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Signs & concerns
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Signs & concerns
What early indicators of Attachment Difficulties should a paediatrician watch for?
Watch for limited comfort-seeking when distressed, muted social reciprocity, abnormal stranger response (withdrawn or indiscriminately familiar), and flat or fearful affect with the caregiver — especially with a history of neglect, maltreatment or disrupted care. Signs are meaningful from around 9 months; refer for developmental and psychosocial assessment rather than reassuring alone.
Read the answer AnswerEarly Indicators of Auditory Processing Difficulties
Watch for a mismatch between normal hearing and real-world listening: frequent repetition requests, marked difficulty understanding speech in noise, weak phonological awareness, and slow responses to verbal instructions. Exclude otitis media and hearing loss first. Formal diagnosis is generally deferred until around age 7, but younger children with persistent patterns warrant developmental and speech-language review.
Read the answer AnswerEarly Indicators of Autism Spectrum for Paediatricians
Watch for persistent social-communication differences and restricted, repetitive behaviours across settings, not explained by hearing loss or global delay. Refer most urgently on any skill regression, no babble or gesture by 12 months, no single words by 16 months, or no two-word phrases by 24 months — full ICD-11 criteria are not required for referral.
Read the answer AnswerEarly Indicators of Cerebral Palsy
Watch for delayed or asymmetric motor milestones, persistent abnormal tone, early hand preference before 12 months, retained primitive reflexes and atypical movement quality. The strongest infancy predictor is an abnormal General Movements Assessment plus abnormal neurological exam plus relevant perinatal history — refer promptly rather than waiting.
Read the answer AnswerEarly Indicators of Childhood Anxiety for Paediatricians
Watch for excessive, persistent, impairing fear or worry out of proportion to age — often presenting somatically (recurrent tummy aches, headaches, sleep disturbance), behaviourally (clinging, avoidance, school refusal, irritability), or cognitively (catastrophic worry). Screen when symptoms persist beyond weeks and impair function across settings.
Read the answer AnswerEarly indicators of Childhood Apraxia of Speech a paediatrician should watch for
Watch for inconsistent errors on the same word, articulatory groping, disrupted prosody, vowel distortions, and a marked gap between intact comprehension and effortful, limited expressive speech. Errors increase with word length. Refer to speech-language pathology early — CAS responds to intensive motor-based therapy and should not be managed by wait-and-see.
Read the answer AnswerEarly Indicators of Childhood Epilepsy
Suspect childhood epilepsy with recurrent, stereotyped, unprovoked paroxysmal events — staring spells, focal or generalised jerks, automatisms, myoclonus or infantile spasms — recurring across settings. Refer promptly to paediatric neurology; treat infantile spasms, status, or a first afebrile or focal seizure as urgent.
Read the answer AnswerEarly Indicators of Childhood Sleep Difficulties for Paediatricians
Watch for persistent difficulty initiating or maintaining sleep, frequent age-inappropriate night waking, snoring or witnessed apnoeas, and daytime consequences such as hyperactivity, irritability or inattention. Most is behavioural and modifiable; habitual snoring with pauses or new daytime sleepiness warrants prompt evaluation.
Read the answer AnswerEarly indicators of conduct-dissocial disorder for paediatricians
Watch for a repetitive, persistent pattern that violates others' rights or major age norms — aggression, deceit, destruction, serious rule-breaking — sustained over months across settings, not a single incident. Early onset (under 10) and callous-unemotional traits raise concern; screen for ADHD, trauma and safeguarding in parallel.
Read the answer AnswerEarly Indicators of Developmental Coordination Disorder
Watch for motor skill acquisition and execution markedly below age expectation that interferes with daily life — clumsiness, late milestones, frequent falls, trouble with buttons, cutlery and pencils, and weak motor planning — not explained by intellectual disability or a neurological condition. DCD is reliably judged from around age 5; earlier soft signs warrant monitoring and referral.
Read the answer AnswerEarly Indicators of Developmental Language Disorder
Watch for persistently delayed or atypical language in a child with typical hearing, non-verbal cognition and social reciprocity: no babble by 12 months, fewer than 50 words and no word combinations by 24 months, and ongoing comprehension or grammar difficulty beyond age 3. Confirm hearing first; refer for speech and language therapy when concern persists.
Read the answer AnswerEarly Indicators of Developmental Regression
Developmental regression — loss of previously acquired language, social, motor or self-care skills — always warrants prompt investigation, never watch-and-wait. Treat it as a potential neurological, metabolic or epileptic marker; document the timeline, screen for treatable causes, and refer for paediatric neurology assessment in parallel.
Read the answer AnswerEarly Indicators of Developmental Trauma for Paediatricians
Watch for a persistent, cross-setting pattern of arousal dysregulation (hypervigilance or shut-down), attachment differences (indiscriminate friendliness or extreme withdrawal), developmental regression and unexplained somatic complaints — not better explained by a primary neurodevelopmental or medical cause. Any abuse or neglect concern triggers the safeguarding pathway; persistent signs warrant multidisciplinary, trauma-informed assessment.
Read the answer AnswerEarly Indicators of Down Syndrome for the Paediatrician
Down syndrome is recognised at or near birth from a cluster — hypotonia, flat facial profile, upslanting palpebral fissures, epicanthic folds, single palmar crease, sandal gap — rather than any single sign. When the pattern is present, confirm by karyotype and start the cardiac, hearing and thyroid surveillance bundle with early intervention.
Read the answer AnswerEarly indicators of dyscalculia for paediatricians
Watch for persistent difficulty with number sense — counting, subitising, magnitude comparison and arithmetic-fact retrieval — that sits below age expectation and isn't explained by limited schooling or global delay. A formal dyscalculia label is generally not applied before ~6–8 years, but early markers warrant monitoring and educational support.
Read the answer AnswerEarly indicators of dysgraphia for paediatricians
Watch for written output disproportionately poor for the child's age and intelligence — illegible, laboured handwriting, inconsistent letter formation, spelling worse on paper than orally, and writing avoidance. Dysgraphia is meaningfully identified from around age 6–7 once formal writing instruction is established; only a clinician can confirm.
Read the answer AnswerWhat early indicators of dyslexia should a paediatrician watch for?
Watch for a persistent gap between strong verbal ability and weak phonological skills, letter-sound mapping and word reading — disproportionate to age and effort. Preschool red flags (poor rhyme awareness, slow letter learning, slow rapid naming) and family history raise probability and warrant screening; formal diagnosis firms up around 6–8 years.
Read the answer AnswerEarly Indicators of Emotional & Behavioural Difficulties
Watch for distress, dysregulation or conduct problems that are persistent, pervasive across home and school, and impairing — not transient stress reactions. Threshold for referral is duration, pervasiveness and functional impairment; act same-day on any self-harm or hopelessness.
Read the answer AnswerEarly indicators of Feeding & Eating Difficulties for paediatricians
Watch for feeds that are unsafe, distressing, prolonged or nutritionally inadequate rather than transient fussiness. Key early indicators are coughing/choking and wet voice (aspiration), poor suck-swallow coordination, marked texture selectivity, stalled texture progression, and faltering growth. Refer urgently on aspiration signs or weight loss; only a clinician can confirm.
Read the answer AnswerEarly Indicators of Fetal Alcohol Spectrum Disorder
Watch for the convergence of prenatal-onset growth restriction, CNS dysfunction (microcephaly, neonatal irritability, feeding and sleep dysregulation, emerging developmental delay) and — when present — the sentinel facial triad. A known history of prenatal alcohol exposure raises suspicion; most children lack the full facial phenotype, so its absence never excludes FASD.
Read the answer AnswerEarly Indicators of Fine Motor Delay
Watch for fine motor lags across grasp, manipulation and tool use that persist across visits — no pincer grasp by ~12 months, difficulty with cubes, scribbling, cutlery, buttons. Refer urgently on regression, hand asymmetry before 18 months, or delay within a broader developmental picture. Only a clinician confirms.
Read the answer AnswerEarly indicators of genetic and chromosomal syndromes a paediatrician should watch for
Watch for a cluster rather than a single sign: dysmorphic features, congenital anomalies, growth deviation, neonatal hypotonia or feeding difficulty, and developmental delay across domains. Three or more minor anomalies, or any major anomaly with developmental concern, warrants genetic referral and first-tier testing.
Read the answer AnswerWhat early indicators of Global Developmental Delay should a paediatrician watch for?
Suspect Global Developmental Delay when a child under five shows significant delay across two or more domains — motor, speech-language, cognition, personal-social. Confirm hearing and vision, refer for multidisciplinary assessment and aetiological work-up, and act urgently on any regression. GDD is a provisional under-five descriptor, not a final diagnosis.
Read the answer AnswerEarly Indicators of Gross Motor Delay
Watch for missed gross-motor milestones (no head control by ~4m, no sitting by ~9m, no walking by ~18m), persistent asymmetry, abnormal tone, retained primitive reflexes, or any motor regression. Refer for aetiological workup — delay is a sign, not a diagnosis.
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