Developmental delay is common and often responds to early intervention. As with other health outcomes, the prevalence of developmental delay may be socially determined. Children in many Indigenous communities experience increased risk for developmental delay. This article highlights special conditions in Indigenous communities related to child development. It addresses the challenges of screening and evaluation for developmental delay in the context of Indigenous cultures, and in settings where resources are often inadequate. It is clear that careful research on child development in Indigenous settings is urgently needed. Intervention strategies tied to cultural traditions could enhance interest, acceptability, and ultimately developmental outcomes in children at risk.