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  • Writer's pictureKatherine Wallisch

Red Flags in Early Childhood Development

Gross Motor


• Not pushing up on straight arms, lifting his head and shoulders, by 8 months of age

• Not rolling by 7 months of age

• Not sitting independently by 10 months of age

• Not crawling("commando" crawling--moving across the floor on his belly) by 10 months of age

• Not creeping(on all fours, what is typically called "crawling") by 12 months of age

• Not sitting upright in a child-sized chair by 12 months of age

• Not pulling to stand by 12 months of age

• Not standing alone by 14 months of age

• Not walking by 18 months of age

• Not jumping by 30 months of age

• Not independent on stairs (up and down)by 30 months of age


...an early intervention/developmental therapy referral may be appropriate.


Here are some other gross motor "red flags":


• "walking" their hands up their bodies to achieve a standing position

• only walking on their toes, not the soles of their feet

• frequently falling/tripping, for no apparent reason

• still "toeing in" at two years of age

• unusual creeping patterns

• any known medical diagnosis can be considered a "red flag": Down's syndrome, cerebral palsy, congenital heart condition etc.


Fine Motor

If a child is...

• Frequently in a fisted position with both hands after6 months of age

• Not bringing both hands to midline (center of body) by 10 months of age

• Not banging objects together by 10 months of age

• Not clapping their hands by 12 months of age

• Not deliberately and immediately releasing objects by 12 months of age

• Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age

• Still using a fisted grasp to hold a crayon at 18 months of age

• Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age

• Not imitating a drawing of a vertical line by 24 months of age

• Not able to snip with scissors by 30 months


...an early childhood intervention/development therapy referral may be appropriate



Here are some other fine motor"red flags":


• Using only one hand to complete tasks

• Not being able to move/open one hand/arm

• Drooling during small tasks that require intense concentration

• Displaying uncoordinated or jerky movements when doing activities

• Crayon strokes are either too heavy or too light to see

• Any know medical diagnosis can be considered a "red flag": Down's Syndrome, cerebral palsy etc.


Cognition/Problem Solving

If a child is...

• Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)

• Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)

• Not able to imitate a model from memory by 27 months(ie, show me how you brush your teeth)

• Not able to match two sets of objects by color by 31 months of age

• Having difficulty problem solving during activities in comparison to his/her peers

• Unaware of changes in his/her environment and routine


...an early intervention/developmental therapy referral may be appropriate


Sensory

If a child is...

• Very busy, always on the go, and has a very short attention to task

• Often lethargic or low arousal(appears to be tired/slow to respond, all the time, even after a nap)

• A picky eater

• Not aware of when they get hurt (no crying, startle, or reaction to injury)

• Afraid of swinging/movement activities; does not like to be picked up or be upside down

• Showing difficulty learning new activities (motor planning)

• Having a hard time calming themselves down appropriately

• Appearing to be constantly moving around, even while sitting

• Showing poor or no eye contact

• Frequently jumping and/or purposely falling to the floor/crashing into things

• Seeking opportunities to fall without regard to his/her safety or that of others

• Constantly touching everything they see, including other children

• Hypotonic (floppy body, like a wet noodle)

• Having a difficult time with transitions between activity or location

• Overly upset with change in routine

• Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.

• Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.


...an early childhood intervention/developmental therapy referral may be appropriate.


NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.


Possible visual problems may exist if the child...

• Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes

• Does not reach for an object close by


Possible hearing problems may exist if the child...


• Does not respond to sounds or to the voices of familiar people

• Does not attend to bells or other sound-producing objects

• Does not respond appropriately to different levels of sound

• Does not babble

Self-Care

If a child is...

• Having difficulty biting or chewing food during mealtime

• Needing a prolonged period of time to chew and/or swallow

• Coughing/choking during or after eating on a regular basis

• Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)

• Having significant difficulty transitioning between different food stages

• Not feeding him/herself finger foods by 14 months of age

• Not attempting to use a spoon by 15 months of age

• Not picking up and drinking from a regular open cup by 15 months of age

• Not able to pull off hat, socks or mittens on request by 15 months of age

• Not attempting to wash own hands or face by 19 months

• Not assisting with dressing tasks (excluding clothes fasteners) by 22 months

• Not able to deliberately undo large buttons, snaps and shoe laces by 34 months


...an early intervention/developmental therapy and referral may be appropriate.



Social/Emotional/Play Skills

If a child is...

• Not smiling by 4 months

• Not making eye contact during activities and interacting with peers and/or adults

• Not performing for social attention by 12 months

• Not imitating actions and movements by the age of 24 months

• Not engaging in pretend play by the age of 24 months

• Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)

• Fixating on objects that spin or turn (i.e. See 'n Say, toy cars, etc.);also children who are trying to spin things that are not normally spun

• Having significant difficulty attending to tasks

• Getting overly upset with change or transitions from activity to activity




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