What referral criteria should I consider for a child showing signs of significant developmental delay?

Consider referral to paediatric or specialist services for a child presenting with significant developmental delay if any of the following criteria are met:

• Developmental problems or disorders are identified, including global developmental delay, learning disability, or language problems, especially if confirmed by standardised assessments such as the Parent Report of Children's Abilities – Revised (PARCA-R) or suitable alternatives ¹.
• Presence of neurological signs such as hypotonia (floppiness) with acute onset or persistent weakness, especially if associated with feeding or breathing difficulties, or sudden/progressive limb or facial weakness ².
• Abnormal head shape measurements suggesting craniosynostosis (e.g., equal measurements in plagiocephaly) rather than positional plagiocephaly ².
• Children born preterm with risk factors such as birth before 30 weeks’ gestation, brain lesions on neuroimaging, hypoxic ischaemic encephalopathy, neonatal meningitis or encephalitis, or other risk factors like small for gestational age or multiple pregnancy, should have enhanced developmental surveillance and referral to multidisciplinary teams ¹.
• Signs suggestive of cerebral palsy or other neurodevelopmental disorders, including abnormal Gross Motor Function Classification System (GMFCS) scores, warrant referral to paediatric services with neurodevelopmental expertise ¹,².

Referral should be urgent or immediate if there are acute neurological signs or rapidly progressive symptoms, and routine referral if developmental delay is persistent without acute deterioration ².