Making Sure Johnny Sits Up on Time

Motor skill development in children requires ongoing observation and assessment

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) If a child has delays in motor development, it may indicate a developmental disorder. Parents can learn to understand what doctors are looking for in a child's normal development.

A recent report published by the American Academy of Pediatrics outlines the procedures pediatricians should follow in screening children for developmental delays.

This report outlined which skills children should have at each well-child visit and what a doctor's screening process involves.

"Discuss child development concerns with your pediatrician."

The report, whose authors were led by Garey H. Noritz, MD, of the Council on Children with Disabilities, provided guidelines for developmental screening of children at different well-child visits.

Well-child visits are the routine preventive care visits where children get a check up with their pediatricians, as well as any recommended vaccinations.

The authors recommend that pediatricians formally screen children for delays in motor skills at 9 months, 18 months, 2.5 years and 4 years old.

Most children are already typically screened by pediatricians for language and social development delays at the 9-month, 18-month and 2.5-year visits.

The report also provides more specific information on the neurological exam the children should receive.

This exam may include a magnetic resonance imaging (MRI) brain scan, an imaging of the child's brain done using a machine with a large magnet.

The report outlined the motor development skills children should have at each of the ages discussed.

At 9 months old, babies should be able to roll to both sides, to sit well without support, to be able to grasp objects and to transfer them from one hand to another.

Nine-month-olds should also have equal motor skills on both their right and left sides. They will not show a preference for handedness yet.

At 18 months old, children should be able to sit, stand and walk independently and to grasp and manipulate small objects.

"Mild motor delays undetected at the 9-month screening visit may be apparent at 18 months," the authors wrote.

At 2.5 years old (30 months), pediatricians may be able to detect more subtle motor delays in toddlers that were missed at previous visits, though most motor delays would already have been observed by this visit.

"However, more subtle gross motor, fine motor, speech, and oral motor impairments may emerge at this visit," the authors wrote.

Pediatricians should be looking for delays in coordination, fine motor skills and motor skills related to writing during the well-child visit for 4-year-olds.

The preschool-aged child should have early elementary school skills, with emerging fine motor, handwriting, gross motor, communication, and feeding abilities that promote participation with peers in group activities," the authors wrote.

Even after the 4-year-old well-child visit, however, healthcare providers should be on the lookout for developmental delays throughout early and middle childhood, especially if parents raise concerns.

The authors noted the five steps to effective surveillance of children's developmental skills:

  • Ask parents about their child's development and respond to their concerns
  • Adequately document a child's developmental history
  • Make accurate observations of a child
  • Identify a child's risk factors and protective factors for development
  • Maintain an accurate record of the surveillance process and what the doctor finds

"If a developmental disorder is identified, the child should be identified as a child with special health care needs, and chronic-condition management should be initiated," the authors wrote.

In general, because a doctor should follow up on any concerns parents have about their child's development, parents should be sure to communicate any concerns they have to their doctor.

The report was published May 27 in the journal Pediatrics. The research was funded by the American Academy of Pediatrics with the Centers for Disease Control and Prevention. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
May 25, 2013
Last Updated:
August 9, 2013