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Signs & concerns
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Signs & concerns
Selective Mutism red flags warranting referral in young children
Refer when a child consistently fails to speak in specific settings (typically school) despite fluent speech at home, the pattern persists beyond one month of starting school, and it interferes with education or social functioning — and isn't better explained by a language disorder, autism or an unfamiliar language.
Read the answer AnswerSelf-Regulation Difficulties: Red Flags for Referral
Refer a young child for self-regulation difficulties when emotional and physiological dysregulation is pervasive across settings, disproportionate to age, and impairing sleep, feeding, learning or relationships. Act promptly on regression, persistent inconsolability, or co-occurring developmental or medical red flags, and exclude medical mimics such as pain, reflux and seizures.
Read the answer AnswerSensory-Based Feeding Selectivity: red flags for referral
Refer for Sensory-Based Feeding Selectivity when it is severe, persistent and impairing — faltering growth, nutritional deficiency, a narrowing accepted-food range, mealtime distress disrupting family life, or signs of aspiration. Distinguish it from transient toddler neophobia.
Read the answer AnswerSensory Processing Red Flags for Referral in Young Children
Refer a young child for sensory processing assessment when over- or under-responsivity, sensory seeking, or motor-planning and regulatory difficulties are disproportionate, persist across settings, and disrupt feeding, sleep, dressing, play or participation — and are not better explained by autism, ADHD, or hearing/visual impairment.
Read the answer AnswerSeparation Anxiety Disorder red flags warranting referral
Refer when separation-related fear is developmentally excessive, persists four weeks or more, and impairs functioning across settings. Escalate urgently with school refusal, somatic symptoms without medical cause, low mood, or onset after trauma or loss.
Read the answer AnswerSocial Communication Difficulties: Clinical Red Flags for Referral
Refer when social use of language — reciprocity, adjusting to listener, reading inference and context — is impaired across settings, exceeds developmental expectation, and isn't explained by hearing loss, global delay, or autism with restricted/repetitive behaviour. Persistent parent or teacher concern is itself a sufficient trigger.
Read the answer AnswerClinical red flags for Specific Learning Disability referral
Specific Learning Disability is not formally diagnosed before about age 6–8. In younger children, refer when pre-literacy, language and numeracy precursors lag persistently despite adequate instruction, with intact hearing and vision — especially with a family history of learning difficulty.
Read the answer AnswerClinical Red Flags for Speech and Language Delay
Refer when speech or language is meaningfully behind age norms, when acquired words are lost, or when comprehension lags expression — most urgently no babble or gesture by 12 months, no single words by 16 months, no two-word phrases by 24 months. Always rule out hearing loss first.
Read the answer AnswerRed flags for Stereotyped Movement Disorder warranting referral
Refer for Stereotyped Movement Disorder when rhythmic, purposeless movements persist beyond age 3, impair function, cause self-injury, or arise with developmental concern — most urgently with self-injury, regression, abrupt onset, or features suggesting seizure rather than stereotypy.
Read the answer AnswerTourette Syndrome red flags for referral in young children
Refer when multiple motor and at least one vocal tic show a waxing-and-waning course beyond 12 months — most urgently when tics impair function, cause injury, or coexist with ADHD, OCD or anxiety. Atypical or abrupt onset warrants prompt neurology review.
Read the answer AnswerVisual Impairment Red Flags in Young Children
Refer a young child for visual impairment when there is absent fix-and-follow by 3 months, leucocoria (white reflex), persistent or acquired nystagmus, a manifest squint after 4 months, abnormal red reflex, or any regression in visual behaviour. Leucocoria and acquired nystagmus warrant same-day ophthalmology referral.
Read the answer AnswerWhat cognitive difficulties might a teacher notice in a young child?
A teacher may notice a young child who struggles to follow multi-step instructions, takes longer to grasp and retain new ideas, has trouble paying attention or finishing tasks, and finds problem-solving or pretend play harder than peers. A persistent pattern across weeks and settings — not a one-off — is what warrants a supportive developmental check.
Read the answer AnswerWhat cognitive milestones should a 12-to-18-month-old reach?
Between 12 and 18 months, most toddlers explore objects with purpose, find hidden toys, follow simple one-step requests, recognise named people and objects, imitate actions, and begin simple pretend play. Children vary widely, so steady progress and no loss of skills matter more than exact timing.
Read the answer AnswerWhat cognitive milestones should a 18-to-24-month-old reach?
By 18–24 months most toddlers begin pretend play, copy adults, find hidden objects, sort and match simple things, follow one-step instructions and explore cause and effect. These are guideposts, not a strict checklist — children vary. If several skills are clearly behind, or any are lost, a gentle developmental check brings clarity.
Read the answer AnswerWhat cognitive milestones should a 2-year-old reach?
By two, most toddlers begin to pretend, solve simple problems, sort shapes and colours, follow two-step instructions, and remember where things belong. These are flexible guideposts, not a pass-fail test — children reach them across a wide age range. Consider a gentle check if there's no pretend play, no response to simple instructions, any loss of skills, or a persistent parental concern.
Read the answer AnswerWhat cognitive milestones should a 3-to-6-month-old reach?
From 3 to 6 months, cognitive milestones appear as curiosity and connection: tracking moving objects with the eyes, recognising familiar faces and voices, mouthing and grasping to explore, and showing delight at cause-and-effect like shaking a rattle. These are flexible guideposts, not deadlines.
Read the answer AnswerWhat cognitive milestones should a 3-year-old reach?
Around age 3, most children complete simple puzzles, sort by shape and colour, grasp counting to two or three, follow two-step instructions, recall parts of stories and enjoy rich pretend play. These are guides, not tests — steady month-on-month growth matters most, and a gentle developmental check helps if pretend play, instructions or interest in toys seem very limited.
Read the answer AnswerWhat cognitive milestones should a 4-year-old reach?
Most four-year-olds count a few objects, name some colours, recall parts of a story, follow two- or three-step instructions, and enjoy rich pretend play. Milestones are a guide across the whole year, not a pass-or-fail test. If several skills seem well behind, a gentle developmental check is a kind next step.
Read the answer AnswerWhat cognitive milestones should a 5-year-old reach?
Most 5-year-olds count to ten or more, name colours and some letters, follow two- to three-step instructions, and create detailed pretend play. These are signposts, not a strict checklist — children reach them at their own pace, and steady year-on-year progress matters most.
Read the answer AnswerWhat cognitive milestones should a 6-to-9-month-old reach?
Between 6 and 9 months, most babies begin to understand object permanence, explore toys with curiosity, recognise familiar faces and names, and grasp simple cause and effect. These gains emerge gradually across a wide, healthy range — a check helps only if your baby makes no sounds back, shows no interest in toys, doesn't recognise familiar people by 9 months, or loses a skill.
Read the answer AnswerWhat cognitive milestones should a 6-year-old reach?
Most 6-year-olds count past 20, begin simple addition, recognise letters and read simple words, follow two-to-three-step instructions, sort objects, and tell a sequenced story. These are typical ranges, not a fixed checklist; a gentle developmental check brings clarity if several skills feel far behind.
Read the answer AnswerWhat cognitive milestones should a 9-to-12-month-old reach?
Between 9 and 12 months most babies begin to grasp object permanence (searching for hidden toys), explore objects by shaking and dropping, imitate gestures like waving, respond to their name, and understand simple words. These are guides, not deadlines — steady progress matters most, and a friendly check helps if a baby isn't searching for hidden objects or responding to their name by 12 months.
Read the answer AnswerWhat cognitive milestones should a doctor check at routine visits?
At routine visits track cognition as a trajectory: object permanence and means-end problem-solving in infancy, symbolic play through the second year, and reasoning, attention and pre-academic skills in pre-school years. Use surveillance every visit plus validated screens at 9, 18 and 30 months, escalating on any skill loss or persistent parental concern.
Read the answer AnswerCognitive milestones for frontline routine visits
During routine visits, frontline workers should check age-based cognitive markers — object permanence, cause-and-effect play, pointing to share, following instructions, pretend play and memory — alongside parent concern. These are watch-and-monitor checks; any persistent gap or lost skill is a reason to route the child for a developmental check, never a diagnosis.
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