When to see a specialist

The most common reason concerned parents stay concerned is that the 'wait and see' conversation with a GP has dragged out longer than it should. This article is a field guide to the specific thresholds at which referral to a specialist is clinically indicated — and how to ask for it.

The general principle

Developmental assessment is a specialist skill. GPs are generalists whose job is to notice patterns and pass them on. Most GPs are excellent at this; some, through time pressure or training gaps, default to 'wait and see' for longer than current evidence supports. When in doubt, referral costs little and waitlists only grow — earlier requests mean earlier positions.

Speech and language — speech pathologist

• No babble with varied consonants by 10–12 months.
• No words by 18 months.
• Fewer than 50 words or no two-word combinations by 24 months.
• Regression at any age (loss of previously-used words).
• Being difficult to understand by unfamiliar adults at age 3.
• Stuttering that is distressing the child or lasting more than 6 months.
• Any swallowing or feeding difficulty alongside language concern.

Motor development — paediatric physiotherapist or OT

• Not sitting unsupported by 9 months.
• Not crawling, rolling, or moving by 12 months.
• Not pulling to stand by 12 months.
• Not walking by 18 months.
• Strong hand preference before 18 months (can indicate weakness on the non-dominant side).
• Persistent difficulty with age-typical fine motor — grasping, pincer grip, scribbling — a year or more after peers.
• Regression in motor skills at any age — urgent.

Social communication and interaction — paediatrician

• No back-and-forth smiles or facial expressions by 9 months.
• No babbling or back-and-forth gestures (pointing, showing, reaching, waving) by 12 months.
• No single words by 16 months.
• No two-word phrases by 24 months.
• Regression in social behaviour or language at any age — urgent.
• Limited eye contact, particularly in the context of other features.
• Very narrow range of interests, strong need for sameness, or distress with minor changes.

Attention, behaviour, and emotion — paediatrician or psychiatrist

• Persistent difficulty regulating attention, impulse, or movement beyond what is age-typical — noticed across home and school.
• Emotional dysregulation well out of proportion to age and triggers, multiple times a week.
• Persistent anxiety that is restricting the child's daily life.
• School refusal lasting more than 2–3 weeks.
• Depressive symptoms in older children — low mood, withdrawal, sleep change, loss of interest.
• Any talk of self-harm or suicide at any age — urgent.

Hearing — audiologist

• Any concern about hearing at any age. Hearing loss is one of the most common reversible causes of language delay.
• History of recurrent middle ear infections with fluid.
• Turning up the volume excessively, asking for repetitions, not responding from the next room.
• Not responding consistently to their name by 12 months.

Audiology referrals are often the fastest-moving specialist pathway in Australia and are foundational — hearing should always be ruled in or out when language or attention is a concern.

Vision — optometrist or ophthalmologist

• Any eye that turns in or out.
• Holding things very close, tilting head to see, frequent headaches (older children).
• Difficulty tracking objects.
• Family history of serious eye conditions.

Growth and weight — paediatrician or paediatric dietitian

• Growth crossing two major percentiles downward on the growth chart.
• Failure to thrive.
• Very selective eating affecting growth or daily life.
• Sudden significant weight change in older children — up or down.

The exact conversation with your GP

A clear, specific request moves faster than a general worry. Useful framings:

• 'I would like a referral to a developmental paediatrician because [X, Y, Z].' Naming the specialist you want makes it harder to defer.
• 'If we wait six months and the pattern is still here, I will have wasted six months of a waitlist. I would rather hold a place and cancel than wait.'
• 'Can we please also check hearing / vision, since that would change my understanding of what is going on.'
• 'I am asking for a Mental Health Care Plan and a paediatric referral. I would like both today.'

You know your child. A GP who takes one of these signals seriously, even if it turns out to be nothing, is a GP who has done their job. The cost of a specialist assessment that confirms everything is fine is low. The cost of missing a time-sensitive window is not.