Although medical investigations may give an indication of the parts of the brain that have been damaged, only gradually does the full range of problems that may result become apparent. There is a tendency to "wait and see" by both the medical and teaching professions, before advocating any specialist help.

There is a very wide range of "normal" with all children so it is essential that careful monitoring of the child takes place over time.

It should be remembered that the child may be unaware of and unable to tell the parent what the differences are from before they were ill. They may have problems describing how they feel. This can result in temper tantrums which may appear to be the normal "terrible two" type behaviour but could be due to frustration arising from any of the above problems.

Children may adapt to problems over time but their capacity to do so may be limited. Some may not be immediately apparent either because the ability or function has not yet developed (see Age at Diagnosis) or because of the subtle nature of the function.

It is difficult to assess young children accurately, they are easily distracted and may not co-operate. There is also a tendency to "wait and see" by both the medical and educational profession, before advocating any specialist help. But it is important for them to be reviewed regularly, especially before commencing school, when an appropriate developmental assessment should be able to differentiate problems due to delay or deficit. A community physician (Child Health) should be able to arrange a developmental assessment.

Help can be provided by PORTAGE before your child starts school. This is a home visiting service which offers support, help and advice to families with young children who have special needs. Children are usually between 6 months and 3 years old when they are referred to Portage. They can also be contacted direct at the following address: National Portage Association, 127 Monks Dale, Yeovil, Somerset BA21 JE Tel: 01935 471641 www.portage.org.uk or if you prefer you can discuss Portage with your doctor, health visitor or social worker who will contact the service for you.

There is no portage in Scotland. However, there is a duty on the education authority to provide appropriate support for children under 5 where a child has been referred by the health authority and additional support needs have been identified.