Points for Concern: Birth to 3 Months

If a baby has feeble cry, pallor, problems with sucking or is hard to calm and 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.
 
It is usually easy to notice reduced or atypical movements of the arms and body, obvious physical or structural differences. Smaller differences in normal position seen consistently such as the head always turned to one side, or the arm or foot bent differently, are easier to miss in the short consultation time. Ask if the baby typically breast feeds only on one side or can only be easily carried or cuddled on one side – issues usually seen in children who have high tone on one side. Please refer to Disabled Village Children  Chapter 6: Guide for Identifying Disabilities to identify possible issues and locate intervention suggestions.
 
Babies by about two months should be able to lift their head up when lying on their stomach and fists should be more open at least half their waking time. Recommend simple activities such as those in Disabled Village Children, Chapter 3: “Early Stimulation and Development Activities” to encourage movement and play and refer to “Fisted Hands _activity” for more ideas on using hands. If babies are showing delays in these milestones, please also monitor other indicators of good health such as sleep patterns, level of irritability, and sucking, and refer for clinical care as needed. Please specifically test for sensory issues as they are often missed. If children have sensory as well as motor delays, please refer to the Multiple Sensory Impairments Resources page for further information and ideas.
 
If children do not calm to touch, reject touch or seem sensitive to certain sounds or textures of certain materials, they may be having trouble with sensory reception or registration. Please refer to Sensory Resources  for some guidelines and suggestions.
 
If the child doesn’t attend to voices or react to loud sounds, please ensure a comprehensive hearing test is done. Please refer to Helping Children Who Are Deaf, Delays in motor development or problems with tone are often accompanied by impairment of vision and hearing. These are easily missed as the child may not be totally blind or deaf and their lack of response is put down to the motor impairmentChapter 5: What can your child hear? for simple guidelines for testing. Please also refer Chapters 2, 3, & 4 in the same book for suggestions for language & communication development and “Communication Decision Chart” for more ideas.
 
If the child doesn’t look at bright, patterned or moving objects or show interest in faces, ensure a comprehensive vision test is done. For functional testing, please 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 Vision Impairment” and “Early Vision” suggest activities.
 
By two months, the baby should be vocalizing more and crying less. If the baby doesn’t smile at three months, consider whether vision is a concern, whether the baby has issues with awareness of and interaction with people or whether there are other health issues. Children who do not seem to enjoy being held or carried may have issues with sensory reception, sensory tolerance or sensory perception itself. Diagnosis may take a while, but meanwhile, please refer to Communication in children with multiple disabilities and Infant Massage for some strategies to build relationships with the baby.
 
The regression or loss of skills at any age is always a matter of concern and the child must be referred for clinical assessment.