Algorithm for earlier detection of motor delays

New guidelines underscore the need for earlier detection of motor delays among children and posit an algorithm for use in the primary care setting.

The guidelines, developed by a multidisciplinary Neuromotor Screening Expert Panel of the American Academy of Pediatrics, review how to evaluate children for potential motor problems and offer an approach to children who demonstrate motor delays and variations in muscle tone.

The report emphasizes that formal developmental screening should take place not only at the traditional 9-, 18-, and 30-month well-child visits, but that an additional screening should take place at the 48-month well-child visit, specifically to identify problems with coordination and with fine-motor and graphomotor skills before a child enters kindergarten.

The guidelines present an approach to the neurologic examination with emphasis on the assessment of muscle tone and describe the use of initial diagnostic tests. These include brain magnetic resonance imaging for children with high muscle tone, which can be indicative of cerebral palsy, and the measurement of serum creatine phosphokinase and thyroid-stimulating hormone concentrations in those children with decreased muscle tone, which can indicate such disorders as Duchenne muscular dystrophy. The panel emphasizes pursuing diagnostic tests while simultaneously referring children and their parents to early intervention programs.

The researchers note that although gross motor delays are common, a minority of children have more pronounced or progressive problems that may require intervention. For example, cerebral palsy affects about 3.3 per 1,000 children. Developmental coordination disorder affects about 5% of children and generally becomes evident about the time children start primary school.

The bottom line is that timely identification of motor problems in children allows for earlier referral and diagnosis and optimal intervention.