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Thursday, July 29, 2010

Developmental "Red Flags"

By Dr. Kurt Klinepeter, Brenner Children’s Hospital
Developmental and Behavioral Pediatrician

Many parents worry at some point whether their child is developing normally and when they should be concerned about sitting up, walking, talking and interacting with others. It is commonly stated that children, and particularly siblings, should not be compared to each other. However, because children’s developmental skills develop in an orderly and predictable manner, it is quite possible and appropriate to compare children to the skill set they should have at any age and to be aware of developmental “red flags”.

Gross or large motor skills are the primary developmental skills in the first 12-18 months of life. Even newborn infants should demonstrate some head control. The 5-6 month old is holding his or her head up, popping up on his or her arms in prone position, and starting to sit with support. By 8-10 months of age, infants should be sitting independently and developing mobility (scooting, crawling). They are usually pulling up by at least 12 months of age and walking with, and then without, support a few months afterwards. Muscle tightness, weakness, or any unusual movements are a developmental red flag. The rate of motor progress can vary, but the key is steady progress over time.

Infants develop reaching, grasping, and transferring skills by 8-10 months of age. Most are able to self feed by 12 months of age with further refinement of self-help skills thereafter. Most 2 years-olds help with dressing and bathing. The range of toilet training is 2 to 4 years of age. Toddlers know what to do with a crayon -- making a stroke by 2.5 years-old and a circle by 3 years-old. True handedness is not usually apparent until 3 years of age. Early handedness (right or left), particularly in the first year of life is a developmental red flag.

Babies are social and demonstrate responsiveness to others by 6-8 weeks of age. Their eyes track together by 3 months of age and they are able to localize to voice or environmental sounds by 8-10 months of age. Any failure to respond to visual stimuli by 3-6 months of age or auditory stimuli by 8-12 months of age is a developmental red flag.

Young babies produce vowel sounds and then babble (consonant-vowel sounds) beginning at 6-8 months of age. Failure to babble by 12 months of age is a concern. Single words occur at least by 12-18 months of age. Thereafter, speech/language development literally explodes. Typical two year-olds have a multiword vocabulary and are putting words together. No expressive language by 2 years of age is a developmental red flag. Even limited language should be noted by 2 years of age and closely tracked since speech/language delays are the most common developmental disorder in young children. Children should be talking in complete and lengthy sentences by 3 years of age and in paragraphs with the ability to relate a story by 4 years of age. Speech sound development is not complete until 6-7 years of age. This means that young children predictably mispronounce certain speech sounds. By 3 years of age, approximately 75% of speech production should be understood in a typically developing child. If you find that you are still “interpreting” for your child after that point, a speech/language evaluation may be needed.

Children will look at something that is pointed out to them by 15-18 months of age. Failure to seek, share, and be motivated by social interaction (wanting mom and dad’s attention) after 18 months of age is a developmental red flag.

The bottom line is that children grow and progress in a steady fashion within age appropriate ranges. Any loss of developmental skills at any age is a developmental red flag. Trust your instincts. As a parent you can best serve your child by fostering a good relationship with your child’s pediatrician or health care professional and discuss any questions or concerns that you have at your child’s well-check visits. Development is easily screened in the primary care office and, if necessary, you and the provider can discuss whether a referral for assessment is indicated. Developmental disorders occur frequently and it is well known that the key to the best possible outcome is to identify and treat as early as possible.

Brenner Children’s Hospital houses the only medical and developmental evaluation clinic in the region for developmental delays and disabilities. For more information, call 336-716-2255.


Emily Parker said...

Thank you for this consise list. I feel like I have been googling all over the place trying to find answers to a few of these milestone questions.

AMY said...

Thank you Brenner and TSP! You always come to my rescue when I need questions answered!

Kristie said...

It has been almost 8 years since our preemies were born and I cannot say enough about the information and care we have received from Dr. Klinepeter and his entire staff at Amos Cottage. Our triplets were sent to Amos Cottage to aid in research of the development of preemies. Once they turned 3, two of our children were developing normally and one of our sons was not. I do not know what we would have done without the wonderful early intervention Andrew received. I always had a gut feeling that something was not quite right. I kept researching and pushing for answers because I knew that early internvention was key. Andrew started in a half-day preschool program for speech/language delay. An occupational therapist came to his 'regular' preschool several times a week, we had an ISFP (Individualized Family Service Plan) and now, in a mainstream school, Andrew has an IEP (Individualized Education Plan) that will follow him all the way through high school graduation.

I did not know that all of this even existed free-of-charge (at least it was 8 years ago) for children that qualified for services. I would suggest to ANY mother or father that has a 'gut' feeling to go with it...embrace it and tackle will be challenging but it will be worth it for your child and your family in the long run.

Our family has learned how we can help Andrew with his ADHD and Aspergers - all through the knowledgeable people at Brenner's/WFU/Amos Cottage. We are now involved with ABC of NC (Deveoplental Agency in Winston-Salem) and Dr. Klinepeter is on the Board of Directors. It is another great resource and I can't say enough about the staff there either.

If any of you out there need someone to talk to about any of this, I feel like I have 'been there, done that' and would love to help you in any way that I can!

Kristie Touchstone

Rachel H said...

Thank you, Kristie! You are always so helpful!

Anonymous said...

I adopted my daughter in the spring and have been so concerned about her developmental progress. Thank you for the reassurance you gave me today. I also know a few things to look out for now!

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