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Asha Phc
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Signs & concerns
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Signs & concerns
When should an ASHA or PHC worker escalate a child showing signs of dyscalculia?
Escalate when a child aged 7 or older shows persistent maths difficulty across two school terms that is out of step with other skills and not explained by missed schooling, language or sensory issues. Below that age, observe and support. Rule out hearing, vision and attendance first, then route to the PHC medical officer or RBSK pathway. Only a clinician can confirm dyscalculia.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Dysgraphia?
Escalate a school-age child (7+ years) showing persistent, clustered written-expression difficulty despite adequate teaching, normal vision and no obvious intellectual delay. Below 6–7, reassure and monitor. Route urgent signs — seizures, skill loss, motor weakness — for prompt medical review. ASHA/PHC workers recognise and refer; they do not diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with signs of dyslexia?
Escalate a school-age child (roughly 6–8 years or older) with persistent reading difficulty that does not match their ability, once hearing and vision are ruled out, and especially if it persists beyond one school term or causes distress. Below 6, monitor rather than label. Diagnosis is made only by a clinician.
Read the answer AnswerEscalating Emotional & Behavioural Difficulties from ASHA/PHC
Escalate when an emotional or behavioural difficulty is persistent (beyond 4–6 weeks), severe, or disrupting daily life — and immediately for self-harm, harm to others, or sudden regression. ASHA/PHC workers recognise the pattern and route; clinicians diagnose.
Read the answer AnswerWhen to Escalate Feeding & Eating Difficulties
Escalate promptly when feeding difficulty threatens safety, hydration or growth: choking or gurgly breathing during feeds, signs of dehydration, faltering growth, or any infant under 6 months feeding poorly need same-day medical referral. Persistent but stable difficulties warrant routine developmental assessment. When in doubt, refer — feeding is a safety domain.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of FASD?
An ASHA or PHC worker should escalate when a child shows growth faltering plus developmental or behavioural concerns — especially with suspected prenatal alcohol exposure. The worker recognises the pattern and refers to the Medical Officer or DEIC; FASD is confirmed only by a clinician, never in the field.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Fine Motor Delay?
Escalate when a fine motor delay is persistent across visits, when a milestone is clearly missed for age, or when red flags appear — regression, asymmetry, stiffness/floppiness, or delay alongside other developmental concerns. A single off-day observation is not enough; a documented pattern or any red flag warrants prompt referral. Workers screen and route — clinicians diagnose.
Read the answer AnswerEscalating 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.
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