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Developmental Red Flags

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
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
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
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
Immediate speech therapy evaluation indications
1. No babbling by 12 months
2. No pointing or gestures by 12 months
3. No single words by 16 months
4. No 2-word spontaneous phrases by 24 months
5. Speech not understandable by 24 months
6. Regression of skills at any age
  1. Loss of language or babbling
  2. Loss of social skills
Resources
1. Georgetown Bright Futures Provider Guidelines
  1. http://www.brightfutures.org/bf2/pdf/index.html
References
1. Frankenburg (1990) Denver II Developmental Screening
2. Blondis (1999) Pediatr Clin North Am 46:899

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.