Red Flags for Feeding
- Ongoing poor weight gain (percentiles falling) or weight loss
- Ongoing choking, gagging or coughing during meals
- Ongoing problems with vomiting
- More than one incident of nasal reflux
- History of traumatic choking incident
- History of eating & breathing coordination problems, with ongoing respiratory issues
- Inability to transition to baby food purees by 10 months of age
- Inability to accept any table food solids by 12 months of age
- Inability to transition from breast/bottle to a cup by 16 months of age
- Has not weaned off baby foods by 16 months of age
- Aversion or avoidance of all foods in specific texture or food group
- Food range of less than 20 foods, especially if foods are being dropped over time with no new foods replacing those lost
- An infant who cries and/or arches at most meals
- Family is fighting about food and feeding (i.e. meals are battles)
- Parent repeatedly reports that the child is difficult for everyone to feed
- Parental history of an eating disorder, with a child not meeting weight goals
Red Flags for Speech and Language
Under 18 months
- No big smiles or other warm, joyful expressions by 6 months
- No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months or thereafter
- No babbling by 12 months
- Does not respond to his/her name by 12 months
- No sharing/reciprocal interactions like pointing, sharing, reaching or waving by 12 months
- No pointing at objects of interest by 14 months (pointing at a car driving by)
- Does not understand simple common words like mama or milk
- Is not using any words by 16 months
- Does not imitate gross motor movements like clapping or stomping feet
By 18 Months
- Does not use at least 8-10 meaningful words
- Does not follow simple commands like "come here" "stop" "don't" "give me the __________" or "touch your nose"
- Does not follow your pointing with his gaze
- Is not playing "pretend" with items (talking on toy phone, feeding a doll)
- Does not play in proximity to other children
By Age Two
- No two-word meaningful phrases (without imitating or repeating) by 24 months
- Does not follow simple two step commands such as "Get the ball and put it on the table"
- Speech is not at least 50% understandable
- Cannot point to pictures of items in books when asked
By Three Years
- Is not using three and four word sentences
- Speech is not at least 75% or more understandable
- Child is leaving the beginnings or ends off of most words
- Cannot accurately answer yes/no questions
- Cannot answer simple "wh" questions like "who is that" or "where is the truck"
- Does not play with other children
- Is experiencing stuttering behavior for more than 6 months
By Four to Five Years
- Is not 90-100% understandable to strangers despite age appropriate articulation errors (may not be able to say /r, sh, ch, l, or th yet)
- Is not consistently using 4+ word, complex sentences
- Is not asking a variety of questions to gain information (who, what, where, why and when)
- Is having difficulty with grammar or pronoun use
- Cannot tell a simple story on topic
- Canot follow simple two step directions
- Has difficulty answering simple who, what, where and why questions
- Is not yet able to name a few letters, numbers, and rhyming words
Overall Warning Signs
- ANY loss of speech or babbling or social skills at ANY age
- Never gestures or imitates
- Does not appear to understand speech, or appears to be unable to hear
- Never develops words beyond repeating others over and over