Points for Concern: 9 to 12 Months

Children who are passive and do not seem interested in the world around them may have poor nutritional status or poor early experiences. Check the Mother Child Protection Card to see how the child is progressing on the growth chart and ensure Girl sitting up and holding bellthat clinical program has been followed through. If you see disinterest in people and objects along with self-stimulatory behaviours such as eye poking, rocking, or flicking the fingers in front of the eyes, please consider sensory impairment or multiple sensory impairment and refer to Sensory Impairment resources to guide investigations and intervention.   
 
If a child is not able to protect herself by putting her hands out in front when falling out of sitting position, not pulling to stand, not able to come to supported standing or in standing if the weight is not equally distributed at the hip, knee or foot level, the child should be referred for further review. Refer to Disabled Village Children, Chapter 6: Guide for Identifying Disabilities for assessment and resource suggestions.  
 
Children should be able to place at least one small block on the other, with reasonable accuracy, demonstrating their fine motor control. Children should be able to use their fingers individually to poke, dig, and manipulate small objects. See Sequential Development of Grasp to identify what the child’s current capacity is and Development of Hand Function in the First Year to identify some starting points for intervention. 
 
If you notice that a child does not demand or show interest in adult attention or does not show a preference for the primary caregiver consider the quality of his early social experiences and look at how you could encourage more interaction in his routines. 
 
Remember to consider whether the child is able to recognize people just by seeing or by hearing their voice and if not, consider sensory impairment as a possibility. Always check both senses as mild or moderate losses are easy to miss. 
 
Children who are not speaking or have reduced vocalizations may have issues with hearing Please refer to Helping Children who are Deaf, Chapter 5: What can your child hear? for testing. Please also refer to Chapters 2, 3, & 4 in the same book and “Communication Decision Chart” in the Communication Resources Folder for activity suggestions.  If you also see drooling, trouble with biting, chewing or swallowing, the child may have oral motor issues. Please refer to http://www.nimhindia.org/list.htm for evaluation and guidance on feeding
 
Children who are not looking at small objects or pictures or not attending to faces or responding to expressions may have poor vision. Squints at this age, even when they appear and disappear should be referred for clinical appraisal and intervention. Refer to Helping Children who are Blind, Chapter 4: Finding out what your child can see and “Help your child to see more easily” & “Early Intervention for Children with Visual Impairments” for suggestions for intervention.