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Signs & concerns
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Signs & concerns
Escalating Suspected Genetic / Chromosomal Syndromes: A Guide for ASHA & PHC Workers
Escalate to the PHC Medical Officer or RBSK/DEIC when a child shows a cluster of features — distinctive facial features with poor feeding or low tone, multiple congenital anomalies, failure to thrive, or developmental delay — rather than a single sign. The worker recognises and refers; clinicians diagnose. Refer urgently for feeding failure, lethargy, breathing difficulty or seizures.
Read the answer AnswerWhen to Escalate Global Developmental Delay — ASHA/PHC Guide
Escalate any child under five with delay across two or more developmental domains, or any loss of acquired skills or medical red flags, to the PHC Medical Officer and DEIC under RBSK. The community worker's role is to flag and route early, not to diagnose — early referral changes the trajectory.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Gross Motor Delay?
Escalate a child with gross motor delay when a milestone window is clearly missed (e.g. not sitting by 9 months, not walking by 18 months), when any skill is lost, or when red flags like marked stiffness, floppiness or asymmetry appear. Isolated late milestones warrant a recheck; delay plus red flags warrants prompt referral. ASHA and PHC workers screen and refer — diagnosis happens only at a centre.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Hearing Impairment?
Escalate any child with a missed or failed newborn hearing screen, any unmet hearing milestone, recurrent ear discharge, or a high-risk birth history. Suspected hearing loss is a prompt medical referral to audiology/ENT — never watch-and-wait. The 1-3-6 standard means early action protects speech and language.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with hypotonia?
Hypotonia is a sign, not a diagnosis, and should never be watched-and-waited. Escalate urgently the same day for poor feeding, weak cry, breathing difficulty, choking, seizures or sudden loss of tone; refer stable but persistently floppy children to the Medical Officer within days. The ASHA/PHC role is reliable recognition and prompt routing.
Read the answer AnswerWhen Should an ASHA or PHC Worker Escalate a Child Showing Signs of Intellectual Disability?
Escalate when a child shows persistent, cross-domain developmental delay, when a caregiver is worried, or — urgently — when previously gained skills are lost. A single late milestone in an otherwise responsive child usually needs only monitoring. ASHA and PHC workers recognise and refer; diagnosis happens only with a clinician.
Read the answer AnswerWhen to Escalate Motor Planning Difficulties — ASHA & PHC Guide
Escalate when motor planning difficulty is persistent, affects daily function, or comes with a red flag — regression, asymmetry, floppiness, stiffness or seizures need prompt medical review first. A single clumsy phase often passes; a pattern is the trigger. ASHA and PHC workers screen and route — only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a non-verbal or minimally verbal child?
Escalate a non-verbal or minimally verbal child when the pattern persists for age — no babble/gesture by 12 months, no words by 18 months, no two-word phrases by 24 months, or unclear speech by 3 years — and immediately for any loss of words or no response to sound. Refer for hearing testing first. ASHA/PHC workers screen and route; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of ODD?
Escalate when a child's defiant, hostile behaviour is frequent, lasts six months or more, is severe for the child's age, and harms family, school or friendships — and urgently if there is aggression, self-harm or suspected abuse. Ordinary tantrums do not need escalation. Only a clinician can confirm ODD.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Persistent Toe-Walking?
Escalate when toe-walking persists past age 2, when the heel cannot reach the floor, when only one leg is affected, or when it appears with stiffness, regression or other developmental concerns. The ASHA/PHC role is to screen, document and route — not to diagnose. When in doubt, refer for a developmental check.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with Prematurity-Related Developmental Risk?
Escalate any preterm or low-birth-weight child when a milestone is missed (using corrected age), when a parent voices concern, or when a danger sign appears. Treat breathing, feeding, seizure and tone flags as same-day medical referrals; route all other developmental concerns for assessment rather than waiting. Only a clinician confirms anything.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Rett Syndrome?
Escalate promptly when a girl aged 6–18 months loses previously acquired skills — hand use, babble, social interest — especially with repetitive hand-wringing and slowing head growth. This is a medical and genetic referral via RBSK/DEIC, not a watch-and-wait. Diagnosis is only ever confirmed by a clinician.
Read the answer AnswerWhen to Escalate a School Readiness Gap
Escalate a 4–6 year old when a persistent pattern spans two or more readiness domains — speech, following instructions, pre-number concepts, group attention or self-care — over several weeks. A single lagging area in a thriving child can be watched; loss of skills or no clear speech by age 4 needs prompt referral. Diagnosis is never made at village level.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Selective Mutism?
Escalate when a child who speaks freely at home stays consistently silent in a specific setting (school, anganwadi) for more than one month and it disrupts learning or friendships. Refer for medical review first if the child speaks nowhere, or if hearing is a concern. Only a clinician can confirm selective mutism.
Read the answer AnswerWhen to escalate a child with self-regulation difficulties
Escalate when regulation difficulties are persistent, pervasive across settings, and out of step with age — not a single hard day. Route feeding or sleep problems affecting growth, and any possible seizure or loss of skills, to a doctor promptly. Your screening flags concern; only a clinician confirms cause.
Read the answer AnswerWhen to Escalate Sensory-Based Feeding Selectivity
Escalate when feeding selectivity is persistent, narrowing the diet, or affecting growth — and treat dehydration, choking, or breathing difficulty during feeds as same-day medical emergencies. Brief fussy phases with normal growth can be reassured and monitored. Diagnosis is made only by a clinician.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Sensory Processing Differences?
Most sensory quirks settle and need only watchful observation. An ASHA or PHC worker should escalate when sensory responses are persistent, intense and disrupt feeding, sleep, play or learning — or co-occur with speech, social or motor delays. Refer same-day for any seizure-like or medical signs.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Separation Anxiety Disorder?
Escalate when separation distress is excessive for the child's age, lasts four weeks or more, and disrupts school, sleep or eating. Escalate urgently for panic with breathing difficulty, self-harm talk, or refusal of food. The ASHA/PHC role is to notice, reassure and route on time — diagnosis happens only at a Pinnacle centre.
Read the answer AnswerWhen should an ASHA or PHC worker escalate social communication difficulties?
ASHA and PHC workers should escalate when social-communication concerns persist beyond one contact, when red flags appear at any age, or whenever a parent raises worry. Any loss of previously acquired language or social skills warrants same-day referral. Workers screen and route — diagnosis happens only under a clinician.
Read the answer AnswerWhen 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.
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