# Should a frontline worker refer a child not pointing to show things? Canonical: https://pinnacleblooms.org/ask/should-a-frontline-worker-refer-a-child-showing-not-pointing-to-show-things Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited If a child is not pointing to show or share things by around 16–18 months, a frontline worker should refer for a developmental check — yes. Sharing-pointing (protodeclarative pointing) is a key early social-communication milestone, and persistent absence is a reliable early flag. Strengthen the picture by checking for other shared-attention behaviours, language, response to name and hearing. This is a reason to assess early, not a diagnosis. *A child who points to share a moment — "look at that!" — is showing one of the earliest, richest signs of social communication; noticing when it's absent is exactly the frontline instinct that changes lives.* ## In short Yes — if a child is not pointing to show or share things by around 16–18 months, this is a meaningful flag that warrants a referral for a developmental check. Protodeclarative pointing (pointing to share interest, not just to request) is a key early social-communication milestone, and its absence is one of the most reliable early indicators that a closer look is worthwhile. This is a reason to refer for assessment, not a diagnosis — and early routing means early support, which works best. ## What to check before you refer At the PHC or community level, confirm the picture with a few quick, calm observations rather than a single moment: - **Age** — sharing-pointing typically emerges by 12–16 months and is usually well established by 18 months. Brief absence in a younger infant is not concerning; persistent absence at or beyond 16–18 months is. - **Does the child share interest in other ways?** — bringing or showing you objects, following your point, looking back and forth between an object and your face, shared smiling and eye contact. If these are also missing, the flag is stronger. - **Travelling signs** — few or no words by 16 months, not responding to name, little eye contact, not engaging in simple back-and-forth play, or loss of a skill once had. - **Hearing** — always consider hearing as part of any communication concern, as undetected hearing loss can mimic social-communication delay. If sharing-pointing is absent at 18 months — especially alongside any of the above — refer. When in doubt, refer; an unnecessary check costs little, while a missed early window costs much. ## Why this matters Pointing to share is a window into joint attention — the ability to coordinate attention with another person around a third thing. It is a foundation for language and social learning, which is why its absence features in early screening worldwide. A referral does not label the child; it simply opens the door to a structured clinical look while the developing brain is most responsive. ## The Pinnacle way A clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — never from a single observation or checklist in the field. Your role as a frontline worker is to notice, reassure the family, and route promptly. Our [speech therapy](https://www.pinnacleblooms.org/top-speech-therapy-center-india-proven-improvement-rate) and developmental teams across [70+ centres](/) then build a full picture of the child's strengths and shape support around play. ## Trusted sources CDC "Learn the Signs, Act Early" developmental milestones, which list pointing to show interest among 18-month communication milestones; American Academy of Pediatrics (healthychildren.org) guidance on early social-communication monitoring and developmental surveillance; WHO Nurturing Care framework for early childhood development. **Next step —** Trust the flag. Reassure the family and [refer the child for a developmental assessment](https://www.pinnacleblooms.org/enroll-autism-speech-aba-therapies-india) at the nearest Pinnacle Blooms Network centre for a calm, structured review. ## Sources - CDC — 18-month developmental milestones: https://www.cdc.gov/child-development - AAP HealthyChildren — early social communication: https://www.healthychildren.org - WHO Nurturing Care Framework: https://nurturing-care.org ## Connected topics and perspectives - Behaviours: https://pinnacleblooms.org/ask/behaviours - Asha Phc: https://pinnacleblooms.org/ask/lens/stakeholder/asha_phc - Communication: https://pinnacleblooms.org/ask/lens/domain/communication - Concern: https://pinnacleblooms.org/ask/lens/intent/concern - Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen - Book Assessment: https://pinnacleblooms.org/ask/lens/route/book-assessment - Early Clarity: https://pinnacleblooms.org/ask/lens/empowerment/early_clarity ## Related question paths ### Recognise signs & concerns - Should a frontline worker refer a child showing difficulty sharing?: https://pinnacleblooms.org/ask/should-a-frontline-worker-refer-a-child-showing-difficulty-sharing - When should a doctor investigate not pointing to show things in a young child?: https://pinnacleblooms.org/ask/when-should-a-doctor-investigate-not-pointing-to-show-things-in-a-young-child - Should a frontline worker refer a child showing late talking?: https://pinnacleblooms.org/ask/should-a-frontline-worker-refer-a-child-showing-late-talking - When should I worry about not pointing to show things?: https://pinnacleblooms.org/ask/when-should-i-worry-about-not-pointing-to-show-things-in-my-child - Should a frontline worker refer a child not playing with other children?: https://pinnacleblooms.org/ask/should-a-frontline-worker-refer-a-child-showing-not-playing-with-other-children - Can Not Pointing To Show Things Be an Early Sign of a Developmental Concern?: https://pinnacleblooms.org/ask/can-not-pointing-to-show-things-be-an-early-sign-of-a-developmental-concern - Should I worry about not pointing to show things in a 1-year-old?: https://pinnacleblooms.org/ask/should-i-worry-about-not-pointing-to-show-things-in-a-1-year-old - Absent Pointing to Show: A Clinician's Signs Guide: https://pinnacleblooms.org/ask/what-developmental-conditions-can-not-pointing-to-show-things-in-a-child-point-to ### Explore causes & influences - Why a 1-Year-Old May Not Point to Show Things: https://pinnacleblooms.org/ask/what-causes-not-pointing-to-show-things-in-a-1-year-old - What causes not pointing to show things in young children?: https://pinnacleblooms.org/ask/what-causes-not-pointing-to-show-things-in-young-children ### Explore therapy & support - How should a frontline worker respond to a child not pointing to show things?: https://pinnacleblooms.org/ask/how-should-a-frontline-worker-respond-to-not-pointing-to-show-things-in-a-child - Can Not Pointing To Show Things Be a Sign of Autism?: https://pinnacleblooms.org/ask/can-not-pointing-to-show-things-be-a-sign-of-autism - Do children usually outgrow not pointing to show things?: https://pinnacleblooms.org/ask/do-children-usually-outgrow-not-pointing-to-show-things - How can a teacher support a 1-year-old who isn't pointing to show things?: https://pinnacleblooms.org/ask/how-can-a-teacher-support-a-1-year-old-who-shows-not-pointing-to-show-things-in-class - How therapy addresses a child not pointing to show things: https://pinnacleblooms.org/ask/how-does-therapy-address-not-pointing-to-show-things-in-a-child - How should a teacher respond to not pointing to show things in a young child?: https://pinnacleblooms.org/ask/how-should-a-teacher-respond-to-not-pointing-to-show-things-in-a-young-child - Is Not Pointing To Show Things Normal?: https://pinnacleblooms.org/ask/is-not-pointing-to-show-things-a-normal-part-of-child-development - What makes not pointing to show things worse in a child?: https://pinnacleblooms.org/ask/what-makes-not-pointing-to-show-things-worse-in-a-child - What other behaviours often occur with Not Pointing To Show Things?: https://pinnacleblooms.org/ask/what-other-behaviours-often-occur-with-not-pointing-to-show-things - Therapy techniques for not pointing to show things: https://pinnacleblooms.org/ask/what-therapy-techniques-help-a-child-with-not-pointing-to-show-things ### At home & in everyday life - How to Help a Young Child Who Isn't Pointing to Show Things: https://pinnacleblooms.org/ask/how-can-i-help-a-young-child-with-not-pointing-to-show-things - How do I handle not pointing to show things in a 1-year-old?: https://pinnacleblooms.org/ask/how-do-i-handle-not-pointing-to-show-things-in-a-1-year-old