Identifying Challenges in Children

Nicole Brown (OT) 

As seen in January 2017 PAKMAG 

My first child walked at 9 months and my second at 15 months. My first child spoke 2 words at 18 months and my second spoke at 11 months. Such differences are expected in children and it can be hard at times to know when something is not quite right in your child.

The first five years of a child’s life are very important for their development. During these years, a child’s brain develops faster than at any other time in their life. Developmental changes include not only the physical growth and skills (eg. rolling, walking, riding a bike) but also cognitive (eg. Thinking and learning), social and emotional (managing feelings, playing with others) and language and communication skills.

It is important to remember that development is different for every child and typical development varies a lot. Some children will walk much later than others. Some children will talk early, some not until three and others will toilet themselves almost overnight whilst your three year old remains disinterested. As parents we need to know what a “typical” development is so we can watch as our children grow and know when to seek advice/assistance.


The following is a list of developmental red flags’ for parents to be aware of. Having a ‘red flag’ doesn’t mean your child has a disability, but they may require additional help to address their area of developmental difficulty.


Red flags at 6 months:

Your child:

  • is crying a lot and difficult to settle
  • isn’t making eye contact with you, isn’t following moving objects with his eyes
  • isn’t babbling or turning towards sounds or voices.
  • doesn’t smile at people
  • isn’t rolling
  • has poor head control (can’t hold head up from shoulders when on their tummy)
  • doesn’t reach for objects
  • differences between right and left sides of their body in strength, movement


Red flags at 12 months:

Your child:

  • Doesn’t crawl or drags one side of body while crawling
  • Can’t stand when supported
  • Doesn’t search for objects that they see being hidden
  • Says no single words
  • Doesn’t use gestures such as shaking head “no”
  • Doesn’t point to objects or pictures
  • Can’t walk (by 18 months)
  • Doesn’t walk heel-toe within a few months of walking
  • Doesn’t recognize familiar people


Red flags at 18 months

Your child:

  • Lacks interest in playing and interacting with others
  • No clear words
  • Doesn’t point, wave or use other gestures
  • Cannot hold or scribble with a crayon
  • Does not attempt to stack blocks
  • Cannot understand short requests eg. ‘Where is the ball?’
  • Not attempting to walk without support
  • Not standing alone


Red flags at 2 years:

Your child:

  • Doesn’t speak at least 15 words
  • Doesn’t use two-word sentences
  • Makes poor eye contact
  • No interest in self care such as dressing
  • Can’t push a wheeled toy along the ground
  • Has trouble seeing or hearing things
  • Can’t follow simple instructions – for example, ‘Please give me the ball’
  • Doesn’t copy actions or words – for example, when singing ‘Heads, shoulders, knees and toes’
  • Doesn’t pretend during play – eg. Doesn’t pretend to feed a doll
  • Isn’t showing feelings
  • Doesn’t come to you for affection or comfort.
  • Can’t walk up and down stairs, even if holding on to you or a rail
  • Can’t run
  • Finds it hard to handle small objects – for example, a crayon
  • Isn’t scribbling or trying to draw.


Red flags at 3 years:

Your child:

  • Frequently falls or has difficulty with stairs
  • Drools persistently or speaks unclearly
  • Can’t communicate in short phrases
  • Doesn’t understand simple instructions
  • Shows no interest in other children
  • Makes poor eye contact
  • No interest in self care such as toileting
  • Has little interest in toys
  • Can’t build a tower of more than four blocks
  • Has trouble manipulating small objects such as duplo stacking, or stringing beads
  • Can’t copy a circle
  • Doesn’t pretend during play- doesn’t pretend play shops or “riding on the bus”
  • Can’t run


Red flags at 4 years:

Your child:

  • Unwilling / unable to play cooperatively with other children
  • Speech difficult to understand to a stranger
  • Unable to follow directions with 2 steps “Get your shoes and hop in the car”
  • Has difficulty eating with a spoon or fork, dressing
  • Not toilet trained by day
  • Unable to draw lines and circles
  • Doesn’t use sentences of more than three words.
  • Doesn’t pretend during play –eg, doesn’t pretend to be mum or dad
  • Has very challenging behaviour – for example, has big tantrums over very small things or still clings or cries when you leave
  • Seems very afraid, unhappy or sad a lot of the time.
  • Is clumsy – for example, trips over a lot when walking or running, can’t catch, throw or kick a ball, pedal a tricycle


Red flags at 5 years:

Your child:

  • Cannot answer questions in a simple conversation
  • Not using or understanding long sentences.
  • Difficulty telling a story (or re-telling)
  • Has difficulty answering simple “wh” questions – i.e. “who, where, what?”
  • Speech is difficult to understand or leaving beginning or end sounds off most words.
  • Has difficulty engaging in play with other children
  • Not independent with eating using a fork or spoon and dressing self
  • Cannot draw simple pictures (eg. Stick person)
  • Clumsy when walking, running, climbing and using stairs
  • Ball skills are very different to their peers (catches a ball in an uncoordinated way)
  • Unable to hop 5 times on each foot
  • Can’t understand three-part commands like ‘Put the doll down, get the ball from under the chair and put it in the box’
  • Is easily distracted and can’t concentrate on any single activity for more than a few minutes


It is important to note that this is not a complete list of developmental difficulties. If you have concerns for your child’s development at any time, it is best to seek out advice rather than wait and see.

If you have concerns about your child’s development make an appointment with your GP or child health nurse. Health professionals that also can assist with your child’s development are paediatricians, occupational therapists,