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Early Signs
Explore explanations, everyday questions and next steps connected with early signs.
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Signs & concerns
Observing Object Permanence on a Home Visit
During a home visit, a frontline worker should observe whether the child follows a dropped or moving toy with their eyes, looks toward where an object disappeared, lifts a cloth to find a hidden toy by around 8–10 months, and enjoys peek-a-boo. Object permanence usually emerges between 6 and 12 months. These are signs to observe and note, not diagnose — refer onward for a developmental check if searching and playful interaction seem consistently absent or a parent is worried.
Read the answer AnswerObject recognition on a home visit: what to observe
On a home visit, a frontline worker should observe how the child looks at, reaches for and uses familiar everyday objects — a cup, spoon, ball or face. Object recognition means the child shows they know what something is and what it's for, follows moving objects, finds named items and uses them correctly. These are observations to note and discuss, not diagnose. Check hearing and vision first, and if concerns persist across visits, route the family to the PHC for a developmental check.
Read the answer AnswerObserving oral sensory processing on a home visit
On a home visit, a frontline worker should observe a child's mouth-based experiences — feeding, accepting textures, mouthing objects, and tolerating tooth-brushing — and note any persistent, distressing patterns. Watch for ongoing texture refusal, gagging at food, a very narrow diet, constant mouthing beyond toddlerhood, or distress with oral care. These are signs to observe and route for a developmental check, not to diagnose. The worker's role is to notice, reassure and refer early.
Read the answer AnswerObserving organization skills during a home visit
On a home visit, a frontline worker should observe how a child manages everyday tasks for their age — gathering items to start an activity, following simple 2–3 step routines, keeping toys roughly in order, tidying with prompts, and coping with transitions. Organization develops gradually, so the worker observes and notes patterns across visits rather than scoring or diagnosing. Where a child is well behind same-age peers across several routines, gently route the family to a general developmental check.
Read the answer AnswerObserving organisation skills on a home visit
On a home visit, observe how the child follows simple routines, puts belongings back, completes tasks, gathers what they need, and moves between activities. Organisation skills grow unevenly in early years, so note patterns rather than label. Mark a referral when difficulties are persistent, marked and seen across many situations — paired with hearing and vision screening.
Read the answer AnswerWhat to Observe About Parent Characteristics on a Home Visit
On a home visit, a frontline worker should observe how warmly and responsively the parent interacts with the child — eye contact, talking, comforting and play — plus confidence with feeding, sleep and safety, and the parent's own wellbeing. This is strengths-based observation, not judgement or diagnosis. Responsive parenting strongly protects early development, so noticing patterns helps the worker encourage what works and route a struggling family to PHC or a developmental check early.
Read the answer AnswerPatience and Turn-Taking on a Home Visit
During a home visit, a frontline worker should observe how a child waits, shares attention and takes turns in everyday play — handing objects back and forth, pausing for a caregiver, and managing short waits with or without help. These social skills develop gradually, so the worker observes patterns over time, encourages play, and routes concerns onward rather than diagnosing. A persistent lack of back-and-forth play, no interest in turn-taking, or hard-to-settle distress over several months is worth flagging for a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning pattern recognition?
On a home visit, observe how the child notices and predicts what comes next — matching like objects, sorting by colour or size, continuing simple repeating patterns, completing rhymes, anticipating routines and recalling rules. These are everyday signs of pattern recognition to note over time, not to diagnose. Concern grows when several signs lag clearly behind peers, persist across visits, or a skill is lost — gently route the family to a developmental check.
Read the answer AnswerWhat to observe about a child's pencil grip on a home visit
On a home visit, a frontline worker should observe how a child holds the pencil (whole-fist grip in toddlers, refining to a fingertip tripod grip by 5–6 years), what they do with it (scribbling, copying lines and circles), hand preference, and the supporting skills of sitting balance and pincer grasp. These are observations to note and monitor by age, not to diagnose at home. Refer to the PHC medical officer or a developmental check if grip lags well behind age, if there is weakness or stiffness, or if the family is concerned.
Read the answer AnswerObserving Perspective Taking on a Home Visit
On a home visit, observe how a child shares attention, follows pointing, checks a caregiver's face, responds to others' feelings, takes turns and begins pretend play — all signs of emerging perspective taking. This is an ICF d7 social skill that grows gradually through the toddler and preschool years. Watch patterns across visits, fitted to age, and never diagnose at home. If shared attention, emotional response and turn-taking show little growth for the child's age, note it kindly and route the family to a general developmental check.
Read the answer AnswerWhat to Observe About Fine Motor Skills on a Home Visit
During a home visit, a frontline worker should observe how a child uses hands and fingers in everyday play and feeding — reaching, grasping, releasing, transferring objects, pincer grip, stacking, scribbling and self-feeding — judged against age. These are observations to note and monitor, not to diagnose. Refer for a developmental check if hand skills lag across several visits, if tone is stiff or floppy, or if one hand is strongly favoured before 12 months.
Read the answer AnswerGross motor: what to observe on a home visit
On a home visit, a frontline worker should observe a child's gross motor skills — head control, sitting, crawling, standing, walking — alongside the *quality* of movement: muscle tone (too stiff or floppy), symmetry (using both sides), and balance. Watch for stalled or lost skills, strong one-sidedness, or several milestones delayed together. These are signs to record and refer to the PHC medical officer, never to diagnose at home. Judge preterm babies by corrected age.
Read the answer AnswerWhat to observe about a child's physical play on a home visit
During a home visit, a frontline worker should observe how a child moves and plays with their whole body — running, climbing, jumping, throwing, balancing — and how this compares with same-age peers. Notice whether active play is joyful and varied, whether the child joins others, and whether movement looks steady or unusually stiff, floppy or clumsy. These are signs to observe and note, not diagnose at home; a persistent or widening gap, several areas affected, or loss of skills is a reason to suggest a friendly developmental screen.
Read the answer AnswerPicture Description on a Home Visit
On a home visit, observe whether the child can look at a simple picture and describe it — naming objects and actions, building short sentences, finding words readily, and answering simple 'what' and 'where' questions. Note attention to the picture and whether ideas are linked rather than only single words pointed at. This is observation to record and share, not a home diagnosis; a persistent gap over visits, alongside a hearing check, warrants a gentle developmental referral.
Read the answer AnswerWhat to observe about a child's play during a home visit
On a home visit, a frontline worker should observe the quality and growth of a child's play: whether they explore and use objects, show curiosity, play socially with eye contact and turn-taking, and (for toddlers) try simple pretend play. The aim is to observe and encourage — not to test or diagnose. Play that stays very limited, rarely involves people, or has not grown over months should be gently routed to a general developmental check, never labelled at home.
Read the answer AnswerHome Visit: Observing a Child's Practical Skills
During a home visit, a frontline worker should observe how a child manages practical everyday skills — feeding, dressing, holding objects, following simple instructions and copying daily tasks — at an age-appropriate level. These are things to observe and note, not diagnose at home. A child behind across several practical skills, or clearly behind same-age peers, should be gently routed for a developmental check.
Read the answer AnswerObserving pretend play on a home visit
During a home visit, a frontline worker should observe how a child uses objects imaginatively — feeding a doll, copying chores, making one object stand for another, and inviting others into make-believe. Pretend play emerges roughly between 12 and 30 months. The worker observes and records patterns over time, not a single visit, and gently routes any persistent gap or caregiver concern to a developmental check. This is monitoring, not diagnosis.
Read the answer AnswerWhat to Observe About a Child's Problem Solving on a Home Visit
On a home visit, a frontline worker should observe how a child works things out in everyday play — reaching for out-of-grasp toys, fitting shapes, finding hidden objects, using tools, and trying a new approach when the first fails. These show growing problem solving, an early-learning skill. The worker observes and notes patterns over time rather than diagnosing. Persistent very limited exploration or problem solving well behind same-age peers is worth gently referring to the PHC medical officer or a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning pronunciation skills?
On a home visit, a frontline worker should observe how clearly a child's speech sounds emerge, how much family and outsiders understand them, which sounds are present or missing, and whether speech grows month by month. Rules of thumb help: understood by family by age 3, by others by age 4. These are signs to monitor and refer — never to diagnose at home. A hearing check is a sensible first step, and steady progress matters more than isolated errors.
Read the answer AnswerProprioceptive Processing: Home-Visit Observation Guide
During a home visit, a frontline worker should observe how a child uses their body in everyday play — force and handling (too rough or too gentle), posture and body awareness (slumping, bumping, seeking deep pressure), and coordination in daily tasks. These are observations to note and monitor, never to diagnose. A pattern that is consistent across visits, affects more than one activity, or frustrates the child warrants a gentle route to a developmental screen alongside hearing and vision checks.
Read the answer AnswerQuantitative reasoning on a home visit: what to observe
On a home visit, observe a child's everyday number sense — noticing more versus less, grouping and sorting objects, sharing items out, and counting touchable things by preschool age. These early quantitative reasoning skills (ICF d1) are observed through ordinary play with home objects, not tested. Worth a closer look: no interest in amounts, inability to count objects by school age, or number play far behind other development. Note kindly for the family and route to a developmental screen — never a home diagnosis.
Read the answer AnswerObserving quantity comparison during a home visit
On a home visit, a frontline worker should watch whether a child can compare two small groups of everyday objects and tell which has more or less, reach for the larger share, and use words like zyada or kam. This is everyday observation to encourage and monitor, not to diagnose. A child who consistently struggles compared with same-age peers should be routed to a friendly developmental check.
Read the answer AnswerWhat to observe about a child's question-asking on a home visit
During a home visit, a frontline worker should observe how a child uses questions to explore and connect — pointing and looking to ask, raising the voice questioningly, and using words like what, where, who and why. Note whether the child waits for and uses the answer, and across which people. Children may ask freely in their mother tongue, and talkative homes invite more questions. This is gentle observation to share with the team and route to a developmental check — not a diagnosis.
Read the answer AnswerWhat to Observe About Question Comprehension on a Home Visit
On a home visit, a frontline worker should observe how the child responds to simple spoken questions in their home language — looking, pointing, fetching or answering "where", "what", "who" and "which one" within familiar routines. Question comprehension (ICF d3) develops step by step, so the worker watches the pattern across play, meals and chatter, noting what the child can do rather than testing or diagnosing. Supporting clues include attention to the speaker, response to name and use of gestures or words. Gently flag a hearing check and developmental screen if responses to spoken words seem consistently limited or the family is concerned.
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