Evidence-based red flags for pediatricians, teachers, Early Intervention coordinators and parents, with a printable referral sheet.
A one-page guide for pediatricians, teachers, child care providers, Early Intervention coordinators and parents: the signs that a child may need a physical therapy, occupational therapy or speech-language evaluation. Every red flag below is tied to a public source you can check, mostly the CDC’s Learn the Signs. Act Early. milestones, the American Academy of Pediatrics and the National Institutes of Health.
| Red flag | Suggested step | Source |
|---|---|---|
| The child has lost skills he or she once had, at any age. | Act early: talk with the child’s doctor and ask about developmental screening. | CDC milestone pages (all ages) |
| A parent or caregiver is worried. CDC: “You know your child best. Don’t wait.” | Take the concern seriously; share it with the doctor and ask about developmental screening. | CDC, Concerned About Your Child’s Development? |
| The child is not meeting one or more milestones for their age. | CDC’s checklists are meant to avoid a “wait and see” approach: “any missed milestone or concern should prompt discussion or action.” | CDC, About Learn the Signs. Act Early. |
| Red flag | Suggested step | Source |
|---|---|---|
| Infant with a head tilt or turning preference: postural preference, reduced neck range of motion, a lump in the neck muscle (SCM mass), or face or head asymmetry. | Refer to the primary care provider and a physical therapist with expertise in infants as soon as the asymmetry is noted (Action Statement 3, strong recommendation). | APTA Academy of Pediatric Physical Therapy, Congenital Muscular Torticollis CPG (Sargent et al., Pediatr Phys Ther 2024;36(4):370-421) |
| Struggling to roll over, sit or walk; difficulty holding head and neck steady; muscles seem stiff or floppy; a hard time staying balanced or an unusual gait when walking or running. | Share with the pediatrician. AAP: a child with delayed gross motor skills like rolling over, sitting or walking may be referred to a physical therapist. | HealthyChildren.org (American Academy of Pediatrics), Is Your Baby’s Physical Development on Track? |
| Not yet doing CDC movement milestones, for example: “Holds head steady without support when you are holding him” (4 months); “Sits without support” (9 months); “Walks without holding on to anyone or anything” (18 months); “Walks (not climbs) up a few stairs with or without help” (2 years); “Jumps off the ground with both feet” (30 months); “Hops on one foot” (5 years). | Talk with the doctor and ask about developmental screening; under age 3, contact Early Intervention. | CDC 4 mo, 9 mo, 18 mo, 2 yr, 30 mo, 5 yr milestones |
| Red flag | Suggested step | Source |
|---|---|---|
| Struggling with fine motor skills, visual motor skills or independent skills, such as feeding themself, picking up small objects or buttoning clothes. | AAP: such a child may benefit from occupational therapy. | HealthyChildren.org (AAP) |
| Not yet doing CDC hand-skill and self-care milestones, for example: “Picks things up between thumb and pointer finger, like small bits of food” (1 year); “Tries to use a spoon” (18 months); “Uses a fork” and “Puts on some clothes by himself, like loose pants or a jacket” (3 years); “Holds crayon or pencil between fingers and thumb (not a fist)” (4 years); “Buttons some buttons” (5 years). | Talk with the doctor and ask about developmental screening; under age 3, contact Early Intervention; age 3+, the public school. | CDC 1 yr, 18 mo, 3 yr, 4 yr, 5 yr milestones |
| Red flag | Suggested step | Source |
|---|---|---|
| Trouble understanding language, using language, or swallowing. | AAP: the child may be seen for speech-language therapy. | HealthyChildren.org (AAP) |
| Not yet doing CDC language milestones, for example: “Tries to say three or more words besides “mama” or “dada”” (18 months); “Says at least two words together, like “More milk.”” (2 years); “Talks well enough for others to understand, most of the time” (3 years). | Talk with the doctor; NIDCD notes the doctor may refer to a speech-language pathologist. | CDC 18 mo, 2 yr, 3 yr milestones |
| Ages 3–4: not yet “Speaks easily without having to repeat syllables or words”. Ages 4–5: not yet “Says most sounds correctly except for a few (l, s, r, v, z, ch, sh, and th)”. | NIDCD: “Talk to your child’s doctor if you have any concerns.” | NIDCD (NIH), Speech and Language Developmental Milestones |
| Any speech or language delay, or hearing items not met (e.g., “Hears you when you call from another room”, ages 3–4). | Include a hearing check. NIDCD: “Sometimes a delay may be caused by hearing loss”; “A hearing test is often included in the evaluation because a hearing problem can affect speech and language development.” | NIDCD (NIH) |
| Red flag | Suggested step | Source |
|---|---|---|
| Not yet doing CDC social-communication milestones, for example: “Looks when you call her name” (9 months); “Points to show you something interesting” (18 months). | Talk with the doctor and ask about developmental screening. | CDC 9 mo, 18 mo milestones |
| Toddler at the 18- or 24-month visit. | CDC notes the AAP recommends autism screening at 18 and 24 months, or whenever a parent or provider has a concern. The free M-CHAT-R/F is intended for children 16 to 30 months; get it from mchatscreen.com. | CDC; NIH/NICHD |
Talk with the doctor and request a free evaluation at the same time. CDC advises that, at the same time as you ask the doctor for a referral to a specialist, you call your state’s public early childhood system to request a free evaluation. “You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.”
New Jersey: NJ Early Intervention System (NJEIS), 888-653-4463 (toll-free for New Jersey residents). The evaluation is at public expense; some ongoing services have a family co-pay based on household income and size, and families below 300% of the federal poverty level pay nothing (NJ Department of Health).
New York: the New York State Early Intervention Program (EIP). In New York City, call 311 and ask for “Early Intervention.” Elsewhere, call your county Early Intervention Official. New York says there is no cost to families (NYS Department of Health).
Other states: CDC’s Early Intervention contacts by state.
CDC says: “If your child is age 3 or older, call any local public elementary school (even if your child does not go to school there) and say: ‘I have concerns about my child’s development and I would like to have my child evaluated through the school system for preschool special education services.’” (CDC)
You do not need a doctor’s referral or a diagnosis to ask for these evaluations (CDC).
Outpatient pediatric therapy at Holsman. The Holsman Children’s Therapy Center, 15-01 Broadway, Suite 14C, Fair Lawn, NJ 07410 (201-351-1682), offers pediatric physical therapy, occupational therapy and speech therapy for children from birth to age 21, with a sensory gym and a multi-sensory room. Pediatric occupational therapy is also offered at our Clifton clinic, 1070 Clifton Ave., Suite 1A (973-246-6565). You can schedule pediatric physical, occupational and speech therapy directly — no physician referral needed. Some insurance plans require a referral for coverage; our team will check your child’s plan before the first visit.
Teachers and child care providers: share what you notice with the family, and point them to the free CDC milestone checklist to bring to the doctor. CDC also has resources for early childhood educators.
One page, ready to fill in by hand: child and parent details, referring provider, PT / OT / Speech check boxes, reasons for referral, a hearing-test line, space for concerns, and our contact details. It prints on its own, without the rest of this page.
Tip: in the print window you can also choose “Save as PDF” to keep a blank copy for your office.
This guide is for general information. It does not replace clinical judgment, a developmental screening or an evaluation. A red flag is a reason to look closer, not a diagnosis.
Sources (all checked November 3, 2026):
The 2024 APTA Academy of Pediatric Physical Therapy torticollis guideline recommends referring infants with postural preference, reduced neck range of motion, a neck muscle mass or face or head asymmetry to their primary care provider and a physical therapist with expertise in infants as soon as the asymmetry is noted.
The American Academy of Pediatrics says a child struggling with fine motor skills, visual motor skills or independent skills, such as feeding themself, picking up small objects or buttoning clothes, may benefit from occupational therapy.
NIDCD (NIH) says a hearing test is often included in a speech-language evaluation because a hearing problem can affect speech and language development.
You can schedule pediatric physical, occupational and speech therapy directly — no physician referral needed. Some insurance plans require a referral for coverage; our team will check your child’s plan before the first visit.
Under age 3: Early Intervention (in New Jersey, NJEIS at 888-653-4463; in New York, the county or New York City Early Intervention Program, or 311 in NYC). Age 3 or older: any local public elementary school, according to CDC.
Pediatric physical, occupational and speech therapy for ages 0–21 at 15-01 Broadway, Suite 14C, Fair Lawn, NJ.
📞 Call 201-351-1682