# What cognitive warning signs should an ASHA worker act on?

Canonical: https://pinnacleblooms.org/ask/what-cognitive-warning-signs-should-an-asha-worker-act-on
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Act on cognitive warning signs when a child is not learning, understanding or playing as expected for their age — and most urgently on any loss of skills already gained. The ASHA role is to notice the pattern and refer to the PHC Medical Officer, never to diagnose. Two or more signs together, a clear lag behind peers, or any regression warrant a developmental check with hearing and vision review.

*An ASHA worker often meets a child long before any clinic does — which is exactly why your eyes on a child's understanding, play and learning matter so much.*

## In short
Act on cognitive warning signs when a child is not learning, understanding or playing the way most children of the same age do — and especially on any loss of skills already gained. You are not diagnosing; you are noticing a pattern and connecting the family to a developmental check at the PHC. When in doubt, refer — early action protects the child.

## Cognitive warning signs to act on
**Infancy (by 6–12 months)**
- Not watching faces, not following moving objects with the eyes
- Not turning to sounds or showing interest in surroundings
- Not reaching for or exploring toys by mouth and hands

**Toddler (12–24 months)**
- Not pointing to ask for or show things; not following a simple instruction
- No simple pretend play (feeding a doll, talking on a toy phone)
- Not learning new words or imitating everyday actions

**Preschool (2–5 years)**
- Difficulty understanding simple questions or instructions
- Not learning colours, naming familiar objects, or solving simple puzzles expected for age
- Trouble with cause-and-effect play or remembering routines

**Always act on — at any age**
- **Loss of skills** the child once had (words, understanding, play) — refer the same week
- Strong, repeated parental concern that "something is different" about how the child learns or understands
- Cognitive concerns alongside seizures, poor feeding, or not responding to sound — these need prompt medical referral, not waiting

## When to refer
A single milestone slightly late is usually worth watching, not panic. But two or more signs together, a child clearly behind peers, or any regression should go to the Medical Officer at the [PHC](/) for a developmental check and a hearing and vision review. Cognitive delay is not the child's fault and not the family's — and earlier support means better outcomes.

## The Pinnacle way
Developmental measurement supports care planning; diagnosis requires an appropriately qualified healthcare professional. under qualified clinician care — your role is to spot the pattern and refer, never to label. The [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) is a clinician-administered structured assessment that gives an objective baseline across developmental domains, and our [early intervention](/early-intervention) team can support families once a child reaches us.

## Trusted sources
Aligned with the WHO International Classification of Functioning, Disability and Health (ICF) framing of mental functions (b1), and with WHO and CDC early-childhood developmental monitoring guidance.

**Next step —** when you notice these signs, refer the child to your PHC Medical Officer for a developmental check; for a clinical referral partnership, reach the Pinnacle team on WhatsApp: +91 91001 81181.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICF · Mental functions (b1): https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
- CDC · Learn the Signs. Act Early.: https://www.cdc.gov/child-development

## Connected topics and perspectives
- Developmental Domains: https://pinnacleblooms.org/ask/domains
- Asha Phc: https://pinnacleblooms.org/ask/lens/stakeholder/asha_phc
- Cognitive: https://pinnacleblooms.org/ask/lens/domain/cognitive
- Signs: https://pinnacleblooms.org/ask/lens/intent/signs
- Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen
- Book Assessment: https://pinnacleblooms.org/ask/lens/route/book-assessment
- Early Clarity: https://pinnacleblooms.org/ask/lens/empowerment/early_clarity

## Related question paths

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- How Cognitive Skills Develop From Birth to School Age: https://pinnacleblooms.org/ask/how-does-cognitive-develop-from-birth-to-school-age
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