Red flags in child development

As you watch your child grow, you are constantly on guard for red flags in child development. Is my child starting to talk when he/she is supposed to? Is my child crawling at the right age? When is my child supposed to start smiling?

All these questions race through your mind. You can’t help but run to the nearest bookstore, pick up all the baby books and start reading them cover-to-cover. While some books may provide some useful information, others simply use too much scientific jargon and you are left with the same feeling as you started.

Developmental Milestones

Experts created a simple, easy-to-read series of developmental guidelines, known as “developmental milestones.” You, as a parent, are encouraged to check what you observe in your baby against it. You can also most definitely use it to preview what you can look forward to in the months ahead.

From https://www.cdc.gov/ncbddd/actearly/index.html

The above image is an example of a ‘Developmental Milestone Chart’. There are more detailed ones out there but this one covers the main areas of development. It is easy to read and follow.

Not reaching these milestones, or reaching them much later than other children, could be a sign of a developmental delay. Therefore, it is helpful to be aware of these signs or ‘red flags’ for potential developmental delays in children. Children can show signs of delays in different aspects of their development.

For example, delay could be in their language skills or motor skills or even social skills. That is why to make it easier for parents, experts have divided ‘red flags’ into the following categories: Speech & Language, Motor Skills, Social/Emotional, and Cognition.

Speech and Language

Speech refers to verbal expression, including the way words are formed. Language, on the other hand, is a broader system of expressing and receiving information, such as being able to understand gestures.

Check the following signs of delay or red flags in child development, specifically in speech and language:

By 4 months, if your child:

• Does not respond to loud noises
• Does not babble

By 7 months, if your child:

• Does not respond to sounds

By 1 year, if your child:

• Does not use any single words (like “mama” or “dada”)

By 2 years, if your child:

• Cannot speak at least 15 words
• Does not use 2-word phrases without repetition (like “want cookie”);
• Can only imitate speech (but does not form own phrases)

By 3 years old, if your child:

• Cannot use at least 50 words
• Does not use simple sentence (e.g. Big car go)

By 5 years old, if your child:

• Cannot understand 2 part commands with prepositions (such as “under” or “on”)
• Cannot use plurals or past tense in the right way
• Cannot describe what they did that day

If your child shows more than 6 months delay in any of the aforementioned areas, you are recommended to consult a Speech & Language Pathologist for formal assessment. 

Motor Skills

Developmental delays in motor skills may be related with gross motor skills, such as crawling or walking, or fine motor skills, such as using fingers to grasp a spoon.

The following are red flags in child development, specifically in motor skills:

By 4 months, if your child:

• Does not reach for, grasp, or hold objects, or bring to mouth
• Does not support his or her head well

By 7 months, if your child:

• Has stiff and tight or very floppy muscles
• Flops his/ her head when pulled into a sitting position
• Doesn’t roll over in either direction
• Cannot sit up without help

By 1 year, if your child:

• Does not crawl
• Drags one side of his or her body while crawling
• Cannot stand when supported

By 2 years, if your child:

• Cannot walk or walks only on toes
• Cannot push a wheeled toy

By 5 years, if your child:

• Cannot kick or throw a ball
• Cannot pedal a tricycle
• Cannot brush their teeth
• Cannot take off their clothes easily

If your child shows more than 6 months delay in any of the aforementioned areas, you are recommended to consult an Occupational Therapist.

Social & Emotional

Children may experience problems interacting with adults or other children. This is called social and/or emotional developmental delay. Usually these difficulties show up before a child begins school.

The following are red flags in child development, specifically in social and emotional skills:

By 3 months, if your child:

• Does not smile at people
• Does not pay attention to new faces

By 7 months, if your child:

• Refuses to cuddle
• Shows no affection for parents or caregivers
• Shows no interest in games of peek-a-boo

By 1 year, if your child:

• Shows no back-and-forth sharing of sounds, smiles, or facial expressions
• Shows no back-and-forth gestures, such as waving, reaching, or pointing

By 3 years, if your child:

• Does not show interest in other children
• Does not maintain good eye contact

By 5 years, if your child

• Does not want to play with other children
• Cannot separate from parents easily
• Show limited emotional response

If your child shows more than 6-9 months delay in any of the aforementioned areas, you are recommended to consult a Developmental & Behavioral Pediatrician or an Early Intervention Therapist.

Cognition

Cognitive Delay is commonly defined as difficulty with thinking, such as logic, reasoning, problem solving, memory, etc.

Check for delays in cognition through the following:

By 1 year, if your child:

• Does not search for objects that are hidden while he or she watches
• Does not point to objects or pictures

By 2 years, if your child:

• Does not know the function of common objects, such as a hairbrush, telephone, or spoon
• Does not follow simple instructions
• Does not imitate actions or words

By 3 years, if your child:

• Does not join in “pretend” or “make-believe” play

By 5 years, if your child

• Cannot concentrate on one activity for at least 5 minutes
• Is easily distracted

If your child shows more than 6 months delay in any of the aforementioned areas, you are recommended to consult a Clinical Psychologist for formal assessment.