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Communication
Explore explanations, everyday questions and next steps connected with communication.
4,098 published answers · English · Page 22
Signs & concerns
When to escalate slow naming speed in a child
Naming speed becomes clinically meaningful from around age 4. A frontline health worker should escalate for a developmental check when slow or effortful naming persists past 5–6 years, travels with other language or pre-reading delays, or when parents and teachers report struggle beyond peers. This is a reason to assess early, not a diagnosis — early language support works best.
Read the answer AnswerWhen should a frontline worker escalate a non-verbal child?
Escalate a non-verbal child for a developmental check now — not at the next routine visit — if there is no babbling by 12 months, no single words by 16–18 months, or no two-word phrases by 24 months. Escalate the same day for loss of words once gained, no response to name, no pointing or gestures, or staring episodes. Always arrange a hearing check first. This is a referral, not a diagnosis — early support works best.
Read the answer AnswerWhen to escalate delayed non-verbal communication
Non-verbal communication — pointing, eye contact, gestures, shared smiles — develops before speech. A frontline health worker should escalate to the Medical Officer when a child misses these gesture milestones (no response to name or babble by ~9–12 months, no pointing or showing by ~15–18 months), loses a social skill once present, or shows flat engagement with other delays. This is an early-support screen, not a diagnosis, and a hearing review should accompany referral.
Read the answer AnswerNonverbal communication delay: when to escalate
Frontline health workers should escalate when expected nonverbal milestones are clearly missing — no shared eye contact or name response by 9 months, no pointing, waving or gaze-following by 12 months, very few gestures by 18 months — or when any skill is lost (regression) or a parent reports concern. This is screening, not diagnosis; prompt referral to the Medical Officer or a developmental check gives the child the best start.
Read the answer AnswerWhen to escalate delayed object identification
If a child cannot identify common objects by around 18–24 months, a frontline worker should counsel the family, recheck within 4–6 weeks, and escalate to the Medical Officer or developmental clinic if there is no progress, if red flags appear, or if the family is worried. Refer promptly for any hearing concern, no pointing or showing, no response to name, few words, or loss of a skill. This is a screen-and-refer step, never a diagnosis.
Read the answer AnswerWhen to escalate a child who cannot describe a picture
Picture description — telling what is happening in a picture — usually emerges around 3 to 4 years. A frontline health worker should escalate when a child well past this age cannot name objects in a picture, cannot join two words about a scene, or shows this with broader delays in talking, understanding or play. Always check hearing first. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child's unclear pronunciation
Most toddlers mispronounce sounds while learning to talk. As a guide, a 2-year-old is understood by familiar people about half the time and a 3-year-old by most listeners. A frontline health worker should escalate to a medical officer or speech-language pathologist when a child's speech is markedly harder to understand than same-age peers, is not improving over a few months, or comes with delays in understanding, social connection or hearing. This is a reason to assess early — not a diagnosis.
Read the answer AnswerWhen to escalate if a child isn't asking questions
Most children begin asking simple questions between 18 months and 3 years, after pointing and naming emerge. A frontline health worker should escalate to a developmental check when a child of about 2½–3 years is not asking any questions and shows other communication gaps — few words, no pointing, not responding to name, or little back-and-forth. Always consider a hearing check first. This signals early assessment, never a diagnosis.
Read the answer AnswerWhen to escalate delayed question comprehension
When a child cannot understand and respond to spoken questions at the expected age — roughly simple questions by 18–24 months and 'who/what doing' questions by 3 years — a frontline health worker should escalate if the gap is clear, persists despite a hearing check, or travels with other communication, social or play delays. Rule out hearing first, then refer to the medical officer and onward to a speech-language pathologist. This is screening, not a diagnosis, and early referral widens the window for support.
Read the answer AnswerWhen should a frontline worker escalate delayed receptive language?
A frontline health worker should escalate when a child clearly lags expected understanding for age — no response to name by 12 months, not following simple requests by 18 months, not understanding short instructions by 24 months, or any loss of skill or hearing concern. These are reasons to refer early, not a diagnosis, and a same-week hearing check is wise whenever hearing is in doubt.
Read the answer AnswerWhen to escalate delayed sentence and phrase complexity
Frontline health workers should escalate when a child clearly lags peers in joining words into phrases — no two-word phrases by ~24 months, or still mostly single words at 30–36 months. Escalate sooner with poor comprehension, lost words, no gestures, or family concern, and always include a hearing check. This is a referral signal, not a diagnosis — early review enables early, effective support.
Read the answer AnswerWhen to escalate delayed sentence formation
Most children join two words by around 24 months and form simple sentences by 3 years. A frontline health worker should escalate when a 2-year-old uses no two-word phrases, a 3-year-old is not making short sentences or is very hard to understand, when words once used are lost, or when language delay travels with hearing concerns or social flags. Always arrange a hearing check, and refer for a developmental review — early support, not a label.
Read the answer AnswerSentence repetition delay: when should a frontline worker escalate?
If a child cannot repeat short, age-appropriate sentences on screening, a frontline health worker should escalate to a developmental or speech-language assessment when the difficulty is clear, persists across two or more visits, or comes with other language, comprehension or hearing concerns. Pair the concern with a hearing check, since hearing loss is a common and treatable cause. This is a referral signal, not a diagnosis — early assessment opens early support.
Read the answer AnswerWhen should a frontline worker escalate a social-communication concern?
A frontline health worker should escalate when a child clearly misses social-communication milestones for their age and the gap persists or comes with other concerns. Rough guides: no babbling or gestures by 12 months, no single words by 16 months, no two-word phrases by 24 months, no name response, little eye contact, or any loss of a skill. One isolated flag means watch and review in 4–6 weeks; persistent or multiple flags, skill loss, or parent worry mean refer onward now for a proper assessment — early, never alarmed.
Read the answer AnswerWhen to escalate delayed sound production
A frontline health worker should escalate when a child's sound production is clearly behind — little babbling by 12 months, no clear words by 18 months, fewer than ~50 words by 2 years, or speech strangers can't understand by 3 years. Escalate sooner if hearing seems affected or sounds are lost. This is a referral for assessment, not a diagnosis, and early support works best.
Read the answer AnswerWhen should a frontline health worker escalate a spatial concept delay?
Spatial concepts like in, on, under and behind develop gradually, with simple ones by about 3 years and complex ones by 4–5. A frontline health worker should escalate when a child is clearly behind peers, shows no progress over a few months, or has spatial difficulty alongside delays in talking, understanding instructions or play. This is a reason to assess early, not a diagnosis.
Read the answer AnswerEscalating unclear speech: a frontline worker's thresholds
A frontline health worker should escalate when a child's speech is clearly less intelligible than expected for age — for example, when strangers understand under half at 2 years or speech is still hard to follow at 4 — especially alongside few words, no two-word phrases by 2, not following instructions, or any loss of speech. Always check hearing first. This is a screen toward assessment, not a diagnosis, and early referral works best.
Read the answer AnswerEscalating speech, language and communication delays at the frontline
A frontline health worker should escalate as soon as a clear language milestone is missed — no babble or gesture by 12 months, no words by 16 months, no two-word phrases by 24 months — or whenever a child loses skills already gained, hearing seems poor, or a parent is worried. The first PHC step is checking hearing and referring for a developmental review. Referral is never too early; early support gives the best outcomes, and screening is not a diagnosis.
Read the answer AnswerWhen to Escalate Delayed Storytelling Skills
Storytelling skills typically emerge between 3 and 5 years, growing from simple sentences into linked events with a beginning, middle and end. A frontline health worker should escalate for a developmental check when a child of 4–5 years cannot sequence two or three connected ideas, when storytelling lags alongside other language or social delays, or when a family is worried. Always rule out hearing first. This is a referral for early support, not a diagnosis.
Read the answer AnswerWhen to escalate a delay in temporal concepts
Temporal concepts (now, later, before, after, yesterday, tomorrow) emerge gradually between ages 3 and 6. A frontline health worker should escalate when a child beyond age 5–6 still cannot use or understand everyday time words or follow time-order instructions, especially alongside broader language delays. This signals the need for an early developmental check, not a diagnosis.
Read the answer AnswerWhen should a frontline health worker escalate a speech delay?
A frontline health worker should escalate when a child misses key speech milestones — no babbling by 12 months, no single words by 16–18 months, no two-word phrases by 24 months — or shows any loss of words or social skills at any age. Parent worry alone justifies referral. Always pair the referral with a hearing check, since undetected hearing loss often underlies speech delay. Early referral is an opportunity, not a diagnosis.
Read the answer AnswerWhen to escalate a verbal-knowledge delay
A frontline health worker should escalate a verbal-knowledge concern when a child clearly lags age milestones — no babble or gestures by 12 months, no words by 18 months, fewer than ~50 words by 24 months — or when words are lost, hearing is in doubt, or the family is worried. Check hearing first and refer early for a developmental assessment; this is screening, not diagnosis, and early support works best.
Read the answer AnswerWhen to escalate a child's verbal reasoning delay
Verbal reasoning develops gradually through the preschool years. A frontline health worker should escalate for a developmental check when a child is clearly behind peers in understanding or using language, isn't gaining new words or ideas over time, has lost a skill, or shows language gaps alongside hearing or social concerns. Always check hearing first. This signals early assessment, not a diagnosis.
Read the answer AnswerWhen to escalate delayed verbal understanding
A frontline health worker should escalate a child for a developmental check when verbal understanding is clearly behind the expected window: no response to name by 12 months, unable to follow a simple request by 18 months, not pointing to named objects by 24 months, or any loss of a skill once gained. Always honour parental concern and arrange a hearing check in parallel, since hearing loss is a common, treatable cause. This is early opportunity, not diagnosis.
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