Guidance for Identifying Motor Delays in Children

Diedtra Henderson

May 30, 2013

An algorithm that includes formal developmental screening of children for possible motor delays and variations in muscle tone at their 9-, 18-, 30-, and 48-month well-child visits could help affected children receive diagnostic evaluations and treatments in a more timely fashion, according to new guidelines.

Garey H. Noritz, MD, from the Council on Children With Disabilities, and coauthors, including members of the Neuromotor Screening Expert Panel, present guidance for pediatric primary care providers in an article published online May 27 in Pediatrics.

Gross motor delays are common among children, according to the authors. About 3.3 children per 1000 have more permanent motor disabilities, such as cerebral palsy, and 6% of children have developmental coordination disorder. According to the multidisciplinary expert panel, early diagnosis can help reduce family stress, and earlier access to available treatments can improve outcomes for children with neuromuscular diseases. The most frequently used developmental screening instruments, however, have not been validated on children with motor delays.

During focus groups involving 48 pediatricians attending an American Academy of Pediatrics conference in 2010, practitioners reported uncertainty in detecting and diagnosing motor delays in children.

Underscoring recommendations made by the academy in 2006, the expert panel now recommends using a standardized test to provide children with periodic developmental screening during their 9-, 18-, and 30-month well-child visits. By 9 months, an infant should be able to roll to both sides and sit without help. By 18 months, toddlers should have mastered sitting, standing, and walking on their own. Although most motor delays would have already been evident at a younger age, by 30 months, more subtle impairments may become evident, and progressive neuromuscular disorders may begin to appear. By 48 months, preschoolers should climb stairs without help, skip on 1 foot, feed themselves, and demonstrate such fine motor milestones as drawing stick people and fastening medium-sized buttons.

Pediatricians not only should watch how children perform a requested task but also should pay keen attention to their general posture, play, and spontaneous motor functions, the authors counsel.

Muscle tone can provide an additional clue of a possible neuromotor delay, such as cerebral palsy. A magnetic resonance imaging scan can be ordered for patients with heightened muscle tone, and serum creatine kinase concentrations should be measured in children with decreased muscle tone. Such interventions can occur at the same time children are referred to specialists for diagnosis.

Pediatricians treating a child with mild abnormalities should develop a time-definite follow-up plan should they worsen or develop new symptoms, such as regression in motor skills or loss of strength. Acting quickly on such clinical changes can help expedite appropriate medical attention.

"The initial responsibility for identifying a child with motor delay rests with the medical home. By using the algorithm presented here, the medical home provider can begin the diagnostic process and make referrals as appropriate," the authors conclude.

Financial support for the clinical report was provided by the American Academy of Pediatrics. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online May 27, 2013. Abstract