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

Baby Milestones and Recognizing Early Motor Delays

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

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

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

Early Motor Delay 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

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Why Early Detection Matters 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

Recognizing Early Motor Delays Typical Eight positions to Atypical observe movement: 1. Supine 2. Sidelying 3. Prone 4. Pull to Sit 5. Sitting Good vertical 6. Horizontal Suspension alignment from 7. Protective Response head to feet No independent head lifting 8. Standing

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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Tummy Time Supervised time while awake that babies spend on their stomachs.

National survey of pediatric experts indicates increase in infant motor delays; more Tummy Time is key.9

Increase in early motor delays, can be due to lack of Tummy Time while awake.

Tummy Time can begin as soon as baby comes home from the hospital.

Importance of Tummy Time Positional Torticollis Positional Plagiocephaly

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Positional Plagiocephaly 4 Month Old

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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Early Intervention Pediatric therapy improves the abilities of a child.

Pediatric Pediatric Occupational Physical Therapy Therapy

Pediatric Speech/Language Therapy

Communicating with Parents

• Ask parents questions • Listen to parents

• Schedule a follow-up visit • Suggest parents keep a notebook of observations • Suggest a second opinion/referral

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Referrals 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

If a child requires therapy… Collaboration of the physician and the therapist is essential for maximizing the child's developmental outcome.

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 you for 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

Questions 1. IDEA (Individuals with Disability Education Act) mandates beginning intervention at _____ for all children with physical 4. Which is a physical development warning sign for a child 6 months or challenges and special needs. older? A. 9 months A. Rounded Back B. 5 years old B. Keeps hands fisted and lacks arm movement C. Birth C. Stiff legs D. 2 years old D. Poor head control E. None of the above E. All of the above 2. Things to look for while observing a child’s development are: 5. A 6 month old boy is not able to bear weight when placed in supported A. Variety of movement standing. He was born full-term with no prenatal problems and an B. Muscle tone uneventful delivery. Your exam noted hypotonia in legs. What C. Antigravity movement decision regarding early intervention is appropriate? D. Ability to track an object 180 degrees from side to side A. Refer to early intervention only if parent asks E. All of the above B. No referral is needed 3. By 3 months of age a typically developing child should meet C. Simultaneous refer to early intervention programs and order imaging the following milestone: . and/or diagnostic tests A. Begins to use an open cup D. Wait till the next well-child visit. B. Lifts and holds head up E. Wait until child is eligible for special education in preschool C. Uses thumb and pointer finger to pick up tiny objects D. Sits independently E. None of the above

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References 1 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):298-304 9 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. 1997 18 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=201701061217120964 21 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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