(Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. 2008:39; Pediatr Rev 2010;31:267; Pediatr Rev 2010;31;364; Pediatr Rev 2011;32;533)
Red Flags
• Missed milestones (particularly bolded ones) or loss of previously acquired milestones should prompt further developmental & medical assessment
• Persistent fisting at 3 mo may represent earliest indication of neuromotor dysfxn
• Rolling <3 mo, pulling directly to stand (rather than sit) at 4 mo, W-sitting, bunny hopping, and toe-walking may indicate spasticity
• Primitive reflexes (Moro, asymmetric tonic neck) disappear btw 4–6 mo; persistence at 9 mo may indicate neuromotor dysfxn
• Protective postural reflexes (righting, protection, equilibrium) appear btw 6–9 mo; if not present, will lead to difficulty sitting and standing
• Due to Back to Sleep campaign, tummy time important for reaching milestones
• Hand dominance before 18 mo may indicate contralateral weakness
• Failure to alert to environmental stimuli may indicate visual or auditory deficits