GPAtlas🧭 When to suspect (and the surveillance context)
Developmental concern reaches primary care by three routes: a parent or carer voices worry, a professional (usually the health visitor) flags a problem, or a child does not pass a routine review. England screens and surveils every child through the Healthy Child Programme – five mandated reviews in the early years, including the 2–2½ year review, where development is assessed with the Ages and Stages Questionnaire (ASQ-3). This is surveillance – ongoing, opportunistic and structured – not a single pass/fail screen.
Two principles do most of the work. First, parental concern is one of the strongest predictors of a genuine developmental problem and must never be dismissed without assessment. Second, refer against limit ages, not average ages: a limit age is the age by which the great majority of children have acquired a skill, and a child who has missed it warrants assessment even though “every child is different”. For any child born preterm, use the corrected age (calculated from the due date, not the birth date) for the first two years.
| Developmental domain | Refer if a limit-age milestone is not reached |
|---|---|
| Gross motor | Not sitting unsupported by 8 months · not walking independently by 18 months · persistent toe walking · hand preference before 12 months (all corrected for gestational age) |
| Fine motor & vision | Persistent hand-fisting beyond 3 months · not reaching for objects by 6 months · no pincer grip by 12 months · poor fixing or following / any vision concern |
| Speech, language & hearing | Reduced or absent babble by 10 months · no meaningful single words by 18 months · fewer than 10 words, or not joining two words, by 2 years · any hearing concern |
| Social, emotional & behavioural | No social smile by 8 weeks · reduced eye contact or response to name · not pointing to share interest by 18–24 months · loss of social interest |
| Any domain – always abnormal | Regression / loss of any acquired skill at any age · head circumference < 0.4th or > 99.6th centile, or crossing two centile lines |
Source: NICE NG62 · NICE CG128 · Healthy Child Programme
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