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Occupational Therapy Red Flags
Birth- 2 years of age
  • Not looking at caregivers face or making eye contact

  • Not reaching or grasping for toys

  • Not bringing toys to mouth

  • No visual tracking (not watching people or toys move)

  • Does not search for hidden objects (by 10-12 months)

  • Not using gestures (waving, clapping, shaking head)

  • Crawling in an abnormal pattern (army crawling, scooting, etc.)

  • Showing a strong hand preference, lack of use of the other hand

  • Not reaching across the center of the body

  • Not feeding self (finger feeding or beginning of utensil use)

  • No finger isolation while pointing (by 1 year)

  • Not displaying “showing/sharing” behaviors (looking for affirmation or attention from caregivers)

  • Poor self-soothing

  • Unable to engage in cause/effect play

3- 5 years of age
  • Not engaging in pretend play

  • Still using a fisted grasp (whole hand grasp)

  • Shows no hand preference

  • Either always moving or always sedentary

  • Difficulty expressing emotions

  • Excessive drooling

  • Extreme difficulty separating from caregivers

  • Not engaging or playing with peers

  • Cannot stack blocks into a tower

  • Cannot ride a tricycle

  • Resists dressing, using the toilet, sleeping

  • Difficulty with transitions

  • Throwing tantrums that are more significant in severity and duration than peers

  • Overly sensitive or avoidant of grooming and bathing tasks (bathing, teeth brushing, hair brushing, haircuts, nail trimming, etc.)

6-8 years of age
  • Falling behind academically

  • Difficulty with sustaining attention at school or while completing homework

  • Poor/messy handwriting

  • Difficulty coloring within the lines

  • Difficulty using scissors

  • Poor organizational skills (forgetting to turn in homework, messy desks and/or backpack)

  • Unable to tie shoes

  • Unable to zipper, button or snap

  • Unable to cut food with a knife and fork

  • Needing assistance for dressing, grooming or bathing tasks 

  • Hyperactive

  • Difficulty with making and sustaining friendships

  • Not engaging in collaborative play with other

  • Difficulty with sharing and taking turns

  • Difficulty with following rules of sports games or board games

  • Difficulty coping with losing games or competitions 

  • Difficulty with self-entertaining

  • Unable to ride a 2-wheel bike 

  • Unable to ride a 2-wheel scooter 

  • Difficulty with jumping jacks, skipping, galloping, hopscotch

Speech Therapy Red Flags
Under 18 Months
  • No big smiles or other warm, joyful expressions by 6 months

  • No reaction to sound

  • No imitation

  • Limited use of gestures

  • No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months

  • No babbling by 12 months

  • Does not respond to name by 12 months

  • No sharing/reciprocal interactions (pointing, sharing, reaching, waving) by 12 months

  • No pointing at objects of interest by 14 months

  • Does not understand simple common words like “mama” or “milk”

  • Is not using any words by 16 months

  • Does not imitate gross motor movements like clapping or stomping feet

By 18 Months
  • Does not use at least 8-10 meaningful words

  • Does not follow simple commands like “come here”, “stop”, “don’t”, “give me the ___”, or “touch your nose”

  • Does not follow your pointing with gaze

  • Is not playing “pretend” with items (talking on toy phone, feeding a doll)

  • Does not play in proximity to other children

2 years old
  • Minimal attempts to communicate with gestures or words

  • No first words

  • Difficulty following simple directions

  • Inconsistent response to “no”

  • No two-word meaningful phrases (without imitating or repeating)

  • Speech is not at least 50% intelligible

  • Cannot point to pictures of items in books when asked

3 years old
  • Limited use of speech (not using 3-4 word sentences)

  • Speech is not at least 75% or greater intelligible

  • Limited understanding of simple questions

  • Difficulty naming objects

  • Frustration related to communication

  • Leaving the beginnings or ends of most words

  • Cannot accurately answer yes/no questions

  • Cannot answer simple “Wh” questions like “who is that?” or “where is the truck?”

  • Does not play with other children

  • Is experiencing stutter behavior for more than 6 months

4-5 years old
  • 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)

  • Is not consistently using 4+ word complex sentences

  • Is not asking a variety of questions to gain information (who, what, where, why, and when)

  • Is having difficulty with grammar or pronoun use

  • Takes a long time to understand others

  • Cannot tell a simple story on topic

  • Cannot follow simple two step directions

  • Has difficulty answering simple who, what, where, and why questions

  • Is not yet able to name a few letters, numbers, and rhyming words

  • Difficulty with peer interactions

School Age 
  • Difficulty with reading, writing, or math

  • Difficulty following directions or repeating sentences

  • Uses sentences with grammatical errors and/or limited vocabulary

  • Difficulty with social interactions

Physical Therapy Red Flags
0-5 months:
  • Limitations in neck range of motion

  • Always looking to 1 side/difficulty looking towards 1 side 

  • Head tilted to one side

  • Unable to look up when on his/her belly 

  • Tries to push up on arms when on belly 

  • Little to no movement of arms and legs when excited

  • Unable to open/close fists 

  • Decreased use of 1 side of his/her body


6 months
  • Not rolling back to belly or belly to back 

  • Not reaching for toys 

  • Not bearing weight through legs when supported

  • Very stiff or tight muscles, resistant to movement

  • Appears “floppy” with low muscle tone, poor head control 

  • When laying on back, unable to grab feet with both hands 

  • Decreased use of 1 side of his/her body


9 months
  • Not bearing weight through legs when supported

  • Cannot sit independently, poor control in trunk with sitting 

  • Poor use of arms when independently sitting

  • Not crawling or not pushing up onto all 4’s 

  • Abnormal crawling, such as scooting on bottom 

  • Decreased use of 1 side of his/her body


12 months
  • Cannot sit independently 

  • Not pulling to stand 

  • Pulling into standing through use of stiff legs and pointed toes 

  • Needs hands to maintain sitting balance 

  • Not cruising the furniture

  • Not crawling 

  • Decreased use of 1 side of his/her body

  • Walking on toes only 


15 months
  • Not yet standing

  • Not yet walking 

  • Not attempting to crawl up stairs 

  • Unable to squat and pick up toy and return to stand 

  • Consistently walking on toes 


24 months
  • Difficulty walking or walking on toes

  • Consistent falling/unsteadiness 

  • Does not attempt to run

  • Difficulty climbing/crawling on furniture

  • Not attempting to crawl up stairs or go up stairs with hand held 

  • Difficulty keeping up with peers 


2-3 years old
  • Difficulty walking

  • Difficulty running 

  • Cannot jump off small step 

  • Consistent falling/unsteadiness

  • Difficulty with stair negotiation skills

  • Requires help/support on stairs

  • Unable to maintain balance when attempting ball skills 

  • Difficulty keeping up with peers 


4 years old
  • Unable to stand on 1 leg for brief 1-2 seconds

  • Unable to jump in place/jump forward 

  • Unable to kick a ball about 5 feet forward

  • Unable to catch a ball thrown to them 


5-6 years old
  • Unable to skip or gallop following demonstration

  • Unable to stand on 1 leg for >10 seconds

  • Unable to catch a small ball with hands only 

  • Unable to perform a jumping jack 

  • Slumped over when sitting, difficulty sitting in chair 


  • Widespread pain or general pain 

  • Specific joint pain

  • Limping consistently

  • Generally clumsy/uncoordinated 

  • Falling or getting hurt more often than peers 

  • Loss of skills previously gained

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