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.
• 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.
• A child who has missed a limit age 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 or 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 or 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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