” Red Flags”: behaviors that may warrant a Pediatric Boulevard referral
Gross Motor

If a child is….

  • not rolling by 7 months of age
  • not pushing up on extended arms, lifting his head and shoulders in prone by 8 months of age
  • not sitting independently by 10 months of age
  • not crawling by 12 months of age
  • not sitting upright in a child-size chair by 12 months of age
  • not pulling to stand by 12 months of age
  • not standing alone by 12 months of age
  • not walking by 18 months of age
  • not jumping by 30 months of age
  • not independent on stairs by 30 months of age
  • “walking” their hands up their bodies to achieve a standing position
  • only walking on their toes, not the soles of their feet
  • frequently falling/tripping for no apparent reason
  • still “toeing in” at 2 years of age
  • unusual creeping patterns
  • any known diagnosis:  Down’s Syndrome, Cerebral Palsy, congenital heart condition, etc.


Fine Motor

If a child is…

  • frequently in a fisted position with both hands after 6 months of age
  • not bringing both hands to midline by 10 months of age
  • not banging objects together by 10 months of age
  • not clapping their hands by 12 months of age
  • not deliberately and immediately releasing objects by 12 months of age
  • not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age
  • still using a fisted grasp to hold a crayon at 18 months of age
  • not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age
  • not drawing a vertical line by 24 months of age
  • not able to snip with scissors by 30 months of age
  • using only one hand to complete tasks
  • not being able to move/open one hand/arm
  • drooling during small tasks that require intense concentration
  • displaying uncoordinated or jerky movements when doing activities
  • crayon strokes are either too heavy or too light to see
  • any know medical diagnosis:  Down’s Syndrome, Cerebral Palsy, etc.


Cognition/Problem Solving

If a child is…

  • not imitating body action on a doll by 15 months of age (kiss the baby, feed the baby)
  • not able to match 2 sets of objects by item by 27 months of age (blocks in one container and people in another container)
  • not able to imitate a model from memory by 27 months of age (show me how you brush your teeth)
  • not able to match 2 sets of objects by color by 31 months of age
  • having difficulty problem solving during activities in comparison to his/her peer
  • unaware of changes in his/her environment and routine



If a child is…

  • very busy, always on the go, and has a very short attention to task
  • often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap
  • a picky eater
  • not aware of when they get hurt (no crying, startle, or reaction to injury)
  • afraid of swinging/movement activities; does not like to be picked up or be upside down
  • showing difficulty learning new activities (motor planning)
  • having a hard time calming themselves down appropriately
  • appearing to be constantly touching everything they see, including other children
  • hypotonic (floppy body, like a wet noodle)
  • having a difficult time with transitions between activity or location
  • overly upset with change in routine
  • hates bath time or grooming activities such as:  brushing teeth, brushing hair, hair cuts, having nails cut, etc.
  • afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, play dough, etc.



If a child is…

  • having difficulty biting or chewing food during mealtime
  • needing a prolonged period of time to chew and/or swallow
  • coughing/choking during or after eating on a regular basis
  • demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)
  • having significant difficulty transitioning between different food stages
  • not feeding self finger foods by 14 months of age
  • not attempting to use a spoon by 15 months of age
  • not picking up and drinking from a regular open cup by 15 months of age
  • not able to pull off hat, socks, or mittens on request by 15 months of age
  • not attempting to wash own hands or face by 19 months
  • not assisting with dressing tasks (excluding clothes fasteners) by 22 months
  • not able to deliberately undo large buttons, snaps, and shoelaces by 34 months


Social/Emotional/Play Skills

If a child is…

  • not smiling by the age of 4 months
  • not making eye contact during activities and interacting with peers and/or adults
  • not performing for social attention by the age of 12 months
  • not imitating actions and movements by the age of 24 months
  • not engaging in pretend play by the age of 24 months
  • not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)
  • fixating on objects that spin or turn (i.e. See ‘n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun
  • having significant difficulty attending to tasks
  • getting overly upset with change or transitions from activity to activity


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