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Children’s Health Queensland Hospital and Health Service

Child and Youth Community Health Service

Red Flags Early Identification Guide


for children aged birth to five years SECOND EDITION

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 Red Flags Early Identification Guide will: Tips for using the guide Stimulate your child’s development with PLAY!

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• Assist with early identification of developmental concerns • Children’s Health Queensland recommends this resource Partner: be your child’s partner in play.
in a child’s developmental domains (social/emotional; be used in discussions with parents/carers about typical Follow their lead and wait for them to take their turn.

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communication; fine motor/cognition/self-care; and gross development and parental understanding/expectations Look and listen: adjust the play to your child’s level and follow
motor) that are impacting on their day-to-day functioning. of development. This process facilitates identification their instructions.

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• Assist with clinical decision making when used in of parental concerns/questions about a child’s growth, Add: introduce new ideas to guide, support and expand on the
conjunction with other evidence-based screening tools, development and activities of daily living. play your child is leading.

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such as the Parents Evaluation of Developmental Status • A single red flag is not always an indication for concern You and your child together: get down on their level and enjoy
(PEDS) and/or Ages and Stages Questionnaire (ASQ). or referral, rather the functional impact of one or more being together.
The guide is not a standardised screening tool and red flags on the child’s everyday functioning and
should not replace standardised assessment. participation, should be taken into consideration. Ways to PLAY?
• Use your senses: touch, listen and look at objects (e.g. sand, leaves and toys)
• Facilitate conversation with parents/carers around their • The negative statements of ‘does not…’ and ‘not
• Move about: help your child move, push and pull objects
child’s development and the benefits of early identification able to…’ have been used to highlight a delay/lack of
• Out and about: go to libraries, talk about books; visit parks – climb, throw
and early intervention in particular when a parent may not acquisition of skills. The red flags have been linked to
and kick balls, ride a bike
be concerned about their child’s development. the absence or delay of skill/s which lie at the boundary
• Talk and problem solve, e.g. with puzzles
• Facilitate conversation about a plan of action and of the typical developmental range. Therefore the
• Use imagination: play out simple ideas and gradually introduce different
where to obtain a more detailed developmental screen guide should not be used as a ‘milestones’ screener,
scenarios or roles; play with dolls/teddies/figurines; creatively use boxes or
and/or assessment. as the red flags are not developmental milestones.
containers as play objects (e.g. as a car)
• This second edition includes revised red flags and • Explore: use a variety of things for your child to explore and play with e.g.
directions for appropriate use. bubbles, pots and pans, play doh. Your cupboards are full of exciting things!

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 Not sharing D
 oes not notice L acks interest When
 playing with No interest in Unwilling or Play 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 Significant loss
build blocks) of skills
themselves
and others
(e.g. happy, sad)
Lack of response
to sound or visual
stimuli
Communication Not starting Not using gestures N
 o babbled N
 o clear words N
 ot learning new Speech difficult Speech difficult Difficulty 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
 ot putting words Not able to follow Poor interaction
with adults or
Not using two N
 o response to requests together Not using simple directions with Not 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, ball?’) (e.g. ‘Big car go’) (e.g. ‘Put your bag in a simple
daddy) away and then go conversation
play’) (e.g. ‘What’s your L ack of, or limited
name? Who is your eye contact
family? What do
you like to watch
on TV?’)
Differences
between right
Cognition, fine Not reaching Does not hold D
 oes not feed self D
 oes not scribble D
 oes not attempt D
 oes not attempt Not toilet trained Concerns from and left sides of
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
body in strength,
(grasping) toys hold own bottle/ spoon and/or help care skills (such school readiness
Does not ‘give’ D
 oes not Not able to draw movement or tone
cup with dressing as feeding or
Hands frequently objects on request attempt to stack dressing) lines and circles Not able to
clenched U
 nable to pick up blocks after independently
Cannot move small items using demonstration Difficulty in complete everyday
Does not explore toy from one hand M
 arked low
index finger and manipulating routines such
objects with to another tone (floppy) or
thumb small objects as feeding and
hands, eyes high tone (stiff
(e.g. threading dressing
and mouth and tense) and
beads)
Not able to draw significantly
Does not bring simple pictures impacting on
hands together (e.g. stick person) development
at midline and functional
motor skills
Gross motor Not holding head Not rolling N
 o form of N
 ot standing N
 ot able to walk Not able to walk Not able to walk, Not 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 Not able to run
crawling, bottom support holding on or jump  ot able to catch,
N N
 ot able to hop
Not holding head Not moving throw or kick a ball five times on one
(e.g. creeping, shuffle)
with control in 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

Child Development Program Clinical Access Service call 1300 731 805
or email CDPAccessService@health.qld.gov.au
Child Health Service call 1300 366 039
Call 13HEALTH (13 432584) 24 hours, 7 days to speak to a Child Health Nurse
© Developed by the Child Development Program in conjunction with Brisbane North Primary Health Network. Updated: July 2016

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