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Signs & concerns
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Signs & concerns
Observing imagination during a home visit
On a home visit, observe how a child uses objects and ideas in pretend play — making one object stand for another, 'feeding' a doll, acting out everyday scenes, inventing simple stories, and taking on roles. Imagination (ICF d7) develops gradually, so you watch the richness and pattern of play, not test or diagnose. Gently flag for a developmental check any child whose play stays very limited, fixed or absent over several months, especially alongside delays in talking or playing with peers.
Read the answer AnswerObserving a child learning to imitate imaginative play
During a home visit, a frontline worker should observe how a child of roughly 18 months to 3 years watches, imitates and joins in pretend play — copying a modelled action like feeding a doll, using one object to stand for another, and glancing to share the fun. This is to be observed and noted, not diagnosed at home. A pattern of absent imitation and make-believe beyond about 2.5–3 years, especially with other communication gaps, warrants a gentle, prompt developmental screen.
Read the answer AnswerWhat to observe about imaginative play on a home visit
On a home visit, observe whether the child uses objects to stand in for others (a block as a phone), pretends everyday actions (feeding a doll), takes on simple roles, and shares the play through looks, gestures and words. Pretend play usually emerges between 18 months and 3 years. Note — but do not diagnose — when imaginative play is largely absent past 2.5–3 years, stays repetitive, or is rarely shared, especially alongside limited speech or social connection, and suggest a friendly developmental check.
Read the answer AnswerWhat to observe about imitation during a home visit
At a home visit, a frontline worker should observe whether a child copies simple actions (clapping, waving, banging), sounds and words, and shows interest in copying games. Imitation typically grows from copying actions around 9–12 months to copying words and pretend play around 18–24 months. Gently note any child who rarely imitates by 18 months for a developmental check — this is observation, not diagnosis.
Read the answer AnswerObserving Imitation Skills During a Home Visit
On a home visit, a frontline worker should observe whether the child watches faces and actions and then tries to copy them — waving, clapping, banging a spoon, blowing a kiss, copying chores in play, and echoing sounds and simple words. Imitation grows through everyday play, so look for emerging attempts by the expected windows (e.g. waving and clapping around 9–12 months, pretend-play copying towards 18–24 months). These are observations to note and monitor, not to diagnose, and any persistent pattern should be routed to a developmental check.
Read the answer AnswerObserving imitative behaviour during a home visit
On a home visit, a frontline worker should observe how naturally a child copies facial expressions, gestures (waving, clapping), sounds and everyday actions during ordinary play. Imitation is a key sign of social and learning readiness. Watch for very little spontaneous imitation, no copying by the second year, or skills that seem to have been lost. This is observation to flag for a developmental check — never a home diagnosis.
Read the answer AnswerWhat to Observe About Impulsivity on a Home Visit
On a home visit, a frontline worker should observe how a child manages waiting, turn-taking and stopping an action — judged against the child's age, since impulsivity is normal and expected in young children. Watch patterns over many months, not single moments, and note when difficulty is far greater than same-age peers or affects safety. Never label at home; warmly route worried caregivers to a general developmental check.
Read the answer AnswerWhat a frontline worker should observe about a child learning inhibition
On a home visit, observe whether a child can pause before acting, wait a short turn, stop when asked, and settle with adult help — all part of developing inhibition. Bursts of impulsiveness are normal in young children, so watch and note rather than label. Refer for a friendly developmental check if impulsiveness is much stronger than peers, not easing over several months, or linked to safety risks.
Read the answer AnswerWhat to observe about inquiry skills on a home visit
On a home visit, observe a child's inquiry skills (ICF d1) — how they explore and seek to understand their world. In infants this is curiosity in the body: looking towards new things, following a point, reaching and exploring objects, showing things to share, and repeating actions to see what happens. In older children it becomes curiosity in words: asking "what", "why" and "how", experimenting in play, and seeking answers. Note these as everyday strengths to encourage, not to diagnose. A persisting pattern of very little curiosity, or no pointing or sharing by around 18 months, is worth routing for a general developmental check.
Read the answer AnswerWhat a frontline worker should observe about joint attention
On a home visit, observe how the child shares attention with a caregiver: following a point or gaze, looking back to share enjoyment, and showing or pointing to bring others into what interests them. By around 9–14 months these emerge naturally. These are moments to observe and note, not diagnose at home; if sharing is consistently limited across several visits, route the family for a developmental check, starting with a hearing screen.
Read the answer AnswerJump Rope Coordination on a Home Visit
During a home visit, a frontline worker should observe how a child coordinates jumping, timing and turning the rope together — a skill that typically emerges around 6–7 years and develops gradually. Watch steady two-footed jumps, wrist-turning of the rope, rhythm and balance, and whether difficulty spans several motor skills. This is observation and monitoring, not diagnosis. Route persistent or widening motor gaps to a developmental check, where early playful support helps.
Read the answer AnswerWhat to observe about a child learning to jump
During a home visit, a frontline worker should observe a child's gross-motor readiness for jumping: knee bending and bouncing, stepping and jumping down from a low step, and (around 2–2.5 years) getting both feet off the ground together, landing steadily and using both legs evenly. These are skills to observe and encourage, not diagnose. Refer to a general developmental check if a child past 3 years cannot get both feet off the ground, shows unusual tone, has lost a skill, or if a parent is worried.
Read the answer AnswerObserving Language Development on a Home Visit
During a home visit, a frontline worker should observe how a child understands and uses communication for their age — responding to sounds and their name, babbling or words, pointing and gestures, eye contact, and back-and-forth play in any home language. These are signs to note and discuss, not to diagnose. Refer for a developmental and hearing check when a skill is clearly behind age expectations, has plateaued, or has regressed, since early support works best.
Read the answer AnswerLanguage processing on a home visit: what to observe
During a home visit, a frontline worker should observe how a child receives and understands spoken language — turning to their name, following simple requests, looking towards named objects, and responding to familiar voices and routines. These are observations to note and monitor, not to diagnose at home. A hearing check comes first, since undetected hearing concerns are common. When understanding seems consistently behind a child's age across visits, the family should be guided to a developmental and hearing check.
Read the answer AnswerObserving Long-Term Memory at a Home Visit
At a home visit, a frontline worker should observe whether a child recalls and uses earlier learning — recognising familiar faces and places, finding hidden objects, following known routines, and remembering songs or instructions after a gap. These are signs to observe and note, not to diagnose at home. If recall is consistently weak across several months and settings, gently route the family to a developmental check through the PHC pathway.
Read the answer AnswerObserving manual dexterity during a home visit
On a home visit, a frontline worker should watch how the child reaches, grasps, transfers, holds and releases objects during natural play, and compare this to age expectations. Note hands kept fisted past 3–4 months, a strong hand preference before 18 months, or stiff/floppy hands. These are observations to note and follow up, not to diagnose at home — refer worrying or persistent patterns to a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child's memory retention?
On a home visit, observe how a child holds and recalls information: finding a hidden toy, following one- then two-step instructions, repeating short sequences, naming familiar people, and remembering routines, rhymes or small events. These are everyday signs of memory retention to note and monitor, not to diagnose. Concern grows when a child is clearly behind same-age peers, daily routines are affected, or recall does not improve with simple repetition over weeks — a gentle prompt to suggest a developmental check.
Read the answer AnswerObserving Multi-Step Task Skills During a Home Visit
During a home visit, observe whether a child can follow and complete tasks with two or more linked steps — remembering the sequence, staying on task, and recovering from mistakes — judged against their age. Note how much repetition or demonstration they need. These are observations to monitor and refer, not to diagnose. Refer for a developmental check (with a hearing check) if the child is clearly behind for age, the pattern persists across visits, or a parent is worried.
Read the answer AnswerObserving naming speed during a home visit
On a home visit, observe how quickly and smoothly a child names familiar things they clearly know — objects, people, colours — not whether they are perfect. Slow, hesitant or effortful naming with long pauses or repeated 'that thing' can be an early clue worth noting, after checking home language, shyness, tiredness, hearing and vision. This is to observe and note, never to diagnose at home; route persistent patterns to a general developmental and speech check.
Read the answer AnswerObserving a non-verbal child on a home visit
On a home visit, a frontline worker should observe how a non-verbal child communicates without speech — eye contact, response to name, gestures, pointing, sounds, imitation and play — and how the family responds. The goal is to observe and note, not diagnose, and to route any concern (including a hearing check) for a proper developmental assessment. Early, strengths-first support never waits for a label.
Read the answer AnswerObserving Nonverbal Communication on a Home Visit
On a home visit, observe how a child communicates without words: eye contact, social smiling, turning to their name, following a point, reaching and gesturing to request, pointing to share interest by ~12–18 months, and using facial expressions. These nonverbal skills (ICF d3) appear before speech and signal healthy social communication. Note patterns over time — limited eye contact, no name response, or no pointing by 18 months — and route the family to the PHC medical officer for a developmental check. This is observing and monitoring, never diagnosing at home.
Read the answer AnswerObserving Object Permanence on a Home Visit
During a home visit, a frontline worker should observe whether the child follows a dropped or moving toy with their eyes, looks toward where an object disappeared, lifts a cloth to find a hidden toy by around 8–10 months, and enjoys peek-a-boo. Object permanence usually emerges between 6 and 12 months. These are signs to observe and note, not diagnose — refer onward for a developmental check if searching and playful interaction seem consistently absent or a parent is worried.
Read the answer AnswerObserving oral sensory processing on a home visit
On a home visit, a frontline worker should observe a child's mouth-based experiences — feeding, accepting textures, mouthing objects, and tolerating tooth-brushing — and note any persistent, distressing patterns. Watch for ongoing texture refusal, gagging at food, a very narrow diet, constant mouthing beyond toddlerhood, or distress with oral care. These are signs to observe and route for a developmental check, not to diagnose. The worker's role is to notice, reassure and refer early.
Read the answer AnswerObserving organization skills during a home visit
On a home visit, a frontline worker should observe how a child manages everyday tasks for their age — gathering items to start an activity, following simple 2–3 step routines, keeping toys roughly in order, tidying with prompts, and coping with transitions. Organization develops gradually, so the worker observes and notes patterns across visits rather than scoring or diagnosing. Where a child is well behind same-age peers across several routines, gently route the family to a general developmental check.
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