The following situations place children at greater risk for health and developmental difficulties:
- Prematurity and/or low birth weight
- Parental or other exposure to drugs, alcohol, or tobacco
- Violence in the community or home
- Poor nutrition
- Family stress (for example, poverty, poor housing, homelessness, death in the family)
Some of the following behaviors are causes for concern in any child. Others may just be part of a particular temperament or personality and should be appraised in light of the child's total demeanor.
- By six months of age, avoids being help or talked to or resists being soothed and comforted.
- Does not pay attention or stay focused on an activity for as long a time as other children of the same age do.
- Avoids or rarely makes eye contact with others.
- Gets unusually frustrated when trying to do simple tasks that most children of the same age can do.
- Often acts out; appears to be very stubborn or aggressive.
- Acts extremely shy or withdrawn.
- Does not like being touched.
- Does not like having certain types of materials or clothing next to body.
- Treats other children, animals, or objects cruelly or destructively.
- Tends to break things a lot.
- Displays violent behavior (tantrums, fighting, screaming, or hitting other children) on a daily basis.
- Stares into space, rocks body, or talks to self more often than other children of the same age do.
- Often bangs head against an object, floor, or wall.
- Does not recognize dangerous situations, such as walking in traffic or jumping from high places.
- Tends to be sick often; complains of headaches or stomachaches.
- Has sleeping, feeding, eating, or toileting problems.
- Is overly impulsive, active, or distractible.
- Does not respond to discipline as well as children the same age.
- Has difficulty putting thoughts, actions, and movements together.
- Does not seek approval from parent or caregiver.
- Has frequent earaches.
- Has had many ear, nose, or throat infections or allergies.
- By four months, does not look at the source of sounds or voices or reat to loud noises.
- Talks in a very loud or soft voice.
- Seems to have difficulty responding when called from across the room, even when it is for something interesting.
- Turns body so that the same ear is always turned toward a sound.
- Breathes through mouth.
- Has difficulty understanding what is said.
- Has stiff arms or legs.
- Has floppy or limp body posture.
- Uses one side of the body more than the other.
- Has poor coordination or moves in a disorganized, clumsy manner as compared with other children of the same age.
- At three months, still has difficulty holding head up.
- At nine months, has difficulty sitting without help, standing up with support, reaching for objects, or picking objects up with thumb and index finger.
- At eighteen months, has difficulty walking without help, kicking a large ball, scribbling, or building a tower with two or three blocks.
- At age two, does not walk up or down stairs, squat or stoop and play without falling over.
- By age three, cannot run without falling frequently, or jump with both feet.
- By age four, has difficulty with such activities as hopping on one foot, pedaling a tricycle, catching a large bounced ball, closing a fist, or wiggling a thumb.
- By age five, has difficulty skipping using alternate feet, pumping self on a swing, or cutting with scissors.
- Seems to have difficulty following objects or people with eyes.
- Rubs eyes frequently.
- Has reddened, watering, or crusty eyelids.
- Holds head in a strained or unusual position when trying to look at an object.
- Seems to have difficulty finding or picking up small objects dropped on the floor.
- Has difficulty focusing or making eye contact.
- Closes one eye when trying to look at distant objects.
- At any age, is unusually quiet.
- By four months, rarely makes sounds like cooing or gurgling.
- By nine months, vocalizations are still vowel sounds, without repeated consonant sounds, such as ba-ba.
- By age one, does not shake head no.
- By age one, does not understand first words, such as milk, bottle, or bye-bye.
- By age one, does not say mama or dada.
- By age two, rarely names family members and/or common objects.
- By age two, does not speak in two-word phrases.
- By age two, does not point to objects or people to express want or need.
- By age three, does not know last name, gender, or common rhymes.
- By age three, does not follow simple directions or speak in three- or four-word phrases.
- By age four, does not tell stories, either real or make-believe, or ask frequent questions.
- By age four, does not speak in four- or five-word sentences and has speech that is not understandable by adults.
- By age five, does not know age, and cannot answer who, what, where, when, or why questions or use various types of sentences.
- By age one, has a hard time figuring out simple problems, such as finding an object after it is hidden, or repeating an action to make something happen.
- By age two, does not identify simple body parts by pointing, match similar objects, or recognize self in a mirror.
- By age three, does not understand simple stories and ideas.
- By age three, does not understand simple mathematical concepts such as one, more, or less, or count 1-2-3.
- By age four, does not give correct answers to questions, such as What do you do when you are sleepy or hungry?
- By age four, cannot tell the difference between different shapes or colors.
- By age fice, does not understand the concepts of today, tomorrow, or yesterday.
- By three months, does not coo or smile.
- By age one, does not play games like peek-a-boo or pat-a-cake or wave bye-bye.
- By eighteen months, does not try to get involved with another person's play, or look at a book, or an object, with another person.
- By age two, does not imitate or try to help with routine tasks, like sweeping, washing dishes, dusting, or driving a car.
- By age two, does not play purposefully.
- By age three, tends to play alone more than with other children.
- By age three, initiates play through pushing and hitting.
- By age three, does not interact with adults and children outside the family.
- By age four, does not play make-believe games and group games such as hide-and-seek with other children.
- By age four, does not share or take turns.
- By age five, does not express concern or compassion, when appropriate.
- By age five, does not show off occasionally.
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