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Motor
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Signs & concerns
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Signs & concerns
When should a doctor refer a child with suspected hypotonia for developmental therapy?
Refer early and in parallel — do not wait for an aetiological diagnosis. Any infant or child with persistent hypotonia plus functional impact (head lag, motor delay, feeding difficulty, fatigue) warrants concurrent physiotherapy and developmental therapy alongside neurological workup. Hypotonia is a sign, not a diagnosis.
Read the answer AnswerWhen to refer suspected motor planning difficulties for developmental therapy
Refer when motor-planning difficulty is persistent, functionally limiting and shows a clear plan–execute gap despite intact strength, tone and comprehension — and when no acute or progressive cause is suspected. A formal DCD label is not required to refer; early assessment improves outcomes. Diagnosis is made only by a clinician.
Read the answer AnswerWhen to Refer Persistent Toe-Walking for Developmental Therapy
Refer when toe-walking persists beyond age 2, is idiopathic and habitual, shows fixed or reducing ankle dorsiflexion, or — most importantly — coexists with developmental, sensory or communication flags. Unilateral, asymmetric or regressive presentations need urgent neuromuscular evaluation, not therapy first. Idiopathic toe-walking is a diagnosis of exclusion.
Read the answer AnswerWhen to Refer Suspected Stereotyped Movement Disorder
Refer when stereotypies are functionally impairing, self-injurious, or co-occur with developmental delay — not for benign movements alone. Atypical or urgent features need medical work-up first. Therapy targets participation and safety, never mere suppression.
Read the answer AnswerWhen to Refer Suspected Tourette Syndrome for Developmental Therapy
Refer when functional impairment — not tic severity — limits the child, which is most cases given 80–90% comorbidity (ADHD, OCD, anxiety, learning difficulties). Begin supportive therapy at suspicion; CBIT is first-line for disabling tics, with prompt neurology/psychiatry review for red flags.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Cerebral Palsy?
Refer early — don't wait for certainty. Persistent motor delay, abnormal tone (stiff or floppy), early hand preference before 12 months, feeding difficulty, or a high-risk birth history all warrant prompt specialist referral. The frontline rule: when in doubt, refer.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Fine Motor Delay?
Refer a child with possible Fine Motor Delay when hand-and-finger skills clearly lag age milestones, when a skill is lost, or when the family is worried. A pattern across visits matters more than one slow milestone. When in doubt, refer — only a clinician can assess and diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible gross motor delay?
Refer a child for specialist assessment when gross motor milestones are clearly delayed — not sitting by 9 months, not walking by 18 months — or sooner if you see loss of skills, stiffness, floppiness, or one-sided weakness. A single late milestone is often normal; a pattern, a regression or a red flag warrants prompt referral.
Read the answer AnswerWhen should a frontline health worker refer a child with possible hypotonia?
Refer a child with possible hypotonia when floppiness persists, motor milestones are clearly delayed, skills are lost, or there is feeding/breathing difficulty — and same-day for a limp newborn. Isolated mild tone in a thriving baby can be monitored and re-checked. Hypotonia is a sign, not a diagnosis.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Motor Planning Difficulties?
Refer when difficulty planning and sequencing movement is persistent, age-inappropriate, and interferes with daily tasks — after ruling out an obvious medical cause. You don't need certainty; a clear pattern is enough. Sudden loss of skills, weakness or asymmetry go to a paediatrician urgently.
Read the answer AnswerWhen should a frontline health worker refer persistent toe-walking?
Occasional tiptoe walking under age three is usually normal and settles with growth. A frontline worker should refer when toe-walking persists beyond three, happens on most steps, is one-sided, comes with tight calves or heel cords, or appears alongside delays in speech, play or motor skills. Loss of a previously gained skill needs prompt medical referral. When unsure, a developmental check reassures the family and catches treatable causes early.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Stereotyped Movement Disorder?
Refer a child with possible Stereotyped Movement Disorder when movements cause self-injury, persist past the toddler years, interfere with daily life, or come with developmental concerns. Refer the same day for medical red flags like sudden onset or loss of awareness. Diagnosis is made only by a clinician.
Read the answer AnswerWhen to Refer a Child with Possible Tourette Syndrome
Refer a child with tics that have lasted several weeks or more — especially both movement and sound tics — or that disrupt school, sleep or wellbeing, or distress the family. Frontline workers screen and route; only a specialist diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of cerebral palsy?
Escalate promptly — do not wait-and-watch — when an infant shows persistent stiff or floppy tone, early hand preference before 12 months, a missed motor milestone, or feeding difficulty, especially with a high-risk birth history. Cerebral palsy is a medical referral; any seizure is an emergency. Early referral is always the safer call.
Read the answer AnswerWhen to Escalate a Child Showing Signs of DCD
Escalate when motor clumsiness is persistent past age 5, interferes with daily life, is out of step with other development, and has no obvious cause — routing through the Medical Officer. Loss of skills or neurological signs need urgent medical referral. The worker flags; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Fine Motor Delay?
Escalate when a fine motor delay is persistent across visits, when a milestone is clearly missed for age, or when red flags appear — regression, asymmetry, stiffness/floppiness, or delay alongside other developmental concerns. A single off-day observation is not enough; a documented pattern or any red flag warrants prompt referral. Workers screen and route — clinicians diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Gross Motor Delay?
Escalate a child with gross motor delay when a milestone window is clearly missed (e.g. not sitting by 9 months, not walking by 18 months), when any skill is lost, or when red flags like marked stiffness, floppiness or asymmetry appear. Isolated late milestones warrant a recheck; delay plus red flags warrants prompt referral. ASHA and PHC workers screen and refer — diagnosis happens only at a centre.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with hypotonia?
Hypotonia is a sign, not a diagnosis, and should never be watched-and-waited. Escalate urgently the same day for poor feeding, weak cry, breathing difficulty, choking, seizures or sudden loss of tone; refer stable but persistently floppy children to the Medical Officer within days. The ASHA/PHC role is reliable recognition and prompt routing.
Read the answer AnswerWhen to Escalate Motor Planning Difficulties — ASHA & PHC Guide
Escalate when motor planning difficulty is persistent, affects daily function, or comes with a red flag — regression, asymmetry, floppiness, stiffness or seizures need prompt medical review first. A single clumsy phase often passes; a pattern is the trigger. ASHA and PHC workers screen and route — only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Persistent Toe-Walking?
Escalate when toe-walking persists past age 2, when the heel cannot reach the floor, when only one leg is affected, or when it appears with stiffness, regression or other developmental concerns. The ASHA/PHC role is to screen, document and route — not to diagnose. When in doubt, refer for a developmental check.
Read the answer AnswerEscalation guidance: Stereotyped Movement Disorder for ASHA & PHC workers
Most repetitive movements in young children are harmless and self-soothing. An ASHA or PHC worker should escalate when there is self-injury, interference with daily function, persistence past 3–4 years, co-occurring developmental delay or regression, or any sign suggesting seizures. When in doubt, refer — assessment reassures.
Read the answer AnswerWhen should an ASHA or PHC worker escalate suspected Tourette Syndrome?
ASHA/PHC workers should observe and document repeated involuntary movements or sounds lasting more than a few weeks, then escalate to the Medical Officer — urgently if there is altered awareness, whole-body jerking or sudden behaviour change. Frontline workers refer, never diagnose.
Read the answer AnswerWhen should I worry about my child's motor development?
Some variation in when children sit, crawl and walk is completely normal. Seek a gentle developmental check if your child misses a key motor milestone by a clear margin, loses a skill once had, shows strong hand-preference before age one, stays unusually stiff or floppy, or isn't progressing over several months. These are reasons to assess early — not a diagnosis — because early support works best.
Read the answer AnswerWhen Should I Worry About Toe-Walking?
Occasional toe-walking is very common and usually harmless under age two. Seek a developmental check if toe-walking persists most of the time after two, is on one side only, comes with tight calf muscles, frequent falls, or delays in talking, play or other motor skills. This is a reason to assess early — not a diagnosis — because early support works best.
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