Developmental Red Flags

1. See Also
   1. Language Milestone Red Flags
   2. Muscle Weakness in Children (Pediatric Neuromuscular Disorders)
2. Red Flags: Birth to three month
   1. Rolling prior to 3 months
      1. Evaluate for hypertonia
   2. Persistent fisting at 3 months
      1. Evaluate for neuromotor dysfunction
   3. Failure to alert to environmental stimuli
      1. Evaluate for sensory Impairment
3. Red Flags: 4 to 6 months
   1. Poor head control
      1. Evaluate for hypotonia
   2. Failure to reach for objects by 5 months
      1. Evaluate for motor, visual or cognitive deficits
   3. Absent Smile
      1. Evaluate for visual loss
      2. Evaluate for attachment problems
      3. Evaluate maternal Major Depression
      4. Consider Child Abuse or child neglect in severe cases
4. Red Flags: 6 to 12 months
   1. Persistence of primitive reflexes after 6 months
      1. Evaluate for neuromuscular disorder
   2. Absent babbling by 6 months
      1. Evaluate for Hearing Deficit
   3. Absent stranger anxiety by 7 months
      1. May be related to multiple care providers
   4. W-sitting and bunny hopping at 7 months
      1. Evaluate for adductor spasticity or hypotonia
   5. Inability to localize sound by 10 months
      1. Evaluate for unilateral Hearing Loss
   6. Persistent mouthing of objects at 12 months
      1. May indicate lack of intellectual curiosity
5. Red Flags: 12 to 24 months
   1. Lack of consonant production by 15 months
      1. Evaluate for Mild Hearing Loss
   2. Lack of imitation by 16 months
      1. Evaluate for Hearing Deficit
      2. Evaluate for cognitive or socialization deficit
   3. Lack of protodeclarative pointing by 18 months
      1. Problem in social relatedness
   4. Hand dominance prior to 18 months
      1. May indicate contralateral weakness with Hemiparesis
   5. Inability to walk up and down stairs at 24 months
      1. May lack opportunity rather than motor deficit
   6. Persistent poor transitions in 21 to 24 months
      1. May indicate pervasive Developmental Disorder
   7. Advanced non-communicative speech (e.g. Echolalia)
      1. Simple commands not understood suggests abnormality
      2. Evaluate for Autism
      3. Evaluate for pervasive Developmental Disorder
   8. Delayed Language Development
      1. Requires Hearing Loss Evaluation in all children
6. Management: Immediate speech therapy evaluation indications
   1. See Language Milestone Red Flags
7. Resources
   1. Georgetown Bright Futures Provider Guidelines
      1. http://www.brightfutures.org/bf2/pdf/index.html
8. References
   1. Frankenburg (1990) Denver II Developmental Screening
   2. Blondis (1999) Pediatr Clin North Am 46:899-913 [PubMed]