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Physical health, mental health and development are inseparable. Health is usually viewed medically, but its interpersonal, learning and developmental implications cannot be ignored. Unfortunately, health and medically related signs and symptoms may be overlooked because they may be falsely attributed to the child’s developmental diagnoses. And looking from another angle, signs and functioning related to the child’s developmental diagnoses may be significantly affected by health-related medical issues and should be addressed.

Discomfort alters a child’s availability for connection, communication and learning. There may be continuing medical issues, and there can also be daily or even hourly fluctuations in wellbeing.

Many behaviors traditionally viewed as disciplinary problems can arise from illness, discomfort, fatigue or dysregulation. In many instances, the behavior represents the nervous system’s attempt to manage stress, fear, tiredness, confusion, or physical, emotional, or mental overload that may accompany health problems.

The child’s health and wellness are involved in every interaction and activity. When physical distress becomes chronic, the child’s development often reorganizes itself around survival and regulation rather than curiosity, exploration, and learning.

Looking Deeply and Listening Carefully

Medical and health-related conditions in children with developmental disabilities are biological regulators of the child’s interpersonal relationships, learning, behaviors, and development. They influence how the child experiences the world, how they engage with others and are able to interpersonally connect and to learn.

Are they tired from poor sleep? Distracted by pain? Overwhelmed by sensory input? Trying to regulate and control an uncomfortable and uncooperative body? Are they confused, exhausted, frustrated and self-conscious? Health-related irritants and distractions during learning or play may trigger errors, tears, withdrawal, or explosive reactions.

Behaviors are a form of communication. We observe the child’s demeanor and their behaviors, and then try to imagine what may be happening internally.

Is the child lethargic, unmotivated, or overly active and distracted? Do they miss a lot of school or therapy sessions? Are they excluded, teased or ignored by peers? Do they feel isolated and alone?

The development of a child is never merely an academic process. Development emerges from the interaction of body, brain, emotion, sensation, interpersonal relationship, movement, health, environment and experience.

A child’s learning is affected by their sleeping and waking, breathing and moving, eating and digesting, sensing and responding, attaching and exploring. The child’s physical condition, medical status, emotional well-being, sensory functioning, and physiological stability form the foundations upon which all learning and development are constructed.

For the child with medical conditions and developmental delays, the relationship between health and development is profound. The child’s wellness or illness may shape every aspect of their functioning.

A child who is frightened, confused and fatigued from seizures, distracted by chronic pain, overwhelmed by sensory discomfort, anxious from hormonal or breathing difficulties, affected by medications, or exhausted from poor sleep may appear inattentive, withdrawn, oppositional, cognitively delayed, emotionally dysregulated and/or socially disengaged. The child may not be struggling with motivation or character, but with their physiology and health.

We need to learn to look deeply and to listen carefully. The child is always communicating, even when the child has little or no conventional language. A skilled, attentive pediatrician who cares does not merely listen to symptoms described by adults or written in reports or laboratory results.

The engaged physician continuously observes the child from the moment the family enters the office. How the child walks down the hallway, their hygiene and grooming, their posture while standing and sitting, facial expressions, eye contact, breathing patterns, skin color, movements, gestures, muscle tone, vocalizations, curiosity, alertness, irritability and interaction with the physician and with caregivers all become part of the medical assessment.

Observational assessment becomes especially important when evaluating young children or children with limited cognitive and communicational abilities. Such children may be unable to describe pain, dizziness, nausea, fear, fatigue, sensory discomfort, headaches, anxiety, coordination, visual, auditory or tactile changes, or internal distress. The skilled physician learns to read the language of the child’s looks, behaviors and physiology.

Does the child appear to be energetic or lethargic? Is the child’s paleness or pallor due to a fair complexion or lack of sun exposure, or possibly from being cold or frightened? Or might it indicate illness, anemia or fatigue? Does the child move with intention? Is there weakness, stiffness, tremor, unusual gait, imbalance, or poor coordination? Does the child show interest and curiosity and spontaneously explore toys and surroundings, or remain unusually passive?

Is the child excessively fearful or irritable when touched, possibly suggesting fragility, pain or sensory defensiveness? Does the child avoid eye contact because of social anxiety, or visual impairment, neurological difficulty, exhaustion or emotional withdrawal?

Does the child respond appropriately to sound, gesture, facial expression and verbal interaction? Are there signs of respiratory distress, unusual sweating, congestion, skin rashes, dehydration, poor nutrition, or discomfort while standing, sitting or moving?

Illness may affect the quality of the child’s play and may become diagnostically meaningful. Does the child engage in imaginative play, repetitive activity, impulsive movement, perseverative behavior or fragmented attention that may be related to their health? Does the child smile, show joy, initiative, curiosity, shared attention, frustration tolerance and emotional reciprocity?

Can the child sustain interest? Does the child become overwhelmed by lights, sounds, touch, transitions, or environmental stimulation? Does the child seek excessive movement, or appear unusually under-responsive, or demonstrate fluctuating arousal states? Pain can cause the child to slow down or even to shut down and want to stay in bed, or it can agitate them and make them hyperactive.

Of course, parents, teachers, therapists and caregivers are not trained physicians. Yet all significant adults in the child’s life can learn about the child’s health and inner world from careful attentiveness. Non-medical mediators are not expected to diagnose disease or specific medical issues but need to become sensitive observers and advocates for improvements in the child’s health and wellness. Those who spend daily time with the child a or interact regularly with the child may be the first to notice subtle changes that may later prove medically significant.

A teacher may observe that a child who was interested and enthusiastic about learning or was once socially engaged now appears withdrawn and fatigued. A therapist may notice new weakness, clumsiness, tremors, imbalance, sensory defensiveness or changes in speech clarity. A parent, sibling or caregiver may recognize alterations in appetite, sleep, bowel habits, emotional regulation, forgetfulness, changes in play interests or energy level. Or notice increased irritability, unusual staring spells, headaches, sensitivity to light, changes in movement, emotional instability or loss of previously acquired interests or skills.

Such observations do not replace regular expert medical evaluation but may provide essential information that helps guide medical care, schooling and therapies.

All members of the child’s development team require a working awareness of the child’s medical and health conditions. The child’s pediatricians and medical specialists are central to assessment and treatment, but the daily life of the child unfolds largely in homes, classrooms, therapy rooms, playgrounds and caregiving environments.

Adults in these settings need to continually ask themselves, How is this child feeling today? What physical or emotional issues may the child be experiencing? How might the child’s health be affecting their attention, emotions, movement, communication, learning or behavior on this particular day?

Sleep deprivation, medications and medication changes, allergies, seizures, gastrointestinal distress, chronic pain, asthma, infections, sensory overload, hormonal changes, nutritional problems, anxiety, depression, or fatigue may significantly alter the child’s thinking and functioning from one day to another.

A child receiving anticonvulsant medication, muscle relaxants, stimulants, antidepressants, or other treatments may experience drowsiness, agitation, appetite changes, slowed cognitive processing, emotional fluctuation, gastrointestinal symptoms or altered activity levels. Physical therapy, surgeries, orthopedic devices, hearing aids, visual supports, or medical procedures can influence the child’s mood, energy, movement and participation in positive or negative ways.

Attentive mediators learn to notice the whole child rather than focusing in a superficial way on isolated behaviors without considering medical or health-related antecedents. Is there discomfort hidden beneath behavior that might otherwise be misunderstood as noncompliance or inattention?

What could their facial expressions, body condition, and movement be telling us about how the child is feeling and functioning? Is there pallor, flushing, unusual sweating, tension, grimacing, or diminished expression? How does the child move? Are posture, strength, coordination, balance and motor planning typical for the child? Has there been a recent change in endurance, enthusiasm or participation?

The child’s sensory reactions may also provide important clues. Is the child unusually sensitive to sound, light, touch, movement, or crowded environments? Does the child become overwhelmed by ordinary sensory stimulation? Is there increased withdrawal, irritability, covering of ears, visual avoidance or agitation? Conversely, does the child appear under-responsive, difficult to arouse, disconnected or unusually passive?

Such observations lead to a better understanding of this child’s lived experience. The emotionally attuned observer also recognizes that medical and health conditions affect not only physical functioning but the child’s inner life.

Chronic discomfort, repeated medical procedures, sensory confusion, physical limitations, fatigue, and social frustration may profoundly affect the child’s mood, anxiety, self-esteem, confidence and relationships.

A child struggling physically may become fearful, irritable, withdrawn, impulsive, or emotionally overwhelmed. Changes in health can alter thinking processes, emotional regulation, frustration tolerance, and social engagement. Meaningful learning and development occur within relationships, and relationships are shaped in part by physical well-being.

Developmental work requires collaboration between parenting, caregiving, medicine, education and therapy. No single professional or observer sees the entire child. The physician may observe neurological or physiological signs. The teacher may observe learning and peer interactions. The occupational therapist may observe motor planning or sensory processing, the parent may observe sleep, appetite, attachment, and emotional rhythms across daily life. These combined observations create a fuller understanding of the child’s medical and developmental conditions and challenges.

Caring for, teaching and treating a child with developmental delays requires technical knowledge, but also sustained observation, curiosity, sensitivity and human attentiveness. The child’s behavior is often a form of communication arising from the complex interaction of brain, body, emotion, relationship and health.

The task before all members of the child’s developmental team is not simply to protect, to teach or treat, but to observe carefully, think broadly, and remain alert to the subtle ways in which wellness and illness shape the child’s ability to participate in the world.

Hearing

Fluctuating auditory access alters communication. Speech sounds blur, language becomes less predictable, less graspable. When speech and communication are problematic and confusing, the child may withdraw or become isolated. Social reciprocity is delayed, not from lack of interest, but from diminished access. Over time, this may shape not only language acquisition but also their confidence in social interaction and shared attention, in interactive play, and in auditory-based learning activities. 

Allergy, Asthma and Immune Systems

Symptoms of asthma, allergy and other immunological conditions are triggered by environmental factors. Physical play is curtailed, and endurance is limited. The child who is uncomfortable, distracted, cannot easily run, shout or sustain activity may withdraw from peer interactions. There can be a negative impact on the child’s sense of agency and self-concept. The child may become an observer rather than a participant. An immunological or respiratory vulnerability can become a social and emotional one. And in some cases, life-threatening.

Cerebral Palsy (CP) and Motor Disorders

Cerebral Palsy is primarily expressed as a motor disorder involving difficulties in movement, posture, coordination, muscle tone and/or spasticity. Because CP begins early in life, it affects developmental pathways, how a child learns to move, explore, communicate, and interact.

The motor system does not operate in isolation. Limited motor locomotion and exploration hinder experiential learning. The child may reach and touch less, manipulate objects less, move and travel less. The world is encountered at a distance. This alters not only sensorimotor development but also cognitive development and problem-solving. Communication may be affected, not solely by motor-related speech difficulties, but by reduced opportunities for joint activities and shared discovery. The child’s emotional life may be shaped by frustration, withdrawal and dependency. Or, hopefully, by challenge, resilience and persistence.

Attention Deficit Hyperactivity Disorder (ADHD)

For children with Attention Deficit Hyperactivity Disorder, the difficulty is typically not in cognitive capacity but in regulation of attention, impulse and activity level. It typically affects the child’s executive functioning, attention regulation and self-control.

The child may perceive, understand and have appropriate intentions, but have difficulty sustaining attention and engagement long enough for learning to consolidate or for projects to be completed. They may have difficulty holding instructions in mind, particularly multi-step tasks, and may have trouble organizing tasks and sequencing steps. They may experience multiple and repeated careless errors. They may talk excessively, may interrupt, may shift topics quickly and often. Social exchanges may become fragmented. The child or adult with ADHD may have difficulty organizing their thoughts into coherent narratives, but not always.

There may be signs of internal restlessness or hyperactivity. There may be poor motor inhibition, including impulsive movements, fidgeting, and difficulty staying seated. There may be difficulty following rules, and their interactive play may lose coherence and meaning. Some children have difficulty inhibiting emotional states and may have a low tolerance for frustration and may have a heightened sensitivity to feedback or failure. Adults are prone to misinterpret these as misbehaviors rather than physiological regulatory dysfunctions affecting functionality in all developmental domains, cognitive, social, emotional and motor.

ADHD can affect the child’s health indirectly: sleep disruptions, stress, anxiety, depression, eating and injury risks. Children can have ADHD and medical conditions simultaneously. For instance, ADHD and asthma, epilepsy, sensory issues (vision, hearing, tactile, sensory defensiveness, distortions), hormonal or gastrointestinal disorders.

Chronic Medical Conditions and Medication

Chronic medical conditions impose both physiological and psychological demands. A child may become acutely aware of their bodily states, sometimes feeling anxious and chaotic, or acting overly perfectionistic and controlled in their preoccupations. The child’s medical and biological conditions affect not only their physical health but also patterns of autonomy, dependence and social inclusion. Participation in peer activities may be interrupted or constrained.

Medication effects may influence short and long-term development. Some children become fatigued, emotionally blunted, anxious, restless, dysregulated or even self-harming as unintended consequences of medical treatment. Misdiagnosis, incorrectly prescribed medications, or non-compliance are not rare events.

Sleep and Eating Difficulties

Sleep disorders may involve insufficient sleep, not getting enough hours of sleep, and/or poor-quality of restorative sleep, creating issues with alertness and daytime functioning.

A child experiencing sleep difficulties can become fatigued, less attentive, less able to concentrate or problem-solve, more irritable, and less resilient. Learning becomes more effortful, emotional regulation is uneven, and sensory tolerance lessens. Ineffective and insufficient sleep influences thinking, mood, performance and development across all developmental domains.

Eating, Nutrition and Gastrointestinal Disorders

Children with developmental delays frequently experience gastrointestinal, feeding, and nutritional difficulties that affect all aspects of development: health, growth, comfort, behavior, learning, play, sleep, and participation in daily life.

Nutrition influences every domain of development. The growing brain depends upon stable nourishment for movement, attention, memory, emotional regulation, language development, and cognitive organization.

A child who refuses certain foods may not be oppositional but hypersensitive to texture, smell, temperature or appearance of the food, or may have an undiagnosed allergic reaction or food sensitivity.

Feeding, inadequate nutrition and hydration can cause serious health problems. And health problems or developmental delays can interfere with feeding and nutrition. Feeding and nutrition issues can result in feeling unwell, immunodeficiency, sensory issues, motor coordination and fatigue, anxiety and pain. The need for predictability and control can influence eating habits, nutrition, health and development.

Children with developmental disabilities may experience significant eating and feeding difficulties, such as:

• chewing and swallowing
• gagging or choking
• extremely slow eating
• highly selective eating
• limited food repertoire
• avoidance of unfamiliar foods
• impulsive overeating or food-seeking behaviors
• difficulty recognizing hunger and fullness cues

Vitamin, fiber and mineral deficiencies may occur. A child’s feeding and gastrointestinal difficulties can influence emotional regulation, sleep, behavior, attention, communication, play, school functioning, and family relationships.

Sensory and Motor Experience

Sensory impairments, visual, auditory, tactile or integrative skills affect all parts of the child’s life. A child with visual impairment does not merely see less well. The child explores differently, anticipates differently, makes repeated mistakes, has perceptual irregularities, and constructs alternative spatial, temporal, and social understandings.

When unusual sensory processing functions are involved, everyday internal experiences may feel chaotic, painful, confusing, or frightening.

Some children experience ordinary sensations with unusual intensity. Clothing textures may feel abrasive. Bright lights may become physically distressing. Certain tastes, smells, textures or sounds may feel invasive or alarming.

Some children seek intense movement, pressure, or sensory stimulation because their nervous system struggles to register input clearly. A child who crashes into furniture or seeks constant movement may be attempting to organize bodily awareness and regulation through alternate physical input.

With sensory or movement difficulties, joint attention may be delayed. Play may be less imitative, less exploratory, more limited and repetitive. The social partner must work differently to establish a connection. A sensory or motor difference may become a relational, cognitive and emotional difference.

Medical and health-related issues influence the child’s interests, intentions, their opportunities for interaction, their processing efficiency, the correctness and reliability of their responses, and the meanings the child constructs about themselves and about others.

Movement is not separate from emotions and cognition. Early thinking develops through physical interaction with the world.

Infants and young children learn through reaching, grasping, crawling, climbing, balancing, and exploring and manipulating objects and their own movements. Through movement, the child develops spatial awareness, motor planning, body organization, problem-solving, confidence, and agency.

Older children who have movement difficulties need to experience those developmental prerequisites through enjoyable, meaningful, and intentional mediated activities.

Implications of Medical Conditions for Learning

What is the child’s physical and mental availability for engagement and learning?

Can the child show what they know or does their medical condition prevent others, and even themselves, from recognizing their higher potential? Can the child with medical conditions communicate how they are feeling, what they think of themselves, their fears regarding future capacities or future medical events?

Do the medical conditions influence how deep and how long interpersonal and cognitive engagement can be sustained?

Is the child in discomfort, distracted, anxious, or depressed?

Is the child calm, alert, interested and organized in spite of their health or medical condition, past, present or future?

Is the interaction, the activity, the content and the process of the play and of the learning meaningful for the child when they do not feel well?

Is the child receiving regular, complete and accurate medical assessments and interventions? Is the medical team trained and experienced in assessing and treating your child with their particular medical and health-related issues?

Prioritizing Safety and Health

We always prioritize the child’s safety and health when assessing the child’s developmental needs. The best-qualified medical and health practitioners are essential partners on the child’s development team.

Parents, Family Members, Caregivers, Teachers and Therapists should all be continually aware, every day, regarding how this child is feeling, eating, moving, resting, sleeping, and how their body, their medical condition and treatments, and their subjective feelings, are affecting their performance, mood, motivation, concentration, interest, strength, stamina, enjoyment and effort.

A child who appears stalled, inattentive, or unreachable always possesses higher potential than they currently show. The child and their adult mediators have not yet found more successful and reliable pathways for progress. The problem is not the absence of the child’s ability but the absence of medical, social and learning platforms for their growth.

Health and Developmental Domain Interactions

No child has developmental challenges that belong solely to a single domain. The difficulties and interventions are always distributed and interwoven in all aspects of the child’s health and functioning. Sensorimotor issues are entwined with emotional fragility. Communication delays are accompanied by emotional, cognitive or social constraints.

A child’s difficulties are distributed in all related systems. Their biological, medical, cognitive, emotional and social conditions influence the child’s engagement, understanding and learning, but are not the final word in the child’s growth and development.

Parallel Assessment Continually Investigates

• The child’s biological states and conditions, their nature, variability, and demands, and continually advocates for necessary and effective medical and health-related interventions.
• The child’s functional performance across contexts and domains.
• The interactions between all developmental domains and how they may be affected by the child’s health and wellness.
• The interaction between health, nurture, play and learning in all of the child’s real-life contexts.

Interventions always address the child’s physiology and health while simultaneously nurturing communication, cognition, feelings, emotional regulation, social connection, play and learning.

We do not see the child as a collection of deficits, or as a diagnosis with secondary consequences, but as an integrated dynamic system: biological, psychological and relational. Understanding the child requires collaboration among parents, teachers, therapists and medical professionals. No single observer sees the entire health or developmental picture.

Parents may observe sleep disruption or feeding difficulties at home that educators never witness. Parents learn to recognize signs of overstimulation, illness, fatigue, anxiety, or dysregulation long before others notice them.

Teachers may recognize sensory overload during group activities that physicians do not see in clinical settings.

Therapists carefully assess delays, difficulties, change, and progress that may be health-related.

Supporting the child requires supporting the parenting, caregiving and mediational systems around the child.

Parallel Assessment helps us become better aware of the whole child so we can make adaptations in the child’s world, in ourselves, and in the Goals, Priorities, Prerequisites, Strategies, and Outcomes involved in Parallel Development. The clinician, teacher, and parent shape specific activities and environments for each individual so that healthier and more integrated development can proceed.

The child is far more than their diagnosis, than their current health-related condition or level of functioning. The child experiences life as a continuous interaction between body, mind, emotion, sensation, relationship and environment. Learning emerges from this total developmental experience.

When offered the right nurturing, ongoing assessments, opportunities and treatment, motivation, enjoyable mediated support and practical real-life applications, every child can make meaningful progress in all integrated domains no matter the medical or physical restraints.

Copyright © 2025 Shlomo Chaim

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