6-month-old: Delayed early motor development

Birth and Infancy

M was born following a normal pregnancy, labor and delivery. At 6 months, M’s parents became concerned regarding his gross motor delays. M could not roll over, push up when prone, or sit unassisted. In addition, M demonstrated arm “flapping” when excited. Early intervention services were recommended for M by his PCP. He began weekly PT at 7 months of age to work on strengthening and training.

What should have occurred, based on M’s developmental history? Now read what happened.

Diagnosis

At 21 months M was still not walking, pulling up, or sitting unassisted. The PCP made a referral to neurology for an evaluation. Prior to the consultation, the neurologist requested that the PCP order a CK, which was extremely elevated.

Clinical Pearl: If you evaluate a child with developmental delay, do a CK.

Based on the CK result, the neurologist agreed to see the child with less than the usual wait time. Genetic testing followed and confirmed a diagnosis of Duchenne muscular dystrophy. The PCP communicated the diagnosis with the PT, who subsequently modified M’s therapy plan to reduce the risk of muscle damage. Clinical Pearl: If you evaluate a child with developmental delay, do a CK.