Occupational Therapy Red Flags
Birth- 2 years of age
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Not looking at caregivers face or making eye contact
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Not reaching or grasping for toys
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Not bringing toys to mouth
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No visual tracking (not watching people or toys move)
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Does not search for hidden objects (by 10-12 months)
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Not using gestures (waving, clapping, shaking head)
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Crawling in an abnormal pattern (army crawling, scooting, etc.)
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Showing a strong hand preference, lack of use of the other hand
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Not reaching across the center of the body
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Not feeding self (finger feeding or beginning of utensil use)
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No finger isolation while pointing (by 1 year)
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Not displaying “showing/sharing” behaviors (looking for affirmation or attention from caregivers)
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Poor self-soothing
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Unable to engage in cause/effect play
3- 5 years of age
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Not engaging in pretend play
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Still using a fisted grasp (whole hand grasp)
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Shows no hand preference
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Either always moving or always sedentary
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Difficulty expressing emotions
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Excessive drooling
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Extreme difficulty separating from caregivers
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Not engaging or playing with peers
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Cannot stack blocks into a tower
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Cannot ride a tricycle
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Resists dressing, using the toilet, sleeping
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Difficulty with transitions
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Throwing tantrums that are more significant in severity and duration than peers
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Overly sensitive or avoidant of grooming and bathing tasks (bathing, teeth brushing, hair brushing, haircuts, nail trimming, etc.)
6-8 years of age
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Falling behind academically
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Difficulty with sustaining attention at school or while completing homework
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Poor/messy handwriting
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Difficulty coloring within the lines
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Difficulty using scissors
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Poor organizational skills (forgetting to turn in homework, messy desks and/or backpack)
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Unable to tie shoes
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Unable to zipper, button or snap
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Unable to cut food with a knife and fork
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Needing assistance for dressing, grooming or bathing tasks
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Hyperactive
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Difficulty with making and sustaining friendships
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Not engaging in collaborative play with other
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Difficulty with sharing and taking turns
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Difficulty with following rules of sports games or board games
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Difficulty coping with losing games or competitions
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Difficulty with self-entertaining
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Unable to ride a 2-wheel bike
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Unable to ride a 2-wheel scooter
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Difficulty with jumping jacks, skipping, galloping, hopscotch
Speech Therapy Red Flags
Under 18 Months
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No big smiles or other warm, joyful expressions by 6 months
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No reaction to sound
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No imitation
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Limited use of gestures
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No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
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No babbling by 12 months
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Does not respond to name by 12 months
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No sharing/reciprocal interactions (pointing, sharing, reaching, waving) by 12 months
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No pointing at objects of interest by 14 months
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Does not understand simple common words like “mama” or “milk”
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Is not using any words by 16 months
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Does not imitate gross motor movements like clapping or stomping feet
By 18 Months
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Does not use at least 8-10 meaningful words
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Does not follow simple commands like “come here”, “stop”, “don’t”, “give me the ___”, or “touch your nose”
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Does not follow your pointing with gaze
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Is not playing “pretend” with items (talking on toy phone, feeding a doll)
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Does not play in proximity to other children
2 years old
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Minimal attempts to communicate with gestures or words
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No first words
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Difficulty following simple directions
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Inconsistent response to “no”
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No two-word meaningful phrases (without imitating or repeating)
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Speech is not at least 50% intelligible
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Cannot point to pictures of items in books when asked
3 years old
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Limited use of speech (not using 3-4 word sentences)
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Speech is not at least 75% or greater intelligible
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Limited understanding of simple questions
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Difficulty naming objects
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Frustration related to communication
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Leaving the beginnings or ends of most words
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Cannot accurately answer yes/no questions
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Cannot answer simple “Wh” questions like “who is that?” or “where is the truck?”
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Does not play with other children
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Is experiencing stutter behavior for more than 6 months
4-5 years old
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Is not 90-100% intelligible to strangers despite age-appropriate articulation errors (may not be able to say r, sh, ch, l, or th yet)
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Is not consistently using 4+ word complex sentences
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Is not asking a variety of questions to gain information (who, what, where, why, and when)
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Is having difficulty with grammar or pronoun use
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Takes a long time to understand others
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Cannot tell a simple story on topic
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Cannot follow simple two step directions
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Has difficulty answering simple who, what, where, and why questions
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Is not yet able to name a few letters, numbers, and rhyming words
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Difficulty with peer interactions
School Age
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Difficulty with reading, writing, or math
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Difficulty following directions or repeating sentences
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Uses sentences with grammatical errors and/or limited vocabulary
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Difficulty with social interactions
Physical Therapy Red Flags
0-5 months:
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Limitations in neck range of motion
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Always looking to 1 side/difficulty looking towards 1 side
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Head tilted to one side
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Unable to look up when on his/her belly
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Tries to push up on arms when on belly
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Little to no movement of arms and legs when excited
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Unable to open/close fists
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Decreased use of 1 side of his/her body
6 months
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Not rolling back to belly or belly to back
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Not reaching for toys
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Not bearing weight through legs when supported
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Very stiff or tight muscles, resistant to movement
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Appears “floppy” with low muscle tone, poor head control
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When laying on back, unable to grab feet with both hands
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Decreased use of 1 side of his/her body
9 months
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Not bearing weight through legs when supported
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Cannot sit independently, poor control in trunk with sitting
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Poor use of arms when independently sitting
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Not crawling or not pushing up onto all 4’s
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Abnormal crawling, such as scooting on bottom
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Decreased use of 1 side of his/her body
12 months
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Cannot sit independently
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Not pulling to stand
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Pulling into standing through use of stiff legs and pointed toes
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Needs hands to maintain sitting balance
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Not cruising the furniture
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Not crawling
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Decreased use of 1 side of his/her body
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Walking on toes only
15 months
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Not yet standing
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Not yet walking
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Not attempting to crawl up stairs
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Unable to squat and pick up toy and return to stand
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Consistently walking on toes
24 months
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Difficulty walking or walking on toes
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Consistent falling/unsteadiness
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Does not attempt to run
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Difficulty climbing/crawling on furniture
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Not attempting to crawl up stairs or go up stairs with hand held
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Difficulty keeping up with peers
2-3 years old
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Difficulty walking
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Difficulty running
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Cannot jump off small step
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Consistent falling/unsteadiness
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Difficulty with stair negotiation skills
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Requires help/support on stairs
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Unable to maintain balance when attempting ball skills
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Difficulty keeping up with peers
4 years old
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Unable to stand on 1 leg for brief 1-2 seconds
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Unable to jump in place/jump forward
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Unable to kick a ball about 5 feet forward
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Unable to catch a ball thrown to them
5-6 years old
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Unable to skip or gallop following demonstration
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Unable to stand on 1 leg for >10 seconds
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Unable to catch a small ball with hands only
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Unable to perform a jumping jack
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Slumped over when sitting, difficulty sitting in chair
General
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Widespread pain or general pain
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Specific joint pain
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Limping consistently
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Generally clumsy/uncoordinated
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Falling or getting hurt more often than peers
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Loss of skills previously gained