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Asha Phc
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Signs & concerns
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Signs & concerns
When should a frontline health worker refer Sensory-Based Feeding Selectivity?
Refer when feeding selectivity is persistent or narrowing, affects growth, causes mealtime distress, or limits function beyond a normal fussy phase. Any swallowing difficulty or dehydration needs same-day medical review. Frontline workers notice and route; diagnosis happens only at a Pinnacle centre.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Sensory Processing Differences?
Refer a child with possible sensory processing differences when responses are persistent, intense and interfere with feeding, sleep, learning or family life across settings for weeks — not for occasional fussiness. Pair sensory concerns with a general developmental check. Diagnosis is made only by a qualified clinician.
Read the answer AnswerWhen to refer possible Separation Anxiety Disorder
Refer when separation distress is persistent (around 4 weeks or more), out of step with the child's age, and causing real impairment — school refusal, sleep problems, or unexplained physical complaints. Brief clinginess settles; an escalating, impairing pattern needs a specialist. Only a clinician can diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Social Communication Difficulties?
Refer when a communication concern is persistent, affects everyday social interaction, or keeps being raised by parents or teachers. You needn't confirm anything — notice the pattern, check hearing, and route it. When in doubt, refer; only a clinician diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Specific Learning Disability?
Refer once academic difficulty is persistent (6+ months despite help), well below age expectation, and not explained by schooling, hearing, vision or another condition — typically from age 6–7 when formal learning has begun. Rule out simple causes first; only a clinician confirms it.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Speech and Language Delay?
Refer when language milestones are clearly behind for age, when a parent is worried, or at any red flag — especially loss of words already learned. Always check hearing first. When in doubt, refer: early assessment is low-risk and high-benefit. Only a clinician confirms a diagnosis.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Stereotyped Movement Disorder?
Refer a child with possible Stereotyped Movement Disorder when movements cause self-injury, persist past the toddler years, interfere with daily life, or come with developmental concerns. Refer the same day for medical red flags like sudden onset or loss of awareness. Diagnosis is made only by a clinician.
Read the answer AnswerWhen to Refer a Child with Possible Tourette Syndrome
Refer a child with tics that have lasted several weeks or more — especially both movement and sound tics — or that disrupt school, sleep or wellbeing, or distress the family. Frontline workers screen and route; only a specialist diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible visual impairment?
Refer promptly, never wait and watch. Any white pupil, persistent squint past 3 months, no following of a face/light by 3 months, wobbling eyes, or any preterm baby needs urgent specialist eye referral. Frontline screening flags the concern; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of ADHD?
Escalate a school-age child (around 6+) when inattention, hyperactivity or impulsivity persists for 6+ months across two settings (home and school) and disrupts learning or relationships — confirmed by parent and teacher. Refer promptly if red flags suggest another cause. The worker notices and routes; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Attachment Difficulties?
Escalate when a child shows a persistent pattern — not a single episode — of not seeking comfort, emotional withdrawal, or indiscriminate friendliness, especially with neglect, caregiver instability or growth faltering. Escalate urgently if abuse or failure to thrive is suspected. Observe, document, reassure, route — never label.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Auditory Processing Difficulties?
Escalate when a child hears sound but consistently struggles to understand speech — especially in noise or with multi-step directions — and it persists. Always rule out hearing loss first with an audiology referral. Refer urgent flags (no response to sound, lost skills, ear discharge) promptly; route routine concerns for assessment. The community worker notices and routes; only a clinician confirms.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Autism Spectrum?
Escalate whenever a child fails a routine developmental check, a parent raises a real concern, or any red flag persists — and treat loss of previously acquired skills as urgent. A community health worker catches and routes; only a clinician diagnoses. When in doubt, refer for a developmental check.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of cerebral palsy?
Escalate promptly — do not wait-and-watch — when an infant shows persistent stiff or floppy tone, early hand preference before 12 months, a missed motor milestone, or feeding difficulty, especially with a high-risk birth history. Cerebral palsy is a medical referral; any seizure is an emergency. Early referral is always the safer call.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of childhood anxiety?
Worry is normal in childhood; a persistent pattern that disrupts daily life is the flag. ASHA and PHC workers should route — not diagnose — referring children with weeks-long fearfulness, school refusal or unexplained physical complaints, and escalating same-day for self-harm talk, severe panic or refusal to eat.
Read the answer AnswerWhen to escalate a child with signs of Childhood Apraxia of Speech
Escalate when a child shows persistent, effortful speech difficulty that doesn't match their understanding — groping mouth movements, inconsistent errors, very limited intelligible speech past age, or no steady progress. The worker's job is to recognise and route; only a clinician confirms CAS.
Read the answer AnswerWhen should an ASHA or PHC worker escalate childhood epilepsy?
Childhood epilepsy is referred to a doctor first, not therapy first. Escalate immediately by calling 108 for a seizure over 5 minutes, repeated seizures, breathing trouble, or a first-ever seizure with red flags. Arrange prompt 24–48 hour medical referral for any first seizure or changing seizure pattern. The community worker's role is recognition, first-aid safety and fast escalation.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with sleep difficulties?
Occasional broken sleep is normal and settles with simple routine support. Escalate to the Medical Officer or paediatrician when sleep difficulty is persistent for weeks, involves snoring or breathing pauses, affects daytime development and growth, or comes with seizure-like night events or a developmental concern. The ASHA/PHC role is to spot, support and route — never diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Conduct-Dissocial Disorder?
Escalate when a child of school age shows a persistent pattern (6 months or more) of harmful, rights-violating or seriously norm-breaking behaviour across settings — not a one-off tantrum. Escalate the same day for any safety risk. Frontline workers document and route; only a Pinnacle clinician diagnoses.
Read the answer AnswerWhen to Escalate a Child Showing Signs of DCD
Escalate when motor clumsiness is persistent past age 5, interferes with daily life, is out of step with other development, and has no obvious cause — routing through the Medical Officer. Loss of skills or neurological signs need urgent medical referral. The worker flags; only a clinician diagnoses.
Read the answer AnswerEscalating signs of Developmental Language Disorder: a guide for ASHA and PHC workers
Escalate when a child shows a persistent, age-inappropriate language difficulty — no words by 18 months, no two-word phrases by 2.5–3 years, not understood by age 3, or jumbled speech past age 4 — and especially on any loss of skills. Rule out hearing first and route to a clinician; only a qualified clinician can confirm DLD.
Read the answer AnswerWhen should an ASHA or PHC worker escalate developmental regression?
Developmental regression — the loss of skills a child once had — always warrants prompt escalation, never watch-and-wait. ASHA/PHC workers should refer to the Medical Officer the same week, and the same day if seizures, fever or acute signs appear. Diagnosis is never made in the field.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of developmental trauma?
Escalate when stress-related behavioural, emotional or developmental signs persist beyond 2–4 weeks, occur alongside known adversity, or carry any safety risk. ASHA/PHC workers notice, document, support and route to the Medical Officer and child-protection services — never diagnose. When in doubt, refer.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of Down syndrome?
Down syndrome is recognisable at or near birth, so an ASHA or PHC worker should escalate promptly — refer to the Medical Officer the same day when a cluster of newborn signs is seen, and urgently if there are breathing, feeding or heart-related red flags. Diagnosis is by paediatric karyotype, never a checklist.
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