This site is intended for parents/carers of children who may display an unusual/atypical motor and/or cognitive development (or the lack of). The intent of this website is not to make a diagnosis but to encourage the parents/carers to promptly seek medical advice and/or referral to a relevant specialist.

What can you do?

Each child’s development is individual and unique

You are best placed to detect any unusual signs your child may be showing. Although there may be nothing to worry about, understanding and recording your child’s development may potentially help your healthcare provider recognise any atypical signs of an underlying cause, or a developmental disorder.

You can use the developmental milestones found here, and the prompts below as a guide, to record and report any signs of unusual development in your child. If you do suspect something unusual in your child’s development, urgently contact your healthcare provider.

Your child’s movement and motor skills

Motor skills are important for development. Everything your child does, learns, or interacts with, involves motor skills, making them essential for their progression. It is important to bring any unusual observations of your child’s development to your healthcare provider’s attention as soon as possible.

This section will provide you with further information on what to look out for and some examples of atypical movement and behaviour your child may display. It is important to remember that each child develops at their own pace, so if they have not learned or mastered a skill yet, it does not mean they never will.

Head movement and control1-3

Lay your child flat and pull them gently by their arms to a sitting position.

TYPICAL 

Your child lifting their head along with their body or slightly behind.

ATYPICAL 

Your child no longer has control, and their head extends behind them.

Why this is important:
This provides information relating to how your child’s muscles are developing. It could also provide an early insight into how your child’s brain is developing and could be linked to how your child may deal with emotions and behaviour in a given situation.

Balance and posture2,4

Hold your child upright around their trunk with their feet touching the floor.

TYPICAL 

If their legs stretch out to support themselves standing.

ATYPICAL 

Their legs do not allow them to balance or give way when trying to stand.

Why this is important:
Delays in postural control can be associated with your child’s muscles, strength and coordination not developing as they typically would. This can sometimes indicate neurodevelopmental delay and may result in complications with your child’s learning ability.

Crawling and coordination2,3,5-9

If your child walks, crawls, or bottom shuffles, put them in position and observe/record their movement – trying to get their attention using a toy may help.

TYPICAL 

Your child moves as normal towards you or the toy.

ATYPICAL 

Your child tries but is no longer able to crawl or moves backwards. Your child can still crawl/walk but is now swaying, limping, or leaning more to one side whilst walking.

Put your child against furniture and observe if they cruise.

TYPICAL 

Able to make sideways steps around the furniture.

ATYPICAL 

Can no longer cruise around for at least 3 steps.

Why this is important:
The development of gross motor skills, such as crawling and walking, are associated with the development of communication later in life. Being unable to complete tasks your child had previously mastered may be an indication of neurodevelopmental delay, or an underlying developmental disease.

Fine motor skills2,3,5-8,10

Put a small toy in front of your child, let them hold and interact with it.

TYPICAL 

Picks up the object using their thumb and index finger.

ATYPICAL 

No longer able to do this or grabs the object using their fingers and moves the object into the palm of their hand.

Observing your child during mealtimes

TYPICAL 

Your child picks up the food or tries to put the cutlery/cup in their mouth (even if they miss).

ATYPICAL 

Your child has difficulty using cutlery and drinking from bottles or (sippy) cups.

Why this is important:

A delay or loss of fine motor skills may indicate a range of underlying neurological disorders. Fine motor skills have also been found to predict social and cognitive ability in young children.

Your child’s behaviour2,3,5-8

Engage in an activity or play with a toy they like.

TYPICAL 

Shows interest, laughs and interacts with you.

ATYPICAL 

Does not pay attention or cries when you engage with them.

Chat with your child, call their name, smile, and try to make eye contact.

TYPICAL 

Your child responds, also smiles, and turns their head to make eye contact with you.

ATYPICAL 

Your child does not seem interested, cries, or does not follow your voice or face.

Why this is important:
A sudden lack of interest in activities that were originally well liked by your child, impaired focus, or being absent, may be a sign of developmental delay, or an underlying developmental/rare diseases.

If your child seems to have lost skills they had previously mastered, you should share your documented observations with your healthcare professional urgently for further investigation.

Additional motor and behavioural skills

Along with the above, there are some additional skills or behavioural aspects for you to observe, should you suspect any developmental anomalies in your child. Making note of these and acting quickly may allow you and your healthcare provider to give your child the best possible chance of a positive outcome. These include:3,6-8,11

  • Unexpected loss of balance.
  • Developing a tremor in arms or legs.
  • Difficulties swallowing food or drink, often leading to retching.
  • Suddenly occurring speech disorder.
  • Change in energy levels, appearing fatigued, dazed, or waking up at night.
  • Increased difficulties at school.
  • Uncharacteristic behaviour: sudden impulsivity, stubbornness.
  • Forgetting things already learned.

What to do if you have concerns about your child’s development?

Every parent worries about their child, and these thoughts are natural and justifiable. If you have noticed changes in your child’s movement, learning and behaviour, or feel something is not right, please contact your healthcare provider.

To find out more about the next steps and what happens when you do contact your healthcare provider, visit the next section ‘What happens next?’.

References:

1. Pineda RG, et al. Head Lag in Infancy: What Is It Telling Us? Am J Occup Ther. 2016;70(1):7001220010p1–7001220010p8.
2. Great Ormond Street Hospital. Brief Developmental Assessment (BDA). Accessed via https://www.gosh.nhs.uk/file/1841/download?token=oTvMwb9q on 26 July 2023.
3. Healthier Together. Website accessed via https://www.what0-18.nhs.uk/ on 7 March 2023.
4. Nickel LR, et al. Posture Development in Infants at Heightened vs. Low Risk for Autism Spectrum Disorders. Infancy. 2013;18(5):639-661.
5. Sun A. Lysosomal storage disease overview. Ann Transl Med. 2018;6(24):476.
6. Alenezi S, et al. Findings of a Multidisciplinary Assessment of Children Referred for Possible Neurodevelopmental Disorders: Insights from a Retrospective Chart Review Study. Behav Sci (Basel). 2022;12(12):509.
7. Reiss AL. Childhood developmental disorders: an academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics. J Child Psychol Psychiatry. 2009;50(1-2):87-98.
8. Eichler F, et al. Understanding caregiver descriptions of initial signs and symptoms to improve diagnosis of metachromatic leukodystrophy. Orphanet J Rare Dis. 2022; 17: 370.
9. Valla L, et al. Motor skills and later communication development in early childhood: Results from a population-based study. Child Care Health Dev. 2020;46(4):407-413.
10. Burr P, Choudhurty P. Fine Motor Disability. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 2022 Oct 10.
11. Cleary MA, Green A. Developmental delay: when to suspect and how to investigate for an inborn error of metabolism. Arch Dis Child. 2005;90(11):1128-32.

IE-NoP-2400009, July 2024

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