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Concern
Explore explanations, everyday questions and next steps connected with concern.
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Signs & concerns
When 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 to escalate a child's sequential memory concern
Sequential memory develops gradually, so one miss is rarely a worry. A frontline health worker should escalate to a developmental check when a child's difficulty remembering steps, sounds or routines is persistent, clearly behind same-age peers, and accompanied by delays in speech, understanding or daily routines — or when a parent is concerned. Urgent signs such as staring spells or regression need prompt medical referral. This is not a diagnosis but a wise, early opportunity for support.
Read the answer AnswerWhen to escalate a child who cannot draw shapes at the expected age
Drawing shapes follows a predictable order — a circle around 3, a cross and square around 4, a triangle around 5. A single missed milestone is not an escalation trigger. A frontline worker should escalate when a child is clearly behind the expected age and shows other flags: weak or awkward grasp, trouble with self-care, delayed speech or comprehension, loss of a skill, or a vision concern. Isolated lags often resolve with more crayon-and-paper play, but clustered delays are the signal to refer early, when support works best.
Read the answer AnswerWhen to escalate a shape-recognition concern
Most children match and name simple shapes between 2.5 and 4 years. A frontline worker should escalate when a child of 3.5–4 years still cannot match or sort basic shapes despite everyday exposure, or at any age when shape difficulty comes with delays in vision, language, play or attention. First rule out hearing and vision, confirm the child has had real exposure to shapes, then refer for a developmental check — this is early assessment, not a diagnosis.
Read the answer AnswerWhen to escalate short-term memory concerns
A frontline health worker should escalate not on a single missed task but on a persistent pattern: a child who consistently cannot hold and use simple age-appropriate information — following instructions, recalling familiar names or objects — especially alongside delays in talking, attention, play or learning, or when the family is worried. Refer to the Medical Officer or a developmental check when difficulties persist over weeks and widen the gap with peers. This is a referral decision, never a diagnosis, and early referral opens early support.
Read the answer AnswerSimple Planning Delay: When a Frontline Worker Should Escalate
Simple planning — working out the steps to reach a goal — develops gradually in the toddler and preschool years. A frontline health worker should escalate for a developmental check when a child consistently cannot sequence familiar everyday tasks at the age peers manage them, when this travels with delays in language, play or self-help, or when a skill once present is lost. This flags the need for early assessment — not a diagnosis — because early support works best.
Read the answer AnswerSitting balance delay: when frontline workers should escalate
Most babies sit unsupported by 8–9 months. A frontline health worker should escalate to the Medical Officer or a developmental check when a child is not sitting without support by 9 months, has poor head control beyond 4–5 months, shows marked floppiness or stiffness, a strong one-sided preference, or any loss of a skill once present. This is an early referral, not a diagnosis — trunk control underpins crawling and standing, and early support works best.
Read the answer AnswerSituational factors: when a frontline worker should escalate
Situational factors means a child adjusting behaviour to fit the setting. A frontline health worker should escalate to a developmental check when a child is clearly behind same-age peers in adapting across everyday situations, when the gap persists in all settings, or when it comes with delays in talking, social connection, play or understanding instructions. Regression or caregiver concern warrants prompt referral, not watchful waiting. This is screening, not diagnosis.
Read the answer AnswerWhen should a frontline worker escalate a child's sleep and restlessness?
Occasional sleep difficulty and restlessness are common and often settle with routine changes. A frontline worker should escalate when poor sleep is persistent (most nights for 3–4 weeks), causes daytime distress, feeding or growth problems, or travels with developmental delays. Refer urgently for breathing pauses in sleep or seizure-like episodes — these need prompt medical review, not watchful waiting.
Read the answer AnswerWhen should a frontline worker escalate a social-adaptation delay?
A frontline health worker should escalate a child's social-adaptation concern when two or more age-expected social steps are missed, a clear gap from peers is seen, a social skill once present is lost, or social difficulty appears with speech, hearing or play delays. Always pair with a hearing and vision check. This is a timely referral, not a diagnosis — early support works best, and any loss of skill or worried parent warrants prompt review.
Read the answer AnswerWhen to escalate if a child isn't socialising at the expected age
A frontline health worker should escalate when a child consistently misses social milestones for their age — no social smile by 6 months, no response to name or shared attention by 9–12 months, no pointing or shared joy by 18 months, no pretend play or peer interest by 24 months — and the pattern persists across visits or worsens. Loss of a social skill once present, or a parent's worry, are always reasons to refer onward promptly. This is early action, not a diagnosis, because support works best when it begins soon.
Read the answer AnswerWhen should a health worker escalate delayed social awareness?
Social awareness develops over the first two to three years. A frontline health worker should escalate to a medical officer or developmental check when a child misses several social milestones for their age, shows no progress over 2–3 months, or loses a skill once had. Refer sooner if the family is worried or there is birth-history risk. This is not a diagnosis — it opens an early door, when support works best.
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 a social–emotional delay
A frontline health worker should escalate when a child clearly misses social–emotional milestones for their age — for example no social smile by ~2 months, no response to name or shared joy by 9–12 months, or no interest in others or pretend play by 18–24 months. Escalate promptly for any loss of a previously gained skill, or strong parental concern. Refer for a developmental check rather than waiting — this is early detection, not a diagnosis.
Read the answer AnswerWhen to escalate delayed social-emotional understanding
A frontline health worker should escalate when a child's social-emotional understanding clearly lags age expectations AND the gap persists across two visits, travels with other delays (speech, play, eye contact, response to name), or shows loss of a once-present skill. One isolated observation is not a trigger; a persistent or compounding pattern is. This routes the family to early support — it is never a diagnosis at the doorstep.
Read the answer AnswerWhen should a health worker escalate delayed social engagement?
A frontline health worker should escalate when a child clearly misses social milestones for their age and the gap persists — no shared smiles by ~6 months, no response to name or following a point by 9–12 months, no pointing to share by 18 months, or little interest in others by 2 years. Any loss of a previously held social skill, at any age, is an immediate flag, as is persistent parental concern. This is screening to open the door to support, not a diagnosis.
Read the answer AnswerWhen to Escalate a Child's Social-Function Delay
A frontline health worker should escalate when a child shows a clear, persistent gap in social connection for their age — and escalate immediately, without waiting, if the child has lost skills once present, or shows social differences alongside delays in talking or other red flags. Use a quick screen at every routine contact and act on caregiver concern. This is screening, not diagnosis; early referral opens the door to early support.
Read the answer AnswerWhen to escalate a social greeting delay
Social greeting — waving, smiling back, saying hi or bye — usually appears across the first and second year, with most toddlers waving by 12–15 months. A frontline health worker should watch and review in 4–6 weeks if greeting is the only concern and the child is otherwise connecting, but refer for a developmental check now when absent greeting comes with red flags such as no response to name, little eye contact, no pointing, few words — or any loss of a skill. It is a reason to assess early, never a diagnosis.
Read the answer AnswerSocial imagination delay: when frontline workers should escalate
Social imagination — pretend and shared make-believe play — usually develops between 18 months and 3 years. A frontline health worker should escalate for a developmental check when a child past 2 shows little or no pretend play, no imitation of everyday actions, and isn't joining shared imaginary games, especially alongside limited words, poor eye contact or not responding to their name. This is a reason to assess early, not a diagnosis.
Read the answer AnswerSocial initiation: when a frontline worker should escalate
Social initiation is when a child starts an interaction — a glance, point, reach, babble or shared toy. A frontline worker should escalate when initiation is clearly absent for the child's age signpost, has been lost after once appearing, or travels with delays in words, eye contact or response to name. A caregiver's concern is itself a reason to refer. This is a referral decision, not a diagnosis — early developmental review gives the best outcomes.
Read the answer AnswerIf a child cannot show social initiative, when should a frontline health worker escalate?
Frontline health workers should escalate when a child consistently does not start social contact at expected points — no shared smile or gaze by ~6 months, no gestures or pointing-to-show by 12–18 months, no pretend play or peer interest by 2 years — or when any social skill once present is lost. Referral does not need a diagnosis; a pattern of concern is enough, because early support works best.
Read the answer AnswerWhen to escalate a child's social interaction delay
Frontline health workers should escalate when a child clearly misses age-expected social milestones — no social smile by 2–3 months, no shared babble or joy by 9 months, no pointing or showing by 12 months, little eye contact or gesture by 18 months — and the gap persists across visits, or a skill is lost, or a parent is worried. One quiet day is not a flag; a persistent pattern is. Escalation means a developmental check, not a diagnosis, because early support works best.
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