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Asha Phc
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Signs & concerns
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Signs & concerns
When to Escalate a Running-Skills Delay
Most children begin running between 18 and 24 months. A frontline health worker should escalate for a developmental check if a child is not running by 24 months, has not walked independently by 18 months, is losing motor skills once gained, or shows the delay alongside stiffness, asymmetry, or delays in talking and social connection. Caregiver concern is itself a valid reason to refer. This is a reason to assess early, not a diagnosis, because timely support works best.
Read the answer AnswerWhen to escalate delayed safety awareness in a child
Safety awareness — spotting edges, hot things, traffic and responding to "stop" — develops gradually through the toddler and preschool years. A frontline health worker should escalate for a developmental check when a child shows no caution by 3 years, repeatedly runs into obvious danger without learning, regresses, or when safety gaps come with delays in talking, understanding, walking or social connection. This signals a need to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a scissor-use concern
Difficulty with scissors alone — around the expected ages of snipping (2.5–3y), cutting a line (4–5y) and cutting shapes (5–6y) — is rarely concerning, since practice and opportunity vary widely. Frontline workers should escalate when scissor difficulty travels with wider fine-motor, grasp or coordination delays, shows no progress despite practice, or comes with other developmental flags or loss of a skill. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate concerns about a child's self-advocacy skills
Self-advocacy develops gradually across childhood, so there is no single cut-off. A frontline health worker should escalate to a developmental check when a child's difficulty in speaking up, making choices or asking for help travels with delays in talking, understanding, social connection or daily independence, persists beyond peers, or affects safety and learning. This signals the need for early assessment, not a diagnosis.
Read the answer AnswerWhen to escalate delayed self-awareness
Self-awareness — name response, mirror recognition, using "me" and "mine", showing pride or embarrassment — emerges across the second and third years. A frontline health worker should escalate when a child clearly misses these age markers, shows no progress across follow-up visits, or has self-awareness gaps alongside delays in language, social connection or play. This signals a need for early assessment, not a diagnosis — earlier review means gentler, more effective support.
Read the answer AnswerWhen should a frontline health worker escalate a self-care delay?
Escalate a child for a developmental check when self-care skills (feeding, dressing, toileting, washing) are clearly behind the expected window, when a skill is lost after being achieved, or when the lag comes with delays in talking, moving, hearing or social connection. A single mildly-late skill can be monitored for 4–6 weeks; gaps across several areas, regression, or any suspected medical concern need prompt referral. Early escalation is a strength, never a diagnosis.
Read the answer AnswerWhen should a frontline worker escalate a self-care dexterity delay?
Self-care hand skills like using a spoon, buttoning and hand-washing develop with wide normal variation. A frontline worker should refer for assessment when a child is clearly behind peers over several months, loses a skill once held, shows weakness, stiffness or floppiness, or when hand difficulty travels with delays in walking, talking or social connection. This is routine early referral — not a diagnosis — because support works best when it starts early.
Read the answer AnswerWhen should a frontline worker escalate a self-care delay?
A frontline health worker should escalate a child for a developmental check when self-care skills (feeding, dressing, toileting, washing) show a broad delay across areas, no progress over several months, or loss of a previously mastered skill — especially alongside communication, feeding or motor concerns. A single late skill is rarely a worry; a pattern of delay or regression is the signal to refer. This is timely support, not a label, and early help works best.
Read the answer AnswerWhen should a frontline health worker escalate a self-control concern?
Some difficulty with self-control is normal in young children and matures with age. A frontline health worker should escalate for a developmental check when the difficulty is far greater than same-age peers, persists across home and anganwadi, risks harm, or travels with delays in speech, learning or social connection. Escalate promptly for any safety concern or sudden loss of skills. This is a referral for assessment, never a field diagnosis.
Read the answer AnswerSelf-management delay: frontline escalation guidance
Self-management (ICF d5 self-care) develops gradually, so one lagging skill is rarely alarming. Frontline workers should escalate when a child is clearly behind on several self-care milestones for age, has lost a skill once mastered, or the delay comes alongside concerns in talking, walking, hearing or social connection. Check the child has had a fair chance to learn. This is a referral for assessment, not a diagnosis — early identification gives the best window for support.
Read the answer AnswerWhen should a frontline worker escalate self-regulation concerns?
Self-regulation grows gradually through the toddler and preschool years. A frontline worker should escalate to a developmental check when difficulties calming, waiting or settling are frequent, intense, well beyond the expected age, or disrupt feeding, sleep, play and family life — especially alongside delays in talking, social connection or understanding. Refer early; this is a reason to assess, not a diagnosis.
Read the answer AnswerWhen to escalate sensory concerns in a child
Sensory aspects (ICF b156) cover how a child takes in sound, sight, touch, taste, smell and movement. A frontline worker should escalate when a child consistently does not respond to sounds or their name, does not fix or follow with the eyes, shows extreme distress or no reaction to touch and pain, or when these differences come with delays in talking, play or social connection. Any regression or sudden change needs prompt medical review. This is not a diagnosis but a reason to arrange a developmental check early.
Read the answer AnswerSensory avoidance: when a frontline worker should escalate
Some sensory avoidance of loud sounds, bright lights or textures is normal and protective in young children. A frontline health worker should escalate to a developmental check when the avoidance is intense, persistent, disrupts feeding, sleep, play or routines most days, causes daily distress, or travels with delays in talking, social connection or movement. This is a reason to refer early, not a diagnosis — early support works best.
Read the answer AnswerWhen should a frontline worker escalate sensory integration concerns?
Sensory integration develops gradually. A frontline worker should escalate to a developmental check when a child shows strong, persistent over- or under-reactions to everyday sensations that disrupt play, feeding, sleep or learning — especially if these travel with delays in talking, moving or connecting. Escalate promptly when distress causes self-injury, feeding affects growth, or several flags appear together. This is a reason to refer early, not a diagnosis.
Read the answer AnswerWhen to escalate sensory regulation concerns
Frontline health workers should escalate when a child's sensory regulation difficulties are persistent, intense, disrupt daily routines like feeding and sleep, cause distress or self-injury, or travel alongside speech, social or motor delays. Mild variation that settles with comfort is normal. Escalation means routing to a Medical Officer or developmental check — a referral signal, not a diagnosis — because early support works best.
Read the answer AnswerWhen to escalate sensory seeking concerns
Sensory seeking — spinning, splashing, climbing, squeezing — is a normal part of early play, not a skill that is simply "absent". A frontline health worker should escalate when seeking causes safety risk or self-harm, cannot be redirected into play, crowds out development, or travels with delays in speech, social connection or motor skills. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerEscalating Sensory Sensitivity Concerns: A Frontline Guide
Sensory sensitivity (ICF b156) is not a skill a child passes or fails at a set age — children vary widely in how they respond to sound, touch, light and texture. A frontline health worker should escalate when sensory reactions disrupt feeding, sleep, play or daily routines, cannot be soothed, or travel with delays in talking, social connection or motor skills, or when a parent is worried. This is a reason to refer for a developmental check, not a diagnosis, because early support works best.
Read the answer AnswerSensory Tolerance: Escalation Guidance for Frontline Workers
Sensory tolerance develops differently in every child, and mild fussiness with textures, noise or touch is common. A frontline health worker should escalate when sensory reactions disrupt feeding, sleep, play or routines, persist across settings, cause distress or self-injury, or come with delays in talking, social connection or movement. Document triggers and refer to the PHC medical officer or developmental clinician — this is reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate delayed sentence and phrase complexity
Frontline health workers should escalate when a child clearly lags peers in joining words into phrases — no two-word phrases by ~24 months, or still mostly single words at 30–36 months. Escalate sooner with poor comprehension, lost words, no gestures, or family concern, and always include a hearing check. This is a referral signal, not a diagnosis — early review enables early, effective support.
Read the answer AnswerWhen to escalate delayed sentence formation
Most children join two words by around 24 months and form simple sentences by 3 years. A frontline health worker should escalate when a 2-year-old uses no two-word phrases, a 3-year-old is not making short sentences or is very hard to understand, when words once used are lost, or when language delay travels with hearing concerns or social flags. Always arrange a hearing check, and refer for a developmental review — early support, not a label.
Read the answer AnswerSentence repetition delay: when should a frontline worker escalate?
If a child cannot repeat short, age-appropriate sentences on screening, a frontline health worker should escalate to a developmental or speech-language assessment when the difficulty is clear, persists across two or more visits, or comes with other language, comprehension or hearing concerns. Pair the concern with a hearing check, since hearing loss is a common and treatable cause. This is a referral signal, not a diagnosis — early assessment opens early support.
Read the answer AnswerWhen to escalate a child's sequential memory concern
Sequential memory develops gradually, so one miss is rarely a worry. A frontline health worker should escalate to a developmental check when a child's difficulty remembering steps, sounds or routines is persistent, clearly behind same-age peers, and accompanied by delays in speech, understanding or daily routines — or when a parent is concerned. Urgent signs such as staring spells or regression need prompt medical referral. This is not a diagnosis but a wise, early opportunity for support.
Read the answer AnswerWhen to escalate a child who cannot draw shapes at the expected age
Drawing shapes follows a predictable order — a circle around 3, a cross and square around 4, a triangle around 5. A single missed milestone is not an escalation trigger. A frontline worker should escalate when a child is clearly behind the expected age and shows other flags: weak or awkward grasp, trouble with self-care, delayed speech or comprehension, loss of a skill, or a vision concern. Isolated lags often resolve with more crayon-and-paper play, but clustered delays are the signal to refer early, when support works best.
Read the answer AnswerWhen to escalate a shape-recognition concern
Most children match and name simple shapes between 2.5 and 4 years. A frontline worker should escalate when a child of 3.5–4 years still cannot match or sort basic shapes despite everyday exposure, or at any age when shape difficulty comes with delays in vision, language, play or attention. First rule out hearing and vision, confirm the child has had real exposure to shapes, then refer for a developmental check — this is early assessment, not a diagnosis.
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