Red Flags - for children birth to six years - A quick reference guide for early years professionals

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Red Flags - for children birth to six years - A quick reference guide for early years professionals
Red Flags —
         for children birth to six years

         A quick reference guide for
         early years professionals

         Early Identification in
         Leeds, Grenville & Lanark

Adapted November 2007
Red Flags - for children birth to six years - A quick reference guide for early years professionals
Red Flags - for children birth to six years - A quick reference guide for early years professionals
RED FLAGS: Table of Contents
   Red Flags Introduction
           • Red Flags Committee . ...........................................................................................1
           • Early Identification...................................................................................................2
           • What is “Red Flags”?.................................................................................................2
           • Who Should Use “Red Flags”? .............................................................................2
           • How to use this document....................................................................................2
           • Sensitive Issues..........................................................................................................3
   Duty to Report........................................................................................................................5-7
   Growth & Development:
           • Attachment.................................................................................................................8
           • Fine Motor...................................................................................................................9
           • Gross Motor............................................................................................................. 10
           • Vision.......................................................................................................................... 11
           • Hearing...................................................................................................................... 13
           • Sensory...................................................................................................................... 14
           • Speech & Language . ........................................................................................... 15
           • Literacy & Numeracy ........................................................................................... 18
           • Social/Emotional.................................................................................................... 20
           • Behaviour................................................................................................................. 21
   Nutrition & Oral Health:
           • Nutrition................................................................................................................... 22
           • Feeding & Swallowing......................................................................................... 24
           • Dental........................................................................................................................ 25
   Abuse:
           • Witnessing Family Violence................................................................................ 26
           • Physical...................................................................................................................... 28
           • Sexual........................................................................................................................ 29
           • Emotional................................................................................................................. 30
           • Neglect...................................................................................................................... 31
   Special Needs:
           • Autism . .................................................................................................................... 32
           • Fetal Alcohol Spectrum Disorder.................................................................... 33
           • Learning Disabilities............................................................................................. 34
           • Intellectual & Developmental Disabilities.................................................... 35
           • Mild Traumatic Brain Injury............................................................................... 36
   Other Factors:
            • Family Environmental Stressors...................................................................... 37
            • Postpartum Depression..................................................................................... 38
   Getting Ready for Kindergarten....................................................................................... 39
   Subsidy Information.............................................................................................................. 40
   Where to Go for Help ........................................................................................................... 41
Red Flags - for children birth to six years - A quick reference guide for early years professionals
Disclaimer Notice
Red Flags is a Quick Reference Guide designed to assist early years
professionals in deciding whether to refer for additional services. It is not a
formal screening or diagnostic tool.

The information contained in “Red Flags for children, birth to six years” (this
document) has been provided as a public service. Although every attempt
has been made to ensure accuracy, no warranties or representations,
expressed or implied, are made concerning the accuracy, reliability
or completeness of the information contained in this document. The
information in this document is provided on an “as is” basis without
warranty or condition.

This document cannot substitute for the advice and/or treatment of
professionals trained to properly assess the development and progress
of children, birth to six years. Although this document may be helpful to
determine when to seek out advice and/or treatment, this document should
not be used to diagnose or treat perceived developmental limitations and/
or other health care needs.

This document also refers to websites and other documents that are created
or operated by independent bodies. These references are provided as a
public service and do not imply the investigation or verification of the
websites or other documents. No warranties or representations, expressed
or implied, are made concerning the products, services and information
found on those websites or documents.

This document is being provided for your personal non-commercial use.
This document, or the information contained herein, shall not be modified,
copied, distributed, reproduced, published, licensed, transferred or sold for
a commercial purpose, in whole or in part, without the prior written consent
of the Red Flags Committee, which consent may be withheld at the sole
discretion of Red Flags Committee or be given subject to such terms and
conditions as Red Flags Committee may, in its sole discretion, impose.
Red Flags - for children birth to six years - A quick reference guide for early years professionals
INTRODUCTION
INTRODUCTION TO RED FLAGS
RED FLAGS COMMITTEE                                          Shannon Brown, Early Literacy Specialist,
                                                             Ontario Early Years Centre, United Counties of
The original Red Flags document was developed by
                                                             Leeds and Grenville
the Simcoe County Early Intervention Council and
                                                             Jill Brulé, Home Visiting Coordinator,
piloted in 2002. It was printed and disseminated             Connections Program, Lanark
by the Healthy Babies Healthy Children program,
                                                             Rebecca Carnochan, Open Doors for Lanark
Simcoe County District Health Unit as Red Flags              Children and Youth
- Let’s Grow With Your Child in March 2003.                  Emily Cassell, Data Analysis Coordinator, Lanark
Since that time York Region Early Identification             Jessica Deschamp-Baird, Data Analysis
Planning Coalition and the Kingston, Frontenac and           Coordinator, United Counties of Leeds and
Lennox & Addington Red Flags Committees have                 Grenville
reviewed and revised the original document.                  Darleen Desgens, Healthy Babies Healthy
                                                             Children Program Assistant, Leeds, Grenville
With permission of the Kingston, Frontenac and               and Lanark District Health Unit
Lennox & Addington (KFLA) Red Flags Committee,               Fiona Dufour, Public Health Nurse, Leeds,
the KFL&A Red Flags document was reviewed and                Grenville and Lanark District Health Unit
revised by the School Readiness Sub-Committee of             France Dupuis, Catholic District School Board of
the Healthy Babies Healthy Children Coalition of the         Eastern Ontario
Leeds, Grenville and Lanark District Health Unit and         Laurie Ann Glenn, Nurse Practitioner, Primary
other early years professionals who serve children in        Health Care, North Lanark County Community
                                                             Health Center
Leeds, Grenville and Lanark. The School Readiness
Committee consists of members from:                          Jane Hess, Director of Family Health, Leeds,
                                                             Grenville and Lanark District Health Unit
Brockville and Area YMCA; Catholic District School           Rebecca Langin, Administrative Coordinator,
Board of Eastern Ontario; Children’s Resource on             The Language Express© Preschool Speech
Wheels; Connections Program; Developmental                   - Language Service System
Services of Leeds and Grenville-Inclusive Child Care         Dixie O’Reilly, Infant & Child Development
Program; Healthy Babies Healthy Children Program;            Program, Leeds and Grenville
Infant & Child Development Programs; Lanark                  Catherine Robinson, Clinical Coordinator, The
County Childcare Providers; Lanark Early Integration         Language Express© Preschool Speech-Language
                                                             Service System
Program; Lanark Ontario Early Years Centres-Early
                                                             Rosemary Sheahan, Healthy Babies Healthy
Literacy Specialist and Data Analysis Coordinator;
                                                             Children Coordinator, Leeds Grenville and
Leeds, Grenville and Lanark District Health Unit;            Lanark District Health Unit
North Lanark County Community Health Center;                 Oksana Shewchenko, Production Artist, Leeds
Open Doors for Lanark Children and Youth; The                Grenville and Lanark District Health Unit
Language Express © Preschool Speech-Language                 Shona Stewart, Inclusive Child Care Program-
Service System; United Counties of Leeds and                 Developmental Services of Leeds and Grenville
Grenville-Ontario Early Years Centres, Early Literacy
Specialist and Data Analysis Coordinator; and the          Funding:
Upper Canada District School Board.
                                                           Healthy Babies Healthy Children, Leeds, Grenville
                                                           and Lanark District Health Unit
Acknowledgments:                                           In-Kind-Committee community partner agencies
The Leeds, Grenville and Lanark District Health Unit       listed above
would like to acknowledge the following for their          For further information, additional copies, to suggest
contributions to the resource:                             revisions to this document, or for information on
 Angèle Blaskie, Lanark Early Integration                  sources used, please contact the Leeds, Grenville
 Program                                                   and Lanark District Health Unit at 613-345-5685 or
 Kathy Boelsma, Early Literacy Specialist, Lanark          1-800-660-5853 or forward an email to:
                                                           redflags@healthunit.org

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark                    1
Red Flags - for children birth to six years - A quick reference guide for early years professionals
INTRODUCTION
    Early Identification                                        How to use this document
    Thanks to Dr. Fraser Mustard and other scientists,          This is a quick reference to look at child
    most professionals working with young children              development by domain, reviewing each domain
    are aware of the considerable evidence about                from birth to six years (unlike screening tools
    early brain development and how brief some                  that look at a particular child’s development
    of the “windows of opportunity” are for optimal             across many areas of development at a specific
    development of neural pathways. The early years             age). It includes other areas that may impact
    of development from conception to age six,                  child health, growth and development due to
    particularly for the first three years, set the base        the dynamics of parent-child interaction, such as
    for competence and coping skills that will affect           postpartum depression, abuse, etc.
    learning, behaviour and health throughout life 1.
                                                                Red Flags allows professionals to review and
    It follows, then, that children who may need                better understand domains on a continuum
    additional services and supports to ensure                  that are traditionally outside their own area of
    healthy development must be identified as                   expertise. This increased awareness will help
    quickly as possible and referred to appropriate             professionals better understand when and where
    programs and services. Early intervention during            to refer for further investigation or treatment.
    the period of the greatest development of neural
                                                                Use Red Flags in conjunction with a screening
    pathways, when alternative coping pathways
                                                                tool, such as Nipissing District Developmental
    are most easily built, is critical to ensure the best
                                                                Screens or Ages Stages Questionnaire (ASQ) to
    outcomes for the child. Time is of the essence!
                                                                review developmental milestones and problem
                                                                signs in a particular domain or indicator. Some
    What is Red Flags?                                          information is cross-referenced to other domains,
    Red Flags is a quick reference guide for Early              such as speech with hearing, to assist the
    Years professionals. It can be used in conjunction          screener in pursuing questions or ‘gut feelings’.
    with a validated screening tool, such as Nipissing
                                                                If children are not exhibiting the milestones
    District Developmental Screens (the Nipissing
                                                                for their age, further investigation is needed. If
    Screen 2) or Ages and Stages Questionnaire
                                                                using Nipissing District Developmental Screens,
    (ASQ). Red Flags outlines a range of functional
                                                                remember that the screening tools are age-
    indicators or domains commonly used to
                                                                adjusted; therefore, the skills in each screen are
    monitor healthy child development, as well as
    potential problem areas for child development.
                                                                Footnotes
    It is intended to assist in the determination of
                                                                1. Early Years Study: reversing the real brain drain, Hon.
    when and where to refer for additional advice,                 Margaret McCain and Fraser Mustard, April, 1999. See report
    formal assessment and/or treatment.                            at www.eldis.org/ .
                                                                2. Nipissing District Developmental Screens refer to 13
                                                                   parent checklists available to assist parents to record and
    Who should use Red Flags?                                      monitor development of children from birth to age 6. The
                                                                   screens cover development related to vision, hearing,
    This quick reference guide is intended to be                   communication, gross and fine motor, social/emotional
    used by any professional working with young                    and self-help and offers suggestions to parents for age
    children and their families. A basic knowledge                 appropriate activities to enhance child development.
                                                                   Parents are encouraged to call the Health Action Line of the
    of healthy child development is assumed. Red                   Leeds, Grenville and Lanark District Health Unit at 1-800-660-
    Flags will assist professionals in identifying when            5853 if two or more items are checked ‘No’. A public health
                                                                   nurse will review the results of the screen and suggest next
    a child could be at risk of not meeting his health             steps. It is particularly important for a screen to be reviewed
    and/or developmental milestones, triggering an                 by a professional if a problem is identified. For additional
                                                                   information about Nipissing District Developmental Screens
    alert for the need for further investigation by the            or to obtain copies, visit the website at www.ndds.ca
    appropriate discipline.

2                       Red Flags: Early Identification in Leeds, Grenville & Lanark                          November 2007
Red Flags - for children birth to six years - A quick reference guide for early years professionals
INTRODUCTION
expected to be mastered by most children at               Sensitive Issues
the age shown. If there are two or more “No”
                                                          One of the most difficult parts of recognizing
responses, refer to a professional for assessment.
                                                          a potential difficulty in a child’s development
Refer for further assessment even if you are              is sharing these concerns with the parents/
uncertain if the flags noted are a reflection of a        guardians. It is important to be sensitive when
cultural variation or a real concern.                     suggesting that there may be a reason to have
                                                          further assessment done. You want parents/
Note that some of the indicators focus on the
                                                          guardians to feel capable and to be empowered
parent/guardian, or the interaction between the
                                                          to make decisions. There is no one way that
parent and the child, rather than solely on the
                                                          always works best, but there are some things to
child.
                                                          keep in mind when addressing concerns.
Contact information is indicated at the end of
                                                          ►► Be sensitive to a parent/guardian’s readiness
the document in the “Where to Go for Help”
                                                             for information. If you give too much
section.
                                                             information when people aren’t ready, they
If a child appears to have multiple domains                  may feel overwhelmed or inadequate. You
requiring formal investigation by several                    might start by probing how they feel their
disciplines, screeners are encouraged to refer to            child is progressing. Some parents/guardians
the agencies that can coordinate a collaborative             have concerns, but have not yet expressed
and comprehensive assessment process.                        them. Having a parent use a tool such as the
If referrals are made to private sector agencies,            Nipissing District Developmental Screen may
alert families that fees will not be funded by               help open the way for discussion. It may help
OHIP.                                                        to specify that the screening tool is given
                                                             to parents to help them look at their child’s
                                                             development more easily and to learn about
 How to Use Red Flags                                        new activities that encourage growth and
                                                             development.
 Service providers may contact any agency
 for general information. If a specific case              ►► Be sure to value the parent’s/guardian’s

 will be discussed, ensure consent to share                  knowledge. The ultimate decision about
 information is obtained in accordance with                  what to do is theirs. Express what it is that
 the Ontario Privacy of Personal Information                 you have to offer and what they have to offer
 Act.                                                        as well. You may say something like: “I have
                                                             had training in child development, but you
 Step 1: 		Identify area of concern.                         know your child. You are the expert on your
 Step 2: 		Speak to parents about your                       child”. When you try to be more of a resource
           concerns.                                         than an “authority”, parents/guardians
                                                             feel less threatened. It is best to have the
 Step 3: 		Call agency in the “Where to Go for
                                                             parents/guardians discover how their child is
           Help” section for additional advice.
                                                             doing and decide whether or not extra help
 Step 4: 		Encourage parents to call agency                  would be beneficial. You may want to offer
           in the “Where to Go for Help”                     information you have by asking parents/
           section to initiate a referral.                   guardians what they would like to know.
                                                          ►► Have the family participate fully in the
                                                             final decision about what to do next. The
                                                             final decision is theirs. You provide only
                                                             information, support and guidance.

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark             3
Red Flags - for children birth to six years - A quick reference guide for early years professionals
INTRODUCTION
    ►► Give the family time to talk about how they             ►► Don’t entertain too many “what if” questions.
      feel, if they choose to. If you have only a                 A helpful response could be, “Those are good
      limited time to listen, make this clear to them,            questions. The professionals who will assess
      and offer another appointment if needed.                    your child will be able to answer them. This
                                                                  is a first step to indicate if an assessment is
    ►► Be genuine and caring. You are raising
                                                                  needed”.
      concerns because you want their child to do
      the best that he can, not because you want to            ►► Finally, it is helpful to offer reasons why it is
      point out “weaknesses” or “faults”. Approach                not appropriate to “wait and see”:
      the opportunity for extra help positively; “You
                                                                  □□ Early intervention can dramatically
      can get extra help for your child so he will be
                                                                     improve a child’s development and prevent
      as ready as he can be for school”. Also try to
                                                                     additional concerns such as behaviour
      balance the concerns you raise with genuine
                                                                     issues.
      positives about the child (e.g., Johnny is a real
      delight. He is so helpful when things need                  □□ The wait and see approach may delay
      tidying up. I have noticed that he seems to                    addressing a medical concern that has a
      have some trouble . . .).                                      specific treatment.

    ►► Your body language is important; parents may               □□ Early intervention helps parents
      already be fearful of the information.                         understand child behaviour and health
                                                                     issues, which will increase confidence that
                                                                     everything possible is being done to ensure
                                                                     that the child reaches his full potential.

4                      Red Flags: Early Identification in Leeds, Grenville & Lanark                   November 2007
Red Flags - for children birth to six years - A quick reference guide for early years professionals
DUTY TO REPORT
DUTY TO REPORT
Ontario’s Child and Family Services Act (CFSA)            Child and Family Services Act
provides for a broad range of services for families       CFSA s.72(1)
and children, including children who are or may           Despite the provisions of any other Act, if a
be victims of child abuse or neglect.                     person, including a person who performs
►► The paramount purpose of the Act is to
                                                          professional or official duties with respect to
  promote the best interests, protection and              children, has reasonable grounds to suspect
  well being of children.                                 one of the following, the person shall forthwith
                                                          report the suspicion and the information on
►► The Act recognizes that each of us has a               which it is based to a society.
  responsibility for the welfare of children. It
  states clearly that members of the public,              The child has suffered physical harm, inflicted
  including professionals who work with                   by the person having charge of the child or
  children, have an obligation to report                  caused by or resulting from that person’s failure
  promptly to a children’s aid society if they            to adequately care for, provide for, supervise or
  suspect that a child is or may be in need of            protect the child, or pattern of neglect in caring
  protection.                                             for, providing for, supervising or protecting the
                                                          child.
►► The Act defines the term “child in need
  of protection” and sets out what must be                There is a risk that the child is likely to suffer
  reported to a children’s aid society. This              physical harm inflicted by the person having
  definition (CFSA s.72(1)) is set out in detail          charge of the child or caused by or resulting
  on the following pages. It includes physical,           from that person’s failure to adequately care for,
  sexual and emotional abuse, neglect and risk            provide for, supervising or protecting the child.
  of harm.                                                The child has been sexually molested or sexually
This section summarizes reporting                         exploited, by the person having charge of the
responsibilities under Ontario’s Child and Family         child or by another person where the person
Services Act. It is not meant to give specific legal      having charge of the child knows or should know
advice. If you have questions about a given               of the possibility of sexual molestation or sexual
situation, you should consult a lawyer or your            exploitation and fails to protect the child.
local children’s aid society.                             There is a risk that the child is likely to be sexually
                                                          molested or sexually exploited as described in
Duty to Report                                            paragraph 3.
Responsibility to report a child in need                  The child requires medical treatment to cure,
of protection CFSAs.72(1)                                 prevent or alleviate physical harm or suffering
If a person has reasonable grounds to suspect             and the child’s parent or the person having
that a child is or may be in need of protection,          charge of the child does not provide, or refuses
the person must promptly report the suspicion             or is unavailable or unable to consent to, the
and the information upon which it is based to a           treatment.
children’s aid society.
                                                          The child has suffered emotional harm,
The situations that must be reported are listed in        demonstrated by serious
detail below.                                               □□ anxiety,
                                                            □□ depression,
                                                            □□ withdrawal,
                                                            □□ self-destructive or aggressive behaviour, or

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark                    5
Red Flags - for children birth to six years - A quick reference guide for early years professionals
DUTY TO REPORT
       □□ delayed development,                                  serious damage to another person’s property,
       □□ and there are reasonable grounds to                   services or treatments are necessary to prevent
          believe that the emotional harm suffered              a recurrence and the child’s parent or the person
          by the child results from the actions, failure        having charge of the child does not provide, or
          to act or pattern of neglect on the part              refuses or is unavailable or unable to consent to,
          of the child’s parent or the person having            those services or treatment.
          charge of the child.
                                                                The child is less than 12 years old and has on
    The child has suffered emotional harm of the                more than one occasion injured another person
    kind described in subparagraph i, ii, iii, iv or v of       or caused loss or damage to another person’s
    paragraph 6 and the child’s parent or the person            property, with the encouragement of the person
    having charge of the child does not provide, or             having charge of the child or because of that
    refuses or is unavailable or unable to consent to,          person’s failure or inability to supervise the child
    services or treatment to remedy or alleviate the            adequately.
    harm.
                                                                Ongoing duty to report
    There is a risk that the child is likely to suffer
                                                                CFSA s.72(2)
    emotional harm of the kind described in
    subparagraph i, ii, iii, iv or v of paragraph 6             The duty to report is an ongoing obligation. If
    resulting from the actions, failure to act or               a person has made a previous report about a
    pattern of neglect on the part of the child’s               child, and has additional reasonable grounds
    parent or the person having charge of the child.            to suspect that a child is or may be in need of
                                                                protection, that person must make a further
    There is a risk that the child is likely to suffer          report to a children’s aid society.
    emotional harm of the kind described in
    subparagraph i, ii, iii, iv or v of paragraph 6 and         Persons must report directly
    that the child’s parent or the person having                CFSA s.72(3)
    charge of the child does not provide, or refuses            The person who has the reasonable grounds
    or is unavailable or unable to consent to, services         to suspect that a child is or may be in need of
    or treatment to prevent the harm.                           protection must make the report directly to a
    The child suffers from a mental, emotional or               children’s aid society. The person must not rely
    developmental condition that, if not remedied,              on anyone else to report on his or her behalf.
    could seriously impair the child’s development
    and the child’s parent or the person having                 What are “reasonable grounds to suspect?”
    charge of the child does not provide, or refuses            You do not need to be sure that a child is or
    or is unavailable or unable to consent to,                  may be in need of protection to make a report
    treatment to remedy or alleviate the condition.             to a children’s aid society. “Reasonable grounds”
    The child has been abandoned, the child’s parent            are what an average person, given his or her
    has died or is unavailable to exercise his or her           training, background and experience, exercising
    custodial rights over the child and has not made            normal and honest judgment, would suspect.
    adequate provision for the child’s care and
                                                                Special responsibilities of professionals and
    custody, or the child is in a residential placement
                                                                officials, and penalty for failure to report
    and the parent refuses or is unable or unwilling
                                                                CFSA s.72(4), (6.2)
    to resume the child’s care and custody.
                                                                Professional persons and officials have the same
    The child is less than 12 years old and has killed          duty as any member of the public to report a
    or seriously injured another person or caused               suspicion that a child is in need of protection.

6                       Red Flags: Early Identification in Leeds, Grenville & Lanark                November 2007
DUTY TO REPORT
The Act recognizes, however, that persons                 Professional confidentiality
working closely with children have a special              CFSA s.72(7),(8)
awareness of the signs of child abuse and                 The professional’s duty to report overrides
neglect, and a particular responsibility to report        the provisions of any other provincial statute,
their suspicions, and so makes it an offence to           specifically, those provisions that would otherwise
fail to report.                                           prohibit disclosure by the professional or official.

Any professional or official who fails to report          That is, the professional must report that a child
a suspicion that a child is or may be in need of          is or may be in need of protection even when
protection, where the information on which the            the information is supposed to be confidential
                                                          or privileged. (The only exception for “privileged”
suspicion is based was obtained in the course
                                                          information is in the relationship between a
of his professional or official duties, is liable on
                                                          solicitor and a client.)
conviction to a fine of up to $1,000.

Professionals affected                                    Protection from liability
CFSA s.72(5)                                              CFSA s.72(7)
Persons who perform professional or official              If a civil action is brought against a person who
duties with respect to children include the               made a report, that person will be protected
                                                          unless he acted maliciously or without reasonable
following:
                                                          grounds for his suspicion.
    □□ health care professionals, including
       physicians, nurses, pharmacists and                What will the children’s aid society do?
       psychologists;                                     Children’s aid society workers have the
    □□ teachers and school principals;                    responsibility and the authority to investigate
    □□ social workers and family counsellors;             allegations and to provide services to protect
    □□ priests, rabbis and other members of the           children.
       clergy;                                            A children’s aid society worker may, as part of the
    □□ operators or employees of day nurseries;           investigation and plan to protect the child, involve
    □□ youth and recreation workers;                      the police and other community agencies.
    □□ peace officers and coroners;
    □□ solicitors;                                        WHERE TO GO FOR HELP
    □□ service providers and employees of service
                                                          If you have concerns about a child, please call
       providers; and                                     your local children’s aid society immediately. All
    □□ any other person who performs                      CASs have emergency service 24 hours a day, so
       professional or official duties with respect       you can call anytime.
       to a child.
                                                          Lanark County: Children’s Aid Society,
This list sets out examples only. If your work            613-264-9991 or 1-866-664-9991.
involves children but is not listed above, i.e., a
                                                          Leeds and Grenville Counties: Family and
volunteer or student, you may still be considered         Children’s Services of Leeds and Grenville, 613-
to be a professional for purposes of the duty to          498-2100 or 1-800-481-7834. After hours, call
report. If you are not sure whether you may be            the local number and the answering service will
considered to be a professional for purposes              contact the person on call.
of the duty to report, contact your local
                                                          The Ontario Association of Children’s Aid Societies
children’s aid society, professional association, or
                                                          www.oacas.org/childwelfare/how
regulatory body.
                                                          then click on ‘Report Child Abuse’, then ’How and
                                                          When to Report’.

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark                 7
GROWTH & DEVELOPMENT
    ATTACHMENT
    Children’s Mental Health research shows that the quality of early parent-child relationships has an
    important impact on a child’s development and his ability to form secure attachments. A child who
    has secure attachment feels confident that he can rely on the parent to protect him in times of distress.
    This confidence gives the child security to explore the world and establish trusting relationships
    with others. As a result, current mental health practice is to screen the quality of the parent-child
    interactions.
    The following items are considered from the parent’s perspective, rather than the child’s. If a parent
    states that one or more of these statements describes their child, the child may be exhibiting signs of
    an insecure attachment; consider this a red flag:

    0-8 months
       □□ Is difficult to comfort by physical contact            Problem signs ...
          such as rocking or holding                             if a mother or primary caregiver is frequently
       □□ Does things or cries just to annoy you                 displaying any of the following, consider this
                                                                 a red flag:
    8-18 months                                                  ►► Being insensitive to a baby’s
       □□ Does not reach out to you for comfort                     communication cues
       □□ Easily allows a stranger to hold him/her               ►► Often unable to recognize baby’s cues

                                                                 ►► Provides inconsistent patterns of
    18 months - 3 years                                             responses to the baby’s cues
       □□ Is not beginning to develop some
          independence                                           ►► Frequently ignores or rejects the baby

       □□ Seems angry or ignores you after you have              ►► Speaks about the baby in negative terms
          been apart
                                                                 ►► Often appears to be angry with the baby

                                                                 ►► Often expresses emotions in a fearful or
    3-4 years
                                                                    intense way
       □□ Easily goes with a stranger
       □□ Is too passive or clingy with you

    4-5 years
       □□ Becomes aggressive for no reason (e.g.,              WHERE TO GO FOR HELP
          with someone who is upset)                           See Attachment in the Where to Go for Help
       □□ Is too dependent on adults for attention,            section at the back of this document.
          encouragement and help

8                      Red Flags: Early Identification in Leeds, Grenville & Lanark                 November 2007
GROWTH & DEVELOPMENT
FINE MOTOR
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:
By 2 months                                               By 3 years
   □□ Sucks well on a nipple                                  □□ Turns the paper pages of a book
   □□ Holds an object momentarily if placed in                □□ Dresses or undresses with help
      hand                                                    □□ Unscrews a jar lid
By 4 months                                                   □□ Holds a crayon with fingers
   □□ Sucks well on a nipple                                  □□ Draws vertical and horizontal lines in
   □□ Brings hands or toy to mouth                               imitation
   □□ Turns head side to side to follow a toy or an           □□ Copies a circle already drawn
      adult face                                          By 4 years
   □□ Brings hands to midline while lying on back             □□ Holds a crayon correctly
By 6 months                                                   □□ Undoes buttons or zippers
   □□ Eats from a spoon (e.g., infant cereal)                 □□ Cuts with scissors
   □□ Reaches for a toy when lying on back                    □□ Dresses and undresses with minimal help
   □□ Uses hands to reach and grasp toys                  By 5 years
By 9 months                                                   □□ Draws diagonal lines and simple shapes
   □□ Picks up small items using thumb and first              □□ Uses scissors to cut along a thick line drawn
      finger                                                     on paper
   □□ Passes an object from one hand to the                   □□ Dresses and undresses without help except
      other                                                      for small buttons, zippers, snaps
   □□ Releases objects voluntarily                            □□ Draws a stick person
By 12 months
   □□ Holds, bites and chews foods (e.g., crackers)            Problem signs...
   □□ Takes things out of a container                          if a child is experiencing any of the
   □□ Points with index finger                                 following, consider this a red flag:
   □□ Plays games like peek-a-boo
                                                               ►► Infants who are unable to hold or grasp
   □□ Holds a cup to drink using two hands
                                                                  an adult finger or a toy/object for a
   □□ Picks up and eats finger foods                              short period of time
By 18 months                                                   ►► Unable to play appropriately with a
   □□ Helps with dressing by pulling out arms                     variety of toys; or avoids crafts and
      and legs                                                    manipulatives
   □□ Stacks two or more blocks
                                                               ►► Consistently ignores or has difficulty
   □□ Scribbles with crayons
                                                                  using one side of body; or uses one
   □□ Eats foods without coughing or choking
                                                                  hand exclusively
By 2 years
   □□ Takes off own shoes, socks or hat
                                                            WHERE TO GO FOR HELP
   □□ Stacks five or more blocks
                                                            See Fine Motor in the Where to Go for Help
   □□ Eats with a spoon with little spilling
                                                            section at the back of this document.

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark                 9
GROWTH & DEVELOPMENT
     GROSS MOTOR
     Healthy Child Development
     ... If a child is missing one or more of these expected age outcomes, consider this a red flag:

     By 3 months                                                By 3 years
        □□ Lifts head up when held at your shoulder                □□ Stands on one foot briefly
        □□ Lifts head up when on tummy                             □□ Climbs stairs with minimal or no support
     By 4 months                                                   □□ Kicks a ball forcefully
        □□ Keeps head in midline and brings hands
           to chest when lying on back
                                                                By 4 years
        □□ Lifts head and supports self on forearms
                                                                   □□ Stands on one foot for one to three seconds
           on tummy
                                                                      without support
        □□ Holds head steady when supported in
                                                                   □□ Goes up stairs alternating feet
           sitting position
                                                                   □□ Rides a tricycle using foot peddles
     By 6 months                                                   □□ Walks on a straight line without stepping
        □□ Rolls from back to stomach or stomach                      off
           to back
                                                                By 5 years
        □□ Pushes up on hands when on tummy
                                                                   □□ Hops on one foot
        □□ Sits on floor with support
                                                                   □□ Throws and catches a ball successfully most
     By 9 months                                                      of the time
        □□ Sits on floor without support                           □□ Plays on playground equipment safely and
        □□ Moves self forward on tummy or rolls                       without difficulty
           continuously to get item
        □□ Stands with support
     By 12 months                                                 Problem signs...
        □□ Gets up to a sitting position on own                   if a child is experiencing any of the
        □□ Pulls to stand at furniture                            following, consider this a red flag:
        □□ Walks holding onto hands or furniture
                                                                  ►► Baby is unable to hold head in the
     By 18 months                                                     middle to turn and look left and right.
        □□ Walks alone
                                                                  ►► Unable to walk with heels down four
        □□ Crawls up stairs                                           months after starting to walk.
        □□ Pushes or pulls toys or other objects
                                                                  ►► Asymmetry (i.e., a difference between
           when walking
                                                                      two sides of body; or body too stiff or
     By 2 years                                                       too floppy).
        □□ Walks backwards or sideways pulling a
           toy
        □□ Plays in a squat position
        □□ Kicks a ball                                         WHERE TO GO FOR HELP
                                                                See Gross Motor in the Where to Go for Help
                                                                section at the back of this document.

10                      Red Flags: Early Identification in Leeds, Grenville & Lanark                   November 2007
GROWTH & DEVELOPMENT
VISION
  Current research suggests that approximately 1 in 6 children has a vision problem. Children born
  with poor vision do not know what “normal vision” is like. They often think that everyone sees
  the same way that they do. Therefore, do not wait for your child to tell you that they have a vision
  problem. An eye examination is covered by OHIP once a year until the individual’s 19th birthday.
  The Ontario Association of Optometrists recommended frequency for children’s eye examinations:
  6 months of age, 3 years of age and then every 12 months or as recommended by the optometrist

Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:

0-3 months                                                12 months-2 years
   □□ Focuses on your face, bright colors and                 □□ Moves eyes and hands together (e.g.,
      lights; follows slow-moving, close objects                 stack blocks, place pegs)
   □□ Blinks when bright lights come on or if a               □□ Judges depth e.g., climbs up and down
      fast moving object comes into close view                   stairs
   □□ Watches as you walk around the room                     □□ Links pictures with real life objects
   □□ Looks at hands and begins to reach out                  □□ Follows objects as they move from above
      and touch nearby objects                                   head to feet
4-6 months                                                2-3 years
   □□ Tries to copy your facial expression                    □□ Sits a normal distance when watching
   □□ Reaches across the crib for objects/                       television
      reaches for objects when playing with                   □□ Follows moving objects with both eyes
      you                                                        working together (coordinated)
   □□ Grasps small objects close by                       3-4 years
   □□ Follows moving objects with eyes only                   □□ Knows people from a distance (across
      (less moving of head)                                      the street)
7-12 months                                                   □□ Uses hands and eyes together (e.g.,
   □□ Plays games like ‘peek-a-boo’, ‘pat-a-cake’,               catches a large ball)
      ‘waves bye-bye’                                         □□ Builds a tower of blocks, string beads;
   □□ Reaches out to play with toys and other                    copies a circle, triangle and square
      objects on own                                      4-5 years
   □□ Moves around to explore what’s in the                   □□ Knows colours and shadings; picks out
      room; searches for a hidden object                         detail in objects and pictures
                                                              □□ Holds a book at a normal distance

                                                                (See VISION problem signs on
                                                                following page)

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark           11
GROWTH & DEVELOPMENT
     VISION continued

       Problem signs...
       if a child is experiencing any of the                 ►► Covering one eye; has difficulty, or is
       following, consider this a red flag:                     irritable with reading or with close work

       ►► Blinking and/or rubbing eyes often; a lot          ►► Eyes that cross, turn in or out, move
          of tearing or eye-rubbing                             independently

       ►► Headaches, nausea, dizziness; blurred or           ►► Holding toys close to eyes, or no interest in
          double vision                                         small objects and pictures

       ►► Eyes that itch or burn; sensitive to bright        ►► Bumping into things, tripping; clumsiness,
          light and sun                                         restricted mobility

       ►► Unusually short attention span; will only          ►► Squinting, frowning; pupils of different
          look at you if he hears you                           sizes

       ►► Avoidance of tasks with small objects              ►► Redness, soreness (eyes or eyelids);
                                                                recurring styes; discoloration
       ►► Turning or tilting head to use only one
          eye to look at things                              ►► Constant jiggling or moving of eyes side-
                                                                to-side (roving)

     WHERE TO GO FOR HELP
     See Vision in the Where to Go for Help
     section at the back of this document.

12                     Red Flags: Early Identification in Leeds, Grenville & Lanark                November 2007
GROWTH & DEVELOPMENT
HEARING
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:

0-3 months                                              2-3 years
   □□ Startles, cries or wakens to loud sounds              □□ Listens to a simple story
   □□ Moves head, eyes, arms and legs in                    □□ Follows two requests (e.g., Get the ball and
      response to a noise or voice                             put it on the table.)
   □□ Smiles when spoken to, or calms down;                 □□ Learns new words every week
      appears to listen to sounds and talking           3-4 years
4-6 months                                                  □□ Hears you when you call from another
   □□ Responds to changes in your voice tone                   room
   □□ Looks around to determine where new                   □□ Listens to the television at the same
      sounds are coming from                                   loudness as the rest of the family
   □□ Responds to music and people’s voices                 □□ Answers simple questions
   □□ Begins to make speech-like sounds e.g.,               □□ Speaks clearly enough to be understood
      buh, ma, boo                                             most of the time by family
6-9 months                                              4-5 years
   □□ Turns or looks up when his name is called             □□ Pays attention to a story and answers
      Responds to the word “no”                                simple questions
   □□ Listens when spoken to                                □□ Hears and understands most of what is said
   □□ Knows common words like “cup”, “shoe”,                   at home and school
      “mom”                                                 □□ Family, teachers, child care providers, and
9-12 months                                                    others think he hears fine
   □□ Responds to requests such as “Want more?”             □□ Speaks clearly enough to be understood
      “Come here.” “ Where’s the ball?”                        most of the time by anyone
   □□ Babbles sounds in a series e.g., bababa,
      dadada, mememe                                       Problem signs...
   □□ Says first word                                      if a child is experiencing any of the
12 months-2 years                                          following, consider this a red flag:
   □□ Turns toward you when you call their name            ►► Early babbling stops
      from behind
   □□ Follows simple commands                              ►► Ear pulling (with fever or crankiness)

   □□ Tries to ‘talk’ by pointing, reaching and            ►► Does not respond when called
      making noises
                                                           ►► Draining ears; a lot of colds and ear
   □□ Knows sounds like a closing door and a                  infections
      ringing phone
                                                           ►► Loud talking
   □□ Listens to simple stories, rhymes, and sings
   □□ Imitates sounds and words
                                                        WHERE TO GO FOR HELP
                                                        See Hearing in the Where to Go for Help section
                                                        at the back of this document.

November 2007                     Red Flags: Early Identification in Leeds, Grenville & Lanark                13
GROWTH & DEVELOPMENT
     SENSORY
     Sensory integration refers to the ability to receive input through all of the senses - taste, smell,
     auditory, visual, touch, movement and body position, and the ability to process this sensory
     information into automatic and appropriate responses to the sensation.
      Problem signs...
      if a child’s responses are exaggerated, irrational, extreme, and/or oppositional and do not seem
      typical for the child’s age, consider this a red flag:
      ►► Auditory                                                □□ Does not enjoy a variety of playground
         □□ Responds negatively to unexpected or                    equipment
            loud noises                                          □□ Enjoys exaggerated positions for long
         □□ Is distracted or has trouble functioning if             periods (e.g., lies head-upside-down off
            there is a lot of background noise                      sofa)
         □□ Enjoys strange noises/seeks to make noise         ►► Touch
            for noise sake                                       □□ Becomes upset during grooming (hair
         □□ Seems to be “in his own world”                          cutting, face washing, fingernail cutting)
      ►► Visual                                                  □□ Has difficulty standing in line or close to
         □□ Children over 3 - trouble staying between               other people; or stands too close, always
            the lines when colouring                                touching others
         □□ Avoids eye contact                                   □□ Is sensitive to certain fabrics
         □□ Squinting, or looking out of the corner of           □□ Fails to notice when face or hands are
            the eye                                                 messy or wet
         □□ Staring at bright, flashing objects                  □□ Cannot tolerate hair washing, hair cutting,
      ►► Taste/Smell                                                nail clipping, teeth brushing
         □□ Avoids certain tastes/smells that are                □□ Craves lots of touch: heavy pressure, long-
            typically part of a child’s diet                        sleeved clothing, hats and certain textures
         □□ Chews/licks non-food objects                      ►► Activity Level
         □□ Gags easily                                          □□ Always on the go; difficulty paying
         □□ Picky eater, especially regarding textures              attention
      ►► Movement and Body Position                              □□ Very inactive, under-responsive
         □□ Continually seeks out all kinds of                ►► Emotional/Social
            movement activities (being whirled by                □□ Needs more protection from life than other
            adult, playground equipment, moving                     children
            toys, spinning, rocking)                             □□ Has difficulty with changes in routines
         □□ Becomes anxious or distressed when feet              □□ Is stubborn or uncooperative; gets
            leave ground                                            frustrated easily
         □□ Poor endurance - tires easily; seems to              □□ Has difficulty making friends
            have weak muscles                                    □□ Has difficulty understanding body
         □□ Avoids climbing, jumping, uneven ground                 language or facial expressions
            or roughhousing                                      □□ Does not feel positive about own
         □□ Moves stiffly or walks on toes; clumsy or               accomplishments
            awkward, falls frequently

     WHERE TO GO FOR HELP        See Sensory in the Where to Go for Help section at the back of this document.

14                      Red Flags: Early Identification in Leeds, Grenville & Lanark              November 2007
GROWTH & DEVELOPMENT
SPEECH & LANGUAGE
Healthy Child Development
... If a child is missing one or more of these expected age outcomes, consider this a red flag:

By 3 months                                                   □□ Tries to copy new sounds (e.g., ba, animal
   □□ Cries and grunts; has different cries for                  sounds, car noises)
      different needs                                         □□ Makes sounds to get attention, to make
   □□ Makes a lot of “cooing” and “gooing” sounds                needs known, or to protest
   □□ Responds to parent/caregiver voice (e.g.,,              □□ Responds to hearing own name
      Watches your face as you talk)                          □□ Understands “no” and simple requests (e.g.,,
                                                                 Give it to mommy. Don’t touch. Where’s the
                                                                 ball?)
By 6 months
   □□ Babbles using different sounds                          □□ Plays social games with you (e.g., peek a
                                                                 boo)
   □□ Lets you know by voice sounds to do
      something again                                         □□ Enjoys being around people
   □□ Makes “gurgling” noises
   □□ Understands some words (e.g., daddy, bye            By 18 months
      bye)                                                    □□ Tries to copy your sounds (sounds of our
                                                                 language)
   □□ Smiles or laughs
                                                              □□ Uses at least 20-50 words consistently;
   □□ Vocalizes pleasure and displeasure (e.g.,
                                                                 words do not have to be clear
      squeals with excitement, grunts in anger)
                                                              □□ Understands many more words than
   □□ Enjoys music, songs and rhymes
                                                                 he can say
   □□ Brightens to sound, especially to people’s
                                                              □□ Understands simple directions or questions
      voices
                                                                 (e.g.,, Where is your nose? Get the ball.)
   □□ Smiles and laughs in response to parent/
                                                              □□ Demonstrates some pretend play with toys
      caregiver smiles and laughs
                                                                 (e.g., give Teddy a drink)
   □□ Imitates sounds in his/her repertoire (e.g.,
                                                              □□ Enjoys tickle, bounce and nursery rhymes
      coughs or other sounds – ah, eh, buh)
                                                              □□ Makes at least four consonant sounds from
                                                                 p, b, m, n, d, t, w, h
By 12 months
                                                              □□ Identifies pictures in a book (e.g., Show me
   □□ Consistently uses three to five single words               the baby)
   □□ Takes turns with sounds (e.g., Buh, animal              □□ Enjoys being read to and looking at books
      sounds, car noises)
                                                              □□ Points to familiar people and to some body
   □□ Waves hi/bye (emerging) and begins to use                  parts when asked
      other gestures (e.g., hands up means pick
      me up)                                                  □□ Understands the concepts of in and out, off
                                                                 and on
   □□ Gives a few familiar objects on verbal
      request
   □□ Uses a variety of different voice sounds            By 2 years
      when playing (e.g., bababa, dadada,                     □□ Tries to copy your words
      nanana)                                                 □□ Uses a variety of words and gestures to
   □□ Combines lots of sounds as though talking                  communicate and ask for help (e.g., waving,
      (e.g., abada, baduh, abee)                                 pushing away, pointing)
                                                                                              continued ...

November 2007                       Red Flags: Early Identification in Leeds, Grenville & Lanark                15
GROWTH & DEVELOPMENT
       □□ Uses 100-150 words and combines 2 words                 □□ Uses pronouns: I, you, me and mine
          (e.g., More juice. Want cookie.)                        □□ Understands questions using who, what,
       □□ Follows two step instructions (e.g., go find               why, when and where
          your teddy bear and show it to Grandma)                 □□ Is learning the meaning of several new
       □□ Takes turns in a conversation                              words every week (in spoken language)
       □□ Asks for something by pointing and using                □□ Sings simple songs and familiar rhymes
          sounds or words                                         □□ Talks about past events
       □□ Begins to offer toys to peers and imitates              □□ Tells simple stories
          other children’s actions and words
                                                                  □□ Shows affection for favourite playmates
       □□ People can understand his/her words 50 to
          60 per cent of the time                                 □□ Engages in multi step pretend play
                                                                     – cooking a meal, repairing a car
       □□ Uses many different speech sounds at
          beginning of words (p,b,m,t,d,n,h,w)                    □□ Shows ability to participate in routines
       □□ Enjoys being with other children
       □□ Learns and uses one or more new words a              By 4 ½ years
          week; may only be understood by family                  □□ Most of the time uses complete sentences
                                                                     with 4 or more words (e.g., I go home now.)
                                                                  □□ Uses correct grammar such as plural
     By 30 months
                                                                     (e.g., books), past tense (e.g., walked) and
       □□ Understands the concepts of size (big/little)              pronouns (e.g., I, he, she, me, you)
          and quantity (a lot, little, more)
                                                                  □□ Follows directions involving three or more
       □□ Uses some correct grammar – “two                           steps “First get some paper, then draw a
          cookies”; ‘bird flying”                                    picture, last give it to mom”
       □□ Uses more than 350 words                                □□ Tells stories with clear beginning, middle
       □□ Uses action words – run, fall                              and end
       □□ Begins taking turns with other children                 □□ Talks to try to solve problems with adults
          using both toys and words                                  and other children
       □□ Shows concern when another child is hurt                □□ Demonstrates increasingly complex
          or sad                                                     imaginative play
       □□ Combines several actions in play –feeds                 □□ Is understood by adults outside the family
          dolls then puts him/her to sleep                           almost all the time
       □□ Produces words with two or more syllables               □□ Is learning the meaning of and using several
          or beats: ba-na-na, com-pu-ter                             “new words” every week (in spoken
                                                                     language)
     By 3 years                                                   □□ Recites nursery rhymes and sings familiar
       □□ Responds to simple questions or directions                 songs

       □□ Understands location words like in, on and              □□ Understands “just one”
          under                                                   □□ Enjoys being read to
       □□ Identifies some objects by their functions              □□ Can identify 4-6 colours by name
          (e.g., What is a spoon for?)
       □□ Is understood by most people outside of
          the family most of the time
       □□ Uses long sentences, using 5-8 words

16                     Red Flags: Early Identification in Leeds, Grenville & Lanark                November 2007
GROWTH & DEVELOPMENT
By 5 ½ years
  □□ Talks easily with other children and adults           Problem signs...
     and is understood                                     if a child is experiencing any of the
  □□ Understands spatial relationships, on top             following, consider this a red flag:
     of, under, behind, in front of, etc.                     □□ Stumbling or getting stuck on words
  □□ Explains concepts using words (e.g. ,What is                or sounds (stuttering)
     a cup? What is a car?)                                   □□ Ongoing hoarse voice
  □□ Understands many descriptive words (e.g.,                □□ Excessive drooling
     long/short, soft/hard)
                                                              □□ Problems with swallowing or chewing,
  □□ Follows group directions “All the boys get                  or eating foods with certain textures
     a toy”                                                      (gagging).
  □□ Understands directions involving e.g.,                      See also Feeding and swallowing
     “if…then” – “If you are wearing runners,                    section
     then line up for gym”                                    □□ Lack of eye contact and poor social
  □□ Describes and can retell past, present, and                 skills for age
     future events in detail                                  □□ Frustrated when verbally
  □□ Seeks to please his or her friends                          communicating
  □□ Shows increasing independence in
     friendships
  □□ Uses almost all the sounds of his or her
     language with few to no errors                        See also
  □□ Uses complete sentences with good                     • Literacy & Numeracy
     grammatical structure                                   Speech and language difficulties are often
  □□ Is learning the meaning of and is using                 associated with weak literacy skills.
     several new words every week (in spoken
     language)
  □□ Can recall a brief story that has just been
     heard

                                                        WHERE TO GO FOR HELP
                                                        See Speech & Language in the Where to Go for
                                                        Help section at the back of this document.

November 2007                     Red Flags: Early Identification in Leeds, Grenville & Lanark            17
GROWTH & DEVELOPMENT
     LITERACY & NUMERACY                                       By 2 years
                                                                  □□ Asks for favourite books to be read over and
     By 3 months                                                     over again
       □□ Shows interest in contrast between light
                                                                  □□ Pretends to read
          and dark
                                                                  □□ Names familiar pictures
       □□ Makes eye contact with pictures in book
                                                                  □□ Scribbles
       □□ Looks intensely at pictures for several
          minutes                                                 □□ Holds books the right way up and turns
                                                                     pages easily, one at a time
                                                                  □□ Relates events in books to his/her own past
     By 6 months
                                                                     experiences
       □□ Enjoys music, songs and rhymes
                                                                  □□ Notices print rather than just the pictures
       □□ Reaches for and explores books with hands
          and mouth                                               □□ Can join in and recite phrases
       □□ Sits on lap and holds head up steadily
       □□ Shows preference for photographs of faces            By 30 months
                                                                  □□ Produces words with two or more syllables
       □□ Uses both hands to manipulate the book to
                                                                     or beats: ba-na-na, com-pu-ter
          make the pages open and close
                                                                  □□ Recognizes familiar logos and signs -
                                                                     (e.g., stop sign)
     By 12 months
                                                                  □□ Remembers and understands familiar stories
       □□ Shows interest in looking at books
       □□ Holds book with help
                                                               By 3 years
       □□ Tries to turn several pages at a time
                                                                  □□ Sings simple songs and familiar rhymes
       □□ Looks at pictures, vocalizes and pats picture
                                                                  □□ Pretends to read familiar books aloud
       □□ Sits up without support
                                                                  □□ Knows how to use a book (holds/turns pages
       □□ Plays social games with you (e.g., peek a                  one at a time, starts at beginning,
          boo)                                                       points/talks about pictures)
                                                                  □□ Looks carefully and makes comments about
     By 18 months                                                    books
       □□ Points at pictures with one finger                      □□ Fills in missing words/phrases in familiar
       □□ Enjoys tickle, bounce and nursery rhymes                   books that are read aloud
       □□ Identifies pictures in a book (e.g., Show me            □□ Holds a pencil/crayon with pincer grasp and
          the baby)                                                  uses it to draw/scribble
       □□ Able to carry book and turn pages well                  □□ Imitates writing with linear scribbles
       □□ Holds a crayon or pencil in fist and marks              □□ Copies a circle, vertical and horizontal lines
          paper, scribbles                                           when shown
       □□ Labels a particular picture with a specific             □□ Talks about past events
          sound                                                   □□ Tells simple stories
       □□ Enjoys being read to and looking at books               □□ Engages in multi step pretend play – cooking
       □□ Relates an object or an action in a book to                a meal, repairing a car
          the real world                                          □□ Is aware of the functions of print –
                                                                     in menus, signs
                                                                  □□ Has a beginning interest in, and awareness
                                                                     of, rhyming

18                     Red Flags: Early Identification in Leeds, Grenville & Lanark                 November 2007
GROWTH & DEVELOPMENT
  □□ Requests adult to read or write                         □□ Knowledge of the basic concepts of print
  □□ Understands that print carries a message                   shows in child’s writing (letters instead of
                                                                scribbles, letter groupings that look like
  □□ Shows ability to participate in routines
                                                                words, invented spelling)
                                                             □□ Points to and says the name of most letters
By 4 ½ years                                                    of the alphabet when randomly
  □□ Tells stories with clear beginning, middle                 presented (upper and lower case);
     and end                                                    recognizes how many words are in a
  □□ Matches some letters with their sounds                     sentence
     (e.g., Letter “t” says tuh)                             □□ Prints letters (by copying, or in her full
  □□ Recites nursery rhymes and sings familiar                  name, or when attempting to spell words)
     songs                                                   □□ Makes predictions about stories; retells the
  □□ Reads a book by memory or by making up                     beginning, middle and end of familiar
     the story to go along with the pictures                    stories
  □□ Can guess what will happen next in the                  □□ Can recall a brief story that has just been
     story                                                      heard
  □□ Retells some details of stories read aloud              □□ When being read a story, connects
     but not necessarily in order                               information and events to real life
                                                                experiences
  □□ Traces circle, triangle, square using
     templates                                               □□ Can identify the beginning and ending
                                                                sounds in words e.g., “Pop” starts with the
  □□ Recognizes signs and symbols in daily                      “puh” sound
     environment (e.g., traffic signs, washroom
     signs)                                                  □□ Can shift attention from meanings of words
                                                                to sounds of words
  □□ Holds a pencil correctly
                                                             □□ Draws diagonal lines and simple shapes
  □□ Identifies the names of 10 alphabet letters
     (likely from own name)                                  □□ Able to sort objects by size, colour, use, etc.
  □□ Understands the concept of rhyme;                       □□ Able to understand simple patterning
     recognizes and generates rhyming words                  □□ One to one correspondence for numbers
  □□ Changes a sound in a word to make a new                    from 1 through 10o for hel
     word in familiar games and songs
  □□ Enjoys being read to
                                                         See also
  □□ Is motivated to try to read
                                                         • Speech & Language
                                                           Speech and language difficulties are often
By 5 ½ years                                               associated with weak literacy skills.
  □□ Can match all letter symbols to letter
                                                         Note: Low literacy level of parents is also a risk
     sounds
                                                         factor for literacy development.
  □□ Reads some familiar vocabulary by sight
     (high frequency words)
  □□ Can label pictures quickly
                                                         WHERE TO GO FOR HELP
  □□ Knows parts of a book                               See Literacy & Numeracy in the Where to Go for
                                                         Help section at the back of this document.
  □□ Understands the basic concepts of print
     (difference between letters, words,
     sentences, how the text runs from left to
     right, top to bottom, white space between
     words)

November 2007                      Red Flags: Early Identification in Leeds, Grenville & Lanark                   19
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