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Asha Phc
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Signs & concerns
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Signs & concerns
When to escalate delayed inquiry skills
Inquiry skills — pointing, asking questions and seeking information — usually grow from 18 months through the fourth year. A frontline health worker should escalate to a developmental check when a child shows little curiosity, no pointing by 18 months, very few or no questions by 2.5–3 years, or when limited inquiry travels with delays in talking, social connection or play. A hearing check comes first, then a developmental assessment. This is early referral, not a diagnosis.
Read the answer AnswerWhen to escalate if a child can't recall instructions
A child who cannot follow age-appropriate instructions warrants escalation when the gap is clear, persists over several weeks, or comes with other concerns such as not responding to their name, few words, or hearing worries. A frontline worker should always rule out hearing loss and distraction first, then refer to the PHC medical officer for a developmental and hearing check. This is reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate internalising behaviours in children
Internalising behaviours — sadness, fear, worry, withdrawal — are emotional signals to watch, not a skill a child must develop. A frontline health worker should escalate to the PHC medical officer or a developmental centre when low mood, marked anxiety, social withdrawal or unexplained physical complaints last more than 2–3 weeks, worsen, or disrupt eating, sleep, play or school. Any mention of self-harm needs immediate escalation. This is screening, not diagnosis.
Read the answer AnswerWhen to escalate if a child cannot control interrupting
Interruption control develops slowly across ages 2–6, so frequent interrupting is usually normal toddler impulsivity. A frontline health worker should escalate to a developmental check when poor turn-taking is persistent across home and anganwadi, clearly behind same-age peers, and travels with other concerns such as delayed speech, not responding to name, restlessness disrupting routines, or any loss of skills. This signals a reason to assess early — not a diagnosis.
Read the answer AnswerWhen to escalate if a child cannot joint attention
Joint attention — sharing focus by following a point, gazing back and forth, and pointing to show — usually emerges around 9–14 months. A frontline health worker should escalate for a developmental check when it is clearly absent by around 18 months, or sooner if a child loses a skill once present, does not respond to their name, or makes little eye contact. This is a reason to assess early, not a diagnosis — early support works best.
Read the answer AnswerWhen to escalate difficulty with jump rope coordination
Most children master jump rope around 6–7 years, with wide normal variation, so an isolated inability to skip rarely needs escalation. Frontline workers should escalate when motor difficulty is part of a pattern — broad clumsiness across running, hopping and catching, impact on daily tasks, no progress with practice, or concerns alongside speech, learning or social development. Any loss of previously held motor skills or new weakness needs prompt medical review. This is screening, not diagnosis.
Read the answer AnswerWhen to escalate a jumping delay
Most children begin a two-footed jump between roughly 24 and 36 months. A frontline health worker should escalate for a developmental check when a child past 30 months is not attempting to jump, when the gap travels with other motor or communication delays, when a skill is lost, or when a parent is worried. Any sudden weakness, regression or stiffness needs prompt referral to the medical officer. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate delayed jumping skills
Most children jump with both feet off the ground between 24 and 30 months. A frontline worker should escalate when a child is not jumping at all by around 30 months — especially alongside other gross-motor delays, stiff or floppy tone, frequent falls, or loss of a skill once present. A single isolated delay in an otherwise well-coordinated child is usually watch-and-encourage; clusters of signs warrant a developmental check. This guides early identification, not diagnosis.
Read the answer AnswerWhen to Escalate a Child's Language Delay
Frontline health workers should escalate language delay when a child misses clear milestones — no babble by 12 months, no words by 16 months, no two-word phrases by 24 months, or any loss of words at any age. Hearing concerns, no response to name, or limited social connection alongside delay also warrant prompt referral, with a hearing check arranged first. These are reasons to assess early, not a diagnosis.
Read the answer AnswerLanguage processing delay: when frontline health workers should escalate
Escalate a child with possible language-processing delay when they show no response to their name by 12 months, cannot follow a simple instruction by 18–24 months, understand far less than peers, or lose words once gained. Always check hearing first. These are early-referral flags, not diagnoses — early support works best, so refer to a PHC medical officer or developmental centre promptly rather than waiting.
Read the answer AnswerIf a child cannot reach language structure milestones, when should a frontline health worker escalate?
Frontline health workers should escalate when a child clearly misses language-structure milestones: no babbling by 12 months, no single words by 16–18 months, no two-word phrases by 24 months, or loss of words once used. Also escalate when delay travels with poor eye contact, no response to name, or hearing concerns. Always check hearing and ear infections. This is a timely referral, not a diagnosis — early action works best.
Read the answer AnswerWhen to escalate a child's lateral movement delay
Lateral movement — shifting weight, stepping sideways, reaching across the midline and balancing side to side — grows steadily in early childhood. A frontline ASHA/PHC worker should escalate for a developmental check when the skill is clearly behind same-age peers, has not appeared in the expected window, is lost after being present, shows one-sided asymmetry, or travels with tone, posture or other developmental concerns. Sudden stiffening, repeated falls with stare episodes, or an unwell child need prompt medical referral. This is a referral decision, not a diagnosis — early action enables early support.
Read the answer AnswerIf a child cannot trace lines at the expected age, when should a frontline health worker escalate?
Line tracing usually emerges between 2.5 and 3.5 years. Frontline workers should escalate to a developmental check if a child well past 3.5–4 years cannot attempt or follow a line, shows no interest in holding a crayon, or has fine-motor delay alongside concerns like weak grasp, stiffness, floppiness, vision worry, few words or not following instructions. This signals a reason to assess early — not a diagnosis — because early support works best.
Read the answer AnswerWhen to escalate a child's listening-skill concern
Frontline workers should escalate when a child consistently does not respond to their name by around 12 months, does not follow simple spoken instructions by 18–24 months, or shows no reaction to everyday sounds at any age. A child who loses a listening skill they once had, or whose listening difficulty travels with delays in talking or playing, also needs prompt referral. Always ask about ear infections and arrange a hearing check first, as many listening difficulties respond well to early treatment. This is screening that opens the door to support, never a diagnosis.
Read the answer AnswerWhen to Escalate Long-Term Memory Concerns in a Child
A single forgetful moment is rarely a concern, as young children's recall builds gradually. A frontline health worker should escalate to the Medical Officer or a developmental check when a child consistently struggles to recall familiar people, routines, instructions or recently learned words across several visits, or when memory difficulty travels with delays in speech, understanding, play or daily skills. Any sudden loss of a learned skill or change after illness or seizure needs prompt medical referral. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to Escalate Delayed Manual Dexterity
Frontline workers should escalate when a child clearly misses fine-motor milestones (no reach by 6 months, no pincer grasp by 12 months, no scribble by 18 months, no block-stacking by 24 months), shows a fixed hand preference before 18 months, loses hand skills once gained, or has poor hand use alongside delays in sitting, walking, speech or social connection. Regression or one-sided weakness needs urgent review. This is a referral prompt, not a diagnosis.
Read the answer AnswerWhen to escalate memory and recall concerns in a child
Frontline health workers should escalate memory and recall concerns when they are persistent, seen across settings, paired with delays in speech, understanding or daily skills, or when a child loses a skill once held. Possible medical signs like seizures or head injury need prompt medical referral first. Escalation leads to assessment and early support — never a label at the doorstep.
Read the answer AnswerWhen to escalate a child's memory retention concern
Memory retention develops gradually, so one slow patch rarely needs alarm. A frontline worker should escalate to a doctor or developmental check when a child consistently fails to recognise familiar people or follow daily routines past the expected age, when memory difficulty travels with delays in talking, understanding or play, or when a previously held skill is lost. Sudden memory loss, staring spells, or memory change after illness or a fall need urgent medical review first.
Read the answer AnswerWhen to escalate concerns about a child's mental effort
Mental effort (ICF d1) covers how a child focuses, persists and learns. A frontline worker should escalate when, for the child's age, they consistently cannot settle to a simple task, show little curiosity or persistence, fall clearly behind peers in learning, or show these alongside delays in talking, understanding or play — and always when a parent is worried or a skill is lost. Referral is a reason to assess early, never a diagnosis.
Read the answer AnswerWhen to escalate a child's mobility delay
Escalate a child's mobility concern when clear motor windows are missed: not sitting with support by 9 months, not pulling to stand by 12 months, not walking by 18 months, or any loss of a skill once gained. Refer promptly for stiff or floppy tone, marked one-sided use, or persistent toe-walking. These are reasons to assess early — not a diagnosis — and early referral gives the child the best start.
Read the answer AnswerMood regulation: when frontline workers should escalate
Big feelings, tantrums and tears are normal in young children and ease as language and routine grow. A frontline health worker should escalate to a Medical Officer or developmental check when distress is severe, very frequent, lasts well beyond the age peers settle, causes harm, or comes with delays in talking, play or social connection. Any self-injury or sudden loss of skills needs prompt medical referral. This is a reason to assess early, never a diagnosis.
Read the answer AnswerMotor delay: when should a frontline health worker escalate?
A frontline health worker should escalate a motor concern when a child clearly misses an age-expected milestone (head control by ~4 months, sitting by ~9, walking by ~18), loses a skill once had, shows stiffness, floppiness or one-sided use, or has motor delay alongside speech, social or feeding delays. Stiffening or stare-and-stiffen episodes need prompt medical review. This is early flagging, not diagnosis — early support works best.
Read the answer AnswerWhen 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.
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