Red flags in developmental milestones

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1. Red flags in motor development

(1) Persistent fisting beyond 3 months of age is often the earliest sign of neuromotor problems.

(2) Early rolling over, early pulling to a stand instead of sitting, and persistent toe walking may all indicate spasticity.

(3) Spontaneous postures, such as scissoring in a child with spasticity or a frog-leg position in a hypotonic infant , are important visual clues to motor abnormalities.

(4) Early hand dominance (before 18 months of age ) may be a sign of weakness of the opposite upper extremity associated with a hemiparesis.

2. Red flags in cognitive development. Language development estimates verbal intelligence, whereas problem-solving skills estimate nonverbal intelligence.

(1) If skills are delayed significantly in both language and problem solving domains, mental retardation should be considered.

(2) If only language skills are delayed, hearing impairment or a communication disorder should be considered.

(3) If only problem-solving skills are delayed, visual or fine motor problems that interfere with manipulative tasks may be present .

(4) If there is a significant discrepancy between language and problem solving skills, the child is at high risk for learning disabilities.

3. Red flags in language development (Dd of speech or language delay)

(1) Global developmental delay or mental retardation

(2) Hearing impairment

(3) Environmental deprivation

(4) Pervasive developmental disorders, including autism spectrum disorders

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