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Concern
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Signs & concerns
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Signs & concerns
When should an ASHA or PHC worker escalate a child showing signs of childhood anxiety?
Worry is normal in childhood; a persistent pattern that disrupts daily life is the flag. ASHA and PHC workers should route — not diagnose — referring children with weeks-long fearfulness, school refusal or unexplained physical complaints, and escalating same-day for self-harm talk, severe panic or refusal to eat.
Read the answer AnswerWhen to escalate a child with signs of Childhood Apraxia of Speech
Escalate when a child shows persistent, effortful speech difficulty that doesn't match their understanding — groping mouth movements, inconsistent errors, very limited intelligible speech past age, or no steady progress. The worker's job is to recognise and route; only a clinician confirms CAS.
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 Conduct-Dissocial Disorder?
Escalate when a child of school age shows a persistent pattern (6 months or more) of harmful, rights-violating or seriously norm-breaking behaviour across settings — not a one-off tantrum. Escalate the same day for any safety risk. Frontline workers document and route; only a Pinnacle clinician diagnoses.
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 AnswerEscalating signs of Developmental Language Disorder: a guide for ASHA and PHC workers
Escalate when a child shows a persistent, age-inappropriate language difficulty — no words by 18 months, no two-word phrases by 2.5–3 years, not understood by age 3, or jumbled speech past age 4 — and especially on any loss of skills. Rule out hearing first and route to a clinician; only a qualified clinician can confirm DLD.
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 a child showing signs of developmental trauma?
Escalate when stress-related behavioural, emotional or developmental signs persist beyond 2–4 weeks, occur alongside known adversity, or carry any safety risk. ASHA/PHC workers notice, document, support and route to the Medical Officer and child-protection services — never diagnose. When in doubt, refer.
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 dyscalculia?
Escalate when a child aged 7 or older shows persistent maths difficulty across two school terms that is out of step with other skills and not explained by missed schooling, language or sensory issues. Below that age, observe and support. Rule out hearing, vision and attendance first, then route to the PHC medical officer or RBSK pathway. Only a clinician can confirm dyscalculia.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Dysgraphia?
Escalate a school-age child (7+ years) showing persistent, clustered written-expression difficulty despite adequate teaching, normal vision and no obvious intellectual delay. Below 6–7, reassure and monitor. Route urgent signs — seizures, skill loss, motor weakness — for prompt medical review. ASHA/PHC workers recognise and refer; they do not diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with signs of dyslexia?
Escalate a school-age child (roughly 6–8 years or older) with persistent reading difficulty that does not match their ability, once hearing and vision are ruled out, and especially if it persists beyond one school term or causes distress. Below 6, monitor rather than label. Diagnosis is made only by a clinician.
Read the answer AnswerEscalating Emotional & Behavioural Difficulties from ASHA/PHC
Escalate when an emotional or behavioural difficulty is persistent (beyond 4–6 weeks), severe, or disrupting daily life — and immediately for self-harm, harm to others, or sudden regression. ASHA/PHC workers recognise the pattern and route; clinicians diagnose.
Read the answer AnswerWhen to Escalate Feeding & Eating Difficulties
Escalate promptly when feeding difficulty threatens safety, hydration or growth: choking or gurgly breathing during feeds, signs of dehydration, faltering growth, or any infant under 6 months feeding poorly need same-day medical referral. Persistent but stable difficulties warrant routine developmental assessment. When in doubt, refer — feeding is a safety domain.
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 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 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 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 showing signs of Hearing Impairment?
Escalate any child with a missed or failed newborn hearing screen, any unmet hearing milestone, recurrent ear discharge, or a high-risk birth history. Suspected hearing loss is a prompt medical referral to audiology/ENT — never watch-and-wait. The 1-3-6 standard means early action protects speech and language.
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 Should an ASHA or PHC Worker Escalate a Child Showing Signs of Intellectual Disability?
Escalate when a child shows persistent, cross-domain developmental delay, when a caregiver is worried, or — urgently — when previously gained skills are lost. A single late milestone in an otherwise responsive child usually needs only monitoring. ASHA and PHC workers recognise and refer; diagnosis happens only with a clinician.
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.
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