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Early Signs
Explore explanations, everyday questions and next steps connected with early signs.
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Signs & concerns
Sorting & categorization on a home visit
On a home visit, a frontline worker should observe how a child notices sameness and difference, matches and groups everyday objects (by colour, shape, size or use), follows a simple sorting instruction, and stays engaged. Many children begin matching around 2–3 years and sort by category by 3–4 years. These are observations to note and route — never a home diagnosis. Refer onward if a child past 3 cannot match or group familiar objects with demonstration, or if wider delays are reported.
Read the answer AnswerObserving a child's sound production on a home visit
On a home visit, a frontline worker should observe how a child makes and uses speech sounds for their age — cooing and babbling in babies, first clear words in toddlers, and understandable sentences in preschoolers. The task is to observe and note, not diagnose. Watch for very limited or unclear sounds, loss of sounds once used, or speech far behind same-age peers, and note any hearing concern. When a pattern persists, gently route the family to a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about spatial concepts?
On a home visit, a frontline worker should observe how a child understands and uses spatial words and ideas — putting toys in, on, under or behind things, following simple position directions, and grasping big/small, near/far and up/down through play. These are behaviours to observe and note, not diagnose at home. A pattern that persists across visits, or a child clearly behind same-age peers, should be gently routed for a developmental check and a hearing screen.
Read the answer AnswerSpatial reasoning on a home visit: what to observe
On a home visit, a frontline worker should observe how a child explores space and shape in everyday play — stacking blocks, nesting cups, posting shapes, completing puzzles, navigating around furniture, and using position words like in, on and under. These are skills to watch and encourage, not diagnose at home. A pattern that persists or widens across months, or concerns alongside speech, movement or play, is worth a gentle, planned developmental check and routing to a screen.
Read the answer AnswerObserving special interests on a home visit
During a home visit, a frontline worker should observe whether a child shows interests at all, how flexibly they engage with favourite toys or topics, and crucially whether they share that interest with people — bringing objects, following a pointing gesture, taking turns. Narrow fixed interests, distress at interruption, or interest in objects but not people across visits are patterns worth noting and routing to a general developmental check, not diagnosing at home.
Read the answer AnswerObserving speech intelligibility on a home visit
On a home visit, a frontline worker should observe how clearly a child's speech is understood by family and by strangers, and whether the child uses words to communicate. As a guide, a stranger should understand about half of a 2-year-old, three-quarters of a 3-year-old, and almost all of a 4-year-old. Note unclear speech, missing sounds, or any hearing concern — and refer persistent worries, especially after age 3. This is observation, not diagnosis.
Read the answer AnswerObserving Speech, Language and Communication on a Home Visit
On a home visit, a frontline worker should observe how a child connects, understands and expresses — eye contact, response to name, gestures like pointing and waving, sounds and words for the age, and turn-taking with caregivers. Also note how much the family talks, sings and responds to the child, and any worry about hearing. These are observations to note and route gently, never a home diagnosis. A hearing screen comes first, and any persistent gap across areas should be referred to the nearest PHC or developmental check.
Read the answer AnswerSprinting Ability — Home Visit Observation Guide
On a home visit, a frontline worker should observe how a child runs at pace — whether running looks smooth and balanced, whether arms and legs coordinate, and whether the child can stop, start and change direction without frequent falls. Confident running emerges around 2.5–3 years and refines through 4–5. These are points to observe and note, not diagnose at home — persistent lag, asymmetry or not running by 3 years should be routed for a developmental check.
Read the answer AnswerSquatting balance: what to observe on a home visit
On a home visit, observe whether the child can lower into a squat to reach the floor, hold it steadily for a few seconds, and rise without using hands or furniture. Squatting balance usually appears between about 14 and 24 months, so judge against age. Watch for heels lifting and wobbling, one-sided weakness, or skills that have regressed. This is a skill to observe and encourage, not diagnose at home — route persistent delay, one-sidedness or regression to a developmental check.
Read the answer AnswerWhat to Observe About Stair Climbing on a Home Visit
During a home visit, a frontline worker should observe how a child approaches stairs: crawling or creeping up, stepping with rail or hand support, balance and steadiness, leg symmetry, and confidence and interest in trying. Stair climbing emerges in stages between about 12 and 24 months, so the focus is on quality and progress, not diagnosis. Flag no attempt to climb with support by 18–20 months, marked asymmetry or stiffness, or loss of a skill to the PHC medical officer.
Read the answer AnswerObserving standing balance during a home visit
On a home visit, observe whether the child can pull to stand, hold standing with support, then stand briefly alone, with feet flat and apart, even weight on both legs, and a steady trunk. Pulling to stand and cruising usually appear by 9–12 months; standing alone by about 11–13 months. These are signs to observe and note, not to diagnose at home. No weight-bearing by 12 months, constant tiptoeing, stiff or scissoring legs, or one-sided weakness should be raised gently with the family for a developmental check.
Read the answer AnswerObserving static balance on a home visit
On a home visit, a frontline worker should watch how steadily a child holds a still position — standing with feet together, balancing briefly on one foot (from about 3 years), and staying upright while reaching or playing. Note wobbling, constant grabbing for support, one side being clearly weaker, and stiff or floppy tone. These are observations to track, not diagnose; refer for a developmental check when a gap persists across visits, one side is consistently affected, or the family is worried.
Read the answer AnswerWhat to observe about stereotyped behaviours on a home visit
On a home visit, a frontline worker should observe both the repeated movement itself (hand-flapping, rocking, spinning, head-banging) and the child around it — eye contact, response to name, gestures, play and language. A single self-soothing movement in a connecting child is usually ordinary; what matters is whether the behaviour is very frequent, hard to interrupt, self-injurious, or paired with delays. These are observations to note and refer, never to diagnose at home.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning to story recall?
On a home visit, watch how the child listens to a short familiar story and retells it — noting attention, recall of main characters and events, rough sequencing, and the language they use. A child learning this skill improves with repetition and prompts, so observe growth over several visits rather than one attempt. Persistent low interest, no recall even with picture cues, or retelling far behind peers are observations to share with the team — never a home diagnosis.
Read the answer AnswerObserving Storytelling Skills on a Home Visit
On a home visit, a frontline worker should observe how a child sequences events, uses descriptive and linking words, recalls a simple story, and stays socially connected while telling it. By 4–5 years a child should manage a rough beginning–middle–end with linking words; by 5–6 a clear sequence with reasons and feelings. Watch-points include only single words past age 4, no sequencing, or poor shared attention. These are observations to note and share with families, not home diagnoses — refer for a developmental check if storytelling stays well behind peers.
Read the answer AnswerWhat to observe when a child is learning to support
During a home visit, a frontline worker should observe how a child supports their own body — head control when held, pushing up in tummy time, sitting with and without help, and bearing weight on the legs. Watch whether these are emerging steadily for the child's age, whether tone looks too stiff or too floppy, and whether both sides work equally. These are observations to record and refer, never diagnoses. A persistent gap across visits, several areas affected, or asymmetry should prompt a gentle referral.
Read the answer AnswerObserving sustained attention on a home visit
On a home visit, a frontline worker should observe how long a child stays engaged with one activity, whether they return to it after a distraction, and how this compares to peers of the same age. Attention is naturally short in young children and longer for favoured tasks, so these are points to observe and note across visits — not diagnose at home. Refer for a developmental check when very limited focus persists across settings or when the family raises concern; a hearing check is often a sensible first step.
Read the answer AnswerWhat to observe about tactile processing on a home visit
During a home visit, observe how a child responds to everyday touch — clothing textures, messy play, bathing, food and hugs. Note whether the child is over-reactive (distressed by ordinary touch), under-reactive (barely notices touch or pain), or touch-seeking (craves pressure and textures). These are observations to note and share, not to diagnose at home. Refer for a developmental screen when touch responses persist across settings and disrupt eating, dressing, sleep, play or family routines.
Read the answer AnswerObserving task completion during a home visit
On a home visit, observe whether the child can begin a simple familiar task, stay focused enough to finish, follow a one- or two-step instruction, cope with a small obstacle, and show pride at completing it. These are observations to note and monitor against the child's age, never to diagnose at home. A pattern that persists across visits, is well behind peers, or comes with attention or comprehension concerns is worth raising for a developmental check.
Read the answer AnswerObserving task initiation during a home visit
During a home visit, a frontline worker should observe how readily a child starts an offered activity — picking up a toy, responding to a simple instruction, or beginning a familiar routine without constant prompting. Task initiation (ICF d1) grows with age, so this is gentle observation and pattern-noting, never home diagnosis. Compare across people and settings, and route consistent difficulty — especially alongside other delays — to a general developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning task management?
On a home visit, observe how a child starts, stays with, and finishes a simple everyday task — understanding a one-step instruction, keeping attention for a minute or two, managing a short sequence of steps, and coping with small frustration. Judge against age and the support given. These are observations to note and monitor, not to diagnose. Flag persistent patterns, or delays alongside language, play or attention, to the supervising health team for a developmental screen.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning task monitoring?
During a home visit, a frontline worker should observe how a child begins, holds the goal of, sustains and checks a simple everyday task — whether they remember instructions, stay on task, notice and fix their own mistakes, and finish without constant prompting. These are skills to observe and note over several visits, not to diagnose at home. A persistent struggle across many tasks, clearly behind same-age peers, is the cue to suggest a friendly developmental screen.
Read the answer AnswerObserving Task Participation on a Home Visit
During a home visit, a frontline worker should observe how a child engages with a simple, age-appropriate activity — whether they look at it, follow a one-step instruction, stay with it briefly, keep trying and finish a small step. These are strengths to observe and encourage, not to diagnose at home. If a child consistently cannot settle into or complete simple tasks for their age across several weeks, route the family for a gentle general developmental check.
Read the answer AnswerWhat to Observe About a Child's Task Persistence on a Home Visit
On a home visit, a frontline worker should observe how long a child stays with an age-appropriate activity, whether they return after interruption, and how they cope when it gets hard — keep trying, ask for help, or give up instantly. Task persistence (ICF b152) grows with age, so observe the pattern across several activities and visits, not a single moment. These are observations to note and route, never to diagnose at home; a persistent pattern of giving up across activities is worth gently suggesting a developmental screen.
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