Red Flags Early Identification Guide

Area 6 months 9 months 12 months 18 months 2 years 3 years 4 years 5 years Red flags at
any age
Social emotional Does not smile N
 ot sharing D
 oes not notice L acks interest When
 playing with No
 interest in U
 nwilling or P
 lay is different
or interact with enjoyment with someone new in playing and toys tends to bang, pretend play or unable to play than their friends
people others using eye interacting drop or throw interacting with cooperatively Strong parental
contact or facial D
 oes not play early with others them rather than other children concerns
expression turn-taking games use them for their
(e.g. peekaboo, purpose D
 ifficulty noticing
rolling a ball) (e.g. cuddle dolls, and understanding
feelings in S
 ignificant loss
build blocks) of skills
themselves
and others
(e.g. happy, sad)
Lack of response
to sound or visual
stimuli
Communication Not starting N
 ot using gestures N
 o babbled N
 o clear words N
 ot learning new S
 peech difficult S
 peech difficult D
 ifficulty telling
to babble (e.g. pointing, phrases that words for familiar people to understand a parent what
(e.g. aahh; oohh) showing, waving) sound like talking N
 ot able to to understand is wrong
understand short N P
 oor interaction
 ot putting words Not able to follow
N with adults or
 ot using two N
 o response to requests together N
 ot using simple directions with N
 ot able to
part babble familiar words (e.g. ‘Where is the (e.g. ‘push car’) sentences two steps answer questions other children
(e.g. bubu, dada) (e.g. bottle, daddy) ball?’) (e.g. ‘Big car go’) (e.g. ‘Put your bag in a simple
away and then go conversation
play’) (e.g. ‘What’s your Lack of, or limited
name? Who is your eye contact
family? What do
you like to watch
on TV?’)
Differences between
right and left sides
Cognition, fine Not reaching D
 oes not hold D
 oes not feed self D
 oes not scribble D
 oes not attempt D
 oes not attempt N
 ot toilet trained C
 oncerns from of body in strength,
motor and self care for and holding objects finger foods or with a crayon to feed self using a everyday self by day teacher about
movement or tone
(grasping) toys hold own bottle/ spoon and/or help care skills (such school readiness
D
 oes not ‘give’ cup D
 oes not with dressing as feeding or N
 ot able to draw
Hands frequently objects on request attempt to stack dressing) lines and circles Not able to
clenched U
 nable to pick up blocks after independently
C
 annot move Marked low tone
small items using demonstration D
 ifficulty in complete everyday
Does not explore toy from one hand (floppy) or high tone
index finger and manipulating routines such
objects with to another (stiff and tense)
thumb small objects as feeding and
hands, eyes and significantly
(e.g. threading dressing
and mouth impacting on
beads)
Not able to draw development
Does not bring simple pictures and functional
hands together (e.g. stick person) motor skills
at midline

Gross motor Not holding head N

 ot rolling N
 o form of N
 ot standing N
 ot able to walk N
 ot able to walk N
 ot able to walk, N
 ot able to walk,
and shoulders independent independently independently up and down stairs run, climb, jump run, climb, jump
up with good Not sitting mobility independently and use stairs and use stairs
control when lying independently/ (e.g. crawling, N
 ot attempting N
 ot able to walk confidently confidently
on tummy without support commando to walk without up and down stairs N
 ot able to run
crawling, bottom support holding on or jump Not able to catch, Not able to hop
N
 ot moving
Not holding head shuffle) throw or kick a ball five times on one
with control in (e.g. creeping, leg and stand on
supported sitting crawling) N
 ot pulling one leg for five
Not
 taking weight to stand seconds
on legs when held independently
in standing and holding on
for support

Updated July 2016

 Updated: July 2016
© Developed by the Child Development Program in conjunction with Brisbane North Primary Health Network.
Call 13HEALTH (13 432584) 24 hours, 7 days to speak to a Child Health Nurse
creatively use boxes or containers as the play objects (e.g. as a car)
different scenarios or roles; play with dolls / teddies/ figurines;
 se imagination: play out simple ideas and gradually introduce
U •
Second edition
for children aged birth to five years
Identification Guide
Red Flags Early
Children’s Health Queensland Hospital and Health Service
What is the Red Flags Early Identification Guide?
The Red Flags Early Identification Guide (for children aged
birth to five years) is a health resource for professionals
(including general practitioners, child health nurses, allied
health professionals and early childhood educators) working
with families, to help identify developmental concerns early,
so families can receive support from the right professionals at
the right time.
The guide will:
• Assist with early identification of developmental concerns
in a child’s developmental domains (social/emotional;
communication; fine motor/cognition/self-care; and gross
motor) that are impacting on their day-to-day functioning.
• Assist with clinical decision making when used in
conjunction with other evidence-based screening tools,
such as the Parents Evaluation of Developmental Status
(PEDS) and/or Ages and Stages Questionnaire (ASQ).
The guide is not a standardised screening tool and should
not replace standardised assessment.
• Facilitate conversation with parents/carers around their
child’s development and the benefits of early identification
and early intervention in particular when a parent may not be
concerned about their child’s development.
• Facilitate conversation about a plan of action and
where to obtain a more detailed developmental screen
and/or assessment.
Child Health Service call 1300 366 039
or email CDPAccessService@health.qld.gov.au
Child Development Program Clinical Access Service call 1300 731 805
Your cupboards are full of exciting things!
play with e.g. bubbles, pots and pans, play doh, boxes, blocks.
 xplore: use a variety of things for your child to explore and
• E
Talk and problem solve, e.g. with puzzles •
– climb, throw and kick balls, ride a bike
 ut and about: go to libraries, talk about books; visit parks
O •
Move about: help your child move, push and pull objects •
(e.g. sand, leaves and toys)
 se your senses: touch, listen and look at objects
U •
Ways to PLAY?
enjoy being together.
You and your child together: get down on their level and
Y
the play your child is leading. A
Add: introduce new ideas to guide, support and expand on
and follow their instructions.
Look and listen: adjust play to your child’s level
L
Follow their lead and wait for them to take their turn. P
Partner: be your child’s partner in play.
Stimulate your child’s development with PLAY!
Tips for using the guide
• Children’s Health Queensland recommends this resource
be used in discussions with parents/carers about typical
development and parental understanding/expectations
of development. This process facilitates identification
of parental concerns/questions about a child’s growth,
development and activities of daily living.
• A single red flag is not always an indication for concern or
referral, rather the functional impact of one or more red flags
on the child’s everyday functioning and participation, should
be taken into consideration.
• The negative statements of ‘does not…’ and ‘not
able to…’ have been used to highlight a delay/lack of
acquisition of skills. The red flags have been linked to
the absence or delay of skill/s which lie at the boundary
of the typical developmental range. Therefore the
guide should not be used as a ‘milestones’ screener,
as the red flags are not developmental milestones.
• This second edition of the Red Flags Early Identification
Guide includes revised red flags and directions for
appropriate use.