ACOFP 54th Annual Convention & Scientific Seminars

Recognizing Early Motor Delays at 2, 4 and 6 Months of Age and Importance of Tummy Time

Karen R. Judy, MD

3/7/2017

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Today, 1 in 40 Children in the U.S. Has an Early Motor Delay. 1,2

Celebrating 30 Years of Assuring the Best For All Babies’ Development

Baby Milestones

and

Recognizing Early Motor Delays

About Pathways.org

• National Non-Profit Educational Foundation• Established in 1985

• Medical Roundtable • Members provide strategic and supportive direction

• Consists of leading physicians, clinicians, and lay advisors

• Activities Include: • Brochures and videos on development viewed over 6,000 times per day

• Baby Calendar with weekly Games & Activities to promote development

• Website: All materials are FREE to download and copy• Toll-Free Parents Hotline 800-955-CHILD

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Assure Baby’s Physical Development

A child with an early motor delay could exhibit any of the

following conditions:• Poor head and neck control

• Muscle stiffness

• Speech delays

• Swallowing difficulties

• Slumped or asymmetrical posture

• Clumsiness

• Spasms

• Delayed sitting or walking

• Delayed getting hand to mouth

Early Motor Delay

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Dramatic increase in cases of early motor delays

in the past 25 years.

Reasons for the sharp increase:

• Increase in number of multiple births

• Increase in number of premature births

• Increased survival rate of children with

cardiac, neurological and genetic disorders

• Post-birth positioning 3,4

Why Early Detection Matters

Recognizing Early Motor Delays

1. Supine

2. Sidelying

3. Prone

4. Pull to Sit

5. Sitting

6. Horizontal Suspension

7. Protective Response

8. Standing

Atypical

Good vertical alignment from

head to feet No independent head lifting

Typical Eight positions to

observe movement:

Focus on the quality and symmetry of the movement. 10

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Comparison of Two, Four and Six Month Old

Development

Recognizing Early Motor Delays

Dr. Elsbeth Köng • Internationally recognized authority on early

detection and early intervention for infants

and children with early motor delays.

• Work resulted in the extensive training of

medical professionals around the world.

• Revolutionary vision of beginning therapy at

the critical age of 3 months.

• Power of Observation

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National survey of pediatric experts indicates

increase in infant motor delays;

more Tummy Time is key.9

Tummy Time

Increase in early motor delays,

can be due to lack of

Tummy Time while awake.

Supervised time while awake that babies spend on their stomachs.

Tummy Time can begin as soon as baby

comes home from the hospital.

Positional Torticollis Positional Plagiocephaly

Importance of Tummy Time

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4 Month Old

Positional Plagiocephaly

View from Top View from Behind

Early Detection & Early Intervention

Importance of Tummy Time

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Importance of Tummy Time

Tummy Time is critical for building muscle strength in the core, back,

neck, and shoulders; strength children need to meet their

developmental milestones.

Importance of Tummy Time

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Pediatric

Occupational

Therapy

Early Intervention

Pediatric

Physical

Therapy

Pediatric

Speech/Language

Therapy

Pediatric therapy improves the abilities of a child.

• Ask parents questions

• Listen to parents

• Schedule a follow-up visit

• Suggest parents keep a notebook

of observations

• Suggest a second opinion/referral

Communicating with Parents

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Referrals

If a child requires therapy…Collaboration of the physician and the therapist is essential for

maximizing the child's developmental outcome.

If you assess a child and observe a potential early motor delay

Next step:

Refer your patient

for an evaluation

or a screening by

a specialist

Early treatment of physical differences is vital in assuring the best for a baby.

Recommended Organizations

Some suggestions: American Academy of Pediatrics (AAP): www.AAP.org

American Academy of Pediatrics Parent’s Site: www.healthychildrens.org

American College of Osteopathic Pediatricians(ACOP): www.acopeds.org

American Occupational Therapy Association (AOTA): www.AOTA.org

American Physical Therapy Association (APTA): www.APTA.org

Neuro-Development Treatment Association (NDTA): www.NDTA.org

Pediatric Neurologist: www.childneurologysociety.org

Developmental and Behavioral Pediatricians: www.sdbp.org/find_a_clinician.cfm

Easter Seals: www.easterseals.com

Pathways.org: www.pathways.org

Each States Early Intervention Program:

http://www.nectac.org/~pdfs/topics/earlyid/partc_elig_table.pdf

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Thank youfor taking the time to learn recognizing early delays.

We hope that this overview has provided you with the skills and tools to:

•Understand the importance of observation/surveillance

•Visually recognize early motor delays as early as 2, 4, and 6 months of age

•Tummy Time Tips to share with parents.

•Listen & Communicate with parents.

•Refer children for further screening as soon as possible

Questions1. IDEA (Individuals with Disability Education Act) mandates

beginning intervention at _____ for all children with physical

challenges and special needs.

A. 9 months

B. 5 years old

C. Birth

D. 2 years old

E. None of the above

2. Things to look for while observing a child’s development are:

A. Variety of movement

B. Muscle tone

C. Antigravity movement

D. Ability to track an object 180 degrees from side to side

E. All of the above

3. By 3 months of age a typically developing child should meet

the following milestone:

A. Begins to use an open cup

B. Lifts and holds head up

C. Uses thumb and pointer finger to pick up tiny objects

D. Sits independently

E. None of the above

4. Which is a physical development warning sign for a child 6 months or

older?

A. Rounded Back

B. Keeps hands fisted and lacks arm movement

C. Stiff legs

D. Poor head control

E. All of the above

5. A 6 month old boy is not able to bear weight when placed in supported

standing. He was born full-term with no prenatal problems and an

uneventful delivery. Your exam noted hypotonia in legs. What

decision regarding early intervention is appropriate?

A. Refer to early intervention only if parent asks

B. No referral is needed

C. Simultaneous refer to early intervention programs and order imaging

. and/or diagnostic tests

D. Wait till the next well-child visit.

E. Wait until child is eligible for special education in preschool

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References1 American Academy of Pediatrics and Pathways.org Hot Topics: Recognizing Early Motor Delays (online course)2 Statistics compiled by the Pathways.org Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and

Prevention 3 Caputo A, & Accardo P. Developmental disabilities in infancy and childhood. Baltimore: Paul H. Brooks Publishing Co.; 1996.2 Majnemer A, Barr RG. Influence of supine sleep positioning on early motor milestone acquisition. Dev Med Child Nurol. 2005;47(6):370-6.3 Koren A, Reece SM, Kahn-D'angelo L, Medeiros D. Parental information and behaviors and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care. 2010;24(4):222-30.4 Skonkoff JP, Phillips D. From Neurons to Neighborhoods: The Science of Early Child Development. Washington D.C: National Academy Press; 2000.5 National Center for Health Statistics & NICHD. SIDS Rate & Back Sleeping. Safe to Sleep Public Education Campaign. http://www.nichd.nih.gov/SIDS/upload/SIDS_rate_back_sleep_2006.pdf Accessed Oct. 28,

2013. 6 7 Ianelli V. Reducing the Risk. About.com http://pediatrics.about.com/od/safety/a/05_sids.htm Accessed October 28, 2013.8 Mawji A, Robinson Vollman A, Hatfield J., McNeil DA, Sauvé R. The incidence of positional plagiocephaly: A cohort study. Pediatrics. 2013;132(2):298-3049 American Physical Therapy Association. Lack of ‘Tummy Time’ Leads to Motor Delays in Infants, PTs Say. American Physical Therapy Association. Apta.org.

http://www.apta.org/Media/Releases/Consumer/2008/8/6/ Accessed October 28, 2013.10 Halfon N, Regalado M, Sareen H, Inkelas M, Reuland CP, Glascoe FP, Olson, LM. Assessing development in the pediatric office, Pediatrics, 2004; 113(6):1926-33. 9 Clarren SK, Smith DW, & Hanson JW. Helmet treatment for plagiocephaly and congenital muscular torticollis. The Journal of Pediatrics. 1979;94:43-46.10 Kattwinkle JD, Brooks J, & Myerberg, D. Positioning and SIDS. AAP task force on In infant positioning and SIDS. Pediatrics. 1992;89: 1120-1126.11 Turk AE, McCarthy JG, Thorne CHM, & Wisoff. The "Back to Sleep Campaign" and deformational plagiocephaly. The Journal of Craniofacial Surgery. 1996;7:12-18.12 Biggs WS. Diagnosis and management of positional head deformity. American Family Physician. 2003;67(9):1953-6.13 Biggs W. Diagnosis and management of positional head deformity. American Family Physician. 2003;67(9):1953-1956.14 National Center for Health Statistics & NICHD. SIDS Rate & Back Sleeping. Safe to Sleep Public Education Campaign.15 Iannelli V. Reducing the Risk. About.com Pediatrics and http://www.nichd.nih.gov/SIDS/upload/SIDS_rate_back_sleep_2006.pdf. 2012.16 Jennings JT. Conveying the Message about Optimal Infant Positions. Physical and Occupational Therapy in Pediatrics. 2005; 25(3). 17 Jantz JW, Blosser CD, Fruechting LAA Motor Milestone Change Noted with A Change in Sleep Position. 199718 Davis BE, Moon RY, Sachs HC, Ottolini MC Effects of sleep position on infant motor development. Pediatrics. 1998;102(5):1135-1140.19 Dworkin PH. Detection of behavioral, developmental, and psychosocial problems in pediatric primary care practice. Curr Opin Pediatrics. 1993;5:531–536.20 American Academy of Pediatrics. Motor Delays: Early Identification and Evaluation. PediaLink, The AAP Online Learning Center. Accessed April 2015

http://motordelay.pedialink.courses.aap.org/script/introduction?req=20170106121712096421 Scherzer AL, et al. Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. Developmental Medicine & Child Neurology.

2012; 54 (12): 1079-1084.22. Noritz GH, Murphy NA, and Neuromotor Screening Expert Panel. Motor delays: Early identification and evaluation. Pediatrics. 2013; 131(6): e2016-e2027.23. Scherzer AL, et al. Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. Developmental Medicine & Child Neurology.

2012; 54(12): 1079-1084.24. Mawji A, Robinson Vollman A, Fung T, Hatfield J, McNeil DA, Sauvé R. The incidence of positional plagiocephaly: A cohort study. Pediatrics. 2013; 132(2):298-304.

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at www.Pathways.org