The 18-month check with three worries — CCE clinical encounter

Objectives

1. Interpret the growth trend correctly: weight faltering (two or more centile lines crossed downward) requiring structured assessment, with normal length and HC arguing against systemic disease. ^[2]
2. Complete the 18-month universal developmental screen (M-CHAT-R/F) and act correctly on the result, including the follow-up interview and referral thresholds. ^{[1] [3]}
3. Address language delay with a hearing assessment and honest milestone framing (no two-word phrases by 24 months is the action threshold; single-word count at 18 months sits in a grey zone that screening resolves). ^[6]
4. Rebuild feeding before expanding investigations, and screen for the most common complication (iron deficiency). ^[2]
5. Counter 'he'll grow out of it' with a plan that neither dismisses nor over-medicalises: referral in parallel for persistent positives, not reassurance alone. ^{[1] [5]}