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Signs a Child May Need Special Help

Children develop at different rates and in different ways. Differences in development may be related to personality, temperament, and/or experiences. Some children may also have health needs that affect their development.
The first five years are very important in a child’s life. The sooner a concern is identified, the sooner a child and family can receive specialized services to support growth and development. Parents, family members, and caregivers may have concerns about a child’s development and seek help when needed. It is always a good idea for families to discuss any questions they may have with the child’s doctor. Caregivers should discuss concerns with families to see how best to support them.
Risk Factors
The following factors may place children at greater risk for health and developmental concerns
  • Prematurity or low birth weight
  • Vision or hearing difficulties
  • Prenatal exposure or other types of exposure to drugs, alcohol, or tobacco
  • Poor nutrition or difficulties eating (lacks nutritious foods, vitamins, proteins, or iron in diet)
  • Exposure to lead-based paint (licking, eating, or sucking on surfaces painted with lead-based paint)
  • Environmental factors, such as abuse or neglect
Behaviors and Relationships
Any following signs may be cause for concern in any child regardless of age
  • Avoids being held, does not like being touched
  • Resists being calmed, cannot be comforted
  • Avoids or rarely makes eye contact with others
  • By age four months, does not coo or smile when interacting with others
  • By age one, does not play games
  • By age two, does not imitate parent or caregiver doing everyday things, such as washing dishes, cooking, or brushing teeth
  • By age three, does not play with others
  • Acts aggressively on a regular basis, hurts self or others
  • Has frequent earaches
  • Has had many ear, nose, or throat infections
  • Does not look where sounds or voices are coming from or react to loud noises
  • Talks in a very loud or very low voice, or voice has an unusual sound
  • Does not always respond when called from across a room even when it is for something that would normally interest the child
  • Turns body so that the same ear is always turned toward a sound
  • Has reddened, watery eyes or crusty eyelids
  • Rubs eyes frequently
  • Closes one eye or tilts head when looking at an object
  • Has difficulty following objects or looking at people when talked to
  • Has difficulty focusing or making eye contact
  • Usually holds books or objects very close to face or sits with face very close to television
  • Has an eye or eyes that look crossed or turned, or eyes do not move together
  • Has stiff arms or legs
  • Pushes away or arches back when held close or cuddled
  • By age four months, does not hold head up
  • By age six months, does not roll over
  • By age one, does not sit up or creep using hands and knees, does not pick up small objects with finger and thumb
  • By age two, does not walk alone, has difficulty holding large crayons and scribbling
  • By age three, shows poor coordination and falls or stumbles a lot when running, has difficulty turning pages in a book
  • By age four, has difficulty standing on one foot for a short time
  • By age five, does not skip or hop on one foot, has difficulty drawing simple shapes
  • By age three months, does not coo or smile
  • By age six months, does not babble to get attention
  • By age one, does not respond differently to words such as “night night” or “ball”
  • By age one, does not say words to name people or objects, such as “mama” or “bottle,” or shake head “no”
  • By age two, does not point to or name objects or people to express wants or needs
  • By age two, does not use two-word phrases, such as “want juice” or “mama go”
  • By age three, does not try to say familiar rhymes or songs
  • By age three, cannot follow simple directions
  • By age four, does not tell stories, whether real or make-believe, or ask questions
  • By age four, does not talk so that adults outside the family can understand
  • By age one, has difficulty finding an object after seeing it hidden
  • By age two, does not point to body parts when asked such questions as “Where’s your nose?”
  • By age three, does not play make-believe games
  • By age three, does not understand ideas such as “more” or “one”
  • By age four, does not answer simple questions, such as “What do you do when you are hungry?” or “What color is this?”
  • By age five, does not understand the meaning of today, yesterday, or tomorrow