Develop a Procedure for Referrals
Early sensory, communication and motor delays occur when a child isn’t able to meet critical milestones in the first months and years of life, which can later affect a child’s ability to learn basic skills such as chewing, grasping, crawling, standing, talking and walking. Realizing that his or her child has an early sensory, communication and or motor delay can be a tense and unsettling experience for a parent. Feelings of helplessness and uncertainty about the future are common. However, early therapy is the best chance that children with early sensory, communication and motor delays have to reach their full potential. The earlier therapy begins the better! Pediatricians should focus on guiding parents toward early therapy while allaying their fears about pursuing that course of treatment.
It helps to be prepared ahead of time, developing a practice-wide method of addressing cases of early sensory, communication, and motor delays. This is best accomplished by the following:
- Become familiar with patterns of typical and atypical movement in babies of all ages. Take advantage of resources that allow you to see examples of each. Pathways is developing a series of videos showing a baby developing typically and a baby developing atypically at a variety of ages up through one year, click here to view the sample videos. Other resources include Pathways Awareness’ film, Early Infant Assessment Redefined, and companion handout. There is also a parent-friendly version of this handout that you may wish to keep on hand to share with parents, if there is concern about their child’s development.
- Adopt a surveillance mentality when observing children. Surveillance moves doctors beyond a “schedule” mentality (“At two months, look for X. At four months, look for Y”). Surveillance is “a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. The components of developmental surveillance include eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.” (Dworkin PH Detection of behavioral, developmental, and psychosocial problems in pediatric primary care practice. Curr Opin Pediatr 1993; 5:531-536 [Medline])
- Observe the child in a variety of positions during the exam. Look for both quality and symmetry of movement. If you notice areas of concern, be proactive in referring the child for early therapy. Avoid adopting a “wait and see” attitude.
- Empower parents to take an active role in their child’s development. At the first well-child visit, consider providing them with information they can take home and use to track their child’s physical, speech and play milestones, such as the AAP-endorsed brochure, Assure Baby’s Physical Development
- Ask parents targeted questions about their child’s development, rather than vague questions such as, “Does everything seem to be okay with your baby?”
- Become familiar with your state’s Early Intervention program and the resources it offers. Keep this information readily available, so that it can quickly and easily be passed on to parents when it is needed.
- Become familiar with other resources available to children with early sensory, communication and motor delays. These include local pediatric outpatient therapy clinics. Stress to parents the variety of options available for treatment.
- Consider visiting a physical, occupational or speech therapist’s office. Perhaps you can observe therapy sessions, so that you can learn more about the treatments for a child with an early sensory, communication and or motor delay. Many outpatient clinics are happy to form partnerships with local pediatricians. If your practice trains pediatric residents, you may want to make this activity part of their education.
