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Signs & concerns
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Signs & concerns
When to escalate a child's delay in understanding
A frontline health worker should escalate when a child understands clearly less than peers and the gap persists — for example no response to name or simple words by 18 months, or not following one-step instructions by 2 years in the home language. Any loss of understanding once present needs prompt referral, and hearing should always be checked first. This is a reason to assess early, never a diagnosis.
Read the answer AnswerWhen should a frontline health worker escalate a speech delay?
A frontline health worker should escalate when a child misses key speech milestones — no babbling by 12 months, no single words by 16–18 months, no two-word phrases by 24 months — or shows any loss of words or social skills at any age. Parent worry alone justifies referral. Always pair the referral with a hearing check, since undetected hearing loss often underlies speech delay. Early referral is an opportunity, not a diagnosis.
Read the answer AnswerWhen to escalate a verbal-knowledge delay
A frontline health worker should escalate a verbal-knowledge concern when a child clearly lags age milestones — no babble or gestures by 12 months, no words by 18 months, fewer than ~50 words by 24 months — or when words are lost, hearing is in doubt, or the family is worried. Check hearing first and refer early for a developmental assessment; this is screening, not diagnosis, and early support works best.
Read the answer AnswerWhen to escalate a child's verbal reasoning delay
Verbal reasoning develops gradually through the preschool years. A frontline health worker should escalate for a developmental check when a child is clearly behind peers in understanding or using language, isn't gaining new words or ideas over time, has lost a skill, or shows language gaps alongside hearing or social concerns. Always check hearing first. This signals early assessment, not a diagnosis.
Read the answer AnswerWhen to escalate delayed verbal understanding
A frontline health worker should escalate a child for a developmental check when verbal understanding is clearly behind the expected window: no response to name by 12 months, unable to follow a simple request by 18 months, not pointing to named objects by 24 months, or any loss of a skill once gained. Always honour parental concern and arrange a hearing check in parallel, since hearing loss is a common, treatable cause. This is early opportunity, not diagnosis.
Read the answer AnswerWhen to escalate vestibular processing concerns
Vestibular processing — balance and movement sense — develops gradually, so there is no single pass-or-fail age. A frontline health worker should escalate to a developmental check when balance or movement difficulties persist beyond the expected age and interfere with play, walking or safety, especially alongside motor, speech or social delays. Sudden unsteadiness, head tilt or dizziness with vomiting needs prompt medical review. This guides early assessment, never diagnosis.
Read the answer AnswerWhen to escalate a child's visual motor integration delay
Visual motor integration — eyes and hands working together to copy, draw and build — develops step by step through the preschool years. A frontline health worker should escalate for a developmental check when the skill is clearly behind same-age peers and not improving with everyday practice, when it interferes with daily tasks, or when it travels with vision, fine-motor, speech or learning concerns. Any suspected vision problem needs a prompt eye check first. This is a timely referral, not a diagnosis.
Read the answer AnswerWhen should a frontline worker escalate visual processing concerns?
Visual processing develops steadily, so there is no single failure age. Frontline workers should escalate when a child does not fix on or follow a face by 2–3 months, has eyes that do not move together by 6 months, or shows a white/cloudy pupil, wobbling eyes, strong light sensitivity, head-tilting, or bumping into things — refer same-day for white pupil or wobbling eyes. These are reasons to refer early, not a diagnosis, because vision concerns are time-sensitive.
Read the answer AnswerWhen to escalate a visual-reception concern
If a child is not meeting visual-reception milestones at the expected age, a frontline health worker should escalate to the PHC Medical Officer when the gap is clear or does not resolve at a short follow-up. Escalate the same week for red flags: no fixing or following a face by 3 months, no tracking by 4 months, a white reflex, constantly wandering or misaligned eyes, or loss of a skill. This is early routing, not a diagnosis.
Read the answer AnswerWhen to escalate a child's visual recognition delay
Visual recognition — fixing on faces, then knowing familiar people and objects — emerges in the early months. A frontline worker should escalate if a baby doesn't fix on or follow faces by ~3 months, shows no recognition of familiar people or objects by 6–9 months, or has any eye red flag (misaligned eyes, white/cloudy pupil, persistent watering). Eye abnormalities and any regression need prompt referral; mild isolated lag can be rechecked in 4–6 weeks. This guides referral, not diagnosis.
Read the answer AnswerIf a child cannot visual scanning at the expected age, when should a frontline health worker escalate?
Visual scanning — searching, following and finding with the eyes — develops through the first year. A frontline health worker should escalate when a child does not fix or follow by 2–3 months, has eyes that don't move together by 6 months, isn't visually searching for objects by 9–12 months, shows sudden skill loss or a white/cloudy pupil (same-day referral), or when scanning trouble travels with other developmental delays. This is a referral decision, not a diagnosis.
Read the answer AnswerWhen to escalate visual-spatial processing concerns
Visual-spatial processing develops gradually, so occasional difficulty is normal. A frontline health worker should escalate to a developmental check when the difficulty is persistent for age, clearly behind peers, affecting everyday play or self-care, or travels with other delays. Always rule out a vision problem with an eye examination first. This is a reason to assess early, not a diagnosis.
Read the answer AnswerEscalating Visuospatial Skills Concerns at the Frontline
Visuospatial skills develop gradually, so one missed milestone rarely warrants alarm. A frontline health worker should escalate when the difficulty is persistent and clearly behind peers, travels with motor, language, vision or learning delays, when a parent reports a lost skill, or when a parent senses something is different. First rule out a vision problem, which can mimic visuospatial delay. Escalation is a route to early support, never a diagnosis.
Read the answer AnswerWhen to Escalate a Vocabulary Delay
Frontline health workers should escalate a child for a developmental check when vocabulary is clearly behind expected markers — no babble or gestures by 12 months, under 6–10 words by 18 months, under ~50 words or no two-word phrases by 24 months, or any loss of words once used. Always confirm hearing has been screened. This is a referral for assessment, never a diagnosis, and early action gives the child the best start.
Read the answer AnswerWhen to escalate a child's language delay
Frontline workers should escalate a child's language concern when a clear milestone is missed — no babbling by 12 months, no single words by 16 months, no two-word phrases by 24 months — or when a child loses words or understanding already gained at any age. Always check hearing first and trust parental concern. These are reasons to refer for assessment, not a diagnosis, and earlier referral means earlier support.
Read the answer AnswerWhen to escalate a vocabulary delay
Escalate when a child's vocabulary is clearly behind expectations for age — for example no words by 16–18 months, or fewer than about 50 words and no two-word phrases by 24 months — especially if the child also struggles to understand simple instructions, shows hearing or social concerns, or loses skills once gained. Always pair language concerns with a hearing check. This is a referral cue for early support, never a diagnosis.
Read the answer AnswerIf a child cannot reach expected vocalisation milestones, when should a frontline health worker escalate?
Vocalisation follows a clear arc: cooing by ~3 months, babbling by 6–9 months, first words near 12 months. A frontline health worker should escalate to the Medical Officer or a developmental service when a child misses these milestones, loses sounds or words once had, or when quietness comes with poor eye contact, no response to name, or feeding difficulty. Suspected hearing loss needs prompt audiology referral. This is a referral for assessment, not a diagnosis — early linkage gives the best outcomes.
Read the answer AnswerIf a child cannot walk at the expected age, when should a frontline health worker escalate?
Most children walk independently between 12 and 15 months. A frontline health worker should escalate to the Medical Officer or a developmental check when a child is not walking independently by 18 months, when a walking or standing skill is lost after being gained, or when delayed walking comes with floppiness, stiffness, asymmetry, not bearing weight, or not sitting by 9 months. These are referral triggers, not diagnoses — early review works very well.
Read the answer AnswerWhen should a frontline worker escalate delayed walking balance?
Most children walk with support by 12 months and independently by 18 months. A frontline health worker should escalate if a child is not standing alone by 12 months, not walking independently by 18 months, has lost a walking skill, or shows asymmetry, stiffness, floppiness, persistent toe-walking or frequent falls. These are reasons for early review — not a diagnosis — and early referral lets therapy begin when it works best. Always check corrected age for preterm babies.
Read the answer AnswerWhen to escalate delayed word knowledge
Word knowledge grows on a wide timeline, so single-month variation is normal. A frontline health worker should escalate when a child shows no words by 18 months, no two-word phrases by 24 months, doesn't follow simple instructions, isn't pointing or responding to their name, or has lost words once used. Always include a hearing check, and act on a red flag plus parental concern rather than waiting — early referral gives the best results.
Read the answer AnswerWorking memory concerns: when to escalate
Working memory — holding information in mind to act on it — develops gradually through the preschool years. A frontline health worker should escalate for a developmental check when a child around 4 years or older consistently cannot follow simple two-step instructions, forgets what was just said, or loses track mid-task, especially alongside delays in talking, attention or learning. Escalate sooner if concerns are clear or a parent is worried; refer promptly for any sudden loss of a skill. This signals a reason to assess early, not a diagnosis.
Read the answer AnswerIf my child is behind in Adaptive, what does that mean?
A developmental age that is behind in the Adaptive area means your child's everyday self-care and daily-living skills — feeding, dressing, toileting, washing, following routines — are emerging more slowly than is typical for their age. It reflects practical independence, not intelligence, and is one of the most teachable areas in development. It is a starting point for support, never a diagnosis. Seek a developmental check if the gap is widening or travels alongside delays in speech, movement or social connection — because guided, playful practice now builds lifelong independence.
Read the answer AnswerWhat a cognitive developmental-age gap means
A cognitive developmental-age gap means your child is currently showing thinking, attention, memory and problem-solving skills closer to those of a slightly younger child. It is a present-moment snapshot, not a diagnosis or a ceiling. Children develop at very different paces, and a gap simply shows where focused, play-based support can help most — and early support works best. A clinician's structured look reveals both strengths and stretches.
Read the answer AnswerIf my child's developmental age is behind in Communication, what does that mean?
A developmental age 'behind' in Communication means your child is showing language and interaction skills closer to a younger child's in this one area — it is information, not a diagnosis. Communication covers both understanding (receptive) and expressing (expressive) needs through sounds, words, gestures and back-and-forth. A gap in one area doesn't predict gaps elsewhere, and communication responds beautifully to early, playful support. A calm developmental check is wise, especially if there are few words, no pointing, or any loss of a skill.
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