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Signs & concerns
When to refer suspected FASD for developmental therapy
Refer at the point of suspicion, not at diagnosis. With confirmed or probable prenatal alcohol exposure plus any developmental concern, initiate developmental therapy in parallel with confirmatory assessment — a normal facial phenotype does not exclude FASD.
Read the answer AnswerWhen to Refer a Child with a Genetic Syndrome for Developmental Therapy
For a suspected or confirmed genetic/chromosomal syndrome, refer for developmental therapy at the point of suspicion or diagnosis — not after delay appears. Therapy is anticipatory scaffolding; there is no minimum severity threshold. Medical red flags (seizures, feeding/swallowing risk, regression) need prompt medical referral first.
Read the answer AnswerWhen should a doctor refer a child with suspected Global Developmental Delay for developmental therapy?
Refer at first reasonable suspicion — you do not need a confirmed diagnosis. Once two or more developmental domains lag, or after a failed screen, regression, or persistent parental concern, refer for developmental therapy in parallel with aetiological workup. Therapy should not wait on diagnostics.
Read the answer AnswerWhen to Refer a Preterm Child for Developmental Therapy
Refer high-risk preterm infants (<32 weeks, VLBW, or neonatal neurological insult) into early-intervention therapy at NICU discharge, and promptly at any age when corrected-age milestones, tone, movement, or feeding deviate. Early therapy in the neuroplastic window is preventive — refer on risk and early signs, not on a confirmed diagnosis.
Read the answer AnswerWhen to refer suspected Rett syndrome for developmental therapy
Refer for developmental therapy at the point of clinical suspicion — in parallel with genetic and neurological workup, not after it. The regression phase (6–18 months) is when speech/AAC, OT and physiotherapy best preserve function. Co-refer seizures and airway concerns to paediatric neurology urgently.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Childhood Sleep Difficulties?
Refer a child for specialist assessment when sleep problems persist beyond a few weeks despite routine advice, affect daytime behaviour or growth, or carry red flags like snoring with breathing pauses, possible seizures, or a developmental concern. Most short-lived sleep trouble settles with reassurance and a steady bedtime routine.
Read the answer AnswerWhen to Refer Developmental Regression
Developmental regression — losing skills a child once had — is a red flag, not a wait-and-see sign. Refer promptly: same-day if there are seizures, weakness or altered alertness; within the week for clear loss of language, social or motor skills. Believe the parent's history and route it onward.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Down syndrome?
Refer promptly: any newborn or infant with a cluster of recognisable features — low tone, single palmar crease, upward-slanting eyes, flat nasal bridge, feeding difficulty — needs paediatric referral within days. Confirmation is by clinical exam and karyotype only. Escalate same-day for breathing or heart concerns.
Read the answer AnswerWhen to Refer a Child with Possible FASD
Refer when prenatal alcohol exposure is confirmed or suspected alongside growth, developmental or behavioural concerns — or when unexplained delay and learning or behaviour difficulties appear. You needn't be certain; suspicion plus concern is enough. Confirmation and diagnosis are the specialist's role.
Read the answer AnswerWhen to refer a child with a possible genetic or chromosomal syndrome
Refer when you see a cluster of unusual features, or any feature alongside developmental delay — you don't need to name the syndrome. Same-day medical referral for breathing, feeding crises or seizures. When in doubt, refer; only a clinician diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Global Developmental Delay?
Refer when a child shows significant delay in two or more developmental domains, when a previously gained skill is lost (regression), or when delay comes with red flags like seizures, abnormal tone, or hearing/vision concerns. When in doubt, refer — early referral never harms.
Read the answer AnswerWhen to Refer a Preterm Child for Developmental Risk
Link every preterm baby to specialist follow-up from discharge, and refer promptly on red flags judged by corrected age — stiffness or floppiness, feeding or growth trouble, vision/hearing concerns, delayed babble or words, or any lost skill. When in doubt, refer; field workers screen and route, clinicians diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Rett Syndrome?
Refer promptly when a girl who was developing normally (typically 6–18 months) slows, stalls, or loses skills — especially loss of purposeful hand use with repetitive hand-wringing, slowing head growth, and lost eye contact. You don't need certainty; recognise and route. Diagnosis is made only by a specialist.
Read the answer AnswerWhen should an ASHA or PHC worker escalate childhood epilepsy?
Childhood epilepsy is referred to a doctor first, not therapy first. Escalate immediately by calling 108 for a seizure over 5 minutes, repeated seizures, breathing trouble, or a first-ever seizure with red flags. Arrange prompt 24–48 hour medical referral for any first seizure or changing seizure pattern. The community worker's role is recognition, first-aid safety and fast escalation.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with sleep difficulties?
Occasional broken sleep is normal and settles with simple routine support. Escalate to the Medical Officer or paediatrician when sleep difficulty is persistent for weeks, involves snoring or breathing pauses, affects daytime development and growth, or comes with seizure-like night events or a developmental concern. The ASHA/PHC role is to spot, support and route — never diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate developmental regression?
Developmental regression — the loss of skills a child once had — always warrants prompt escalation, never watch-and-wait. ASHA/PHC workers should refer to the Medical Officer the same week, and the same day if seizures, fever or acute signs appear. Diagnosis is never made in the field.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of Down syndrome?
Down syndrome is recognisable at or near birth, so an ASHA or PHC worker should escalate promptly — refer to the Medical Officer the same day when a cluster of newborn signs is seen, and urgently if there are breathing, feeding or heart-related red flags. Diagnosis is by paediatric karyotype, never a checklist.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of FASD?
An ASHA or PHC worker should escalate when a child shows growth faltering plus developmental or behavioural concerns — especially with suspected prenatal alcohol exposure. The worker recognises the pattern and refers to the Medical Officer or DEIC; FASD is confirmed only by a clinician, never in the field.
Read the answer AnswerEscalating Suspected Genetic / Chromosomal Syndromes: A Guide for ASHA & PHC Workers
Escalate to the PHC Medical Officer or RBSK/DEIC when a child shows a cluster of features — distinctive facial features with poor feeding or low tone, multiple congenital anomalies, failure to thrive, or developmental delay — rather than a single sign. The worker recognises and refers; clinicians diagnose. Refer urgently for feeding failure, lethargy, breathing difficulty or seizures.
Read the answer AnswerWhen to Escalate Global Developmental Delay — ASHA/PHC Guide
Escalate any child under five with delay across two or more developmental domains, or any loss of acquired skills or medical red flags, to the PHC Medical Officer and DEIC under RBSK. The community worker's role is to flag and route early, not to diagnose — early referral changes the trajectory.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with Prematurity-Related Developmental Risk?
Escalate any preterm or low-birth-weight child when a milestone is missed (using corrected age), when a parent voices concern, or when a danger sign appears. Treat breathing, feeding, seizure and tone flags as same-day medical referrals; route all other developmental concerns for assessment rather than waiting. Only a clinician confirms anything.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Rett Syndrome?
Escalate promptly when a girl aged 6–18 months loses previously acquired skills — hand use, babble, social interest — especially with repetitive hand-wringing and slowing head growth. This is a medical and genetic referral via RBSK/DEIC, not a watch-and-wait. Diagnosis is only ever confirmed by a clinician.
Read the answer AnswerWhen should I worry about epilepsy in my 12–18 month old?
Epilepsy in a 12-to-18-month-old is a medical question first, not a therapy one. Any seizure or repeated unusual episode — stiffening, clustered jerks, blank unreachable stares, going limp or blue — deserves a prompt paediatric or neurology review, not home-watching. A single episode is not a diagnosis, but it warrants a same-week medical opinion; call emergency services for any seizure over 5 minutes or breathing trouble. Only a clinician can assess; AbilityScore® is never a substitute for urgent medical care.
Read the answer AnswerWhen should I worry about my 12–18-month-old's sleep?
Frequent night waking and bedtime resistance at 12–18 months are common and usually typical, not a disorder. Most toddlers sleep 11–14 hours and may still wake once or twice. Seek review when problems persist for weeks, exhaust the family, or come with snoring, breathing pauses, or a slip in daytime alertness or skills.
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