Child development

September 2011

FocusChild development

Is my child normal?

Milestones and red flags for referral

Volume 40, No.9, September 2011 Pages 666-670

Frank Oberklaid

Kim Drever


Developmental problems in young children are common and have lifelong implications for health and wellbeing. Early detection of developmental problems provides an opportunity for early intervention to shift a child’s developmental trajectory and optimise their potential.


This article describes and recommends a broader concept of developmental surveillance that should replace the reliance on traditional methods of early detection such as milestone checklists, parent recall, developmental screening tests and clinical judgment.


General practitioners and other professionals in regular contact with children and their families are ideally placed to monitor a child’s development, detect problems early and to intervene to optimise the child’s development and thus promote long term health and wellbeing. Developmental surveillance involves eliciting parental concerns, performing skilled observations of the child, and providing guidance on health and development issues that are relevant to the child’s age and the parents’ needs. Standardised tools are available to assist GPs to elicit parental concerns and guide clinical decision making.

Developmental problems in young children are more common than generally realised. Surveys suggest that up to 15% of children under the age of 5 years may have difficulties in one or more areas of development, including speech and language, motor, social-emotional and cognitive.1 At the more severe end of the spectrum, developmental delay and disability will usually be detected at a relatively early stage, either because the child has a significant delay that is detected by parents and/or a health professional, or because they are high risk (eg. prematurity) and are monitored in a follow up neonatal intensive care unit program.

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