Red flags in child development

Children develop at different rates, with skills emerging at advanced rates, normal rates, or below age expectation. Often, parents gage a child’s progress by comparing him to other children his age or reflecting on how older siblings developed. Developmental delays can go unrecognized and untreated until a child experiences initial exposure to a structured group play environment, such as mommy and me classes, day care centers, baby gym centers, and pre-school programs.

During a routine check-up, your child’s pediatrician will do a general developmental overview, asking you about what milestones your child is achieving, but this is usually a brief question-and-answer between parent and physician. Typically, your doctor has an overflowing schedule that hinders her ability to thoroughly address your child’s progress through each of the five developmental domains (Cognition, Communication, Socialization, Motor Skills, Adaptive Behavior skills). As the parent, you are the constant observer and the best advocate for your child.

From the moment your child is born, his progression through each of the five developmental domains begins. One might ask, but how can an infant communicate? What motor skills would one expect for a child who can’t even walk yet? Assessment tools, such as the Developmental Assessment of Young Children, are used for children from birth to age 5, with other versions addressing the milestones of older children. Developmental milestones focus on what a child can do by a certain age. Red flags can warn parents and caregivers of potential delays and disabilities. So, let’s test your knowledge on what is typical or atypical in child development.

• At what age do children typically put two words together?

Answer: 18 to 24 months

• What is the average attention span for a 3 year old?

Answer: About five minutes

• At what age should children be able to pronounce most speech sounds correctly?

Answer: 5 years old

• What is the average age that a child walks?

Answer: 12 to 18 months

• At what age does a child typically identify primary colors (red, blue, yellow)?

Answer: About 3 years old

What are some red flags we should be aware of during infancy, toddlerhood, and childhood?

By 7 months of age

• Seems physically stiff or floppy like a rag doll.

• Does not roll over in either direction.

• Has difficulty sitting up when assisted or holding head up while sitting.

• Does not bear weight on legs when helped to a standing position.

• When reaching, only uses one hand, or doesn’t reach at all, or has trouble bringing objects to mouth.

• Does not respond to sounds or his name.

• Does not make laughing, babbling, or squealing sounds.

By 12 months of age

• Does not crawl, or drags one side of the body while crawling.

• Cannot stand while supported.

• Does not point to objects or pictures.

• Says no single words.

• Does not use other gestures, such as waving or shaking head “no.”

Eighteen to 24 months

• Does not walk by 18 months, or walks only on his toes.

• Does not speak at least 15 words, and begins to use two word phrases (“Want cookie,” “Give me,” “Mommy up!”)

• Does not use common objects as designed (telephone, hairbrush, utensils, etc.)

• Does not imitate actions or words, or does not follow simple instructions.

• Cannot push a wheeled toy or carry a mid-sized toy while walking.

Three years

• Losses his balance frequently.

• Has difficulty running or stopping when running, needing to crash into furniture, a person, a wall, a door, or falling to the floor.

• Has a hard time going up and down the stairs while alternating feet.

• Cannot build a block tower with four blocks, doesn’t scribble or manipulate a small object.

• Unable to communicate in short phrases or understand instructions.

• Not interested in pretend play.

• Has extreme difficulty separating from parent.

Four years

• Cannot throw a ball, jump in place, jump down from a step, ride a tricycle with feet on the pedals, hold a crayon appropriately, or stack more than four blocks.

• Does not interact with children outside of the family, and tends to play on his own.

• Does not use more than three-word sentences to communicate wants and needs, and does not ask what, where, why, when, who, or how questions.

• Resists dressing tasks, toileting tasks, feeding himself, or sleeping well through the night in his own bed.

• Lashes out (hitting, kicking, screaming, spitting, damaging items) when upset, gets easily frustrated, and takes longer than three minutes to calm.

Five years

• Extremely fearful, timid, or aggressive.

• Continued difficulty in separating from parent.

• Shows little interest in the activities of other children and doesn’t engage in imaginary play.

• Does not respond to other people when they attempt to interact with him.

• Cannot follow a two-part command, such as “Please pick it up and put it in the garbage.”

• Unable to concentrate on a single activity for more than five minutes.

• Often seems sad or passive with a limited range of emotions.

• Doesn’t use plurals, unable to respond to questions about first and last name, or is unable to talk about experiences.

• Cannot build an eight-block tower, hold a crayon and draw a circle, undress (unfastening zippers and snaps), brush teeth, or wash and dry hands independently.

Keep in mind that these red flags are guidelines and are not intended to diagnose any disorder or disability, but should serve to cue parents and caregivers to have their child evaluated. Numerous research studies have concluded that developmental issues addressed as early as possible yield the most benefits.

According to the results of The Abecedarian Program headed by Dr. Craig Ramey, the earlier a problem is addressed, the more likely the child will make great improvement. As a child ages, the rate of improvement tends to slow down. Be aware of any loss of skills. Note any recent changes to your child’s life (new sibling, divorce, moving, etc.) and share that information with the professionals involved in your child’s care. The evaluation process can only be authorized by a primary care giver with the process costing you nothing but your time, and patience.

Dana J. Connelly holds dual master’s degrees in education and special education, and works as an educational evaluator for a New York-based agency. She specializes in applied behavior analysis, and is the proud single mother of a 5-year-old boy.