From Showing Concern to Getting a Referral
Child Development
Child development is a continuous process which consists of many aspects including physical, language, cognitive as well as emotional and behavioral aspects. The developmental progress of each child is affected by interplay of genetic and environmental factors.
When a child is suspected to have developmental problems
If a child does not perform as expected in certain aspects of development, attention for follow up is suggested. If parents have any concerns or queries, please discuss with nurses or doctors in their respective Maternal and Child Health Centres (MCHC), family doctor or paediatrician.
Parents may refer to the following information regarding the developmental milestones of children at different ages. For detailed information, you may refer to the Child Health Information, Family Health Service.
Discuss with doctors or nurses if your child has the following problem(s) when he or she reaches the age:
By the end of the first month, your baby:
- Seldom moves her arms or legs
- Appears excessively floppy or stiff
- Does not blink to bright light
- Does not focus or follow your face briefly at near
- Does not respond to loud noises
By the end of the third month, your baby
- Appears floppy or too stiff on handling
- Does not move much and not support her head temporarily when lying on her tummy
- Keeps her hands fisted all the time and does not hold rattle put in her hand
- Does not look at her own hands
- Does not follow moving objects with her eyes at near
- Does not respond to loud noise
- Does not make any sound
- Does not smile in response to your voice or face
By the end of the seventh month, your baby
- Does not move much or move asymmetrically
- Does not sit well with support on her hands
- Does not bear some weight on legs when being held up
- Does not reach and grasp objects
- Does not visually follow objects nearby or at a distance
- Has one or both eyes consistently turn in or out (i.e. squinting)
- Does not respond to calling
- Does not turn head to locate the source of sound
- Does not vocalize
By the end of ninth month, your baby
- Does not sit alone
- Does not put weight on his legs when being held up
- Cannot transfer toys between his hands
- Does not babble
- Seldom look into the eyes of his carer
- Does not turn head to locate source of sound
- Does not visually follow object nearby or at a distance
- Does not play any games involving back and forth play (eg. Peek a boo)
- Does not show whether they are happy or sad
By the end of 12 months, your baby
- Does not walk along holding onto furniture
- Does not pick up small objects like crumbs and rice using her finger tips
- Seldom look into the eyes of her carer
- Does not respond to calling of her name often
- Does not respond to command with gestured cues e.g. wave "bye-bye", "clap your hands"
- Does not use sounds, words, gestures or pointing to indicate needs
- Appears not hear or see well
By the end of 18-month, your child
- Cannot walk alone
- Does not play meaningfully but engages in throwing and mouthing of toys
- Seldom look into the eyes of her carer
- Does not show interest in playing with her carers, prefers to play on her own
- Does not understand names of familiar people or objects, e.g. Grannie, cup, milk
- Does not point with finger to indicate needs
- Speak no words yet
By the end of 2 years, your child
- Cannot walk steadily
- Does not understand names of common household objects or body parts
- Does not use gestures or words to draw your attention onto things/events of her interest
- Can only speak in single words
- Does not show interest in playing with her carers, prefers to play on her own
- Does not participate in pretend play such as playing toy tea set
- Appears not hear or see well
By the end of 3 years, your child
- Falls frequently or cannot walk on stairs by himself
- Does not draw vertical and horizontal lines
- Does not eat with spoon, fork or chopsticks
- Fails to understand simple instructions e.g. “Go to the room and take the coat”
- Fails to communicate in 2-3 word phrases (e.g. “drink juice”, “want the ball”)
- Shows no interest in other children
- Does not participate in pretend play such as play acting
- Shows extreme difficulty in separating from caregiver in most situations
By the end of 4 years, your child
- Appears clumsy in manipulating simple eating utensils such as spoon or fork
- Has difficulty in following adults’ daily instructions
- Does not speak in sentences
- Has unclear articulation that is difficult to be understood
- Shows excessive or persistent aggressive behaviour
- Still clings and cries excessively whenever you (or the main caregiver) leaves him
- Shows no interest in playing with others;
- Ignores other children and prefers playing on his own
- Appears not to see or hear well
- Has learning or behavioural problem at school
By the end of 5 years, your child
- Shows excessively aggressive behaviour
- Is excessively timid, fearful, or emotionally labile
- Is easily distracted and inattentive when compared to others in class
- Shows little interest in other children and not joining in games
- Cannot follow instructions at home or in school
- Cannot relate simple events
- Cannot speak in adult-like sentences
- Has unclear speech such as misarticulation, stuttering
- Shows definite problem in learning concepts
- Appears clumsy in physical activities
- Appears clumsy in pencil skill or in using simple tools
- Does not see or hear well
- Has any other learning or behaviour problem at school
Referral
If parents suspect the child to have developmental problems, you may consult registered doctor for an initial assessment. Our service accepts referral by MCHC, registered doctor, clinical psychologist or educational psychologist.
Parents may book first assessment by nurse at Child Assessment Centre (CAC) within 6 months from issued date of the original copy of the referral letter, either by phone or direct booking at CAC in person. (Fax referral will not be accepted)