Early childhood development is a critical determinant of health, educational attainment, and socioeconomic productivity across the life course. Developmental delay, defined as the failure to achieve age-appropriate milestones in one or more developmental domains—gross motor, fine motor, language, cognitive, social, or adaptive functioning—poses a major public health concern, particularly in low-resource settings [1]. Globally, it is estimated that more than 250 million children under five years of age in low- and middle-income countries are at risk of not reaching their full developmental potential due to poverty, malnutrition, limited stimulation, and inadequate access to health services [2]. In India, rapid urbanization has led to the expansion of urban slums, characterized by overcrowding, substandard housing, poor sanitation, food insecurity, and limited access to healthcare and early childhood education services [3]. Children residing in these underprivileged urban communities are exposed to multiple biological and psychosocial risk factors during critical periods of brain development. These include low birth weight, recurrent infections, chronic undernutrition, maternal illiteracy, psychosocial deprivation, and exposure to environmental hazards [4]. Collectively, these adversities significantly increase the likelihood of developmental delays during early childhood. Despite the magnitude of the problem, developmental delays in urban slum populations remain under-recognized and under-diagnosed. Health systems in low-resource urban settings often prioritize acute illnesses over developmental surveillance, leading to missed opportunities for early identification and intervention [5]. Furthermore, cultural beliefs, stigma, lack of parental awareness, and limited availability of specialized services contribute to delayed care-seeking for developmental concerns [6]. Most existing Indian studies on childhood developmental delay are quantitative in nature and focus primarily on prevalence estimates and associated risk factors [7,8]. While these studies provide valuable epidemiological data, they offer limited insight into the lived experiences of caregivers, their perceptions of child development, and the contextual barriers they face in accessing appropriate services. Qualitative research is particularly well suited to explore these dimensions, as it enables an in-depth understanding of social, cultural, and health system factors influencing childhood development within marginalized communities [9]. Understanding caregivers’ knowledge, attitudes, and experiences related to child development is essential for designing contextually appropriate interventions and strengthening community-based early childhood programs. In urban slum settings, where formal health and educational infrastructure is often weak, caregiver perceptions and informal support networks play a crucial role in shaping developmental outcomes [10]. The present qualitative study was therefore undertaken to assess developmental delays among children residing in urban underprivileged communities of India, with a focus on caregiver perceptions, observed developmental concerns, health-seeking behaviors, and perceived barriers to early intervention. By capturing community-level narratives, this study aims to inform policymakers and public health practitioners about the ground realities of childhood developmental delay in urban slums and to guide the development of culturally sensitive, community-based strategies for early identification and intervention.

Study Design and Setting A qualitative, community-based descriptive study was conducted in selected urban slum areas of a metropolitan city in India. These slum clusters were characterized by high population density, low socioeconomic status, and limited access to formal healthcare and early childhood development services. Study Population The study population comprised primary caregivers (mothers, fathers, or grandparents) of children aged 6 months to 5 years residing in the selected urban slum areas for at least one year. Caregivers of children with known congenital anomalies or previously diagnosed neurodevelopmental disorders were excluded to focus on community-perceived developmental delays. Sampling Technique Purposive sampling was employed to ensure representation of caregivers across different child age groups and socioeconomic backgrounds. Recruitment continued until data saturation was achieved, defined as the point at which no new themes emerged during interviews. A total of 40 caregivers participated in the study. Data Collection Tools and Procedure Data were collected using a semi-structured, pre-validated interview guide developed after an extensive literature review and expert consultation. The interview guide explored the following domains: • Caregiver understanding of normal child development • Perceived developmental concerns in their children • Observed delays in speech, motor, social, or cognitive domains • Health-seeking behavior for developmental issues • Barriers to accessing developmental and rehabilitative services In-depth interviews were conducted in the local language by trained investigators familiar with the sociocultural context of the community. Each interview lasted approximately 30–45 minutes. With participant consent, interviews were audio-recorded and supplemented by field notes. Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee prior to the commencement of the study. Written informed consent was obtained from all participants. Confidentiality and anonymity were strictly maintained throughout the research process. Data Analysis Audio recordings were transcribed verbatim and translated into English. Thematic analysis was performed using an inductive approach. Transcripts were read repeatedly to achieve familiarization, followed by open coding. Codes were grouped into categories and overarching themes. To enhance rigor, investigator triangulation was performed, and discrepancies were resolved through consensus.

A total of 40 caregivers participated in the study. The findings are presented thematically and supported by descriptive tables. The majority of caregivers were mothers, and nearly two-thirds had education limited to primary level or below. Most children belonged to the 2–5-year age group, a critical period for language and social development. Low maternal education emerged as a contextual factor influencing awareness of developmental milestones. Table 1 Table 1. Socio-Demographic Profile of Caregivers and Children (n = 40) Variable Frequency Percentage Mothers as caregivers 32 80.0 Fathers as caregivers 5 12.5 Grandparents 3 7.5 Children aged 6–24 months 14 35.0 Children aged 25–60 months 26 65.0 Maternal education ≤ primary 27 67.5 Speech and language delay was the most commonly perceived concern, followed by social interaction difficulties. Caregivers often described children as “not talking like others” or “not mixing with peers,” indicating delayed recognition primarily when comparisons with other children were made. Table 2 Table 2. Caregiver-Reported Domains of Developmental Concern Developmental Domain Caregivers Reporting Concern (n) Percentage Speech and language 22 55.0 Gross motor 10 25.0 Social interaction 15 37.5 Cognitive skills 8 20.0 Only half of the caregivers sought professional medical advice for developmental concerns. A significant proportion relied on home remedies or took no action, reflecting limited awareness, financial constraints, and perceived normalization of delayed development. Table 3 Table 3. Health-Seeking Behavior for Developmental Concerns Action Taken Frequency Percentage Consulted government facility 12 30.0 Consulted private practitioner 8 20.0 Traditional/home remedies 10 25.0 No action taken 10 25.0 Lack of awareness regarding child development and available services was the most frequently reported barrier. Financial limitations and physical inaccessibility of services further compounded delays in seeking care, particularly for rehabilitative and therapy-based interventions. Table 4 Table 4. Perceived Barriers to Early Intervention Barrier Frequency Percentage Lack of awareness 26 65.0 Financial constraints 22 55.0 Distance to services 18 45.0 Social stigma 14 35.0

The present qualitative study provides important insights into caregiver perceptions and experiences related to childhood developmental delays in urban underprivileged communities of India. The findings highlight that developmental concerns are common in these settings, yet recognition and appropriate health-seeking behavior remain suboptimal. Speech and language delay emerged as the most frequently perceived developmental concern, consistent with previous studies indicating that language delays are often the earliest and most noticeable developmental issues recognized by caregivers [11]. This may be attributed to the salience of verbal communication in social interactions and schooling readiness. However, caregivers often normalized mild delays, perceiving them as temporary variations rather than indicators of underlying developmental vulnerability. Social and behavioral concerns were also commonly reported, particularly among older preschool children. Difficulties in peer interaction, poor eye contact, and reduced play engagement were frequently described. Similar observations have been documented in studies emphasizing the impact of psychosocial deprivation and limited stimulation in slum environments on socio-emotional development [12]. A critical finding of this study was the low rate of professional consultation for developmental concerns. Nearly one-quarter of caregivers reported taking no action, while another quarter relied on traditional or home-based remedies. These findings align with existing literature that identifies poor awareness of developmental milestones, limited trust in public health services, and financial constraints as major deterrents to care-seeking in low-income urban populations [13,14]. The role of maternal education emerged as a significant contextual factor influencing developmental awareness. Caregivers with limited formal education often lacked knowledge regarding age-appropriate milestones and the importance of early intervention. Previous research has consistently demonstrated a strong association between maternal education and early childhood developmental outcomes [15]. Structural barriers, including distance to healthcare facilities and indirect costs of therapy services, further restricted access to early intervention. Rehabilitation services such as speech therapy and occupational therapy are often concentrated in tertiary centers, making them inaccessible to slum populations [16]. The absence of integrated developmental screening at the primary healthcare level exacerbates this gap. Social stigma associated with developmental delay was another notable theme. Caregivers expressed fear of labeling and discrimination, which discouraged disclosure and delayed help-seeking. Stigma related to neurodevelopmental conditions has been widely reported in South Asian contexts and remains a major barrier to early diagnosis [17]. The qualitative nature of this study allowed for an in-depth exploration of lived experiences that are often overlooked in quantitative surveys. By capturing caregiver narratives, the study underscores the need for community-based awareness programs, capacity building of frontline health workers, and integration of developmental surveillance into routine maternal and child health services [18-20]. Strengthening early childhood development initiatives under existing national programs, promoting parental education, and decentralizing rehabilitative services could substantially improve early identification and intervention for developmental delays in urban slum settings [21-25].

This qualitative study highlights the substantial burden of perceived developmental delays among children living in urban underprivileged communities of India. Speech, social, and motor delays were commonly reported, yet timely professional consultation remained limited due to poor awareness, financial constraints, service inaccessibility, and social stigma. Caregiver perceptions were strongly influenced by educational status and community norms, often resulting in delayed recognition and normalization of developmental concerns. The findings emphasize the urgent need for community-level awareness initiatives, integration of developmental screening into primary healthcare services, and improved accessibility of early intervention programs within urban slums. Addressing both demand-side and supply-side barriers is essential to ensure that vulnerable children receive timely support during critical periods of development. Community-based, culturally sensitive strategies will be pivotal in reducing long-term developmental inequities among children in urban marginalized settings.

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