Points for Concern: 3 to 6 Months

This is an age where you should see a lot of movement, so passive babies require thorough investigation. Lay the child down and look to see if there are any differences in body movement, alignment or structure and refer for immediate intervention. The regression or loss of skills at any age is always a matter of concern and the child must be referred for clinical assessment.Please refer Disabled Village Children, Chapter 6: Guide for Identifying Disabilities to identify issues and locate suggestions. 
If the baby has not rolled or achieved head control, it could point to motor impairment or indicate the presence of vision impairment. Children with large head circumference will also often have these difficulties. Ensure that required medical investigations are completed. Recommend activities from Disabled Village Children, Chapter 35: “Early Stimulation and Development Activities” to encourage movement and play. Refer to “Postural support” for some ideas for positioning. 
If the baby is not weight bearing on their elbows or pushing up on their hands when placed on If a baby has feeble cry, pallor, problems with sucking or is constantly crying, please refer to medical services to rule out health related issues. Check major health indicators; head circumference, weight, height and their rate of growth. Make sure they are documented in the Mother Child Protection Card and issues are being addressed. their tummy or if you see that the baby’s hands are still fisted in all positions, these are all signs of concern. Check to see if the child has had lots of opportunities to play on their tummy and in good supported sitting and if the child has had adequate opportunities to play with hands free – hands in mittens all day or babies wrapped so their arms are not free, restrict learning opportunities. 
Give the baby lot of experience of taking weight on their hands – for example, push against a soft toy or spongy ball together, place the child on their tummy on your lap and gently rock them forward so that their hands push on the floor. Refer to “Fisted Hands activity”  for suggestions. If in spite of opportunities for experiences, the child still has a closed fist, look for other signs of tone imbalances. Refer to Disabled Village Children, Chapter 6: Guide for Identifying Disabilities for assessment and resource suggestions. For children with cerebral palsy, refer “Positioning, handling, carrying a young child” for some ideas. 
If the baby is not reaching for objects hanging within arm’s reach, consider whether the child is able to see the objects. It could also be due to motor impairment so look for other signs such as the baby not playing with both hands at midline or not mouthing hands. Disabled Village Children, Chapter 35: “Early Stimulation and Development Activities”, Chapter 5, Activities for the Young Baby in “Helping Children who are Blind” and “Early Intervention for Children with Visual Impairments" have some suggestions for you to begin.  
Babies should be showing a definite enjoyment of human interaction and should understand and preferentially attend to changes in expressions and tone of voice. If delays are seen in this area, explore the child’s typical routine to see if they have enough opportunity for consistent caregiving. Children who are resistant to being held, or who don’t calm easily even when given something to suck, may have issues in sensory reception and processing. To explore possible issues, refer to “Sensory Processing Disorder Checklist” & Normal Development of Speech Language and Communication. Ideas for developing early relationships can be found in the “Communication Decision Chart” & the Sensory Resources & Multiple Sensory Impairment Resources
If the child doesn’t show visual recognition of familiar faces, attention to and copying expressions or doesn’t look to toys, then consider vision issues. For testing, refer to “Observational testing of vision” and Helping children who are Blind, Chapter 4  “Finding out what your child can see”. Chapter 5, Activities for the Young Baby in the same book and “Early Intervention for Children with Visual Impairments” have activity suggestions.  
Feeble or no vocalizations, no changes in tone and erratic attention or lack of attention to sudden sounds or to voices could point to issues in hearing. Please refer to Helping Children who are Deaf, Chapter 5: What can your child hear? for testing. Please also refer Chapters 2, 3, & 4 in the same book and “Communication Decision Chart” in the Communication Resources Folder for activity suggestions.  Feeble vocalizations combined with poor sucking or tongue thrust could be signs of tonal issues. Refer to Disabled Village Children, Chapter 9: Cerebral Palsy.