When to escalate if a child isn't greeting at the expected age

A child who waves bye-bye, smiles back or says hello in their own way is showing us their social world is opening — when that's slow to come, a calm, timely look is exactly the right response.

In short

Social greeting — waving, smiling in return, saying or gesturing "hi" and "bye" — usually emerges across the first and second year, with most toddlers waving by around 12–15 months. As a frontline health worker, escalate to a developmental check when greeting is clearly absent for age AND travels with other red flags: no response to name, little eye contact or shared smiling, no pointing or showing, few or no words, or loss of a skill once present. One isolated delay is a reason to watch and review; a cluster, or any regression, is a reason to refer now — not to wait.

When to escalate

Use a simple watch-and-refer approach at each contact:

• Watch and review in 4–6 weeks — if greeting is the only concern, the child is otherwise connecting (eye contact, shared smiles, responding to name), and there's no regression.
• Refer for a developmental check now when absent greeting comes with any of: not responding to name by 12 months, no waving/pointing/showing by 15–18 months, little or no babble or words, minimal eye contact or social smiling, or no interest in people.
• Refer promptly regardless of age if a child has lost greeting, words or social skills once present, or if a parent feels something has changed — parent instinct is valuable screening information.

Greeting is a single ICF activity (d7, interpersonal interactions). It is one data point, never a diagnosis — your job is to spot the pattern and route the family kindly and early.

The Pinnacle way

A clinical AbilityScore® and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — never from a checklist or a single missed milestone. Our clinicians build a full picture of how a child connects, plays and communicates. You can read more about social greeting and how we support early social communication, and our speech therapy team works closely with families once a referral arrives.

Trusted sources

WHO ICF framework (interpersonal interactions, chapter d7); CDC "Learn the Signs, Act Early" developmental milestones and act-early guidance; American Academy of Pediatrics (healthychildren.org) on developmental surveillance and when to refer in primary care.

Next step — When you see absent greeting plus other flags, route the family today. Book a developmental assessment with a Pinnacle clinician for a calm, clear review.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.