# When should an ASHA or PHC worker escalate a child showing signs of FASD?

Canonical: https://pinnacleblooms.org/ask/when-should-an-asha-or-phc-worker-escalate-a-child-showing-signs-of-fetal-alcohol-spectrum-disorder
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

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.

*An ASHA or PHC worker is often the first to notice a child who isn't growing or developing as expected — and that early eye matters enormously. Here is when to act, and how.*

## In short
Escalate promptly when a child has **growth faltering** (low weight, short stature or small head) **plus** developmental delay or behavioural concerns — especially where there is any **known or suspected maternal alcohol use in pregnancy**. You do not need to confirm [Fetal Alcohol Spectrum Disorder](/fasd) yourself; FASD is a clinical diagnosis. Your role is to recognise the pattern, refer up the line to the Medical Officer or District Early Intervention Centre (DEIC) under RBSK, and ensure the family reaches assessment. When in doubt, refer — early action protects the child's future.

## When to escalate — a field decision guide
Escalate to the PHC Medical Officer / DEIC when you observe a **combination** rather than a single isolated sign:

- **Growth** — persistent low weight-for-age, poor height gain, or a head that appears small relative to the body, tracked across visits.
- **Development** — missed milestones in speech, motor skills, attention or social interaction; learning or behavioural difficulty as the child grows.
- **Feeding & sleep** — early feeding difficulty, irritability or disturbed sleep in infancy.
- **History** — any reported or suspected alcohol exposure during pregnancy (ask gently, without blame).
- **Facial features** — subtle facial differences are sometimes present but are **not reliable** for a field worker to judge; never rule FASD in or out on appearance alone.

**Escalate immediately**, not at routine cadence, if there are seizures, marked failure to thrive, or significant loss of skills — these need prompt medical review regardless of cause.

Document what you see in the child's RBSK / growth records, refer through the standard 4D screening pathway (Defects, Deficiencies, Diseases, Developmental delays including disability), and follow up to confirm the family attended.

## The Pinnacle way
FASD cannot be diagnosed in the community — and it must never be diagnosed from a checklist. A clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care, after structured assessment that looks for other causes first. Once a child reaches assessment, support is practical and hopeful: [early intervention](/early-intervention-therapy) and [speech therapy](/speech-therapy) help children build skills and confidence. Across 70+ centres in 4 states, our role complements yours — you find the child early; we help them grow.

## Trusted sources
WHO ICD-11 framework for developmental conditions; CDC guidance on Fetal Alcohol Spectrum Disorders and growth/development indicators; AAP recommendations on early developmental screening and referral; RBSK 4D screening approach under India's child-health programme.

**Next step —** When the pattern fits, refer the family for assessment without delay. [Book a developmental assessment](/enroll) at a Pinnacle Blooms Network centre.

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

## Sources
- CDC — About Fetal Alcohol Spectrum Disorders: https://www.cdc.gov/fasd/about/index.html
- WHO ICD-11: https://icd.who.int/
- American Academy of Pediatrics — developmental screening: https://www.aap.org/