Name: Age: Date of Ax:

Age: 0-6 Months Activity Comments REDFLAGS: 6 months

Gross Motor Pulls self to sitting with support, bracing Not rolling.
shoulders.

Can sit with support with head and back straight.

Turns head from side to side to look.

Put on abdomen: Lifts head and chest wall up Not holding head and shoulders up
on extended arms. when on tummy.

Held standing: Weight bears on feet.

Fine Motor Able to bring hands to the midline? Hand frequently clenched.

Picks up objects with one hand?

Grasp: Not reaching for and holding
Attempts to grasp using grasping toys.
raking motion?
Palmar grasp.
Takes everything to mouth?
Visual Eyes move in unison
Perceptual
Follows/directs attention to activities in the room
When toy falls out of visual field, searches vaguely for object or

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 forgets it?
Cognitive Can they imitate movement of a banging toy?
Do they pull a cloth from their face?
Communicative Vocalises to self and response to speaker: a-a, much, goo, aroo. Not starting to babble.

Smiling, laughing and chuckling in play.

Turns to familiar voices. Does not smile or squeal in
response to people.

Emotional Still friendly with strangers, may display some shyness.

When put in front of a mirror, do they reach out or co at self?

Play Sequence 1. Eye Contact Abnormal Play:
2. Reciprocal cooling - stereotyped or poor repertoire
3. Reaching to Grasp - jerky or poor quality changes
4. Banging, Shaking Mouthing between toys and interactions
5. Cause and effect play: toys - rapid state changes or never
6. Active play: rough and tumble achieves quiet alert state
- poor self-regulation: needs a time
out often or support to achieve
arousal
- poor exploration or repetitive play
- lack of fit between infant and
caregiver.

References:
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Infancy [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298746_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 Name: Age: Date of Ax:
Age: 6-9 Months Activity Comments REDFLAGS: 9 months
Gross Motor Pulls self to sitting and sits unsupported on the floor. Not sitting without support.

Moves on floor by rolling, wriggling on ab or crawling. Not moving, creeping or

crawling.

Pulls to standing with object support cannot lower self backward.

Held standing: Steps with alternative feet. Does not take weight well
when held by an adult.

Fine Motor Pointing or poking with index finger.

Grasp: Inferior pincer grip developing: tips of fingers and thumbs.

One hand leading.

Transfers toy from hand to hand. Cannot move toy from one
hand to another.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 Brings toy to mouth.

Release: by dropping or pressing against surface, cannot release Unable to hold and or
smoothly. release toys.

Visual Looks in direction of fallen object.

Perceptual
Watches activities with attention for 3 minutes.
Enjoys casting objects from side of cot or chair.
Cognitive Can they imitate consonant sounds?
Can they imitate a gesture: eg. Clapping, waving? No gestures (pointing,
showing, waving).
Watches a toy being hidden under a cover and then goes to find it.
Communicative Vocalises (babbling) for interpersonal communication, friendliness Not using 2 part babble.
and annoyance.
Responds when name is called?
Understands ‘no’ and ‘bye-bye’.
Emotional Expresses physical states: anger, tiredness, excitement and hunger. Not sharing enjoyment
with others using eye
contact or facial
expression

Responds differently to stranger and caregiver: separation protest.

Play Bimanual Play: Transfers between hands, holds out toy to give, bang
together toys and objects.
References:
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Infancy [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298746_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Name: Age: Date of Ax:
Age: 9-12 Activity Comments REDFLAGS: 12 months
Months
Gross Motor Can rise to sitting position from lying with ease.
Crawls on hands and knees, shuffles on bottom or Not crawling or bottom
bearwalks. shuffling.

Pulls to stand, cruising on furniture, lifts one foot, Not pulling to stand.
steps sideways. Not standing onto furniture.

May stand alone for a few minutes.

Fine Motor Points with index finger.

Grasp: Neat pincer grasp Unable to pick up small items

between thumb and index using index finger and thumb.
finger: one co-ordinated action.

May show preference for one hand.

Takes objects to mouth less often- little drooling and saliva.
Active release of objects – dropping and throwing toys.
Visual Watches movements of objects for prolong periods.
Perceptual
Shows interest in pictures and all activities.
Looks in correct place for toys that fall out of sight.
Cognitive Are they pointing to objects/ do they turn over a blank card to
Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 view the picture?
Imitation of single action of a daily event eg. Brushing their hair,
talking on telephone
Promptly finds a toy that is hidden under a cup.
Communicative Babbles loudly and incessantly in conversation. Articulates most No babbling phrases that
speech sounds (vowels and constants). sound like talking.
Immediately responds to own name. No response to familiar
words.
Understands simple instructions with a gesture eg. ‘Come to
mummy.’
Emotional Expresses two or more emotions eg. pleasure, fear, sadness. Does not notice someone
new.
Expresses affection eg. hugging, patting.
Fear or reluctance to stranger.
Play Early imitative play: understanding of use of objects: brmm
cars, talk on phone, wipe floor with cloth
Plays simple games: ‘pat a cake’ and ‘peek a boo.’ Enjoys play Does not play early turn-
with adults taking games. Eg. peekaboo.

References:

Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Infancy [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298746_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Name: Age: Date of Ax:
Age: 1- 2 Years Activity Comments REDFLAGS: 18months REDFLAGS: 2 years
Gross Motor Walks in a straight line, stops and starts safely. Not standing alone.
Able to run. Not attempting to walk Unable to run.
without support .

Pushes and pulls large toys/boxes along the floor.

Enjoys climbing and can walk down stairs. Unable to use stairs
holding on.
Squats to play.
Rises to feet using hands as support.
Beginning to throw or kick a ball. Unable to throw a ball.
Fine Motor Grasp: Delicate pincer grasp for small objects. Does not attempt to
tower blocks.
Pencil Grip: Not holding or scribbling
Mid shaft, cylindrical. with a crayon.

Can copy single lines in one direction.

No longer takes toy to mouth.
Turns pages of books.
Visual Learning relative size of objects.
Perceptual
Cognitive Naming or pointing to familiar objects on request:
“What is this?”
Activates toy with help from parent or independently.
Communicative Chatters to self during play. Most of what is said is
not easily understood.
Uses 6-20 recognisable words. No clear words. Does not have at least
50 words.
Not putting words
together eg. Push car.
Follows simple instructions eg. ‘Shut the door.’ Cannot understand short
requests.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 Recognises body parts eg. ‘Can you point to hair,
shoes, nose, face?’
Demands by using single words and gestures.
Emotional Expresses likes and dislikes of activities.
Desire for social attention.
Discriminates between familiar and unfamiliar.
Still dependent upon familiar adult: may be between
clinging and resistance.
Play Functional: simple everyday activities. No interest in self care
Container: objects in and out of containers. skills eg. Feeding,
Constructive: Stacks 4-6 items. dressing
Early Symbolic/Imaginative: With toys When playing with
toys tends to bang,
drop or throw them
rather than use them
for a purpose.

Parallel player: plays alone near adult but explores the Lacks interest in playing
environment. and interacting with
others.

References:

Haines, J., Ames, L.B., Gillespie, C. (1980) The Gesell Preschool Test Manual Pennsylvania: Modern Learning Press
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Toddlers [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298763_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Name: Age: Date of Ax:
Age: 2 –3 Years Activity Comments REDFLAGS: 3 Years
Gross Motor Able to run smoothly eg. Does not appear to fall when running. Not running well.
Cannot walk up and
down stairs.
Propels self on push along toy eg. Scooter board, balance board or
shopping trolley.
Jumps in one place with two feet together. Cannot jump with two
feet together.
Balances on one foot for 3 seconds. Cannot balance well
standing on one leg.
Throws ball from hand stiffly.
Kicks large ball by walking into it .
Fine Motor Grasp: Neat grasp and release of small objects. Difficulty manipulating
small objects.

Pencil Grip: Mid shaft,

pronated one hand scribble.

Can draw a horizontal line and circle.

Hand preferences beginning.
Visual Begins to correct orientation of shapes eg. Shape puzzle
Perceptual
Matches simple shapes and colours.
Cognitive Begin to categorise objects to function not just appearance.
Understands ‘one’ v. all eg. “Can you give me one block.”
Interview:
Name: First and Last
Age: 3 ½ years
Sex: 3 years
Birthdates: 5 Years
Siblings: 31/2 years
Cube Test: 9/10 cubes
Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 Train: Builds train with chimney.
Bridge: Builds a tower or may imitate after demonstration.
Comprehension/Problem Solving:
What must you do when you are hungry?
What must you do when you are sleepy?
What must you do when you are cold?
Communicative Chatters to self during play, events happening here and now. Speech difficult to
understand.

Uses 200 words, speech immature articulations. Not using simple

Sentence structure (3 or 4 words long) joining words together. sentences eg. Big car go.
Can follow instructions.
Asking W questions eg. What, Where?
Can point to 3 body parts.
Emotional Learning to share with others.
Asks for assistance when having trouble.
Shows pride in accomplishments.
Emotions are extreme and short lived. Difficulties in noticing and
understanding feelings in
themselves and others.
Play Dramatic or symbolic play: Difficulty helping with self
Uses objects for pretend ideas. care skills.
Toys to represent animals or people.
Plays out dramas with stuffed animals/imaginary friends.
Constructive Play: Drawing, puzzles, Imitates parents in
household tasks, making messes.
Associative Parallel player: watches other children play, No interest in pretend
occasionally join in. play or other children.

References:

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Haines, J., Ames, L.B., Gillespie, C. (1980) The Gesell Preschool Test Manual Pennsylvania: Modern Learning Press
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Toddlers [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298763_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Name: Age: Date of Ax:
Age: 3-4 Years Activity Comments REDFLAGS: 4 Years
Gross Motor Sits with knees crossed.
Jumps with two feet together.
Able to walk on tip toes.

Stands on one foot for longer than 3 seconds. Cannot balance well.
Able to hop.
Throwing and catching ball with both hands. Cannot catch, throw or kick a
ball.

Galloping or beginning skipping action.

Fine Motor Pencil: Modified
tripod grasp; hand
preference.

Forms simple shapes out of play dough eg. ball, snake, pancake (in-
hand manipulation).
Can thread beads onto string (hand-eye co-ordination).
Cutting: Cutting on straight line? Able to make blades go up and
down?
Visual Beery Shapes: Can copy simple shapes: L, I, O, + Unable to draw circles and
Perceptual lines.

The incomplete Man: Three or four parts

Does he have a name?
How does he look?
How does he feel? Happy or Sad?
How can you tell? 4 Years
Matches simple shapes and colours eg. shape puzzle

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Cognitive Able to identify between smallest and biggest eg. “Can you tell me
which one is bigger?”
Understands ‘one’ v. all eg. “Can you give me one block?”
Counts to 5.
Interview:
Name: First and Last
Age: 3 years
Sex: 3 years
Birthdates: 5 years
Siblings: 31/2 years
Cube Test: 10 or more cubes
Train: Builds Train with chimney.
Bridge: Builds bridge after model
Gate: Imitates with a demonstration
Comprehension:
What must you do when you are hungry?
What must you do when you are sleepy?
What must you do when you are cold?
What must you do when you have lost something?
What must you do before you cross the street?
Communicative Uses pronouns, plurals and some past tense.
90% of what says should be intelligible. Speech difficult to understand.

Discriminates Prepositions:: 3-5 Commands. Unable to follow 2 directions.

Knows chief body parts: eg. “Can you point to?” Not toilet trained by day.

3- 5 word sentences.
Able to follow two step directions.
Emotional Shares toys with others. Unwilling/unable to play co-
operativley.
Shoes empathy for others/affection for siblings.
Separates from parents without crying.
Play Imaginary Play: Creates scripts where objects have actions that
reflect real life, plays dress up. Involves others in fantasy.
Constructive Play: Drawing, puzzles.
Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 Social Play: beginning co-operative play, games with simple rules.

References:

Haines, J., Ames, L.B., Gillespie, C. (1980) The Gesell Preschool Test Manual Pennsylvania: Modern Learning Press
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Middle Childhood [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298777_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
Name: Age: Date of Ax:
Age: 4-5 Years Activity Comments REDFLAGS: 5 Years
Gross Motor Moves well when walking: can walk heel to heel. Awkward when walking, running,
climbing and using stairs.

Able to balance on one foot for longer than 5 seconds.

Throwing/catching/kicking/ bouncing a ball: hands move Ball skills are very different to
together smoothly and automatically. peers.

Jumps using two feet together

Able to hop on both left and right leg . Unable to hop 5 times on each
foot.
Skipping may be uneven, able to run well.
Fine Motor Pencil: Modified tripod/dynamic tripod grasp.

Able to copy own name.

Forms simple shapes out of play dough eg. ball, snake,
pancake (in hand manipulation).
Able to thread beads onto string (hand-eye co-ordination).
Cutting: can cut continuously on a straight line and cuts
out a circle.
Visual Beery Shapes: Cross, square, triangle. Cannot draw simple pictures.
Perceptual
The incomplete Man: Sex difference + 5 body parts
Does he have a name?
How does he look?
How does he feel? Happy or Sad?
Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 How can you tell? 4 Years
Knows common opposites: big/small, hard/soft, heavy/light
Cognitive Matches shapes and colours: Names 5 different colours.
Counts to 10.
Interview: Cannot answer questions in a
Name: First and Last simple conversation.
Age: 3 Years
Sex: 3 Years
Birthdates: 5 Years
Siblings: 3 ½- number, 4 ½ names
Is it Morning or Night?
Cube Test: 10 or more cubes
Gate: Uses cube from model, builds side towers but doesn’t
tilt cube, may build gate at an angle.
Comprehension:
What must you do when you are hungry?
What must you do when you are sleepy?
What must you do when you are cold?
What must you do when you have lost something?
What must you do before you cross the street?
Communicative Speech should be completely intelligible.
Discriminates Prepositions:: 5-6 commands.
Knows chief body parts eg. “Can you point to?”
Long sentences and some compound sentences (4 or 5
words)
Able to follow 3 step directions.
Emotional Learning to take turns with others.
Can share about own feelings. Difficulty telling parent what is
wrong
Do they pack away belongings?
Developing friendship eg. Best freind.
Play Games with rules: simple rules. Play is different than their friends.
Constructive Play: takes pride in products, goal of art
activity.
Social/Dramatic play: role play with other children, dress
Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS
 up, tell stories.

References:

Haines, J., Ames, L.B., Gillespie, C. (1980) The Gesell Preschool Test Manual Pennsylvania: Modern Learning Press
Larsen, P.D., Stensaas, S.S., (2015) Pediatric NeuroLogic Exam. Retrived October, 16, 2015 from [Link]
Queensland Government., (2010 ) The “Red Flag” Early Intervention Referral Guide for Children 0-5 years. Retrieved from:
[Link]
Sherdian, Mary D. (2008) From Birth To Five Years. Wiltshire: The Cromwell Press.
Squires, J., Bricker, D. (2009) Ages and Stages Questionnaires (ASQ-3). New York: Springer. doi. 10.1007/978-1-4419-1698-3_283
Syliva, R., Desha, L., (2013) OCTY1203: Middle Childhood [PowerPoint Slides] Retrieved from [Link]
course_id=_5934_1&content_id=_298777_1
Voress, J.K., Pearson, N.A. (2006) Early Childhood Development Chart. Shoal Creek Boulevard: PRO-ED, Inc.

Baby Development Clinic Occupational Therapy Red Flag Indicator Tool – with thanks to Western Cluster of South West HHS