What are the referral criteria for a child suspected of having a developmental delay?

Referral criteria for a child suspected of having a developmental delay vary depending on the specific concerns and associated conditions:

• General Developmental Delay and Neurological Concerns:
  • Refer any child with features suggestive of neurological disorders, excluding cerebral palsy, to a specialist in paediatric neurology ¹.
  • Refer all children to a child development service for further assessment if they have delayed motor milestones ¹.
  • Refer all children to a child development service for further assessment if they exhibit persistent toe walking ¹.
  • For babies under 1 year with hypotonia (floppiness) present for weeks or months, if the baby is weak (e.g., with feeding and breathing difficulties), refer urgently to paediatric services ⁴. If the baby is not weak and has no signs of intercurrent illness, consider referring in line with recommendations for cerebral palsy ⁴.
  • Refer children with limb weakness that is part of a developmental disorder to paediatric services, in line with recommendations for cerebral palsy ⁴.
• Suspected Cerebral Palsy (CP):
  • Children with suspected CP should be referred to a child development service for a multidisciplinary assessment to facilitate early diagnosis and intervention ¹.
  • Refer all children with risk factors for CP who exhibit abnormal motor features urgently to a child development service ¹.
• Suspected Autism:
  • Arrange referral to a local multidisciplinary autism team (or a neurodevelopmental paediatrician or child and adolescent psychiatrist) if a child is under 3 years of age and has regression of language or social developmental milestones ³.
  • Arrange referral to a local multidisciplinary autism team if a child or young person of any age has persistent and significant limitations or impairments to activities of daily living caused by clinical features suggestive of autism ³.
  • Consider referral to a local multidisciplinary autism team if a child or young person has moderate limitations or impairments to activities of daily living caused by clinical features suggestive of autism, and there are significant family and/or carer concerns about their level of development or functioning, or risk factors for autism ³.
  • Arrange referral to a neurodevelopmental paediatrician or paediatric neurologist if a child or young person is suspected of having autism or another neurodevelopmental condition and is over 3 years of age with regression in language developmental milestones ³.
  • Arrange referral to a neurodevelopmental paediatrician or paediatric neurologist if a child or young person is suspected of having autism or another neurodevelopmental condition and is of any age with regression in motor developmental milestones ³.
  • Consider referral to a clinical genetics specialist if a chromosomal or genetic anomaly is suspected, or if a teratogenic exposure is suspected or confirmed ³.
  • If there is an uncertain diagnosis and insufficient current concern for specialist referral, consider reviewing the child after a period of 'watchful waiting' ³. Arrange referral after this period if new clinical features suggestive of autism develop or there are ongoing concerns ³.
• Children Born Preterm:
  • If findings at any stage of developmental surveillance, including assessments at 2 years (corrected age) and 4 years (uncorrected age), indicate a developmental problem or disorder, information sharing and referral should occur ².
  • Provide enhanced developmental support and surveillance by a multidisciplinary team up to 2 years (corrected age) for children born preterm who have a developmental problem or disorder, or are at increased risk of developmental problems or disorders (e.g., born before 30+0 weeks' gestation, or between 30+0 and 36+6 weeks' gestation with specific risk factors like brain lesions, grade 2 or 3 hypoxic ischaemic encephalopathy, neonatal bacterial meningitis, or herpes simplex encephalitis) ².
  • Consider enhanced developmental support and surveillance for children born preterm who do not meet the above criteria but are suspected of being at increased risk of developmental problems or disorders ².