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Signs & concerns
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Signs & concerns
Early indicators of hearing impairment for paediatricians
Refer for diagnostic audiology on any failed newborn hearing screen, absent startle or localisation to sound, no babble by 9–12 months, no single words by 15–18 months, stalled or regressing speech, or persistent parental concern. A normal newborn screen never excludes later or progressive loss; high-risk infants need surveillance regardless.
Read the answer AnswerEarly Indicators of Hypotonia for Paediatricians
Watch for reduced resistance to passive movement, head lag on pull-to-sit, frog-leg posture, slipping-through on suspension, delayed gross-motor milestones and feeding difficulty. Distinguish central from peripheral causes and refer urgently when areflexia, progressive weakness or respiratory/swallowing compromise coexist.
Read the answer AnswerEarly indicators of Intellectual Disability for paediatricians
Watch for global delay across language, motor, social and adaptive domains rather than an isolated lag — slow skill acquisition over serial visits or any regression warrants developmental assessment. "Global developmental delay" is the working term under 5; disorders of intellectual development are confirmed once standardised cognitive and adaptive testing is reliable.
Read the answer AnswerWhat early indicators of Motor Planning Difficulties should a paediatrician watch for?
Watch for difficulty conceiving, sequencing and executing novel movements that is disproportionate to strength, tone or intelligence — clumsiness, slow acquisition of multi-step skills (dressing, cutlery, handwriting), inconsistent performance and heavy reliance on cueing. Refer when persistent across settings and once primary neurological causes are excluded.
Read the answer AnswerEarly indicators of non-verbal / minimally verbal presentation
A non-verbal / minimally verbal presentation is a descriptor, not a diagnosis. Watch for absent babble or gesture by 12 months, no single words by 16 months, no two-word phrases by 24 months, or any regression. Rule out hearing loss first, then refer for multidisciplinary assessment without waiting for a label.
Read the answer AnswerEarly indicators of Oppositional Defiant Disorder for paediatricians
ODD presents as a persistent (6+ month) pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness that is pervasive across settings and functionally impairing — beyond normative limit-testing. Key clinician task is excluding mimics (ADHD, language/hearing difficulty, anxiety, trauma) and referring when the pattern is pervasive and impairing. Diagnosis is a clinical decision, never a screen output.
Read the answer AnswerEarly Indicators of Persistent Toe-Walking
Watch for toe-walking persisting past ~24–36 months that is bilateral, habitual, or paired with reduced ankle dorsiflexion. Refer rather than reassure when there is asymmetry, hyperreflexia or spasticity, regression, calf hypertrophy, late milestones, or co-occurring developmental concerns — these point to a secondary cause.
Read the answer AnswerEarly Indicators of Prematurity-Related Developmental Risk
In preterm infants, watch for atypical tone, motor asymmetry, absent fidgety general movements, feeding difficulty, and milestone delay corrected for gestational age, plus emerging communication and attention concerns. Use corrected age to 24 months, screen serially, and escalate on tone abnormalities, asymmetry or regression. Pattern and persistence matter; no single sign is diagnostic.
Read the answer AnswerEarly indicators of Rett syndrome for paediatricians
Watch for the regression signature of Rett syndrome: seemingly normal development to ~6 months, a plateau, then loss of purposeful hand use and language, stereotypic midline hand movements (wringing, washing), gait abnormality and acquired microcephaly. Any regression warrants prompt neurology and MECP2 genetic referral.
Read the answer AnswerEarly Indicators of the School Readiness Gap
Watch for clustering across domains — limited expressive language and instruction-following, immature pencil grasp and fine-motor difficulty, poor attention and self-regulation, and weak cooperative play — in the 3–5 year window. Gaps persisting across home and preschool, or strong parental concern, warrant structured profiling rather than waiting.
Read the answer AnswerEarly Indicators of Selective Mutism for Paediatricians
Selective Mutism (ICD-11 6B06) presents as consistent failure to speak in specific settings — usually school — despite fluent speech at home. Refer when situational silence persists beyond a month of a new setting, interferes with function, and isn't explained by a language disorder, hearing loss, or unfamiliarity with the language of instruction.
Read the answer AnswerEarly Indicators of Self-Regulation Difficulties
Watch for poor state regulation in infancy — disorganised sleep and feeding, inconsolable crying, atypical sensory responses — escalating to intense, prolonged meltdowns and slow recovery in toddlerhood. Refer when patterns persist across settings, impair daily life, or coincide with parental concern; only a clinician can profile and confirm.
Read the answer AnswerEarly indicators of sensory-based feeding selectivity
Suspect sensory-based feeding selectivity when intake is restricted by sensory features — texture, colour, smell, brand — rather than appetite or oromotor skill, with a shrinking food list, distress or gagging on non-preferred foods, and mealtime impairment. Always exclude dysphagia, reflux and growth faltering first.
Read the answer AnswerEarly Indicators of Sensory Processing Differences
Watch for disproportionate, persistent responses to sound, touch, movement, taste or light that disrupt feeding, sleep, play or participation across settings. Sensory processing differences are a functional pattern, not a standalone diagnosis — exclude hearing, vision and GI causes, then refer for OT-led developmental assessment when daily function is affected.
Read the answer AnswerEarly indicators of Separation Anxiety Disorder for paediatricians
Watch for separation-related fear that is developmentally excessive, persists at least four weeks and causes functional impairment — school refusal, clinging, sleep disruption, nightmares and recurrent unexplained somatic complaints. Distinguish from normative toddler protest and refer when school attendance or daily life is affected.
Read the answer AnswerEarly indicators of Social Communication Difficulties
Watch for a gap between structural language and its social use — weak joint attention, limited gesture/pointing, poor conversational turn-taking and repair, over-literal interpretation and failure to adjust language to listener. Refer when these persist across settings and aren't explained by hearing loss, global delay or autism's restricted behaviours.
Read the answer AnswerEarly Indicators of Specific Learning Disability
Refer when a child shows persistent, domain-specific difficulty with reading, writing or arithmetic markedly below age expectation despite adequate instruction and intact hearing, vision and intelligence. Diagnosis is meaningful from ~6–8 years; preschool precursors (weak phonological awareness, letter-learning difficulty, family history) warrant monitoring and early support.
Read the answer AnswerWhat early indicators of Speech and Language Delay should a paediatrician watch for?
Watch for absent babble and gesture by 9–12 months, no single words by 16 months, no two-word phrases by 24 months, and speech unintelligible by 36 months — most urgently any loss of acquired words. Refer in parallel for a hearing check; a child need not meet full ICD-11 6A01 criteria to warrant assessment.
Read the answer AnswerEarly Indicators of Stereotyped Movement Disorder
Watch for repetitive, rhythmic, self-driven movements — hand-flapping, rocking, head-banging, self-biting — beginning before age 3, persisting beyond the expected window, suppressible on distraction and rising with stress or excitement. Refer when self-injurious, functionally impairing or developmentally concerning; refer urgently if events are non-suppressible and seizure-like.
Read the answer AnswerEarly indicators of Tourette Syndrome for paediatricians
Watch for sudden, recurrent, non-rhythmic motor tics (eye-blinking, facial grimacing, head jerks) from ages 4–7, followed by vocal tics (throat-clearing, sniffing). Tics wax and wane, migrate, and are briefly suppressible. Tourette per ICD-11 needs multiple motor plus one vocal tic over a year; refer for persistence, functional impact, or to screen comorbid ADHD/OCD.
Read the answer AnswerWhat early indicators of Visual Impairment should a paediatrician watch for?
Watch for absent fixation or following, no social smile by 6–8 weeks, roving eye movements, nystagmus, squint beyond 3–4 months, poor reach, and any abnormal red reflex or loss of visual skills. Abnormal red reflex or leukocoria needs same-day ophthalmology referral; persistent concerns warrant prompt referral plus a parallel developmental review.
Read the answer AnswerWhat emotional milestones should a doctor check at routine visits?
Track emotional milestones as observable, age-anchored capacities: social smiling and shared affect in infancy, self-regulation and stranger/separation responses in toddlers, emotional vocabulary and impulse control in preschoolers, and empathy and frustration tolerance into school age — mapped to ICF emotional functions (b152), with persistent parental concern weighed as a sensitive signal.
Read the answer AnswerEmotional milestones for your 12-to-18-month-old
Between 12 and 18 months most toddlers show affection, share joy by bringing or pointing at things, look to you for reassurance, protest at separation and settle when comforted, and begin simple pretend. Temperament varies widely — what matters is growing back-and-forth connection. A gentle check helps if a child rarely seeks comfort or shows little shared emotion by 18 months.
Read the answer AnswerEmotional milestones for your 18-to-24-month-old
By 18–24 months most toddlers share a range of feelings, look to you for emotional cues, seek comfort when upset, show early empathy and pride, and begin asserting independence — with big tantrums and little self-control still completely normal. These are guides, not a checklist; a clinician confirms any concern.
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