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Signs & concerns
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Signs & concerns
When should an ASHA or PHC worker escalate suspected SLD?
ASHA/PHC workers should escalate when a school-age child (about 6+) shows persistent, unexplained difficulty with reading, writing or maths despite adequate schooling and normal effort — after first ruling out vision, hearing and attendance issues. Refer to the Medical Officer or DEIC; SLD is not diagnosed before formal schooling, and never at community level.
Read the answer AnswerWhen to escalate Speech and Language Delay — ASHA & PHC guidance
Escalate any child who misses an age-appropriate language milestone, shows regression or suspected hearing loss, or whose parent raises a concern. Screen at every contact, refer on any concern, and pair every referral with a hearing check. Referral is for assessment, never diagnosis.
Read the answer AnswerEscalation guidance: Stereotyped Movement Disorder for ASHA & PHC workers
Most repetitive movements in young children are harmless and self-soothing. An ASHA or PHC worker should escalate when there is self-injury, interference with daily function, persistence past 3–4 years, co-occurring developmental delay or regression, or any sign suggesting seizures. When in doubt, refer — assessment reassures.
Read the answer AnswerWhen should an ASHA or PHC worker escalate suspected Tourette Syndrome?
ASHA/PHC workers should observe and document repeated involuntary movements or sounds lasting more than a few weeks, then escalate to the Medical Officer — urgently if there is altered awareness, whole-body jerking or sudden behaviour change. Frontline workers refer, never diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Visual Impairment?
Escalate same-day for any infant with a white or cloudy pupil, absent red reflex, watering or light-sensitive eyes, or enlarged hazy corneas. Refer promptly if a baby does not fix-and-follow by 3 months, has constant squint or roving eyes, or if an older child holds things close, tilts the head or bumps into objects. When in doubt, refer through the RBSK pathway — early eye care changes outcomes.
Read the answer AnswerWhen should I worry about avoiding messy play in my child?
Avoiding messy play is very common and usually a passing preference between 18 months and 6 years. Worry — and seek a gentle developmental check — only if the avoidance is strongly distressing, persistent, spreads into eating, dressing, bathing or hand-washing, or comes with other sensory, speech or social differences. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerWhen to Worry About Bedtime Resistance
Bedtime resistance — stalling, negotiating, calling out or refusing to settle — is very common and usually typical between 1 and 6 years. Seek a gentle developmental or paediatric check when resistance is severe and nightly for weeks despite a calm routine, leaves your child exhausted by day, comes with loud snoring or breathing pauses, or travels with delays in talking, play or social connection. This is a reason to assess, not a diagnosis — settled sleep supports all of development.
Read the answer AnswerWhen should I worry about bedwetting in my child?
Bedwetting is normal and common up to around age 5, and still common at 6 and 7 — most children grow out of it as their bladder and sleep mature. Speak with a doctor if your child is still wetting most nights past about 5–6, if dryness suddenly returns, or if there is daytime wetting, pain, excessive thirst, snoring or constipation alongside it. These point to simple, treatable causes — never punish or shame, as a child cannot control wetting in their sleep.
Read the answer AnswerWhen should I worry about biting in my child?
Biting between 12 and 42 months is usually a normal, passing phase driven by teething, frustration, excitement or sensory seeking, and it fades as language and self-regulation grow. Seek a gentle developmental check if biting is very frequent or intense, regularly breaks skin, is hard to redirect, continues well past age 3, or travels alongside delays in talking, connecting or playing. This is a reason to look early — not a diagnosis — because early support works best.
Read the answer AnswerWhen should I worry about breath-holding spells in my child?
Breath-holding spells in children aged about 6 months to 3 years are common and, though frightening to watch, are almost always harmless and self-limiting. They are triggered by crying, pain or fright, with the child going blue or pale and sometimes briefly losing consciousness. Worry — and seek prompt medical review — if spells start before 6 months, have no trigger, last over a minute, involve continued jerking, or come with poor recovery or general unwellness. This is a medical question first, so see your paediatrician before any therapy.
Read the answer AnswerWhen should I worry that my child cannot sit still?
From 2 to 7 years, high energy and fidgeting are usually normal — young children are made to move, and sitting still comes slowly with age. Seek a developmental check when restlessness is far greater than peers, happens in every setting, gets in the way of play, learning or friendships, or comes with delays in talking or listening. This is a reason to look calmly and early, not a diagnosis.
Read the answer AnswerWhen Should I Worry About Clinginess in My Child?
Clinginess is normal and healthy, especially between 8 months and 5 years when separation anxiety naturally peaks — it usually reflects secure attachment. Seek a gentle developmental check if it is extreme, doesn't ease over months, stops your child playing or settling at all, or comes with delays in talking, play or social connection. This is a reason to look early, never a diagnosis.
Read the answer AnswerWhen should I worry about clothing-tag sensitivity in my child?
For most children aged 2 to 7, disliking clothing tags and scratchy fabrics is a normal part of sensory development and usually eases over time. Seek a developmental check when the sensitivity is intense and daily, stops your child getting dressed, sleeping, eating or leaving the house, or travels with other sensory, communication or social differences. This is a reason to observe early, not a diagnosis, because gentle early support works best.
Read the answer AnswerWhen should I worry about co-sleeping dependence in my child?
Co-sleeping is a normal, healthy family choice and not a disorder, so there is no fixed worry age. Seek a developmental check not for the co-sleeping itself but when sleep loss is harming daytime mood, learning or growth, when separation distress is extreme across many settings, when a preschooler cannot self-settle in any situation despite gentle routines, or when sleep struggles travel with delays in talking, attention or self-help. These are reasons to review early — not a diagnosis.
Read the answer AnswerWhen should I worry about covering ears to sounds in my child?
Covering ears to loud or sudden sounds is very common and usually typical in children aged 1–6 years. Seek a calm developmental check if it happens with everyday sounds, causes big distress or meltdowns, narrows your child's play and outings, or travels with delays in talking, social connection or other sensory differences. A hearing check is wise if your child also seems not to hear you well. This is a reason to observe early, not a diagnosis — early support works best.
Read the answer AnswerWhen should I worry about daytime wetting in my child?
Occasional daytime wetting is common between 3 and 7 years and usually settles as bladder control matures. Seek a calm check when wetting is frequent, returns suddenly after months of being dry, or comes with pain, urgency, straining, a weak stream, excessive thirst, fever or tiredness. Constipation and bladder habits are the most common, very treatable causes — this is a reason to check, not to panic.
Read the answer AnswerWhen should I worry about defiance and saying no in my child?
Saying no, tantrums and testing limits are normal and healthy between 18 months and about 5 years — it is how a child learns independence. Seek a developmental check when defiance is intense and frequent for the age, lasts beyond about 6 months, happens across many settings, involves frequent aggression, or comes with delays in talking, play or social connection. This is a reason to look early, not a diagnosis — most strong-willed toddlers are simply doing their developmental job.
Read the answer AnswerWhen should I worry about difficulty sharing in my child?
Difficulty sharing is completely normal for children aged 2–5, who are only just learning that others have their own feelings and wants. Sharing develops gradually, usually settling between 3 and 5 years with gentle practice. A developmental check is wise only when trouble sharing comes with wider patterns — little interest in other children, very limited pretend play, frequent overwhelming meltdowns, or delays in talking and connecting. On its own, not sharing is a sign of a normal, growing child, not a worry.
Read the answer AnswerWhen should I worry about difficulty weaning off the bottle?
Most toddlers are ready to move from bottle to cup between 12 and 18 months, and mild resistance is normal. Speak with a clinician if your child is still mainly bottle-feeding past 2 years, takes the bottle to bed, refuses a cup entirely, or struggles to chew and move to solids — especially alongside limited words or very fussy eating. This is a reason to review feeding and routines early, not a diagnosis, because the habit is easiest to reshape gently when young.
Read the answer AnswerWhen to worry about haircut distress in your child
Distress at haircuts is very common and usually typical in children aged 1–6, easing with familiarity and preparation. Seek a developmental check when the distress is intense, lasts well beyond the haircut, forms part of a wider sensory pattern (nail-cutting, teeth-brushing, clothing, sounds, food textures), or travels with delays in talking, play or social connection. This is a reason to assess gently — not a diagnosis — because early sensory support works well.
Read the answer AnswerWhen should I worry about distress with nail cutting in my child?
Distress with nail-cutting is very common in children aged 1–6 and is usually about disliking the sensation or being held still, not a sign of a problem. Seek a developmental check if the distress is extreme and hard to soothe, spreads to many other touch or grooming experiences, or comes alongside differences in talking, play or social connection. This is a reason to observe calmly — not a diagnosis — because early sensory support works well.
Read the answer AnswerWhen should I worry about extreme shyness in my child?
Shyness is a normal temperament trait in children aged roughly 18 months to 7 years, and warming up slowly to new people or places is typical. Seek a developmental check when shyness is intense and persistent across many settings, causes real distress, includes consistent silence in certain places, or comes with delays in talking, connecting or play. These are reasons to assess early — not a diagnosis — because early support works best.
Read the answer AnswerWhen should I worry about food refusal in my child?
Fussy eating and food refusal are very common between 1 and 5 years and usually part of normal development as appetite slows and independence grows. Seek a check when the diet narrows to very few foods, weight gain falters or weight is lost, eating involves choking, gagging or pain, or refusal travels with delays in talking, play or chewing. These are reasons to assess early — not a diagnosis — because gentle, early support works best.
Read the answer AnswerFood Texture Aversion: When to Worry
Texture fussiness is very common between 1 and 6 years and usually eases with gentle, repeated, low-pressure exposure. Seek a feeding or developmental check when the aversion is severe and persistent, narrows the diet to very few foods, causes gagging or choking, affects weight or growth, or comes with delays in speech, social connection or sensory regulation. These are reasons to assess early — not a diagnosis — because early support works best.
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