(The following red flags may indicate a child is at risk for atypical development, and is in need of an immediate evaluation.)
In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that indicate that a child should be evaluated. For a parent, these are the “red flags” that your child should be screened to ensure that he/she is on the right developmental path. If your baby shows any of these signs, please ask your pediatrician or family practitioner for an immediate evaluation:
- No big smiles or other warm, joyful expressions by six months or thereafter
- No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
- No babbling by 12 months
- No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
- No words by 16 months
- No two-word meaningful phrases (without imitating or repeating) by 24 months
- Any loss of speech or babbling or social skills at any age
Why Early Identification
About 17 percent of children under the age of 18 are affected by a developmental, behavioral, or learning disability.1 Autism is the second most common serious developmental disorder after mental retardation.2 According to the Centers for Disease Control, the incidence rate for autism spectrum disorders may be as high as one in 166.3
With proper intervention, a child can overcome a wide range of developmental, behavioral, and learning problems. Intensive, well designed and timely intervention can improve the prospects—and the quality of life—for many children who are considered at risk for cognitive, social, or emotional impairment. In some cases, effective intervention can improve conditions once thought to be virtually untreatable, such as autism. Well-implemented programs can brighten a child’s future and the impact a developmental disorder has on the family. It can lead a child to greater independence, enable that child to be included in his/her community, and offer him/her a more productive and fulfilling life.
Unfortunately, many physicians fail to identify a developmental delay at an age when the child should be receiving early intervention services. Birth to three is a critical time in a child’s development, so a delayed diagnosis may compromise his/her chances for success.
The high (and growing5) incidence of developmental disabilities demands greater awareness and improved early identification. Too few physicians refer young children to early intervention, primarily, because (1) physicians may not know what critical signs to look for in a child during each stage; (2) physicians may not be familiar with early intervention; (3) insurance companies allow physicians limited time for office visits; and (4) some pediatricians believe a child’s severe developmental disability will not be affected by early intervention, while others would rather not alarm the parents unnecessarily in case the child is able to overcome the developmental delay.
Key Social, Emotional, and Communication Milestones for Your Baby's Healthy Development
Milestones enable parents and physicians to monitor a baby's learning, behavior, and development. While each child develops differently, some differences may indicate a slight delay and others may be a cause for greater concern. The following milestones provide important guidelines for tracking healthy development from four months to three years of age.
Before your child's next visit to the physician, please take the time to see if your child has met his/her key milestones. These milestones should not be used in place of a screening, but should be used as discussion points between parents and physicians at each well visit. If a child does not have the skills listed---or if there is a loss of any skill at any age---be sure to let your physician know.
Does Your Baby…
At 4 Months:
- Follow and react to bright colors, movement, and objects?
- Turn toward sounds?
- Show interest in watching people's faces?
- Smile back when you smile?
- Relate to you with real joy?
- Smile often while playing with you?
- Coo or babble when happy?
- Cry when unhappy?
- Smile and laugh while looking at you?
- Exchange back-and-forth smiles, loving faces, and other expressions with you?
- Exchange back-and-forth sounds with you?
- Exchange back-and-forth gestures with you, such as giving, taking, and reaching?
- Use a few gestures, one after another, to get needs met, like giving, showing, reaching, waving, and pointing?
- Play peek-a-boo, patty cake, or other social games?
- Make sounds, like “ma,” “ba,” “na,” “da,” and “ga”?
- Turn to the person speaking when his/her name is called?
- Exchange with you many back-and-forth smiles, sounds, and gestures in a row?
- Use pointing or other “showing” gestures to draw attention to something of interest?
- Use different sounds to get needs met and draw attention to something of interest?
- Use and understand at least three words, such as “mama,” “dada,” “bottle,” or “bye-bye”?
- Use lots of gestures with words to get needs met, like pointing or taking you by the hand and saying, “want juice”?
- Use at least four different consonants in babbling or words, such as m, n, p, b, t, and d?
- Use and understand at least 10 words?
- Show that he or she knows the names of familiar people or body parts by pointing to or looking at them when they are named?
- Do simple pretend play, like feeding a doll or stuffed animal, and attracting your attention by looking up at you?
- Do pretend play with you with more than one action, like feeding the doll and then putting the doll to sleep?
- Use and understand at least 50 words?
- Use at least two words together (without imitating or repeating) and in a way that makes sense, like “want juice”?
- Enjoy being next to children of the same age and show interest in playing with them, perhaps giving a toy to another child?
- Look for familiar objects out of sight when asked?
- Enjoy pretending to play different characters with you or talking "for" dolls or action figures?
- Enjoy playing with children of the same age, perhaps showing and telling another child about a favorite toy?
- Use thoughts and actions together in speech and in play in a way that makes sense, like “sleepy, go take nap” and “baby hungry, feed bottle”?
- Answer “what,” “where,” and “who” questions easily?
- Talk about interests and feelings about the past and the future?