When to see a child neurologist: a guide by age

Usually: at 2 months, looks at your face and smiles and holds the head up briefly; at 4 months, holds the head steady and reaches for objects with the hands; at 6 months, sits with support, rolls over and makes sounds; at 9 months, sits without support, passes objects from hand to hand and turns to their name; at 12 months, pulls up to stand, says words like “mama” and “dada,” and points to show what they want.

Show to a neurologist: does not hold the head up at 3 months; does not look at your face and smile at 4 months; does not roll over at 6 months, or uses one hand noticeably less than the other; does not sit without support or turn to their name at 9 months; does not pull up to stand, say any word or gesture at 12 months; muscles are very floppy or very stiff; head circumference is growing quickly or not growing; the baby was born prematurely, had a difficult delivery or was in intensive care.

Often asked about at this age, but usually harmless: brief jerks during sleep (benign sleep myoclonus), the body shaking for a few seconds when excited (shuddering attacks), a trembling chin. To tell them apart, record a video and show it at the exam.

Usually: at 15 months, takes a few steps and says 1–2 words; at 18 months, walks independently, says 3 or more words, follows a simple instruction and points to show something interesting; at 24 months, runs, puts two words together (“give water”) and begins to play alongside others; at 30 months, uses about 50 words and plays simple pretend games; at 36 months, climbs stairs, makes 3-word sentences, and strangers mostly understand their speech.

Show to a neurologist: does not walk at 18 months, or walks only on tiptoe; has no meaningful words at 18 months, does not make eye contact, does not respond to their name, does not point; does not combine two words at 24 months; loses skills they had before (this is the most important sign); uses one side weakly; falls often, or their gait has changed; has had a seizure or unusual episodes of attacks.

Often at this age: holding the breath while crying until turning blue (breath-holding spells: they look frightening but are usually harmless; iron deficiency should be checked), the start of stuttering (ages 2–4), night terrors. A standard screening questionnaire for autism spectrum disorder (M-CHAT-R/F) is recommended at 18 and 24 months.

Usually: at age 4, stands on one foot, speaks in short sentences, asks questions, knows colors and plays with other children; at age 5, hops, tells a story, counts, tries to write their name and takes part in games with rules.

Show to a neurologist: strangers cannot understand their speech at age 4; stuttering that lasts longer than 12 months or gets worse; frequent “spacing out” episodes, when the child does not respond for a few seconds and stares into space (these may be absence seizures); tics such as eye blinking and face or neck movements that last more than a year or get in the child's way; morning headaches and vomiting; a change in gait, frequent falls, difficulty on stairs; loss of skills.

Often at this age: night terrors and talking in sleep (usually harmless), high activity (an ADHD diagnosis is made with caution before age 6), febrile seizures (rare after age 5).

Usually: learns to read and write, keeps attention on a task for 20–30 minutes, makes friends, follows rules, and athletic skills develop.

Show to a neurologist: headaches that recur several times a month, especially in the morning, with vomiting, or pain that wakes the child at night; inattention, impulsivity and hyperactivity that last more than 6 months both at home and at school and interfere with learning (ADHD); persistent difficulty learning to read and write; fatigue, leg weakness, trouble climbing stairs; “spacing out” episodes; strange movements during sleep or seizures at night.

Usually: abstract thinking, independence, and a sleep schedule that shifts later into the night (biologically normal, but it clashes with school hours).

Show to a neurologist: migraine often starts at this age: 4 or more painful days a month, missing school, taking painkillers more than 2–3 times a week; a first seizure (lack of sleep and screens sometimes act as triggers); episodes of loss of consciousness (fainting has to be told apart from a seizure); persistent fatigue, sleep problems; hand tremor, movement disorders; dizziness.

• Bring your child's previous test results, an EEG and MRI (if you have them), and a list of medications.
• If you can, record any seizure, shaking, tic or “spacing out” episode on video: a 20-second video is worth more than a long description.
• Prepare a short note about the pregnancy, the birth, birth weight and the first months.
• For a school-age child, a short note from the teacher (attention, behavior, learning) is helpful.
• Tell your child in advance that the exam is painless; the preparation guidelines for an EEG are given separately.