Detecting Early Motor Delays at Well-Baby Visits

In the past 25 years, the number of children with early motor delays has dramatically increased. The American Academy of Pediatrics Council on Disabilities estimates that as many as 400,000 children are at risk for an early motor delay[1]. Suggested reasons for this sharp increase are varied and include: a rise in multiple and premature births, increased survival rate of children with cardiac, neurological, and genetic disorders, and post birth positioning[2].

An early motor delay can refer to a variety of conditions ranging from low tone to cerebral palsy. Most severe motor irregularities are detected at birth and minor delays become apparent as early as two months of age. These delays can affect a child’s ability to learn basic skills such as grasping, crawling, standing, walking, and talking. Synapse development for motor skills, seeing, and hearing peaks at 3 months of age[3], so the sooner a child with a suspected motor delay is referred for an evaluation, the better. The commonly used “wait and see” method can slow a child’s developmental progress. Treatment and prevention for delays can be as simple as doing more tummy time while the baby is awake, while complex cases could require physical, occupational, or speech therapy.

When trying to detect early motor delays it is helpful to know the signs of typical and atypical development. Pathways.org offers free videos and handouts that show typical and atypical development in infants at 2, 4, and 6 months of age. The videos show an infant assessment created by Dr. Elspeth Kong, a Swiss pediatrician, and demonstrate how the power of observation can be a physician’s greatest tool in evaluating a child. The assessment encourages physicians to focus on the quality and symmetry of a movement rather than the existence of a movement.

Physicians should also regularly recommend tummy time to parents. When talking about “Back to Sleep” it is important to include “Tummy to Play”.  In 2008, a national survey of pediatric occupational and physical therapists was conducted. Sixty-six percent observed an increase in motor delays in babies under 12 months of age, and a majority of these therapists suggested that lack of tummy time contributed to the increase. Seventy percent of the therapists noted that most parents have little or no understanding of tummy time[4]. By increasing tummy time many children can avoid conditions like positional plagiocephaly, positional torticollis, and other conditions associated with early motor delays.

Tummy Time can start as soon as a baby comes home from the hospital. Parents often struggle with tummy time when their baby cries; however making tummy time a part of a baby’s routine can help minimize the struggle. If a parent is unsure of how to begin tummy time, then suggest the video “5 Essential Tummy Time Moves”. This video can help give parents some tips and make tummy time easier.  The accompanying handout can be helpful to discuss these positions during office visits.

A child can be referred to the state’s Early Intervention Services if an early motor delay is suspected. Early Intervention offers a number of services to children and their families including physical, occupational, and speech therapy.