Age

Expected Age Outcomes

Problem signs … if a child is experiencing any one of the following, consider this a red flag:

2 years

• Drinks from a cup  and swallows solid food with easy lip closure; no loss of liquid
• Chewing motion is rapid and skilful from side to side without pausing in the centre
• Will use tongue to clean food from the upper and lower lips
• Able to open jaw to bite foods of varying thicknesses

• Arching or stiffening of the body during feeding
• Irritability or lack of alertness during feeding
• Won’t accept different textures of food
• Takes a long time to eat (more than 30 minutes)
• Lots of drooling or leaking food or liquid from mouth
• Gurgly, hoarse or breathy voice quality
• Coughing, gagging, or throwing up during or after meals
• Frequent pneumonia or chest infections
• Difficulty coordinating breathing with eating or drinking
• Frequent spitting up
• Less than normal weight gain or growth
• Pocketing food in the mouth for a prolonged period of time.

3 years

• Eats the same food as the rest of the family

• Any of the above red flags
• Extremely picky eater.

If there are concerns, advise the parent to contact the Children's Therapy & Family Resource Centre at 371-4100 (Speech Therapy or Occupational Therapy department)

Age

Risk Factors/Red Flag

General Risk Factors:

1 -2 years

• Drinking less than 16 oz(2 cups) or more than 24 oz (3 cups) of milk per day
• Drinking more than 4 oz (1/2 cup) per day of juice
• Not eating a variety of table foods
• Parent or caregiver still feeding child; not allowing child to self-feed (finger, spoon, cup)
• A low fat cow’s milk is provided before the age of 2
• Food is used as a reward or punishment

• Rate of growth is falling off the growth curve
• Identified as Failure to Thrive *
• Identified as overweight or obese by a health care professional
• Unexpected and/or unexplained weight loss or gain
• Food allergies (e.g. cow's milk) or food intolerance (e.g. lactose intolerance)
• Problems with sucking, chewing, swallowing, gagging, vomiting or coughing while eating
• Frequent constipation and/or diarrhea; abdominal pain
• Displays signs of iron deficiency (e.g. irritability, recurrent illness)
• Follows a "special diet" that limits or includes special foods
• Eats non-food items
• Suffers from tooth or mouth problems that make it difficult to eat or drink
• Mealtimes are rarely pleasant
• Consistently not eating from one or more of the food groups
• Excludes all animal products including milk and eggs
• Unsafe or inappropriate foods are given (e.g. raw eggs, unpasteurized milk, foods that are choking
• hazards, herbal teas, pop, fruit drink)
• Home has inadequate food storage/cooking facilities
• Parent or care provider is unable to obtain adequate food due to financial constraints
• Parent or care provider offers inappropriate amounts of food or force feeds

• Drinking less than 16 oz (2cups) or more than 25 oz (3cups) of milk per day
• Drinking more than 4 oz (1/2 cup) per day of juice
• Still drinking from a bottle; still being spoon fed
• Not eating a variety of table foods from the four food groups
• Does not eat at regular times throughout the day (breakfast, lunch, and supper plus 2 – 3 between meal snacks)
• Spending a long time at meals (e.g. an hour)
• Lack of physical activity (i.e. Watches TV or videos, uses the computer.
• Food is used as a reward or punishment

Age

Expected Age Outcomes

Problem signs … if a child is experiencing any one of the following, consider this a red flag:

2 – 3 years

Sits a normal distance when watching television
Follows moving objects with both eyes working together (coordinated)

• Blinking and/or rubbing eyes often ; a lot of tearing or eye-rubbing
• Headaches nausea, dizziness; blurred or double vision
• Eyes that itch or burn; sensitive to bright light and sun
• Unusual short attention span; will only look at you if he or she hear you
• Avoidance of tasks with small objects
• Turning or tilting head to use only one eye to look at things
• Covering one eye; has difficulty, or is irritable with reading or with close work
• Eyes that cross, turn in or out, move independently
• Holding toys close to eyes, or no interest in small objects and pictures
• Bumping into things, tripping; clumsiness, restricted mobility
• Squinting, frowning; pupils of different sizes
• Redness, soreness (eyes or eyelids); recurring styles; discoloration
• Constant jiggling or moving of eyes side-to-side

3 – 4 years

Knows people from a distance (across the street)
Uses hands and feet together (i.e. catches a large ball)
Builds a tower of blocks, string beads; copies a circle and square

• Eyes do not follow what hand are doing

If there are concerns about a child's vision, advise the parent to arrange for a vision test with an optometrist, or contact the family physician who can refer the child to an ophthalmologist.

Age

Red Flags

18 months – 3 years

• Child and parent have little or not playful or verbal interaction
• Child initiates overly friendly or affectionate interactions with strangers
• Child ignores, avoids or  is hostile with parent when distressed or after separation
• Child is excessively distressed by separation from parent
• Child freezes or moves toward parent by approaching sideways, backwards or circuitously
• Child alternates between being hostile and overly affectionate with parent communication of child
• Parent uses inappropriate or ineffective behaviour management techniques

• Doesn’t smile in response to another person
• Delayed imaginative play – lack of varied, spontaneous make-believe play
• Prefers to play alone, decreased interest in other children
• Poor interactive play
• Poor eye contact – this does not mean it is absent
• Less showing, giving sharing and directing others’ attention than usual
• Any loss of social skills at any age (regression)
• Prefers to do things for him/herself rather than ask for help

• Awkward or absent greeting of others

If there are concerns, contact Children’s Therapy & Family Resource Centre at 371-4100  or Infant Development Program at 371-4140.

• Responds negatively to unexpected or loud noises
• Is distracted or has trouble functioning if there is a lot of background noise
• Enjoys strange noises/seeks to make noise for noise sake
• Seems to be in his/her own world

Visual

• Children over 3 – trouble staying between the lines when coloring
• Avoids eye contact
• Squinting or looking out of the corner of the eye
• Staring at bright, flashing objects

Taste/Smell

• Avoids certain tastes/smells that are typically part of a child’s diet
• Chew/licks non-food objects
• Gags easily
• Picky eater, especially regarding textures

Movement and Body Position

• Continually seeks out all kinds of movement activities (being whirled by adult, playground equipment, moving toys, spinning, rocking)
• Becomes anxious or distressed when feet leave ground
• Poor endurance – tires easily; seems to have weak muscles
• Avoids climbing, jumping, uneven ground or roughhousing
• Moves stiffly or walks on toes; clumsy or awkward, falls frequently
• Does not enjoy a variety of playground equipment
• Enjoys exaggerated positions for long periods (e.g. lies head-upside-down off sofa)

Touch

• Becomes upset during grooming (hair cutting, face washing)
• Has difficulty standing in line or close to other people; or stands too close, always touching others
• Is sensitive to certain fabrics
• Fails to notice when face or hands are messy or wet
• Cannot tolerate hair washing, hair cutting, nail clipping, teeth brushing
• Craves lots of touch: heavy pressure, long-sleeved clothing, hats and certain textures

Activity Level

• Always on the go; difficulty paying attention
• Very inactive, under-responsive

Emotional/Social

• Needs more protection from “life“ than other children
• Has difficulty with changes in routine
• Is stubborn or uncooperative; gets frustrated easily
• Has difficulty making friends
• Has difficulty understanding body language or facial expressions
• Does not feel positive about own accomplishments

If there are concerns, advise parent to contact Children’s Therapy & Family Resource Centre at 371-4100.

Self-injurious Behaviour

• Bites self; slaps self; grabs at self
• Picks at skin; sucks excessively on skin/bangs head on surfaces
• Eats inedibles
• Intentional vomiting (when not ill)
• Intentional vomiting (when not ill)
• Potentially harmful risk taking (e.g. running into traffic, setting fires)
• High pain tolerance

Aggression

• Temper tantrums; excessive anger, threats
• Hits; kicks; bites; scratches others; pulls hair
• Bangs, slams objects; property damage
• Cruelty to animals
• Hurting those less able/bullies others

Social Behaviour

• Difficulty paying attention/hyperactive; overly impulsive
• Screams; cries excessively; swears; severe tantrums
• Hoarding; stealing
• No friends; socially isolated; will not make eye or other contact; withdrawn
• Anxious; fearful/extreme shyness; agitated
• Compulsive behaviour in public; undressing in public
• Touches self or others in inappropriate ways; precocious knowledge of a sexual nature
• Flat affect, inappropriate emotions, unpredictable angry outburst, disrespect or striking female teachers are examples of post trauma red flags for children who have witnessed violence
• Narrow range of interests that he/she engages in repetitively
• Insists on maintaining sameness in routines, activities, clothing, etc

Non-compliance

• Oppositional behaviour
• Running away
• Resists assistance that is appropriate to age (ie: holding hands to cross the road)

Life Skills

• Deficits in expected functional behaviours (e.g. eating, toileting, dressing, poor play skills)
• Regression; loss of skills; refusal to eat; sleep disturbances
• Difficulty managing transitions/routine changes

Self-Stimulatory Behaviour

• Hand-flapping; hand wringing; rocking; swaying
• Repetitious twirling; repetitive object manipulation
• Unusual sensory interest – visually squinting or looking at things out of the corner of eye; smelling; licking; mouthing objects, etc

If there are social-emotional concerns, advise the parent to contact Child & Youth Mental Health at phone:  851-3600, Children’s Therapy & Family Resource Centre at 371-4100, or the Infant Development Program at phone 371-4140.