Red Flags in Developmental Screening and SurveillanceThese indicators suggest that development is seriously disordered and that the child should be promptly referred to a developmental or community pediatrician. Note: Most children do not have "red flags" and thus require quality screening to detect any problems. POSITIVE INDICATORS (THE PRESENCE OF ANY OF THE FOLLOWING) Loss of developmental skills at any ageParental or professional concerns about vision, fixing, or following an object or a confirmed visual impairment at any age (simultaneous referral to pediatric ophthalmology)Hearing loss at any age (simultaneous referral for expe audiologic or ear, nose, and throat assessment)Persistently low muscle tone or floppinessNo speech by 18 mo, especially if the child does not try to communicate by other means such as gestures (simultaneous referral for urgent hearing test)Asymmetry of movements or other features suggestive of cerebral palsy, such as increased muscle tonePersistent toe walkingComplex disabilitiesHead circumference above the 99.6th centile or below 0.4th centile. Also, if circumference has crossed 2 centiles (up or down) on the appropriate cha or is dispropoionate to parental head circumferenceAn assessing clinician who is unceain about any aspect of assessment but thinks that development may be disordered NEGATIVE INDICATORS(ACTIVITIES THAT THE CHILD CANNOT DO) Sit unsuppoed by 12 months Walk by 18 mo (boys) or 2 yr (girls) (check creatine kinase urgently)Walk other than on tiptoes Run by 2.5 yr .Hold object placed in hand by 5 months (corrected for gestation)Reach for objects by 6 mo (corrected for gestation)Point at objects to share interest with others by 2 yr Ref.nelson 20th edition pg100