice as your child gets older and starts falling behind in basic skills.
Signs of HIE Developmental Delay in Newborns (0–3 Months)
Some newborns with HIE show signs of neurological injury shortly after birth, especially if the brain damage is moderate to severe.
- Floppy or very stiff muscles (hypotonia or hypertonia)
- Poor feeding or difficulty latching
- Seizures, twitching, or staring spells
- Trouble lifting or controlling the head
- Unusual crying patterns, such as persistent irritability or high-pitched cries
- Weak or absent reflexes, such as sucking, rooting, or startle
These symptoms may occur with other HIE symptoms, including low Apgar scores, need for resuscitation, or NICU admission.
Signs of HIE Developmental Delay in Infants (3–9 Months)
Depending on the severity and cause of hypoxic ischemic encephalopathy, signs of developmental delay may not appear until 3 to 9 months of age.
- Difficulty holding up the head without support
- Limited eye contact or reduced interest in surroundings
- Little or no movement in the arms or legs
- Muscle stiffness or floppy limbs
- Trouble rolling over or pushing up when lying on the stomach
Some babies may also begin to favor one side of the body or show involuntary movements, depending on the extent of the brain injury.
Signs of HIE Developmental Delay in Toddlers (1–3 Years)
As children grow, HIE-related developmental delays often affect walking, speech, and social skills.
- Delayed speech or trouble using simple words
- Difficulty interacting with others or showing limited emotional expression
- Poor balance or frequent falls
- Struggling with tasks like stacking blocks or feeding themselves
- Trouble with cognitive skills and learning new things
- Unable to walk by 18 months or walking with an unusual gait
These signs don’t confirm a diagnosis but may indicate a need for developmental screening and follow-up care.
If you’ve noticed symptoms in your child and aren’t sure if they could be related to HIE, our experienced labor and delivery nurses can help — at no cost to you.
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How an HIE Developmental Delay Affects Milestones
All babies reach milestones at their own pace, but children with hypoxic-ischemic encephalopathy may need extra support to meet developmental goals. Tracking your child’s progress is one of the best ways to spot delays early and get help when it matters most.
- Cognitive: Recognizing faces, exploring objects, and showing curiosity
- Motor: Holding up the head, sitting, crawling, standing, and walking
- Speech and language: Making sounds, babbling, using words, understanding directions
- Social and emotional: Smiling, showing interest in others, responding to emotions
- Self-help: Feeding, grasping toys, trying to dress or hold a cup
Children with HIE may reach some of these milestones later than expected — or in a different order — depending on how the brain injury affected their development.
Keeping a milestone journal or using a developmental checklist can help parents track progress and bring up any concerns during well-baby visits.
If you’re worried your child is showing signs of a HIE developmental delay, take our free milestone quiz.
IS YOUR CHILD MISSING DEVELOPMENTAL MILESTONES?
Take Our Milestones Quiz
Taking note of your child’s physical, social, and emotional skills can help you determine if they potentially suffered from an injury at birth. An early diagnosis can help your child get the treatment they need as soon as possible.
Q1: How old is your child?
0-2 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child hold their head steadily on their own?
- Q3: Can your child push themselves up when they are lying on their stomach?
- Q4: Has your child started to make smoother movements with their arms and legs?
- Q5: Does your child smile at other people?
- Q6: Can your child bring their hands to their mouth?
- Q7: Does your child turn their head when they hear a noise?
- Q8: Does your child coo or make gurgling noises?
- Q9: Does your child follow things with their eyes?
- Q10: Does your child try to look at their parents or caregivers?
- Q11: Does your child show boredom, cry, or fuss when engaged in an activity that hasn’t changed in a while?
3-4 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child hold their head steadily on their own?
- Q3: Does your child push down on their legs when their feet are on a flat surface?
- Q4: Has your child started to roll over from their stomach to their back?
- Q5: Can your child hold and shake a toy such as a rattle?
- Q6: Does your child bring their hands to their mouth?
- Q7: Does your child play with people and start to cry when the playing stops?
- Q8: Does your child smile spontaneously, especially at people?
- Q9: Does your child copy some movements and facial expressions of other people?
- Q10: Does your child babble with expressions and copy sounds they hear?
- Q11: Does your child cry in different ways to show hunger, pain, or tiredness?
- Q12: Does your child respond to affection like hugging or kissing?
- Q13: Does your child follow moving things with their eyes from side to side?
- Q14: Does your child recognize familiar people at a distance?
5-6 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child roll over on both sides (front to back/back to front)?
- Q3: Has your child begun to sit without support?
- Q4: Does your child rock back and forth?
- Q5: Can your child support their weight on their legs (and perhaps bounce) when standing?
- Q6: Has your child begun to pass things from one hand to the other?
- Q7: Does your child bring objects such as toys to their mouth?
- Q8: Does your child know if someone is not familiar to them and is a stranger?
- Q9: Does your child respond to other people’s emotions, such as a smile or a frown?
- Q10: Does your child enjoy looking at themselves in the mirror?
- Q11: Does your child look at things around them?
- Q12: Does your child respond to sounds they hear by making sounds themselves?
- Q13: Does your child make sounds to show joy or displeasure?
- Q14: Does your child respond to their own name?
- Q15: Has your child started to string vowels together, such as "ah," "eh," or "oh," or started to say consonant sounds such as "m" or "b"?
- Q16: Has your child begun to laugh?
7-9 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child crawl?
- Q3: Can your child stand while holding on to something to support them?
- Q4: Can your child sit without support?
- Q5: Can your child pull themselves up to stand?
- Q6: Does your child play peekaboo?
- Q7: Can your child move things from one hand to the other?
- Q8: Can your child pick small things up, such as a piece of cereal, with their thumb and index finger?
- Q9: Does your child look for things that they see you hide?
- Q10: Does your child watch the path of something as it falls?
- Q11: Does your child show fear when around strangers?
- Q12: Does your child become clingy with adults who are familiar to them?
- Q13: Does your child have favorite toys?
- Q14: Does your child use their fingers to point?
- Q15: Does your child understand “no”?
- Q16: Does your child make a lot of repetitive sounds, such as “mamama” or “bababa”?
- Q17: Does your child copy the sounds and gestures of other people?
10-12 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child stand alone with no support?
- Q3: Does your child walk while holding on to furniture?
- Q4: Can your child take a few steps without holding on to anything?
- Q5: Can your child get into a sitting position without any help?
- Q6: Does your child bang two things together when playing?
- Q7: Does your child poke with their index finger?
- Q8: Has your child started to use things like hairbrushes or drinking cups correctly?
- Q9: Does your child find hidden objects easily?
- Q10: Does your child play peekaboo or pat-a-cake?
- Q11: Does your child become shy or nervous around strangers?
- Q12: Does your child repeat actions or sounds to get attention?
- Q13: Does your child put out an arm or leg to help when getting dressed?
- Q14: Does your child cry when a parent leaves the room?
- Q15: Does your child show that they have favorite things or people?
- Q16: Does your child show fear?
- Q17: Does your child say things such as “mama,” “dada,” or “uh-oh”?
- Q18: Does your child try to say the words you say?
- Q19: Has your child started to use gestures like waving or shaking their head “no”?
13-18 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child walk by themselves?
- Q3: Does your child walk up stairs and run?
- Q4: Does your child pull toys while walking?
- Q5: Can your child drink from a cup on their own?
- Q6: Can your child eat with a spoon on their own?
- Q7: Can your child help undress themselves?
- Q8: Does your child have occasional temper tantrums?
- Q9: Does your child show affection to familiar people?
- Q10: Does your child become clingy in new situations?
- Q11: Does your child explore their environment alone with parents close by?
- Q12: Can your child say several single words?
- Q13: Can your child say and shake their head “no”?
- Q14: Does your child point to show things to other people?
- Q15: Does your child scribble?
- Q16: Does your child know what ordinary products such as phones, spoons, and brushes are used for?
- Q17: Can your child follow one-step commands such as “sit down” or “stand up”?
- Q18: Does your child play with a doll or stuffed animal by pretending to feed it?
19-23 MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Has your child begun to run?
- Q3: Has your child kicked a ball?
- Q4: Can your child climb down and onto furniture on their own?
- Q5: Can your child walk up and down stairs while holding on?
- Q6: Can your child stand on their tiptoes?
- Q7: Has your child thrown a ball overhand?
- Q8: Does your child copy others, especially people older than them?
- Q9: Does your child get excited around other children?
- Q10: Has your child shown more independence as they've aged?
- Q11: Does your child do what they were told not to do and become defiant?
- Q12: Does your child point to things when they are named?
- Q13: Does your child know names of familiar people or body parts?
- Q14: Does your child say 2 to 4-word sentences?
- Q15: Does your child repeat words they hear?
- Q16: Does your child complete sentences and rhymes in familiar books?
- Q17: Does your child name items in books, such as dogs, cats, and birds?
- Q18: Does your child play simple pretend games?
- Q19: Has your child started to use one hand more than the other?
- Q20: Has your child begun to sort shapes and colors?
- Q21: Does your child follow 2-step instructions, such as “pick up your hat and put it on your head?”
24+ MONTHS DEVELOPMENTAL MILESTONES QUIZ
- Q2: Can your child run easily?
- Q3: Can your child climb?
- Q4: Can your child walk up and down stairs with one foot on each step?
- Q5: Can your child dress and undress themselves?
- Q6: Does your child show affection for friends without being told?
- Q7: Does your child take turns when playing games?
- Q8: Does your child show concern when others are crying?
- Q9: Does your child understand the idea of “mine" and "theirs"?
- Q10: Does your child show many different emotions?
- Q11: Does your child copy adults and friends?
- Q12: Does your child separate easily from their parents?
- Q13: Does your child get upset when there is a major change in their routine?
- Q14: Does your child say words such as “I,” “me,” “we,” “you,” and some plural nouns?
- Q15: Can your child say their first name, age, and gender?
- Q16: Can your child carry on a conversation with 2 to 3 sentences?
- Q17: Can your child work toys with buttons and other moving parts?
- Q18: Does your child play pretend with dolls, animals, or people?
- Q19: Can your child finish 3 or 4 piece puzzles?
- Q20: Can your child copy a circle when drawing?
- Q21: Can your child turn pages of a book one page at a time?
- Q22: Can your child turn door handles?
Diagnosing an HIE Developmental Delay
A hypoxic ischemic encephalopathy developmental delay is usually diagnosed through a combination of medical history, developmental screenings, and neurological evaluations.
Some signs may appear shortly after birth, while others become noticeable as the child grows and misses expected milestones.
Doctors may start with general developmental screenings during well-baby visits. These check how a child is progressing in areas like movement, speech, problem-solving, and social interaction. If delays are found, more specialized evaluations may follow.
- Developmental milestone checklists to compare your child’s progress to typical age ranges
- Neuroimaging tests, like magnetic resonance imaging (MRI) and electroencephalogram (EEG), to look for brain injury consistent with HIE
- Neurological exams to assess muscle tone, reflexes, and coordination
- Referral to specialists, like pediatric neurologists or developmental pediatricians
Early diagnosis is key. Identifying a delay as soon as possible allows families to begin therapies that can improve long-term outcomes.
Can You Prevent HIE Developmental Delays?
Not all HIE developmental delays can be prevented. The severity of a child’s delays depends on how long the brain was deprived of oxygen and how early the injury was treated.
In many cases, quick medical action can reduce long-term damage, but delays in care may make the injury worse.
Sometimes, HIE may have been preventable altogether if delivery teams provided better care. In these cases, it may be considered medical malpractice.
- Careful monitoring during labor to catch signs of fetal distress early
- Proper neonatal care immediately after birth
- Regular prenatal visits to identify high-risk pregnancies
- Timely delivery, including emergency C-section when needed
When health care providers fail to act appropriately, the resulting brain damage can lead to lifelong HIE developmental delays. In these cases, families may be eligible to receive money from an HIE settlement.
If you believe medical negligence may have caused your child’s HIE, our team can help you understand your legal options.
Get a free legal case review right now to find out if you may qualify.
Treating HIE Developmental Delays
While there is no cure for brain damage, many children with HIE developmental delays can make progress with early and consistent treatment.
One common emergency intervention for babies with HIE is therapeutic hypothermia (a cooling treatment that lowers the baby’s body temperature to slow brain injury), which may reduce the risk of long-term brain damage if started within 6 hours after birth.
The goal of treatment is to support the child’s development, improve their quality of life, and help them reach their full potential.
Treatment plans are tailored to each child’s needs and may include a combination of therapies and support services.
- Assistive devices, such as braces, walkers, or communication tools
- Behavioral therapy to help with social skills and emotional development
- Occupational therapy to help with everyday tasks like eating, dressing, and writing
- Physical therapy to improve strength, balance, and coordination
- Special education services to provide learning support at school
- Speech therapy to support communication skills and, in some cases, feeding issues
These therapies can be critical for long-term progress, but the cost can add up over time. Some families may qualify to file an HIE claim for compensation to help cover the cost of care and secure additional support.
Get Legal Help for Your Child’s HIE Developmental Delay
Caring for a child with an HIE developmental delay can be overwhelming — emotionally, physically, and financially.
Families often face years of therapy, specialist visits, and support services to help their child thrive.
An experienced HIE lawyer may be able to help if medical negligence caused your child’s condition. Many families choose to file a birth injury claim and pursue compensation for treatment, care, and long-term support.
The Birth Injury Justice Center works with experienced HIE attorneys who can help families in all 50 states.
Our trusted network of lawyers has secured more than $1 billion for families affected by preventable birth injuries like HIE, and they may be able to help your family, too.
Call us at (800) 914-1562 right now or fill out this form to see if we may be able to help you seek the justice and compensation your family deserves.
HIE Developmental Delay FAQs
What is hypoxic-ischemic encephalopathy?
Hypoxic-ischemic encephalopathy (HIE) is a type of brain injury that happens when a baby doesn’t get enough oxygen or blood flow around the time of birth. This lack of oxygen, known as birth asphyxia, can cause brain cells to become damaged or die.
Some cases are mild and may only cause temporary issues, while more severe cases can result in permanent brain damage.
What are the long-term effects of hypoxic ischemic encephalopathy?
The long-term effects of hypoxic ischemic encephalopathy (HIE) depend on how severe the brain injury was and which areas were affected.
Some babies diagnosed with mild HIE may recover with minimal long-term effects, especially with early treatment.
Others may develop conditions like cerebral palsy (brain damage affecting muscle control and movement), epilepsy (seizure disorder), or intellectual disabilities. In the most severe cases, HIE can lead to permanent physical and cognitive impairments.
If your child has HIE and you’re concerned about their future, connect with our team to learn how we may be able to help.
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Is HIE a developmental disability?
HIE itself is not a developmental disability, but it can cause one. If the brain injury affects how a child moves, learns, communicates, or behaves, the resulting delays or impairments may qualify as a developmental disability.
What are the developmental disabilities of hypoxic ischemic encephalopathy?
HIE can lead to several developmental disabilities, depending on how the brain was affected.
These may include:
- Cerebral palsy
- Intellectual disability
- Learning difficulties
- Motor skill problems
- Speech and language delays
Some children may also have social or behavioral challenges.
Can autism be caused by HIE?
Research suggests that HIE may increase the risk of autism spectrum disorder (ASD) in some children.
Lack of oxygen at birth has been linked to a higher likelihood of developmental conditions, including autism. However, autism has many possible causes, and not all children with HIE will develop ASD.
