Developmental delay

Pre-referral guidelines for primary care providers

Developmental delay refers to children who are behind the age-expected norms in one or more of the four main domains: gross motor, fine motor, language and communication and personal/social.


The diagnosis of developmental delay is a clinical one, although investigations may be required to exclude any underlying causes (see Investigation of global delay article). Remember that there is a normal variation in all developmental milestone acquisition, and the 'cut offs' for various parameters usually refers to the age at which 75% of children will achieve this milestone (e.g. walking by 14 months), with 'delay' not being considered evident for several months after this (e.g. 18 months).

Various screening tools are used in the evaluation of developmental delay, such as Brigance screening or Ages and Stages questionnaires. More formal developmental assessment tools are also available, such as the Denver scales, Bailey scales and Griffiths tool.

It is important to remember that the screening tools can lead from finding difficulties in one parameter to perceived deficits in other areas, requiring further assessments in other domains.

Practice points


The mainstay of therapy for developmental delay is allied health service provision. This can be undertaken through specific services (e.g. physiotherapy for isolated gross motor delay) or, when there is more than other parameter involved, Early Childhood Intervention Services.

Speech delay: it is important to ensure audiology screening has been undertaken.

For children with personal/social delay and speech delay, consider the diagnosis of autism spectrum disorder.

Referral pathways

  • Allied health services
    • Early Childhood Intervention Services referrals (through the NDIS) are appropriate for any child prior to school entry (0-6 years) with delay in more than one developmental domain. Referral can be undertaken by any health professional. The referral forms are sent to central intake before the child will undergo intake assessment.
    • Individual allied health services can be either public or private referrals
      • Public services for preschool children can be accessed through BHS
      • School aged children can only access public speech therapy through the school
      • Private services can be accessed (with a partial Medicare rebate) via a Chronic Disease Management Plan from their General Practitioner.
    • Speech delay: Audiology and speech therapy referrals are appropriate for children with significant isolated speech delay.
      • Consider referral when they are no single words by 18 months or less than 50 words with no 2-word combinations by two years.
    • Gross motor delay: Physiotherapy referrals are appropriate for children with significant isolated gross motor delay
    • Fine motor delay: Occupational therapy referrals are appropriate for children with significant isolated gross motor delay
  • Paediatrician
    • Referral to paediatric outpatient services is generally undertaken in a non-urgent manner for exclusion of other diagnoses in global development delay or severe isolated delays.
    • Health providers should refer to relevant allied health services prior to undertaking a paediatric referral.
    • Information to bring to any appointments:
      • recent school reports and any written reports from teachers
      • any testing (cognitive, learning, etc) or developmental screening
      • the child's Maternal and Child Health book ('green book' or 'blue book')