Synopsis
Assess child development across interacting domains, use milestone ranges and corrected age appropriately, recognise normal variation without false reassurance, and act on delay, asymmetry, sensory concern or loss of acquired skills.
- Assess gross motor, fine motor and vision, speech and language, social and emotional, cognition or play, and adaptive or self-care development.
- Milestones are age ranges, not pass–fail dates; sequence, quality, symmetry, trajectory and impact matter more than memorising one median age.
- Correct developmental age for prematurity, generally until age 2 years for infants born before 32 weeks and until age 1 for those born at 32–36 weeks.
- Use parent concerns as clinical data and obtain nursery or school observations; children can perform differently across people, settings and languages.
- First-line assessment includes observation through play, developmental history, growth and head circumference, neurological examination, hearing and vision review.
- By around 6–8 weeks many infants show a social smile; lack of interaction later must be interpreted with vision, hearing and overall state.
- By around 6 months many infants reach and transfer objects, roll, sit with support and produce varied babble.
- By around 9 months many sit unsupported, use emerging pincer grasp, babble repetitively, show social referencing and enjoy interactive games.
- Around 12 months many pull to stand or cruise, use a mature pincer grasp, wave or point and say one or more meaningful words.
- Around 18 months many walk independently, scribble, build a small tower, use several words and begin simple pretend play.
- Around 2 years many run, manage stairs with help, build a tower, combine two words and engage in parallel and symbolic play.
- Regression, persistent asymmetry and missed NICE motor thresholds override watchful waiting; refer while beginning hearing, vision and cause-directed assessment.
Key red flags
Loss of a previously secure motor, language, social or self-care skill is developmental regression and requires prompt specialist assessment.
Not sitting unsupported by 8 months corrected age, early hand preference before 1 year or not walking independently by 15 months in girls or 18 months in boys meets NICE motor-referral criteria.
Absent or inconsistent response to sound, loss of babble or language, or delayed speech requires formal hearing assessment even after a clear newborn screen.
Persistent asymmetry, abnormal tone, fisting, scissoring, head-lag beyond expectation or unusual movement can indicate cerebral palsy or neuromuscular disease.
Dysmorphism, congenital anomalies, abnormal head-growth trajectory, seizures or global delay increases the likelihood of genetic or neurological disease.
A child who does not receive adequate interaction, nutrition, safe care or education needs parallel developmental and safeguarding assessment without assuming either explains the other.
Investigation priorities
Map acquisition, quality, sequence and any loss across all domains.
Observe motor, hand, communication, cognition and reciprocity in a low-distress setting.
Management branches
A child attends a scheduled health or general clinical review.
- Ask parent concerns first and review gross motor, fine motor or vision, language, social, cognitive and adaptive function.
- Observe play and interaction, plot growth and head circumference and perform focused sensory and neurological examination.
- Record acquired skills and quality, give development-promoting advice and state the next surveillance point.