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Early Signs
Explore explanations, everyday questions and next steps connected with early signs.
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Signs & concerns
Observing Emotional Understanding on a Home Visit
On a home visit, a frontline worker should observe how a child reads and responds to feelings: noticing a caregiver's smile or frown, looking to a trusted face when unsure, showing concern for others, expressing and naming their own feelings, and seeking comfort when upset. These are everyday observations to note and discuss with the family, not to diagnose at home. A persistent pattern across several visits — little response to others' feelings or hard-to-settle distress — is worth routing to a general developmental check.
Read the answer AnswerObserving empathy in a child during a home visit
During a home visit, a frontline worker should observe how a child responds to others' feelings — looking towards someone upset, checking a parent's face, offering comfort, sharing, copying smiles, and taking simple turns in play. Empathy (ICF d7) is a slowly-developing social skill, so the worker notes the overall pattern across natural play rather than testing or labelling. These are observations to share with the family and PHC and to route to a developmental check if several signs are consistently missing for the child's age.
Read the answer AnswerEmpathy development on a home visit
On a home visit, a frontline worker should observe how a child notices and responds to others' feelings — looking towards someone upset, offering comfort, sharing, taking turns, and showing warmth in play. Empathy grows gradually, so the aim is to observe and encourage, not to test or diagnose. Route the family to a general developmental check only if a child consistently shows little interest in or response to others across several months, especially alongside other delays.
Read the answer AnswerObserving energy regulation during a home visit
On a home visit, a frontline worker should observe a child's natural rhythm of energy and drive across the day — alertness for play and engagement, energy to feed and explore, and the ability to settle and rest. Both persistent low energy (listlessness, tiring quickly) and unsettled over-activity are worth noting. This is gentle observation to record and follow up, not a diagnosis; where low energy pairs with feeding or growth concerns, a medical review comes first, then route to a developmental screen.
Read the answer AnswerEvent description on a home visit: what to observe
On a home visit, a frontline worker should observe whether the child can describe a simple recent event in their own words — what happened, who was involved and roughly in what order — using short sentences that join ideas, with a growing vocabulary and clear-enough speech. Watch for staying on topic and answering simple what/who/where questions. These are everyday observations to note and monitor, not to diagnose; check hearing first, and route persistent or multi-area concerns to a developmental screen.
Read the answer AnswerObserving Executive Functioning on a Home Visit
On a home visit, a frontline worker should observe how a child holds a simple plan, follows two-step instructions, waits a turn, remembers a step and copes when something goes wrong — the everyday roots of executive functioning. This is observation and gentle noting, never diagnosis. What matters is a pattern seen across visits and across more than one situation; persistent or clearly age-inappropriate difficulty should be routed for a developmental check at the PHC or a Pinnacle centre.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning expressive language?
On a home visit, observe how a child uses sounds, words and gestures to express needs — babbling and pointing in infancy, first words by around 12–15 months, two-word phrases by age 2, and using words to ask, name and refuse. Watch for no babbling by 12 months, no words by 16–18 months, no phrases by 2 years, or any loss of skills, and always note hearing. These are observations to monitor, never to diagnose at home; persisting or widening gaps should be routed for a developmental and hearing check.
Read the answer AnswerWhat to observe about externalizing behaviours on a home visit
On a home visit, a frontline worker should observe how often, how intensely and in what situations a child shows outward behaviours like hitting, frequent tantrums, defiance or trouble settling — and what comes before and after them. Most young children show some of these while learning to manage big feelings; what matters is whether the behaviour is frequent, intense and disrupting daily life. These are patterns to observe and route for a check, not to diagnose at home.
Read the answer AnswerObserving Eye Contact During a Home Visit
During a home visit, a frontline worker should observe whether the child looks towards faces and voices, briefly meets a familiar adult's eyes during play or feeding, shares glances to enjoy a moment, and follows where a parent looks or points. These are everyday social-connection signs (ICF d7) to watch gently across visits — never to diagnose at home. A shy child on one day is not a concern; it is the pattern that matters. If eye contact stays consistently very limited for the child's age, route the family to a friendly developmental check.
Read the answer AnswerWhat to Observe About Face Recognition on a Home Visit
On a home visit, a frontline worker should observe how a child responds to familiar faces — looking towards a parent, holding eye contact, smiling back at a known face, following a face that moves, and preferring familiar people over strangers. These signs show face recognition and early social connection developing, judged by the baby's age. This is observation and monitoring, not diagnosis: note what you see, encourage face-to-face play, and route any persistent concern (no eye contact, no social smile by ~3 months, no interest in familiar faces by 6 months) to a general developmental check after vision and hearing are screened.
Read the answer AnswerWhat to observe about a child learning family values
On a home visit, a frontline worker should observe how a child learns family values through everyday interactions — showing affection, looking to caregivers for comfort, beginning to share and help, imitating household routines, and responding warmly to family. These are social-emotional skills that grow with age, so the aim is to observe and encourage, not test. A connected, engaged child is developing well; persistent lack of eye contact or response to name by 18–24 months is worth a friendly developmental check.
Read the answer AnswerObserving feeding independence on a home visit
On a home visit, a frontline worker should observe how a child takes part in feeding — bringing hand or spoon to mouth, holding a cup, chewing and swallowing safely, and showing interest in self-feeding. Note what the child can do and how the family supports it, watch progress across visits, and raise persistent difficulty such as frequent choking, refusal or poor weight gain with the PHC team. This is observation, not diagnosis, and should be paired with a general developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning fine motor?
During a home visit, a frontline worker should observe how a child uses hands and fingers — reaching, grasping, pincer grip, transferring objects, using both hands together, and managing tools like spoons or crayons. Note whether grasp matches age, whether both hands cooperate, and whether any hand is fisted, stiff, floppy or barely used. These are observations to note and monitor, not to diagnose; persistent concerns should be routed for a developmental check.
Read the answer AnswerDuring a home visit, what to observe about a child learning fluid reasoning
On a home visit, a frontline worker should observe how a child solves new, unfamiliar little problems in play — sorting and matching, copying or continuing patterns, working out cause-and-effect, trying a different approach when one fails, and following new instructions or answering simple 'why' questions. These show fluid reasoning, the ability to think on the spot. The worker observes and notes, never diagnoses, and gently suggests a developmental screen if concerns repeat or parents are worried.
Read the answer AnswerWhat to observe about focus and attention on a home visit
On a home visit, a frontline worker should observe how long a child settles into and sustains play, whether they shift gaze to people or objects, share attention, respond to their name, and follow a simple instruction. Attention is short and interest-driven at young ages, and environment, mood and tiredness all shape it — so observe patterns over several visits rather than testing or diagnosing. A concern that is clearly below same-age peers, persists across visits and shows in more than one setting warrants a gentle route to a developmental screen.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about following directions?
On a home visit, observe how a child responds to everyday spoken requests — turning to their name, looking where you point, fetching a familiar object, or doing a simple action like 'give me'. Watch whether understanding grows with age and whether words and gestures are understood together. These are observations to note and monitor, not to diagnose at home; a hearing check comes first, and a persisting gap is a reason to suggest a friendly developmental screen.
Read the answer AnswerWhat to observe about a child learning foot control on a home visit
On a home visit, a frontline worker should observe how a child uses their feet in everyday movement — standing flat with even weight on both feet, smooth alternating steps, kicking a ball, stepping over low objects, and beginning to balance on one foot with age. These are everyday skills to observe and note, not to diagnose. Watch for clear asymmetry, persistent toe-walking, loss of a skill, or being well behind peers across areas — and route the family to a developmental check when a concern persists or widens.
Read the answer AnswerFriendship seeking: what to observe on a home visit
On a home visit, a frontline worker should observe how a child notices, approaches and engages other children and familiar people — looking towards them, moving closer, offering or sharing a toy, exchanging smiles and simple turn-taking. Friendship seeking (ICF d7) develops gradually, so observations are judged against age and framed by strengths. Persistent low interest in others, little shared attention, or solitary play across several months is worth a gentle referral for a general developmental check — never a home diagnosis.
Read the answer AnswerObserving Friendship Skills on a Home Visit
On a home visit, a frontline worker should observe how a child connects with others — interest in peers, eye contact, taking turns, sharing, responding to others' feelings, and seeking company. Friendship skills (ICF d7) develop gradually, so note patterns over visits rather than judging one moment. Where a child shows little interest in other children, cannot share or take turns far beyond peers, or is distressed by most social situations, flag it for a general developmental check — observe and monitor, never diagnose at home.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about frustration tolerance?
On a home visit, a frontline worker should observe how a child reacts to something hard or unwanted — whether upset stays big and long or the child settles, tries again, or seeks help. Frustration tolerance (ICF b152) grows through the toddler and preschool years, so the worker watches the pattern and how it shifts with support, not a label. Note what you see, share it warmly, and route persistent concern (severe, prolonged, hard-to-soothe distress, or frustration that turns to hurting self or others) to a developmental check.
Read the answer AnswerObserving Game Rule Understanding on a Home Visit
During a home visit, a frontline worker should observe how a child takes turns, waits, follows a simple game instruction, remembers the rule across rounds, and handles winning or losing in a familiar game. These are everyday signs of growing attention, memory and social understanding — to observe and note, never to diagnose at home. Suggest a friendly developmental check only when several signs are consistently behind same-age children.
Read the answer AnswerObserving general knowledge on a home visit
On a home visit, a frontline worker should observe how a child shows general knowledge for their age — recognising familiar people, objects and routines, pointing to or naming everyday things, following simple instructions, showing curiosity and meaningful play. These are observations to note and monitor, not to diagnose. A persistent gap across several areas, judged against the family's language and daily life, is the cue to reassure the family and route them to a PHC medical officer or developmental check, with hearing and vision screens first.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning to general sensory regulation?
On a home visit, a frontline worker should observe how a child responds to and recovers from everyday sensory input — sounds, textures, lights, touch and movement. Watch for reactions that are unusually intense, persistent, or that disrupt feeding, sleep, dressing or family routines, and whether the child can settle and re-engage. These are signs to observe and gently route for a developmental check, not to diagnose at home.
Read the answer AnswerGrammar use on a home visit: what to observe
On a home visit, a frontline worker should observe how a child combines words — moving from single words to two- and three-word phrases, then adding small grammar words (in, on, my) and endings (-ing, plurals, past tense). What matters is steady growth over months and whether family understand the child by about age 3, not perfect grammar. Check hearing first. These are signs to observe and note, not diagnose at home; refer for a screen if combinations are clearly behind or not progressing.
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