Red Flags - for children birth to six years - A quick reference guide for early years professionals
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Red Flags —
for children birth to six years
A quick reference guide for
early years professionals
Early Identification in
Leeds, Grenville & Lanark
Adapted November 2007
RED FLAGS: Table of Contents
Red Flags Introduction
• Red Flags Committee . ...........................................................................................1
• Early Identification...................................................................................................2
• What is “Red Flags”?.................................................................................................2
• Who Should Use “Red Flags”? .............................................................................2
• How to use this document....................................................................................2
• Sensitive Issues..........................................................................................................3
Duty to Report........................................................................................................................5-7
Growth & Development:
• Attachment.................................................................................................................8
• Fine Motor...................................................................................................................9
• Gross Motor............................................................................................................. 10
• Vision.......................................................................................................................... 11
• Hearing...................................................................................................................... 13
• Sensory...................................................................................................................... 14
• Speech & Language . ........................................................................................... 15
• Literacy & Numeracy ........................................................................................... 18
• Social/Emotional.................................................................................................... 20
• Behaviour................................................................................................................. 21
Nutrition & Oral Health:
• Nutrition................................................................................................................... 22
• Feeding & Swallowing......................................................................................... 24
• Dental........................................................................................................................ 25
Abuse:
• Witnessing Family Violence................................................................................ 26
• Physical...................................................................................................................... 28
• Sexual........................................................................................................................ 29
• Emotional................................................................................................................. 30
• Neglect...................................................................................................................... 31
Special Needs:
• Autism . .................................................................................................................... 32
• Fetal Alcohol Spectrum Disorder.................................................................... 33
• Learning Disabilities............................................................................................. 34
• Intellectual & Developmental Disabilities.................................................... 35
• Mild Traumatic Brain Injury............................................................................... 36
Other Factors:
• Family Environmental Stressors...................................................................... 37
• Postpartum Depression..................................................................................... 38
Getting Ready for Kindergarten....................................................................................... 39
Subsidy Information.............................................................................................................. 40
Where to Go for Help ........................................................................................................... 41
Disclaimer Notice Red Flags is a Quick Reference Guide designed to assist early years professionals in deciding whether to refer for additional services. It is not a formal screening or diagnostic tool. The information contained in “Red Flags for children, birth to six years” (this document) has been provided as a public service. Although every attempt has been made to ensure accuracy, no warranties or representations, expressed or implied, are made concerning the accuracy, reliability or completeness of the information contained in this document. The information in this document is provided on an “as is” basis without warranty or condition. This document cannot substitute for the advice and/or treatment of professionals trained to properly assess the development and progress of children, birth to six years. Although this document may be helpful to determine when to seek out advice and/or treatment, this document should not be used to diagnose or treat perceived developmental limitations and/ or other health care needs. This document also refers to websites and other documents that are created or operated by independent bodies. These references are provided as a public service and do not imply the investigation or verification of the websites or other documents. No warranties or representations, expressed or implied, are made concerning the products, services and information found on those websites or documents. This document is being provided for your personal non-commercial use. This document, or the information contained herein, shall not be modified, copied, distributed, reproduced, published, licensed, transferred or sold for a commercial purpose, in whole or in part, without the prior written consent of the Red Flags Committee, which consent may be withheld at the sole discretion of Red Flags Committee or be given subject to such terms and conditions as Red Flags Committee may, in its sole discretion, impose.
INTRODUCTION
INTRODUCTION TO RED FLAGS
RED FLAGS COMMITTEE Shannon Brown, Early Literacy Specialist,
Ontario Early Years Centre, United Counties of
The original Red Flags document was developed by
Leeds and Grenville
the Simcoe County Early Intervention Council and
Jill Brulé, Home Visiting Coordinator,
piloted in 2002. It was printed and disseminated Connections Program, Lanark
by the Healthy Babies Healthy Children program,
Rebecca Carnochan, Open Doors for Lanark
Simcoe County District Health Unit as Red Flags Children and Youth
- Let’s Grow With Your Child in March 2003. Emily Cassell, Data Analysis Coordinator, Lanark
Since that time York Region Early Identification Jessica Deschamp-Baird, Data Analysis
Planning Coalition and the Kingston, Frontenac and Coordinator, United Counties of Leeds and
Lennox & Addington Red Flags Committees have Grenville
reviewed and revised the original document. Darleen Desgens, Healthy Babies Healthy
Children Program Assistant, Leeds, Grenville
With permission of the Kingston, Frontenac and and Lanark District Health Unit
Lennox & Addington (KFLA) Red Flags Committee, Fiona Dufour, Public Health Nurse, Leeds,
the KFL&A Red Flags document was reviewed and Grenville and Lanark District Health Unit
revised by the School Readiness Sub-Committee of France Dupuis, Catholic District School Board of
the Healthy Babies Healthy Children Coalition of the Eastern Ontario
Leeds, Grenville and Lanark District Health Unit and Laurie Ann Glenn, Nurse Practitioner, Primary
other early years professionals who serve children in Health Care, North Lanark County Community
Health Center
Leeds, Grenville and Lanark. The School Readiness
Committee consists of members from: Jane Hess, Director of Family Health, Leeds,
Grenville and Lanark District Health Unit
Brockville and Area YMCA; Catholic District School Rebecca Langin, Administrative Coordinator,
Board of Eastern Ontario; Children’s Resource on The Language Express© Preschool Speech
Wheels; Connections Program; Developmental - Language Service System
Services of Leeds and Grenville-Inclusive Child Care Dixie O’Reilly, Infant & Child Development
Program; Healthy Babies Healthy Children Program; Program, Leeds and Grenville
Infant & Child Development Programs; Lanark Catherine Robinson, Clinical Coordinator, The
County Childcare Providers; Lanark Early Integration Language Express© Preschool Speech-Language
Service System
Program; Lanark Ontario Early Years Centres-Early
Rosemary Sheahan, Healthy Babies Healthy
Literacy Specialist and Data Analysis Coordinator;
Children Coordinator, Leeds Grenville and
Leeds, Grenville and Lanark District Health Unit; Lanark District Health Unit
North Lanark County Community Health Center; Oksana Shewchenko, Production Artist, Leeds
Open Doors for Lanark Children and Youth; The Grenville and Lanark District Health Unit
Language Express © Preschool Speech-Language Shona Stewart, Inclusive Child Care Program-
Service System; United Counties of Leeds and Developmental Services of Leeds and Grenville
Grenville-Ontario Early Years Centres, Early Literacy
Specialist and Data Analysis Coordinator; and the Funding:
Upper Canada District School Board.
Healthy Babies Healthy Children, Leeds, Grenville
and Lanark District Health Unit
Acknowledgments: In-Kind-Committee community partner agencies
The Leeds, Grenville and Lanark District Health Unit listed above
would like to acknowledge the following for their For further information, additional copies, to suggest
contributions to the resource: revisions to this document, or for information on
Angèle Blaskie, Lanark Early Integration sources used, please contact the Leeds, Grenville
Program and Lanark District Health Unit at 613-345-5685 or
Kathy Boelsma, Early Literacy Specialist, Lanark 1-800-660-5853 or forward an email to:
redflags@healthunit.org
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 1
INTRODUCTION
Early Identification How to use this document
Thanks to Dr. Fraser Mustard and other scientists, This is a quick reference to look at child
most professionals working with young children development by domain, reviewing each domain
are aware of the considerable evidence about from birth to six years (unlike screening tools
early brain development and how brief some that look at a particular child’s development
of the “windows of opportunity” are for optimal across many areas of development at a specific
development of neural pathways. The early years age). It includes other areas that may impact
of development from conception to age six, child health, growth and development due to
particularly for the first three years, set the base the dynamics of parent-child interaction, such as
for competence and coping skills that will affect postpartum depression, abuse, etc.
learning, behaviour and health throughout life 1.
Red Flags allows professionals to review and
It follows, then, that children who may need better understand domains on a continuum
additional services and supports to ensure that are traditionally outside their own area of
healthy development must be identified as expertise. This increased awareness will help
quickly as possible and referred to appropriate professionals better understand when and where
programs and services. Early intervention during to refer for further investigation or treatment.
the period of the greatest development of neural
Use Red Flags in conjunction with a screening
pathways, when alternative coping pathways
tool, such as Nipissing District Developmental
are most easily built, is critical to ensure the best
Screens or Ages Stages Questionnaire (ASQ) to
outcomes for the child. Time is of the essence!
review developmental milestones and problem
signs in a particular domain or indicator. Some
What is Red Flags? information is cross-referenced to other domains,
Red Flags is a quick reference guide for Early such as speech with hearing, to assist the
Years professionals. It can be used in conjunction screener in pursuing questions or ‘gut feelings’.
with a validated screening tool, such as Nipissing
If children are not exhibiting the milestones
District Developmental Screens (the Nipissing
for their age, further investigation is needed. If
Screen 2) or Ages and Stages Questionnaire
using Nipissing District Developmental Screens,
(ASQ). Red Flags outlines a range of functional
remember that the screening tools are age-
indicators or domains commonly used to
adjusted; therefore, the skills in each screen are
monitor healthy child development, as well as
potential problem areas for child development.
Footnotes
It is intended to assist in the determination of
1. Early Years Study: reversing the real brain drain, Hon.
when and where to refer for additional advice, Margaret McCain and Fraser Mustard, April, 1999. See report
formal assessment and/or treatment. at www.eldis.org/ .
2. Nipissing District Developmental Screens refer to 13
parent checklists available to assist parents to record and
Who should use Red Flags? monitor development of children from birth to age 6. The
screens cover development related to vision, hearing,
This quick reference guide is intended to be communication, gross and fine motor, social/emotional
used by any professional working with young and self-help and offers suggestions to parents for age
children and their families. A basic knowledge appropriate activities to enhance child development.
Parents are encouraged to call the Health Action Line of the
of healthy child development is assumed. Red Leeds, Grenville and Lanark District Health Unit at 1-800-660-
Flags will assist professionals in identifying when 5853 if two or more items are checked ‘No’. A public health
nurse will review the results of the screen and suggest next
a child could be at risk of not meeting his health steps. It is particularly important for a screen to be reviewed
and/or developmental milestones, triggering an by a professional if a problem is identified. For additional
information about Nipissing District Developmental Screens
alert for the need for further investigation by the or to obtain copies, visit the website at www.ndds.ca
appropriate discipline.
2 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007
INTRODUCTION
expected to be mastered by most children at Sensitive Issues
the age shown. If there are two or more “No”
One of the most difficult parts of recognizing
responses, refer to a professional for assessment.
a potential difficulty in a child’s development
Refer for further assessment even if you are is sharing these concerns with the parents/
uncertain if the flags noted are a reflection of a guardians. It is important to be sensitive when
cultural variation or a real concern. suggesting that there may be a reason to have
further assessment done. You want parents/
Note that some of the indicators focus on the
guardians to feel capable and to be empowered
parent/guardian, or the interaction between the
to make decisions. There is no one way that
parent and the child, rather than solely on the
always works best, but there are some things to
child.
keep in mind when addressing concerns.
Contact information is indicated at the end of
►► Be sensitive to a parent/guardian’s readiness
the document in the “Where to Go for Help”
for information. If you give too much
section.
information when people aren’t ready, they
If a child appears to have multiple domains may feel overwhelmed or inadequate. You
requiring formal investigation by several might start by probing how they feel their
disciplines, screeners are encouraged to refer to child is progressing. Some parents/guardians
the agencies that can coordinate a collaborative have concerns, but have not yet expressed
and comprehensive assessment process. them. Having a parent use a tool such as the
If referrals are made to private sector agencies, Nipissing District Developmental Screen may
alert families that fees will not be funded by help open the way for discussion. It may help
OHIP. to specify that the screening tool is given
to parents to help them look at their child’s
development more easily and to learn about
How to Use Red Flags new activities that encourage growth and
development.
Service providers may contact any agency
for general information. If a specific case ►► Be sure to value the parent’s/guardian’s
will be discussed, ensure consent to share knowledge. The ultimate decision about
information is obtained in accordance with what to do is theirs. Express what it is that
the Ontario Privacy of Personal Information you have to offer and what they have to offer
Act. as well. You may say something like: “I have
had training in child development, but you
Step 1: Identify area of concern. know your child. You are the expert on your
Step 2: Speak to parents about your child”. When you try to be more of a resource
concerns. than an “authority”, parents/guardians
feel less threatened. It is best to have the
Step 3: Call agency in the “Where to Go for
parents/guardians discover how their child is
Help” section for additional advice.
doing and decide whether or not extra help
Step 4: Encourage parents to call agency would be beneficial. You may want to offer
in the “Where to Go for Help” information you have by asking parents/
section to initiate a referral. guardians what they would like to know.
►► Have the family participate fully in the
final decision about what to do next. The
final decision is theirs. You provide only
information, support and guidance.
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 3
INTRODUCTION
►► Give the family time to talk about how they ►► Don’t entertain too many “what if” questions.
feel, if they choose to. If you have only a A helpful response could be, “Those are good
limited time to listen, make this clear to them, questions. The professionals who will assess
and offer another appointment if needed. your child will be able to answer them. This
is a first step to indicate if an assessment is
►► Be genuine and caring. You are raising
needed”.
concerns because you want their child to do
the best that he can, not because you want to ►► Finally, it is helpful to offer reasons why it is
point out “weaknesses” or “faults”. Approach not appropriate to “wait and see”:
the opportunity for extra help positively; “You
□□ Early intervention can dramatically
can get extra help for your child so he will be
improve a child’s development and prevent
as ready as he can be for school”. Also try to
additional concerns such as behaviour
balance the concerns you raise with genuine
issues.
positives about the child (e.g., Johnny is a real
delight. He is so helpful when things need □□ The wait and see approach may delay
tidying up. I have noticed that he seems to addressing a medical concern that has a
have some trouble . . .). specific treatment.
►► Your body language is important; parents may □□ Early intervention helps parents
already be fearful of the information. understand child behaviour and health
issues, which will increase confidence that
everything possible is being done to ensure
that the child reaches his full potential.
4 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007
DUTY TO REPORT
DUTY TO REPORT
Ontario’s Child and Family Services Act (CFSA) Child and Family Services Act
provides for a broad range of services for families CFSA s.72(1)
and children, including children who are or may Despite the provisions of any other Act, if a
be victims of child abuse or neglect. person, including a person who performs
►► The paramount purpose of the Act is to
professional or official duties with respect to
promote the best interests, protection and children, has reasonable grounds to suspect
well being of children. one of the following, the person shall forthwith
report the suspicion and the information on
►► The Act recognizes that each of us has a which it is based to a society.
responsibility for the welfare of children. It
states clearly that members of the public, The child has suffered physical harm, inflicted
including professionals who work with by the person having charge of the child or
children, have an obligation to report caused by or resulting from that person’s failure
promptly to a children’s aid society if they to adequately care for, provide for, supervise or
suspect that a child is or may be in need of protect the child, or pattern of neglect in caring
protection. for, providing for, supervising or protecting the
child.
►► The Act defines the term “child in need
of protection” and sets out what must be There is a risk that the child is likely to suffer
reported to a children’s aid society. This physical harm inflicted by the person having
definition (CFSA s.72(1)) is set out in detail charge of the child or caused by or resulting
on the following pages. It includes physical, from that person’s failure to adequately care for,
sexual and emotional abuse, neglect and risk provide for, supervising or protecting the child.
of harm. The child has been sexually molested or sexually
This section summarizes reporting exploited, by the person having charge of the
responsibilities under Ontario’s Child and Family child or by another person where the person
Services Act. It is not meant to give specific legal having charge of the child knows or should know
advice. If you have questions about a given of the possibility of sexual molestation or sexual
situation, you should consult a lawyer or your exploitation and fails to protect the child.
local children’s aid society. There is a risk that the child is likely to be sexually
molested or sexually exploited as described in
Duty to Report paragraph 3.
Responsibility to report a child in need The child requires medical treatment to cure,
of protection CFSAs.72(1) prevent or alleviate physical harm or suffering
If a person has reasonable grounds to suspect and the child’s parent or the person having
that a child is or may be in need of protection, charge of the child does not provide, or refuses
the person must promptly report the suspicion or is unavailable or unable to consent to, the
and the information upon which it is based to a treatment.
children’s aid society.
The child has suffered emotional harm,
The situations that must be reported are listed in demonstrated by serious
detail below. □□ anxiety,
□□ depression,
□□ withdrawal,
□□ self-destructive or aggressive behaviour, or
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 5
DUTY TO REPORT
□□ delayed development, serious damage to another person’s property,
□□ and there are reasonable grounds to services or treatments are necessary to prevent
believe that the emotional harm suffered a recurrence and the child’s parent or the person
by the child results from the actions, failure having charge of the child does not provide, or
to act or pattern of neglect on the part refuses or is unavailable or unable to consent to,
of the child’s parent or the person having those services or treatment.
charge of the child.
The child is less than 12 years old and has on
The child has suffered emotional harm of the more than one occasion injured another person
kind described in subparagraph i, ii, iii, iv or v of or caused loss or damage to another person’s
paragraph 6 and the child’s parent or the person property, with the encouragement of the person
having charge of the child does not provide, or having charge of the child or because of that
refuses or is unavailable or unable to consent to, person’s failure or inability to supervise the child
services or treatment to remedy or alleviate the adequately.
harm.
Ongoing duty to report
There is a risk that the child is likely to suffer
CFSA s.72(2)
emotional harm of the kind described in
subparagraph i, ii, iii, iv or v of paragraph 6 The duty to report is an ongoing obligation. If
resulting from the actions, failure to act or a person has made a previous report about a
pattern of neglect on the part of the child’s child, and has additional reasonable grounds
parent or the person having charge of the child. to suspect that a child is or may be in need of
protection, that person must make a further
There is a risk that the child is likely to suffer report to a children’s aid society.
emotional harm of the kind described in
subparagraph i, ii, iii, iv or v of paragraph 6 and Persons must report directly
that the child’s parent or the person having CFSA s.72(3)
charge of the child does not provide, or refuses The person who has the reasonable grounds
or is unavailable or unable to consent to, services to suspect that a child is or may be in need of
or treatment to prevent the harm. protection must make the report directly to a
The child suffers from a mental, emotional or children’s aid society. The person must not rely
developmental condition that, if not remedied, on anyone else to report on his or her behalf.
could seriously impair the child’s development
and the child’s parent or the person having What are “reasonable grounds to suspect?”
charge of the child does not provide, or refuses You do not need to be sure that a child is or
or is unavailable or unable to consent to, may be in need of protection to make a report
treatment to remedy or alleviate the condition. to a children’s aid society. “Reasonable grounds”
The child has been abandoned, the child’s parent are what an average person, given his or her
has died or is unavailable to exercise his or her training, background and experience, exercising
custodial rights over the child and has not made normal and honest judgment, would suspect.
adequate provision for the child’s care and
Special responsibilities of professionals and
custody, or the child is in a residential placement
officials, and penalty for failure to report
and the parent refuses or is unable or unwilling
CFSA s.72(4), (6.2)
to resume the child’s care and custody.
Professional persons and officials have the same
The child is less than 12 years old and has killed duty as any member of the public to report a
or seriously injured another person or caused suspicion that a child is in need of protection.
6 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007DUTY TO REPORT
The Act recognizes, however, that persons Professional confidentiality
working closely with children have a special CFSA s.72(7),(8)
awareness of the signs of child abuse and The professional’s duty to report overrides
neglect, and a particular responsibility to report the provisions of any other provincial statute,
their suspicions, and so makes it an offence to specifically, those provisions that would otherwise
fail to report. prohibit disclosure by the professional or official.
Any professional or official who fails to report That is, the professional must report that a child
a suspicion that a child is or may be in need of is or may be in need of protection even when
protection, where the information on which the the information is supposed to be confidential
or privileged. (The only exception for “privileged”
suspicion is based was obtained in the course
information is in the relationship between a
of his professional or official duties, is liable on
solicitor and a client.)
conviction to a fine of up to $1,000.
Professionals affected Protection from liability
CFSA s.72(5) CFSA s.72(7)
Persons who perform professional or official If a civil action is brought against a person who
duties with respect to children include the made a report, that person will be protected
unless he acted maliciously or without reasonable
following:
grounds for his suspicion.
□□ health care professionals, including
physicians, nurses, pharmacists and What will the children’s aid society do?
psychologists; Children’s aid society workers have the
□□ teachers and school principals; responsibility and the authority to investigate
□□ social workers and family counsellors; allegations and to provide services to protect
□□ priests, rabbis and other members of the children.
clergy; A children’s aid society worker may, as part of the
□□ operators or employees of day nurseries; investigation and plan to protect the child, involve
□□ youth and recreation workers; the police and other community agencies.
□□ peace officers and coroners;
□□ solicitors; WHERE TO GO FOR HELP
□□ service providers and employees of service
If you have concerns about a child, please call
providers; and your local children’s aid society immediately. All
□□ any other person who performs CASs have emergency service 24 hours a day, so
professional or official duties with respect you can call anytime.
to a child.
Lanark County: Children’s Aid Society,
This list sets out examples only. If your work 613-264-9991 or 1-866-664-9991.
involves children but is not listed above, i.e., a
Leeds and Grenville Counties: Family and
volunteer or student, you may still be considered Children’s Services of Leeds and Grenville, 613-
to be a professional for purposes of the duty to 498-2100 or 1-800-481-7834. After hours, call
report. If you are not sure whether you may be the local number and the answering service will
considered to be a professional for purposes contact the person on call.
of the duty to report, contact your local
The Ontario Association of Children’s Aid Societies
children’s aid society, professional association, or
www.oacas.org/childwelfare/how
regulatory body.
then click on ‘Report Child Abuse’, then ’How and
When to Report’.
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 7GROWTH & DEVELOPMENT
ATTACHMENT
Children’s Mental Health research shows that the quality of early parent-child relationships has an
important impact on a child’s development and his ability to form secure attachments. A child who
has secure attachment feels confident that he can rely on the parent to protect him in times of distress.
This confidence gives the child security to explore the world and establish trusting relationships
with others. As a result, current mental health practice is to screen the quality of the parent-child
interactions.
The following items are considered from the parent’s perspective, rather than the child’s. If a parent
states that one or more of these statements describes their child, the child may be exhibiting signs of
an insecure attachment; consider this a red flag:
0-8 months
□□ Is difficult to comfort by physical contact Problem signs ...
such as rocking or holding if a mother or primary caregiver is frequently
□□ Does things or cries just to annoy you displaying any of the following, consider this
a red flag:
8-18 months ►► Being insensitive to a baby’s
□□ Does not reach out to you for comfort communication cues
□□ Easily allows a stranger to hold him/her ►► Often unable to recognize baby’s cues
►► Provides inconsistent patterns of
18 months - 3 years responses to the baby’s cues
□□ Is not beginning to develop some
independence ►► Frequently ignores or rejects the baby
□□ Seems angry or ignores you after you have ►► Speaks about the baby in negative terms
been apart
►► Often appears to be angry with the baby
►► Often expresses emotions in a fearful or
3-4 years
intense way
□□ Easily goes with a stranger
□□ Is too passive or clingy with you
4-5 years
□□ Becomes aggressive for no reason (e.g., WHERE TO GO FOR HELP
with someone who is upset) See Attachment in the Where to Go for Help
□□ Is too dependent on adults for attention, section at the back of this document.
encouragement and help
8 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
FINE MOTOR
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
By 2 months By 3 years
□□ Sucks well on a nipple □□ Turns the paper pages of a book
□□ Holds an object momentarily if placed in □□ Dresses or undresses with help
hand □□ Unscrews a jar lid
By 4 months □□ Holds a crayon with fingers
□□ Sucks well on a nipple □□ Draws vertical and horizontal lines in
□□ Brings hands or toy to mouth imitation
□□ Turns head side to side to follow a toy or an □□ Copies a circle already drawn
adult face By 4 years
□□ Brings hands to midline while lying on back □□ Holds a crayon correctly
By 6 months □□ Undoes buttons or zippers
□□ Eats from a spoon (e.g., infant cereal) □□ Cuts with scissors
□□ Reaches for a toy when lying on back □□ Dresses and undresses with minimal help
□□ Uses hands to reach and grasp toys By 5 years
By 9 months □□ Draws diagonal lines and simple shapes
□□ Picks up small items using thumb and first □□ Uses scissors to cut along a thick line drawn
finger on paper
□□ Passes an object from one hand to the □□ Dresses and undresses without help except
other for small buttons, zippers, snaps
□□ Releases objects voluntarily □□ Draws a stick person
By 12 months
□□ Holds, bites and chews foods (e.g., crackers) Problem signs...
□□ Takes things out of a container if a child is experiencing any of the
□□ Points with index finger following, consider this a red flag:
□□ Plays games like peek-a-boo
►► Infants who are unable to hold or grasp
□□ Holds a cup to drink using two hands
an adult finger or a toy/object for a
□□ Picks up and eats finger foods short period of time
By 18 months ►► Unable to play appropriately with a
□□ Helps with dressing by pulling out arms variety of toys; or avoids crafts and
and legs manipulatives
□□ Stacks two or more blocks
►► Consistently ignores or has difficulty
□□ Scribbles with crayons
using one side of body; or uses one
□□ Eats foods without coughing or choking
hand exclusively
By 2 years
□□ Takes off own shoes, socks or hat
WHERE TO GO FOR HELP
□□ Stacks five or more blocks
See Fine Motor in the Where to Go for Help
□□ Eats with a spoon with little spilling
section at the back of this document.
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 9GROWTH & DEVELOPMENT
GROSS MOTOR
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
By 3 months By 3 years
□□ Lifts head up when held at your shoulder □□ Stands on one foot briefly
□□ Lifts head up when on tummy □□ Climbs stairs with minimal or no support
By 4 months □□ Kicks a ball forcefully
□□ Keeps head in midline and brings hands
to chest when lying on back
By 4 years
□□ Lifts head and supports self on forearms
□□ Stands on one foot for one to three seconds
on tummy
without support
□□ Holds head steady when supported in
□□ Goes up stairs alternating feet
sitting position
□□ Rides a tricycle using foot peddles
By 6 months □□ Walks on a straight line without stepping
□□ Rolls from back to stomach or stomach off
to back
By 5 years
□□ Pushes up on hands when on tummy
□□ Hops on one foot
□□ Sits on floor with support
□□ Throws and catches a ball successfully most
By 9 months of the time
□□ Sits on floor without support □□ Plays on playground equipment safely and
□□ Moves self forward on tummy or rolls without difficulty
continuously to get item
□□ Stands with support
By 12 months Problem signs...
□□ Gets up to a sitting position on own if a child is experiencing any of the
□□ Pulls to stand at furniture following, consider this a red flag:
□□ Walks holding onto hands or furniture
►► Baby is unable to hold head in the
By 18 months middle to turn and look left and right.
□□ Walks alone
►► Unable to walk with heels down four
□□ Crawls up stairs months after starting to walk.
□□ Pushes or pulls toys or other objects
►► Asymmetry (i.e., a difference between
when walking
two sides of body; or body too stiff or
By 2 years too floppy).
□□ Walks backwards or sideways pulling a
toy
□□ Plays in a squat position
□□ Kicks a ball WHERE TO GO FOR HELP
See Gross Motor in the Where to Go for Help
section at the back of this document.
10 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
VISION
Current research suggests that approximately 1 in 6 children has a vision problem. Children born
with poor vision do not know what “normal vision” is like. They often think that everyone sees
the same way that they do. Therefore, do not wait for your child to tell you that they have a vision
problem. An eye examination is covered by OHIP once a year until the individual’s 19th birthday.
The Ontario Association of Optometrists recommended frequency for children’s eye examinations:
6 months of age, 3 years of age and then every 12 months or as recommended by the optometrist
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
0-3 months 12 months-2 years
□□ Focuses on your face, bright colors and □□ Moves eyes and hands together (e.g.,
lights; follows slow-moving, close objects stack blocks, place pegs)
□□ Blinks when bright lights come on or if a □□ Judges depth e.g., climbs up and down
fast moving object comes into close view stairs
□□ Watches as you walk around the room □□ Links pictures with real life objects
□□ Looks at hands and begins to reach out □□ Follows objects as they move from above
and touch nearby objects head to feet
4-6 months 2-3 years
□□ Tries to copy your facial expression □□ Sits a normal distance when watching
□□ Reaches across the crib for objects/ television
reaches for objects when playing with □□ Follows moving objects with both eyes
you working together (coordinated)
□□ Grasps small objects close by 3-4 years
□□ Follows moving objects with eyes only □□ Knows people from a distance (across
(less moving of head) the street)
7-12 months □□ Uses hands and eyes together (e.g.,
□□ Plays games like ‘peek-a-boo’, ‘pat-a-cake’, catches a large ball)
‘waves bye-bye’ □□ Builds a tower of blocks, string beads;
□□ Reaches out to play with toys and other copies a circle, triangle and square
objects on own 4-5 years
□□ Moves around to explore what’s in the □□ Knows colours and shadings; picks out
room; searches for a hidden object detail in objects and pictures
□□ Holds a book at a normal distance
(See VISION problem signs on
following page)
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 11GROWTH & DEVELOPMENT
VISION continued
Problem signs...
if a child is experiencing any of the ►► Covering one eye; has difficulty, or is
following, consider this a red flag: irritable with reading or with close work
►► Blinking and/or rubbing eyes often; a lot ►► Eyes that cross, turn in or out, move
of tearing or eye-rubbing independently
►► Headaches, nausea, dizziness; blurred or ►► Holding toys close to eyes, or no interest in
double vision small objects and pictures
►► Eyes that itch or burn; sensitive to bright ►► Bumping into things, tripping; clumsiness,
light and sun restricted mobility
►► Unusually short attention span; will only ►► Squinting, frowning; pupils of different
look at you if he hears you sizes
►► Avoidance of tasks with small objects ►► Redness, soreness (eyes or eyelids);
recurring styes; discoloration
►► Turning or tilting head to use only one
eye to look at things ►► Constant jiggling or moving of eyes side-
to-side (roving)
WHERE TO GO FOR HELP
See Vision in the Where to Go for Help
section at the back of this document.
12 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
HEARING
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
0-3 months 2-3 years
□□ Startles, cries or wakens to loud sounds □□ Listens to a simple story
□□ Moves head, eyes, arms and legs in □□ Follows two requests (e.g., Get the ball and
response to a noise or voice put it on the table.)
□□ Smiles when spoken to, or calms down; □□ Learns new words every week
appears to listen to sounds and talking 3-4 years
4-6 months □□ Hears you when you call from another
□□ Responds to changes in your voice tone room
□□ Looks around to determine where new □□ Listens to the television at the same
sounds are coming from loudness as the rest of the family
□□ Responds to music and people’s voices □□ Answers simple questions
□□ Begins to make speech-like sounds e.g., □□ Speaks clearly enough to be understood
buh, ma, boo most of the time by family
6-9 months 4-5 years
□□ Turns or looks up when his name is called □□ Pays attention to a story and answers
Responds to the word “no” simple questions
□□ Listens when spoken to □□ Hears and understands most of what is said
□□ Knows common words like “cup”, “shoe”, at home and school
“mom” □□ Family, teachers, child care providers, and
9-12 months others think he hears fine
□□ Responds to requests such as “Want more?” □□ Speaks clearly enough to be understood
“Come here.” “ Where’s the ball?” most of the time by anyone
□□ Babbles sounds in a series e.g., bababa,
dadada, mememe Problem signs...
□□ Says first word if a child is experiencing any of the
12 months-2 years following, consider this a red flag:
□□ Turns toward you when you call their name ►► Early babbling stops
from behind
□□ Follows simple commands ►► Ear pulling (with fever or crankiness)
□□ Tries to ‘talk’ by pointing, reaching and ►► Does not respond when called
making noises
►► Draining ears; a lot of colds and ear
□□ Knows sounds like a closing door and a infections
ringing phone
►► Loud talking
□□ Listens to simple stories, rhymes, and sings
□□ Imitates sounds and words
WHERE TO GO FOR HELP
See Hearing in the Where to Go for Help section
at the back of this document.
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 13GROWTH & DEVELOPMENT
SENSORY
Sensory integration refers to the ability to receive input through all of the senses - taste, smell,
auditory, visual, touch, movement and body position, and the ability to process this sensory
information into automatic and appropriate responses to the sensation.
Problem signs...
if a child’s responses are exaggerated, irrational, extreme, and/or oppositional and do not seem
typical for the child’s age, consider this a red flag:
►► Auditory □□ Does not enjoy a variety of playground
□□ Responds negatively to unexpected or equipment
loud noises □□ Enjoys exaggerated positions for long
□□ Is distracted or has trouble functioning if periods (e.g., lies head-upside-down off
there is a lot of background noise sofa)
□□ Enjoys strange noises/seeks to make noise ►► Touch
for noise sake □□ Becomes upset during grooming (hair
□□ Seems to be “in his own world” cutting, face washing, fingernail cutting)
►► Visual □□ Has difficulty standing in line or close to
□□ Children over 3 - trouble staying between other people; or stands too close, always
the lines when colouring touching others
□□ Avoids eye contact □□ Is sensitive to certain fabrics
□□ Squinting, or looking out of the corner of □□ Fails to notice when face or hands are
the eye messy or wet
□□ Staring at bright, flashing objects □□ Cannot tolerate hair washing, hair cutting,
►► Taste/Smell nail clipping, teeth brushing
□□ Avoids certain tastes/smells that are □□ Craves lots of touch: heavy pressure, long-
typically part of a child’s diet sleeved clothing, hats and certain textures
□□ Chews/licks non-food objects ►► Activity Level
□□ Gags easily □□ Always on the go; difficulty paying
□□ Picky eater, especially regarding textures attention
►► Movement and Body Position □□ Very inactive, under-responsive
□□ Continually seeks out all kinds of ►► Emotional/Social
movement activities (being whirled by □□ Needs more protection from life than other
adult, playground equipment, moving children
toys, spinning, rocking) □□ Has difficulty with changes in routines
□□ Becomes anxious or distressed when feet □□ Is stubborn or uncooperative; gets
leave ground frustrated easily
□□ Poor endurance - tires easily; seems to □□ Has difficulty making friends
have weak muscles □□ Has difficulty understanding body
□□ Avoids climbing, jumping, uneven ground language or facial expressions
or roughhousing □□ Does not feel positive about own
□□ Moves stiffly or walks on toes; clumsy or accomplishments
awkward, falls frequently
WHERE TO GO FOR HELP See Sensory in the Where to Go for Help section at the back of this document.
14 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
SPEECH & LANGUAGE
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
By 3 months □□ Tries to copy new sounds (e.g., ba, animal
□□ Cries and grunts; has different cries for sounds, car noises)
different needs □□ Makes sounds to get attention, to make
□□ Makes a lot of “cooing” and “gooing” sounds needs known, or to protest
□□ Responds to parent/caregiver voice (e.g.,, □□ Responds to hearing own name
Watches your face as you talk) □□ Understands “no” and simple requests (e.g.,,
Give it to mommy. Don’t touch. Where’s the
ball?)
By 6 months
□□ Babbles using different sounds □□ Plays social games with you (e.g., peek a
boo)
□□ Lets you know by voice sounds to do
something again □□ Enjoys being around people
□□ Makes “gurgling” noises
□□ Understands some words (e.g., daddy, bye By 18 months
bye) □□ Tries to copy your sounds (sounds of our
language)
□□ Smiles or laughs
□□ Uses at least 20-50 words consistently;
□□ Vocalizes pleasure and displeasure (e.g.,
words do not have to be clear
squeals with excitement, grunts in anger)
□□ Understands many more words than
□□ Enjoys music, songs and rhymes
he can say
□□ Brightens to sound, especially to people’s
□□ Understands simple directions or questions
voices
(e.g.,, Where is your nose? Get the ball.)
□□ Smiles and laughs in response to parent/
□□ Demonstrates some pretend play with toys
caregiver smiles and laughs
(e.g., give Teddy a drink)
□□ Imitates sounds in his/her repertoire (e.g.,
□□ Enjoys tickle, bounce and nursery rhymes
coughs or other sounds – ah, eh, buh)
□□ Makes at least four consonant sounds from
p, b, m, n, d, t, w, h
By 12 months
□□ Identifies pictures in a book (e.g., Show me
□□ Consistently uses three to five single words the baby)
□□ Takes turns with sounds (e.g., Buh, animal □□ Enjoys being read to and looking at books
sounds, car noises)
□□ Points to familiar people and to some body
□□ Waves hi/bye (emerging) and begins to use parts when asked
other gestures (e.g., hands up means pick
me up) □□ Understands the concepts of in and out, off
and on
□□ Gives a few familiar objects on verbal
request
□□ Uses a variety of different voice sounds By 2 years
when playing (e.g., bababa, dadada, □□ Tries to copy your words
nanana) □□ Uses a variety of words and gestures to
□□ Combines lots of sounds as though talking communicate and ask for help (e.g., waving,
(e.g., abada, baduh, abee) pushing away, pointing)
continued ...
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 15GROWTH & DEVELOPMENT
□□ Uses 100-150 words and combines 2 words □□ Uses pronouns: I, you, me and mine
(e.g., More juice. Want cookie.) □□ Understands questions using who, what,
□□ Follows two step instructions (e.g., go find why, when and where
your teddy bear and show it to Grandma) □□ Is learning the meaning of several new
□□ Takes turns in a conversation words every week (in spoken language)
□□ Asks for something by pointing and using □□ Sings simple songs and familiar rhymes
sounds or words □□ Talks about past events
□□ Begins to offer toys to peers and imitates □□ Tells simple stories
other children’s actions and words
□□ Shows affection for favourite playmates
□□ People can understand his/her words 50 to
60 per cent of the time □□ Engages in multi step pretend play
– cooking a meal, repairing a car
□□ Uses many different speech sounds at
beginning of words (p,b,m,t,d,n,h,w) □□ Shows ability to participate in routines
□□ Enjoys being with other children
□□ Learns and uses one or more new words a By 4 ½ years
week; may only be understood by family □□ Most of the time uses complete sentences
with 4 or more words (e.g., I go home now.)
□□ Uses correct grammar such as plural
By 30 months
(e.g., books), past tense (e.g., walked) and
□□ Understands the concepts of size (big/little) pronouns (e.g., I, he, she, me, you)
and quantity (a lot, little, more)
□□ Follows directions involving three or more
□□ Uses some correct grammar – “two steps “First get some paper, then draw a
cookies”; ‘bird flying” picture, last give it to mom”
□□ Uses more than 350 words □□ Tells stories with clear beginning, middle
□□ Uses action words – run, fall and end
□□ Begins taking turns with other children □□ Talks to try to solve problems with adults
using both toys and words and other children
□□ Shows concern when another child is hurt □□ Demonstrates increasingly complex
or sad imaginative play
□□ Combines several actions in play –feeds □□ Is understood by adults outside the family
dolls then puts him/her to sleep almost all the time
□□ Produces words with two or more syllables □□ Is learning the meaning of and using several
or beats: ba-na-na, com-pu-ter “new words” every week (in spoken
language)
By 3 years □□ Recites nursery rhymes and sings familiar
□□ Responds to simple questions or directions songs
□□ Understands location words like in, on and □□ Understands “just one”
under □□ Enjoys being read to
□□ Identifies some objects by their functions □□ Can identify 4-6 colours by name
(e.g., What is a spoon for?)
□□ Is understood by most people outside of
the family most of the time
□□ Uses long sentences, using 5-8 words
16 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
By 5 ½ years
□□ Talks easily with other children and adults Problem signs...
and is understood if a child is experiencing any of the
□□ Understands spatial relationships, on top following, consider this a red flag:
of, under, behind, in front of, etc. □□ Stumbling or getting stuck on words
□□ Explains concepts using words (e.g. ,What is or sounds (stuttering)
a cup? What is a car?) □□ Ongoing hoarse voice
□□ Understands many descriptive words (e.g., □□ Excessive drooling
long/short, soft/hard)
□□ Problems with swallowing or chewing,
□□ Follows group directions “All the boys get or eating foods with certain textures
a toy” (gagging).
□□ Understands directions involving e.g., See also Feeding and swallowing
“if…then” – “If you are wearing runners, section
then line up for gym” □□ Lack of eye contact and poor social
□□ Describes and can retell past, present, and skills for age
future events in detail □□ Frustrated when verbally
□□ Seeks to please his or her friends communicating
□□ Shows increasing independence in
friendships
□□ Uses almost all the sounds of his or her
language with few to no errors See also
□□ Uses complete sentences with good • Literacy & Numeracy
grammatical structure Speech and language difficulties are often
□□ Is learning the meaning of and is using associated with weak literacy skills.
several new words every week (in spoken
language)
□□ Can recall a brief story that has just been
heard
WHERE TO GO FOR HELP
See Speech & Language in the Where to Go for
Help section at the back of this document.
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 17GROWTH & DEVELOPMENT
LITERACY & NUMERACY By 2 years
□□ Asks for favourite books to be read over and
By 3 months over again
□□ Shows interest in contrast between light
□□ Pretends to read
and dark
□□ Names familiar pictures
□□ Makes eye contact with pictures in book
□□ Scribbles
□□ Looks intensely at pictures for several
minutes □□ Holds books the right way up and turns
pages easily, one at a time
□□ Relates events in books to his/her own past
By 6 months
experiences
□□ Enjoys music, songs and rhymes
□□ Notices print rather than just the pictures
□□ Reaches for and explores books with hands
and mouth □□ Can join in and recite phrases
□□ Sits on lap and holds head up steadily
□□ Shows preference for photographs of faces By 30 months
□□ Produces words with two or more syllables
□□ Uses both hands to manipulate the book to
or beats: ba-na-na, com-pu-ter
make the pages open and close
□□ Recognizes familiar logos and signs -
(e.g., stop sign)
By 12 months
□□ Remembers and understands familiar stories
□□ Shows interest in looking at books
□□ Holds book with help
By 3 years
□□ Tries to turn several pages at a time
□□ Sings simple songs and familiar rhymes
□□ Looks at pictures, vocalizes and pats picture
□□ Pretends to read familiar books aloud
□□ Sits up without support
□□ Knows how to use a book (holds/turns pages
□□ Plays social games with you (e.g., peek a one at a time, starts at beginning,
boo) points/talks about pictures)
□□ Looks carefully and makes comments about
By 18 months books
□□ Points at pictures with one finger □□ Fills in missing words/phrases in familiar
□□ Enjoys tickle, bounce and nursery rhymes books that are read aloud
□□ Identifies pictures in a book (e.g., Show me □□ Holds a pencil/crayon with pincer grasp and
the baby) uses it to draw/scribble
□□ Able to carry book and turn pages well □□ Imitates writing with linear scribbles
□□ Holds a crayon or pencil in fist and marks □□ Copies a circle, vertical and horizontal lines
paper, scribbles when shown
□□ Labels a particular picture with a specific □□ Talks about past events
sound □□ Tells simple stories
□□ Enjoys being read to and looking at books □□ Engages in multi step pretend play – cooking
□□ Relates an object or an action in a book to a meal, repairing a car
the real world □□ Is aware of the functions of print –
in menus, signs
□□ Has a beginning interest in, and awareness
of, rhyming
18 Red Flags: Early Identification in Leeds, Grenville & Lanark November 2007GROWTH & DEVELOPMENT
□□ Requests adult to read or write □□ Knowledge of the basic concepts of print
□□ Understands that print carries a message shows in child’s writing (letters instead of
scribbles, letter groupings that look like
□□ Shows ability to participate in routines
words, invented spelling)
□□ Points to and says the name of most letters
By 4 ½ years of the alphabet when randomly
□□ Tells stories with clear beginning, middle presented (upper and lower case);
and end recognizes how many words are in a
□□ Matches some letters with their sounds sentence
(e.g., Letter “t” says tuh) □□ Prints letters (by copying, or in her full
□□ Recites nursery rhymes and sings familiar name, or when attempting to spell words)
songs □□ Makes predictions about stories; retells the
□□ Reads a book by memory or by making up beginning, middle and end of familiar
the story to go along with the pictures stories
□□ Can guess what will happen next in the □□ Can recall a brief story that has just been
story heard
□□ Retells some details of stories read aloud □□ When being read a story, connects
but not necessarily in order information and events to real life
experiences
□□ Traces circle, triangle, square using
templates □□ Can identify the beginning and ending
sounds in words e.g., “Pop” starts with the
□□ Recognizes signs and symbols in daily “puh” sound
environment (e.g., traffic signs, washroom
signs) □□ Can shift attention from meanings of words
to sounds of words
□□ Holds a pencil correctly
□□ Draws diagonal lines and simple shapes
□□ Identifies the names of 10 alphabet letters
(likely from own name) □□ Able to sort objects by size, colour, use, etc.
□□ Understands the concept of rhyme; □□ Able to understand simple patterning
recognizes and generates rhyming words □□ One to one correspondence for numbers
□□ Changes a sound in a word to make a new from 1 through 10o for hel
word in familiar games and songs
□□ Enjoys being read to
See also
□□ Is motivated to try to read
• Speech & Language
Speech and language difficulties are often
By 5 ½ years associated with weak literacy skills.
□□ Can match all letter symbols to letter
Note: Low literacy level of parents is also a risk
sounds
factor for literacy development.
□□ Reads some familiar vocabulary by sight
(high frequency words)
□□ Can label pictures quickly
WHERE TO GO FOR HELP
□□ Knows parts of a book See Literacy & Numeracy in the Where to Go for
Help section at the back of this document.
□□ Understands the basic concepts of print
(difference between letters, words,
sentences, how the text runs from left to
right, top to bottom, white space between
words)
November 2007 Red Flags: Early Identification in Leeds, Grenville & Lanark 19You can also read
