31 Jan 2014
January 31, 2014

Should I Be Worried?

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“Red Flags” That Warrant a Speech, Physical, and/or Occupational Therapy Evaluation

Gross Motor: If a child is…
  • Not rolling by 7 months
  • Not pushing up on straight arms, lifting his head and shoulders, by 8 months
  • Not sitting independently by 10 months
  • Not ”commando” crawling (moving across the floor on his belly) by 10 months Not crawling on all fours by 12 months
  • Not sitting upright in a child-sized chair by 12 months
  • Not pulling to stand by 12 months
  • Not standing alone by 14 months
  • Not walking by 18 months
  • Not jumping by 30 months
  • Not independent on stairs (up and down) by 30 months
  • Only walking on their toes, not the soles of their feet
  • Frequently falling/tripping, for no apparent reason
Fine Motor: If a child is…
  • Frequently in a fisted position with both hands after 6 months
  • Not bringing both hands to midline (center of body) by 10 months
  • Not banging objects together by 10 months
  • Not clapping their hands by 12 months
  • Not deliberately and immediately releasing objects by 12 months
  • Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months
  • Still using a fisted grasp to hold a crayon at 18 months
  • Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months
  • Not imitating a drawing of a vertical line by 24 months
  • Not able to snip with scissors by 30 months
  • Using only one hand to complete tasks
  • Not being able to move/open one hand/arm
  • Drooling during small tasks that require intense concentration
  • Displaying uncoordinated or jerky movements when doing activities
Sensory: If a child is…
  • Very busy, always on the go, and has a very short attention to task most of the time
  • Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)
  • A very picky eater (eats less than 10 foods)
  • Not aware of when he/she gets hurt (no crying, startle, or reaction to injury)
  • Afraid of swinging/movement activities; does not like to be picked up or be upside down
  • Showing difficulty learning new activities (motor planning)
  • Having a hard time calming themselves down appropriately
  • Appearing to be constantly moving around, even while sitting
  • Showing poor or no eye contact
  • Frequently jumping and/or purposely falling to the floor/crashing into things
  • Seeking opportunities to fall without regard to his/her safety or that of others
  • Constantly touching everything they see, including other children
  • Hypotonic (floppy body, like a wet noodle)
  • Having a difficult time with transitions between activity or location
  • Overly upset with change in routine
  • Resistant to bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.
  • Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.
  • Easily upset given change or transitions from activity to activity

NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Self-Care: If a child is…
  • Not feeding him/herself finger foods by 14 months
  • Not attempting to use a spoon by 15 months
  • Not picking up and drinking from a regular open cup by 15 months
  • Not able to pull off hat, socks or mittens on request by 15 months
  • Not attempting to wash own hands or face by 19 months
  • Not assisting with dressing tasks (excluding clothes fasteners) by 22 months
  • Not able to deliberately undo large buttons, snaps and shoelaces by 34 months
Communication/Play Skills: If a child is…
  • Having difficulty making and maintaining eye contact with an adult by 6 months
  • Not exhibiting the back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
  • Not performing for social attention by 12 months
  • Not babbling by 12 months
  • Not exhibiting back-and-forth gestures, such as, pointing, showing, reaching, or waving by 12 months
  • Not consistently responding to his name by 12 months
  • Not using words by 16 months
  • Not following simple and familiar directions by 18 months
  • Not using two-word meaningful phrases & saying at least 50 words by 24 months 
  • Not imitating actions and movements by the age of 24 months
  • Not engaging in pretend play by the age of 24 months
  • Not demonstrating appropriate play with an object
  • Not able to have back-and-forth conversational turn-taking by 30 months
  • Demonstrating a loss of speech, babbling, or social skills (like eye contact) at any age
  • Exhibiting speech that very difficult to understand by people outside of the family at age 3 (speech should be understood at least 75% of the time)
  • Exhibiting sound or word repetitions (i.e., stuttering) more than once every 4 sentences with accompanying frustration and avoidance of speaking tasks.

The presence of any of these concerns in the above sections warrants an immediate discussion with your pediatrician and insistence for a referral to an early intervention program and/or speech-language pathologist, occupational therapist, or physical therapist for a complete evaluation of your child’s skills.

It is important to note that children who are developing typically often exceed these milestones by several months. Your child should meet milestones by the guidelines listed as this list accounts for developmental ranges/differences.


CAPTA Pediatric Therapists

Physical Therapy: Dr. Kristen McDermaid, DPT
Occupational Therapy: Ronel Claassens OTR/L
Speech/Language Therapy: Ericka Shuptar MS, CCC-SLP