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Signs & concerns
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Signs & concerns
When to escalate if a child cannot follow multi-step tasks
Following multi-step instructions develops gradually — two-step tasks around 2–3 years, three-step closer to 3–4 years. A frontline health worker should escalate for a developmental check when a child consistently cannot follow age-appropriate instructions despite clear prompts and good hearing, when delays in talking or understanding travel alongside, or when families are worried. Rule out hearing first. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate slow naming speed in a child
Naming speed becomes clinically meaningful from around age 4. A frontline health worker should escalate for a developmental check when slow or effortful naming persists past 5–6 years, travels with other language or pre-reading delays, or when parents and teachers report struggle beyond peers. This is a reason to assess early, not a diagnosis — early language support works best.
Read the answer AnswerWhen should a frontline worker escalate a non-verbal child?
Escalate a non-verbal child for a developmental check now — not at the next routine visit — if there is no babbling by 12 months, no single words by 16–18 months, or no two-word phrases by 24 months. Escalate the same day for loss of words once gained, no response to name, no pointing or gestures, or staring episodes. Always arrange a hearing check first. This is a referral, not a diagnosis — early support works best.
Read the answer AnswerNonverbal communication delay: when to escalate
Frontline health workers should escalate when expected nonverbal milestones are clearly missing — no shared eye contact or name response by 9 months, no pointing, waving or gaze-following by 12 months, very few gestures by 18 months — or when any skill is lost (regression) or a parent reports concern. This is screening, not diagnosis; prompt referral to the Medical Officer or a developmental check gives the child the best start.
Read the answer AnswerObject permanence delay: when a frontline worker should escalate
Object permanence — knowing a hidden object still exists — emerges around 8–12 months and is established by 18 months. A frontline health worker should escalate when a child shows no searching for hidden objects past 12 months, when the gap persists to 18 months, or when it travels with delays in eye contact, babbling, response to name or grasping. This is a routing decision, not a diagnosis, and early support works best.
Read the answer AnswerOral sensory processing: when a frontline worker should escalate
Frontline workers should escalate a child's oral sensory difficulties to a developmental check when there is persistent refusal of most food textures, gagging or distress with feeding, excessive or absent mouthing well beyond the expected age, or when feeding difficulty travels with poor weight gain, swallow-safety signs or speech delay. Choking, coughing during feeds or faltering growth need same-week referral. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child's organisation-skill concern
A frontline health worker should escalate a child's organisation-skill concern when there is a clear, persistent gap from same-age peers seen across visits — not a single missed milestone. Escalate promptly when the gap travels with delays in language, attention or motor skills, when a skill is lost, or when a parent is worried. This is a routing decision for screening, never a diagnosis; early referral lets a clinician confirm or reassure.
Read the answer AnswerWhen a frontline worker should escalate a missed milestone
A frontline health worker should escalate when a child clearly misses a milestone for the expected age, loses a previously gained skill, shows delays across two or more developmental areas, or when the family voices concern. Escalation means structured screening and referral to the PHC medical officer or a developmental clinic — never a diagnosis. Early identification gives the best outcomes, so persistent or multi-area delays should be referred promptly rather than watched indefinitely.
Read the answer AnswerWhen to escalate concerns about patience and turn-taking
Patience and turn-taking develop gradually, with simple turn-taking by around age 3 and self-control maturing into the school years. A frontline health worker should escalate to a developmental check when the difficulty is clearly behind same-age peers, is not improving over a few months, disrupts play and daily life, or comes alongside delays in language, social connection or play. Escalation means a structured developmental review — not a diagnosis.
Read the answer AnswerWhen to escalate concerns about perspective taking
Perspective taking develops gradually — shared attention by 12–18 months, pretend play and feelings by 2–3 years, and grasping others' differing thoughts by 4–5 years. A frontline health worker should escalate not on this skill alone, but when difficulty travels with broader social-communication concerns — no pointing or shared attention, no pretend play, little eye contact, delayed speech, or any loss of a skill — or when a parent is worried. Escalation means a developmental check, never a diagnosis.
Read the answer AnswerWhen to escalate a child who can't join physical play
A frontline worker should escalate when a child's physical play lags clearly against the local milestone card, when the gap is not closing over a few weeks, when a skill is lost, or when motor delay travels with floppiness, stiffness, asymmetry or social-communication concerns. Under RBSK, suspected developmental delay is reason enough to refer. Escalation means a developmental check, not a diagnosis — early review is low-risk and high-value.
Read the answer AnswerWhen to escalate a child who cannot describe a picture
Picture description — telling what is happening in a picture — usually emerges around 3 to 4 years. A frontline health worker should escalate when a child well past this age cannot name objects in a picture, cannot join two words about a scene, or shows this with broader delays in talking, understanding or play. Always check hearing first. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child who cannot play at the expected age
Escalate when a child consistently does not play in age-typical ways and this does not shift with encouragement, or when the play difference comes with delays in talking, moving, listening or connecting with others. Refer if two or more milestones are missed, if a parent voices concern, or if any skill is lost. This is not a diagnosis — it is an early, valuable door to support that works best when opened early.
Read the answer AnswerWhen to escalate a delayed practical skill
A frontline worker should escalate when a missed practical skill is persistent across visits, affects two or more developmental domains, is widening, or involves loss of a previously held skill. A single mild lag with steady progress can be monitored and reviewed in 4–6 weeks. Medical red flags — fits, floppy or stiff limbs, regression — need same-day medical referral. This is screening guidance, not a diagnosis.
Read the answer AnswerWhen to escalate a pretend play delay
Pretend play usually emerges around 18 months and blooms by 2–3 years. A frontline worker should escalate when a child shows no simple pretend by ~24 months, little or no imaginative play by ~30–36 months, or when absent pretend play travels with delays in language, social connection or response to name. This is a reason to refer for a developmental check, not a diagnosis — and parent worry alone justifies referral.
Read the answer AnswerWhen to escalate a problem-solving concern
A frontline health worker should escalate a child's problem-solving concern when a clearly age-expected skill is absent, when problem solving lags alongside language, social or motor domains, when a previously held skill is lost, or whenever a caregiver is worried. These are reasons to refer for a developmental check — not a diagnosis. At every age, early review is safer than watch-and-wait, because timely support works best.
Read the answer AnswerWhen should a frontline worker escalate proprioceptive processing concerns?
Proprioceptive processing lets a child sense body position, movement and force. A frontline worker should escalate when a child is consistently clumsy, floppy or stiff, uses too much or too little force, strongly seeks or avoids rough movement, or when these signs come with delays in walking, talking or self-care. Sudden loss of a movement skill or new one-sided weakness needs same-day medical referral. This guides early review, not diagnosis.
Read the answer AnswerWhen to escalate quantitative reasoning concerns
Quantitative reasoning develops gradually, so one missed milestone rarely means trouble. A frontline worker should escalate when a child around 5–6 years cannot reliably count, compare more and less, or recognise small quantities despite everyday practice, when there is no progress over a few months, or when number difficulty travels with delays in language, attention or play. Escalation routes the child to a developmental check — it is not a diagnosis, and early support works best.
Read the answer AnswerWhen to escalate if a child cannot compare quantities
Comparing quantities — knowing "more" from "less" — usually emerges between about 2 and 4 years. A frontline worker should escalate for a developmental check when a child is clearly behind same-age peers, shows no progress over three to six months despite everyday exposure, or when the difficulty travels with delays in talking, following instructions, play or attention. First rule out hearing and vision; then route on. This is a reason to assess, not a diagnosis.
Read the answer AnswerWhen to escalate a child who cannot relate to people
If a child is not relating to people as expected — little eye contact, no response to name, no shared smiles, no pointing — a frontline worker should refer for a developmental check without waiting. Escalate when one or more age-matched flags appear, when a skill is lost, or simply when a parent is worried. The worker screens and routes; diagnosis happens only at a clinical centre. Early referral matters because early support works best.
Read the answer AnswerWhen to escalate concerns about relationship skills
Relationship skills — shared attention, turn-taking, responding warmly to people — grow gradually across early childhood. A frontline health worker should escalate for a developmental check when a child shows little interest in people, no shared smiling or eye contact, no response to their name, no pointing or showing, or no shared or pretend play by the expected age, especially alongside language delays. Any loss of social skills needs prompt review. This is not a diagnosis — it means early assessment is wise, because early support works best.
Read the answer AnswerRepetitive behaviour: when a frontline worker should escalate
For a frontline health worker, repetitive movements like rocking or flapping are usually typical in toddlers and fade with growing play and language. Escalate to a developmental check when movements cause self-injury, are very hard to interrupt, crowd out play or learning, appear suddenly, or come with delays in talking, social connection or motor skills. A stare-and-stiffen episode needs prompt medical referral. This is a referral decision, never a diagnosis — early review opens early support.
Read the answer AnswerResponse to name: when should a frontline health worker escalate?
Most babies respond to their name by 9 months, reliably by 12 months. A frontline health worker should escalate when a child consistently does not respond to name by 12 months, has lost a skill once present, or shows other communication and social differences. Always rule out hearing first. This is a prompt for an early developmental check, not a diagnosis — early support works best.
Read the answer AnswerWhen to escalate concerns about responsible decision making
Responsible decision making develops gradually across childhood, so a frontline health worker should judge a child against same-age peers. Escalate to a developmental check when decisions are persistently behind age level, create safety risks, or travel with delays in language, learning, attention or social understanding — or if a child has clearly lost a skill once held. Any safety risk means refer now, not at the next visit. This is screening, not diagnosis: early referral opens the door to the right support.
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