HOW TO IDENTIFY DEVELOPMENTAL RED FLAGS: 0-3 MONTHS
Parenting a new baby comes with so many questions: How do I play with a newborn? When will he sleep through the night? How do I know whether her development is on-track? Is his temperament ‘normal’ or should I be concerned? Today, Occupational Therapist Jennie Shafer is here to help you identify developmental red flags in the first three months of your baby’s precious life. Jennie works exclusively with the birth-to-three population as an Early Intervention OT and is excited to help you better understand your child’s development
Congratulations! You’re a new parent! Hallelujah for little toes and a cute nose! For the first few days and weeks, life is consumed with feeding, sleeping, and finding the time to shower!
Of course your newest addition is front and center, with every aunt, cousin, co-worker, and grocery store stranger leaning in to tell you how adorable they are (duh!) as well as what you didn’t know you were already doing wrong (Gee, thanks!).
All of a sudden, you’re second-guessing yourself…
‘Wait, her baby is already rolling?’
‘When did he start sleeping through the night?! SO NOT FAIR!!’
It’s easy to get overwhelmed.
Stop.
Breathe.
Let’s check it out.
DEVELOPMENTAL MILESTONES
I know you have seen a developmental milestones chart. But what if your little one isn’t hitting those steps? When should you be concerned? This post should help guide you through the process and give you an idea of when to reach out for more information.
Keep in mind, the bullet points below were written for children who are chronologically 0 to 3 months old. Babies who were premature by several weeks will not fall into these categories and will have their own, unique timeline.
As an Occupational Therapist who works exclusively with children from 0 months to 3 years, I can tell you children all develop at their own rate. There are, of course, a few issues that stand out to me as being a concern, while others (I’m looking at you, teething!) are usually nothing to be worried about. So let’s take a look…
DEVELOPMENTAL RED FLAGS FOR 0-3 MONTHS
1. Feeding Skills
During feeding:
- Is your baby falling asleep while eating?
- Is she sneezing, coughing, or going red in the face when taking the bottle or breast?
- What about his little eyes, do you notice them watering excessively?
- Does your baby lose a lot of milk from the corners of his mouth?
If yes, these can be symptoms of poor feeding and oral motor skills.
- Is your baby trying to hold the bottle or place a hand on your breast while feeding?
After feeding:
- Is there reflux?
- Vomiting?
- How about screaming or prolonged crying after feedings?
- Does he try to stretch or appear to pull away from you?
- Does she have chronic constipation?
If yes, these symptoms can be a sign of intolerance to the formula/milk or GI issues.
2. Motor Skills
During play:
- Is your baby able to briefly support weight through her feet and legs when held in a standing position?
- Can she push or roll herself from her side onto her back?
- Is he lifting his head off the ground when placed on tummy?
If no, this can indicate a sign of motor delay.
- Does your baby seem tight or very rigid?
- Does he seem loose or floppy?
- Does she keep her head turned only one way?
If yes, this can indicate an issue with muscle tone or torticollis.
- Is she using both sides of her body equally? You should observe the baby using both hands, kicking both legs and turning the head to both sides equally.
If one side of the body appears limp, this is cause for IMMEDIATE concern and should be reported to the pediatrician.
I love using Pathways.org as a reference and often send parents there to learn more. Their motor development reference sheets have been invaluable to me and I bring them out nearly every day. Take a look at the image below to see an amazing comparison of ‘typical’ and ‘atypical’ motor development across positions in two-month-old infants. Thank you to Pathways.org for creating this incredible resource for parents and professionals! You can download a printable 2-page version of this graphic from this page of the Pathways.org website.
Pathways.org also has created this free 30-minute “course” to help parents and professionals identify early motor delays in babies under three months of age. It was created in conjunction with the American Academy of Pediatrics and is designed so individuals around the world can learn about detecting early motor delays at two months of age, as well as learn about the importance of importance of Tummy Time. You can view the video directly in this post or by opening this new tab to YouTube.
3. Communication Skills
When awake:
- Is he being startled by loud noises or turning her head toward a voice?
- Does she coo when being spoken to by a familiar person?
If no, this can indicate a hearing concern.
- Do they have a history of ear infections?
- What about only being soothed if held in unusual ways (ex: over the shoulder so the head is down)
If yes, this can indicate an issue with fluid in the ears.
- Can your baby make eye contact with you?
- Does she watch items slowly pass in front of her by turning her eyes and or head?
- Will he squint when an overhead light is turned on?
If no, this can indicate a concern with vision.
- Does she fuss with a wet or dirty diaper?
- Does he have special cries for each need by 3 months (e.g., from another room you could tell by the cry if your baby is hungry, dirty, or in pain)?
- Is she smiling at you?
If no, this can indicate a communication problem with getting their needs met, or an attachment concern.
4. Sensory
- During tummy time does he keep his hands fisted or pulled up off the ground?
- Will she pull her hands/feet away when you try to hold or massage them?
- Does he become overly upset about changing clothes or bath time?
If yes, this can indicate an issue with processing touch.
- Can he typically fall asleep easily with little assistance?
- Is he sleeping 4-8 hours at a time by 3 months?
If no, this can indicate an issue with arousal states.
IF YOU HAVE CONCERNS ABOUT YOUR NEWBORN’S DEVELOPMENT
Remember, all children progress through these early milestones at their own speed. It’s very easy to try and compare siblings or your friend’s baby to your own. The points listed in this post are only a few common and easily identifiable issues. If you feel your child is demonstrating delays, please contact your child’s pediatrician to share your concerns and determine whether further information or assessment is needed.