Red Flags

Below you will find a list of milestones and red flags, adapted from a list that was written for the American Academy of Paediatrics by The Early Childhood Direction Center (Shelov, S.P., and Hannemann, R. E. 1994)

Please remember – this list is to be used as a guideline for you, as a parent, to make informed decisions. If you feel concerned that your child is delayed or is displaying any ‘red flag’ behaviours, please consult your nursing practitioner or doctor to discuss this.

How to use this list:

There is a range of time in which individual children could possible achieve a milestone – but the age in brackets at the end of each milestone serves as the ‘limit’ for typically developing children.

One – Three Months
Movement:

• Raises head and cheek when lying on stomach (3 mnths)
• Supports upper body with arms when lying on stomach (3 mnths)
• Stretches legs out when lying on stomach or back (2-3 mnths)
• Opens and shuts hands (2.5-3.5 mnths)
• Pushes down on legs when feet are placed on firm surface (3-4 mnths)

Visual:

• Watches a face intently (1.5-3 mnths)
• Follows moving objects (2 mnths)
• Recognises familiar objects and people at a distance (3 mnths)
• Starts using hands and eyes in coordination (3-4 mnths)

Hearing and Speech

• Smiles at the sound of a voice (1.5-3 mnths)
• Cooing noises; vocal play begins at 3 months
• Attends to sound (1-3 mnths)
• Startles to loud noise (1-3 mnths)

Social and Emotional

• Begins to develop a social smile (1.5-2.5 mnths)
• Enjoys playing with other people and may cry when playing stops (3-4 mnths)
• Becomes more communicative and expressive with face and body (2-3 mnths)
• Imitates some movements and facial expressions (3 mnths)

Developmental Red Flags (One – Three Months)

• Doesn’t seem to respond to loud noises
• Doesn’t follow moving objects with eyes by 2 months
• Doesn’t smile at the sound of your voice by 2 months
• Doesn’t grasp and hold objects by 4 months
• Doesn’t smile at people by 3 months
• Cannot support his head well at 3 months
• Doesn’t reach for and grasp toys by 4 – 5 months
• Doesn’t bring objects to her mouth by 4 months
• Doesn’t push down with legs when his feet are placed on a firm surface by 4 months
• Has trouble moving one or both eyes in all directions
• Crosses her eyes most of the time (occasional crossing of the eyes is normal in these first months)

Four – Seven Months
Movement

• Pushes up on extended arms (5-6 mnths)
• Pulls to sitting position with no head lag (5 mnths)
• Sits with support of his hands (5-7 mnths)
• Sits unsupported for short periods (7-9 mnths)
• Supports his/her whole weight on his/her legs (6-8 mnths)
• Grasps feet (6 mnths)
• Transfers objects from hand to hand (6-7 mnths)
• Uses raking grasp (not pincer) (6 mnths)

Visual

• Looks for toy beyond tracking range (5-6 mnths)
• Tracks moving objects with ease (3-5 mnths)
• Grasps objects dangling in front of him (5-6 mnths)
• Looks for fallen toys (6-7 mnths)

Language

• Distinguishes emotions by tone of voice (3-6 mnths)
• Responds to sound by making sounds (4-6 mnths)
• Uses voice to express joy and displeasure (4-6 mnths)
• Syllable repetition begins (5-7 mnths)

Cognitive

• Finds partially hidden objects (6-7 mnths)
• Explores with hands and mouth (4-7 mnths)
• Works to get objects that are out of reach (5-7 mnths)

Social and Emotional

• Enjoys social play (3-6 mnths)
• Interested in mirror images (5-7 mnths)
• Responds to other people’s expression of emotion (3-6 mnths)

Developmental Red Flags (Four – Seven Months)

• Seems very stiff, tight muscles
• Seems very floppy, like a rag doll
• Head still flops back when body is pulled to sitting position (by 5 months still exhibits head lag)
• Shows no affection for the person who cares for him/her
• Doesn’t seem to enjoy being around people
• One or both eyes consistently turns in or out
• Persistent tearing, eye drainage or sensitivity to light
• Does not respond to sounds around him
• Has difficulty getting objects to her mouth
• Does not turn his head to locate sounds by 4 months
• Doesn’t roll over (stomach to back) by 6 months
• Cannot sit with help by 6 months (not by themselves)
• Does not laugh or make squealing sounds by 5 months
• Does not actively reach for objects by 6 months
• Does not follow objects with both eyes
• Does not bear some weight on legs by 5 months

Eight – Twelve Months
Movement

• Gets to sitting position without assistance (8-10 mnths)
• Crawls forward on belly (army crawl)
• Assumes hand and knee position
• Crawls on hands and knees or moves around in some way
• Gets from sitting to crawling or prone (lying on stomach) position (10-12 mnths)
• Pulls self up to standing position (9-11 mnths)
• Walks holding onto furniture (cruising) (10-12 mnths)
• Stands momentarily without support (11-12 mnths)
• May walk two or three steps without support (10-15 mnths)

Hand and Finger Skills

• Uses pincer grasp (9-12 mnths)
• Bangs two cubes/blocks together (9-12 mnths)
• Puts objects into container (10-12 mnths)
• Takes objects out of container (10-12 mnths)
• Pokes with index finger (9-12 mnths)
• Tries to imitate scribbling (12-14 mnths)

Cognitive

• Explores objects in many different ways (shaking, banging, throwing, dropping) (8-10 mnths)
• Finds hidden objects easily (10-12 mnths)
• Looks at correct picture when image is named (9-12 mnths)
• Imitates gestures (9-12 mnths)

Language

• Responds to simple verbal requests
• Responds to ‘no’ (10-12 mnths)
• Makes simple gestures such as shaking head for no (9-12 mnths)
• Babbles with inflection (7-9 mnths)
• Babbles ‘Dada’ and ‘Mama’ (8-10 mnths)
• Says ‘Dada’ and ‘Mama’ for specific person (11-12 mnths)
• Uses exclamations such as ‘Oh-Oh’ (11-12 mnths)

Social Emotional

• Is shy or cries with strangers (8-12 mnths)
• Cries when mother or father leaves (8-12 mnths)
• Enjoys imitating people in his play (10-12 mnths)
• Shows specific preferences for certain people and toys (8-12 mnths)
• Prefers mother and/or regular care provider over all others (8-12 mnths)
• Repeats sounds or gestures for attention (10-12 mnths)
• Finger Feeds himself (8-12 mnnths)
• Extends arms or leg to help when being dressed (11-12 mnths)

Developmental Red Flags (Eight – Twelve Months)

• Doesn’t crawl or move around over the floor in some way
• Drags one side of body while crawling (for over one month)
• Cannot stand when supported
• Doesn’t search for objects that are hidden (10-12 mnths)
• Doesn’t say single words at 12 months (Mama or Dada)
• Doesn’t learn to use gestures such as waving or shaking head
• Doesn’t sit steadily by 10 months
• Doesn’t show interest in ‘peek-a-boo’ or ‘patty cake’ by 8 months
• Doesn’t babble by 8 months
• Doesn’t babble ‘dada’ or ‘mama’ by 10 months

Twelve to Twenty-Four Months
Movement

• Walks alone (12-15 mnths)
• Pulls toys behind him while walking (13-16 mnths)
• Carries large toy or several toys while waking (13-16 mnths)
• Begins to run stiffly (16-18 mnths)
• Walks into a ball (18-24 mnths)
• Climbs onto and down from furniture unsupported (16-24 mnths)
• Walks up and down stairs holding onto support (18-24 mnths)

Hand and Finger Skills

• Scribbles spontaneously (14-16 mnths)
• Turns over container to pour out contents (12-18 mnths)
• Building Tower of four blocks or more (20-24 mnths)

Language

• Points to object or picture when it’s named for him (18-24 mnths)
• Recognises names of familiar people, objects and body parts (15-24 mnths)
• Says several single words (15-18 mnths)
• Uses two word sentences (18-24 mnths)
• Follows simple one-step instructions (12-18 mnths)
• Repeats words overheard in conversations (16-18 mnths)

Cognitive

• Finds objects even when hidden under 2 or 3 covers
• Begins to sort shapes and colours (20-24 mnths)
• Begins make-believe play (20-24 mnths)

Social

• Imitates behaviour or others, especially adults and older children (12-24 mnths)
• Increasingly enthusiastic about company or other children (20-24 mnths)
• Demonstrates increasing independence (18-24 mnths)
• Begins to show defiant behaviour (18-24 mnths)
• Episodes of separation anxiety increase toward midyear and then fade

Developmental Red Flags (Twelve – Twenty-four Months)

• Cannot walk by 15-18 months
• Fails to develop a mature heel-toe walking pattern after several months of waking, or walks exclusively on his toes
• Does not speak at least 10 words by 18 months
• Does not use 50 words and put together two word sentences by the age of two
• By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
• Does not imitate actions, speech sounds or words
  Does not follow simple two-step instructions by 24 months

Twenty-four to Thirty-six Months
Movement

• Climbs well (24-30 mnths)
• Walks down stairs alone, placing both feet on each step (26-28 mnths)
• Walks up stairs alternating feet with support (24-30 mnths)
• Swings leg to kick ball (24-30 mnths)
• Runs easily (24-26 mnths)
• Pedals tricycle (30-36 mnths)
• Bends over easily without falling (24-30 mnths)

Hand and Finger Skills

• Makes vertical, horizontal and circular strokes with pencil or crayon (30-36 mnths)
• Turns book pages one at a time (24-36 mnths)
• Builds a tower of more than six blocks (24-30 mnths)
• Holds a pencil in writing position with fingers (30-36 mnths)
• Screws and unscrews jar lids, nuts and bolts (24-30 mnths)
• Turns rotating handles (24-30 mnths)

Language

• Recognises and identifies almost all common objects and pictures (26-32 mnths)
• Understands most sentences (24-40 mnths)
• Understands physical relationships – on, in, under (30-36 mnths)
• Can say name, age and sex (30-36 mnths)
• Uses pronouns – I, you, me, we, they (24-30 mnths)
• Strangers can understand half of what he says (24 mnths)

Cognitive

• Makes mechanical toys work (30-36 mnths)
• Matches an object in his hand or room to a picture in a book (24-30 mnths)
• Plays make-believe with dolls, animals and people (24-36 mnths)
• Sorts objects by colour (30-36 mnths)
• Completes puzzles with 3 or 4 pieces (24-36 mnths)
• Understands the concept of ‘two’ (26-32 mnths)

Social and Emotional

• By Three, separates easily from parents
• Expresses a wide range of emotions (24-36 mnths)
• Objects to major changes in routine (24-36 mnths)

Developmental Red Flags (Twenty-four to Thirty-six Months)

• Frequent falling and difficulty with stairs
• Persistent drooling or very unclear speech
• Inability to build a tower of more than four blocks by 24 months
• Difficulty manipulating small objects
• Inability to copy a circle by three
• Inability to communicate in short phrases
• No involvement in pretend play
• Failure to understand simple instructions
• Little interest in other children
• Extreme difficulty in separating from primary care giver

Three to Four Years
Movement (by the end of age 3)

• Hops and stands on one foot for up to 5 seconds
• Goes up stairs and down stairs without support
• Kicks ball forward
• Throws ball overhead
• Catches bounced ball most of the time
• Moves forward and backward
• Uses riding toys

Hand and Finger Skills (by the end of age 3)

• Copies square shapes
• Draws a person with 2 or 4 body parts
• Uses scissors
• Draws circles and squares
• Beings to copy some capital letters
• Can feed self with spoon by 36 months

Language Milestones (by the end of age 3)

• Has mastered some basic rules of grammar
• Speaks in sentences of 4 to 5 words
• Asks questions
• Speaks clearly enough for strangers to understand
• Tells stories

Cognitive Milestones (by the end of age 3)

• Correctly names some colours
• Understands the concept of counting and may know a few numbers
• Begins to have a clearer sense of time
• Follows three-part commands
• Recalls parts of a story
• Understands the concepts of ‘same’ and ‘different’
• Engages in fantasy play
• Understands causality (I can make things happen)

Social Milestones (by the end of age 3)

• Interested in new experiences
• Cooperates/plays with other children
• Plays ‘mom’ or ‘dad’
• More inventive in fantasy play
• Dresses and undresses
• More independent

Emotional Milestones (by the end of age 3)

• Often cannot distinguish between fantasy and reality
• May have imaginary friends or see monsters

Developmental Red Flags (Three to Four Years)

• Cannot jump in place
• Cannot ride a tricycle
• Cannot grasp a crayon between thumb and fingers
• Has difficulty scribbling
• Cannot copy a circle
• Cannot stack six or more blocks
• Still clings or cries when parents leave him
• Shows no interest in interactive games
• Ignores other children
• Doesn’t respond to people outside the family
• Doesn’t engage in fantasy play
• Resists dressing, sleeping, using the toilet
• Lashes out without any self-control when angry or upset
• Doesn’t use sentences of more than three words
• Doesn’t use ‘me’ or ‘you’ appropriately

Four to Five Years
Movement (by the end of age 4)

• Stands on one foot for 10 seconds or longer
• Hops, somersaults
• Swings, climbs
• May be able to skip

Hand and Finger Skills (by the end of age 4)

• Copies triangle and other geometric patterns
• Draws person with a body
• Prints some letters
• Dresses and undresses without assistance
• Uses fork and spoon with confidence
• Usually cares for own toilet needs

Language Milestones (by the end of age 4)

• Recalls parts of a story
• Speaks sentences of more than 5 words
• Uses future tense
• Tells longer stories
• Says name and address

Cognitive Milestones (by the end of age 4)

• Can count 10 or more objects
• Correctly names at least 4 colours
• Better understands the concept of time
• Knows about things used everyday in the home (money, food etc)

Social Milestones (by the end of age 4)

• Wants to please and be with friends
• More likely to agree to rules
• Likes to sing, dance and act
• Shows more independence

Developmental Red Flags (Four to Five Years)

• Exhibits extremely aggressive, fearful or timid behaviour
• Is unable to separate from parents
• Is easily distracted and unable to concentrate on any single activity for more than 10 minutes
• Shows little interest in playing with other children
• Refuses to respond to people in general
• Rarely uses fantasy or imitation play
• Seems unhappy or sad much of the time
• Avoids or seems aloof with other children or adults
• Doesn’t express a wide range of emotions
• Has trouble eating, sleeping and using the toilet
• Can’t differentiate between fantasy and reality
• Seems unusually passive
• Cannot understand two-part commands and prepositions – put the cup ‘on’ the table, get the ball ‘under’ the couch
• Can’t give his first and last name
• Doesn’t use plurals or past tense
• Cannot build a tower of 6-8 blocks
• Seems uncomfortable holding a crayon or presses down too hard or too lightly
• Has trouble taking off clothing
• Cannot brush his teeth or wash and dry his hands