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Child Development Red Flags
A crucial part of helping young children grow is monitoring development--how they learn, how they use motor skills, how they interact with others, how they express feelings, and how they use tools and objects around them. Watching for common actions or achievements in children based on their ages can help in gauging where a child is in development as well as what intervention services might be helpful.
Childcare providers can and should watch for “red flags.” Where developmental milestones focus on what a child can do by a certain age, “red flags” usually warn parents, caregivers and health professionals of potential delays and disabilities when a child cannot do something by a certain age, or when a child has significant difficulty doing something that most children can do easily.
Children benefit when caregivers can identify potential delays and early signs of disability and refer these children into important early intervention programs. Referrals should be made early, but only after patterns of concern exist. Missing one milestone should not cause an overreaction.
Cause for Action, Not Alarm
Developmental milestones give a general idea of the changes you can expect as a child gets older. Because each child develops in his or her own particular manner, it is impossible to predict exactly when or how a given skill will be mastered. Parents and caregivers should not be alarmed if a child’s development takes a slightly different course.
The presence of a “red flag” or the inability to do something most children already can should not incite panic. However, you should alert the parent and pediatrician immediately if a child displays any of the following signs of possible developmental delay for her or his age. Signs can be related to physical development or motor skills, vision and hearing, emotional reactions, and other issues.
Red Flags--Seven Months
Alert the child’s parents and pediatrician if, by the end of seven months, the child:
- Seems either very stiff physically or very floppy like a rag doll.
- Does not roll over in either direction (front to back or back to front).
- Cannot sit with help or hold his or her head up when the body is put in a sitting position.
- Does not bear some weight on the legs.
- Reaches with one hand only, has difficulty getting objects to the mouth, or does not reach for objects at all.
- Refuses to cuddle, seems inconsolable at night, or shows no affection for the primary caregiver.
- Shows specific eye problems (persistent tearing, eye drainage or sensitivity to light) or vision impairments (inability to follow objects with both eyes at near and far ranges).
- Does not respond to sounds or turn her or his head to locate sounds.
- Does not laugh, make squealing sounds, smile spontaneously, babble, try to attract attention, or show interest in peek-a-boo.
Red Flags--12 Months
Alert the child’s parents and pediatrician if, by the end of 12 months, the child:
- Does not crawl or drags one side while crawling.
- Cannot stand when supported.
- Does not point to objects or pictures or search for objects that are hidden while he or she watches.
- Says no single words.
- Does not learn to use gestures, such as waving or head shaking.
Red Flags--18-24 Months
Alert the child’s parents and pediatrician if a child between 18–24 months old:
- Does not walk by 18 months or walks exclusively on the toes.
- Does not speak at least 15 words and begin to use two-word sentences.
- Does not seem to know the function of common household objects like telephones and eating utensils.
- Does not imitate actions or words or follow simple instructions.
- Cannot push a wheeled toy.
Red Flags--Three Years Old
Alert the child’s parents and pediatrician if a three-year-old child:
- Falls frequently or has difficulty using stairs.
- Cannot build a tower of more than four blocks, has difficulty manipulating small objects, or cannot copy a circle.
- Is unable to communicate in short phrases or understand simple instructions.
- Is not interested in “pretend” play or other children.
- Has extreme difficulty separating from his or her mother.
Red Flags--Four Years Old
Alert the child’s parents and pediatrician if a four-year-old child:
- Cannot throw a ball overhand, jump in place, ride a tricycle, grasp a crayon with the thumb and fingers, stack four blocks, or scribble easily.
- Ignores or does not respond to children or people outside the family.
- Is unable to communicate in sentences of more than three words or use “you” or “me” appropriately.
- Shows no interest in interactive games or fantasy play.
- Resists dressing, sleeping, or using the toilet.
- Lashes out with no self-control when angry or upset.
Red Flags--Five Years Old
Alert the child’s parents and pediatrician if a five-year-old child:
- Is extremely fearful, timid or aggressive.
- Cannot separate from her or his parents without major protest.
- Shows little interest in playing with other children or using fantasy or imitation in play
- Refuses to respond to people or responds only superficially.
- Cannot understand two-part commands using prepositions, such as “put the toy in the chest.”
- Is unable to concentrate on any single activity for more than five minutes.
- Seems unhappy, sad, or unusually passive much of the time or alternately, does not express a wide range of emotions.
- Does not use plurals or the past tense properly, correctly give his or her first and last name, or talk about daily activities and experiences.
- Cannot build a tower of six to eight blocks, hold a crayon comfortably, undress, brush her teeth, or wash and dry his hands.
- Cannot differentiate between fantasy and reality.
In addition, slipping backwards in almost any area is of major concern. Loss of language skills and/or social skills at any age is a significant red flag and children who are no longer able to communicate or interact socially at levels they once could should be evaluated immediately by a health professional. An important note: children may exhibit regressive behavior due to upheaval in their lives, such as divorce, separation, illness, or death. Also, regressive behavior may occur in children who are abuse or neglected.
The ages provided are rough guidelines, and children who exhibit these signs are not necessarily delayed or guaranteed to have physical or emotional problems later in life. However, observation of any of these signs calls for evaluation by qualified medical professionals and continued observation and support.
Scott G. Allen
Illinois Chapter, American Academy of Pediatrics
INTERNET RESOURCES
The National Child Care Information Center includes the complete manual Quality Care for Infants and Toddlers from the Zero to Three National Center for Infants and Toddlers. Appendix C of this manual features specific developmental milestones for children from birth to age three. www.nccic.org
The Public Broadcasting System’s program The Whole Child features a section called The ABC’s of Child Development, which provides developmental milestones organized by physical development, social and emotional development, thinking skills, and communication skills. www.pbs.org/wholechild
The National Association for the Education of Young Children (NAEYC) website offers many resources related to developmentally-appropriate practice, including the position statement “Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth through Age 8.” www.naeyc.org
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