Know the Signs: Infant+

Infant+: Pull to sit

All ages (infant +): Pull to sit without head lag

Description

Evaluate pull to sit with attention to head lag, until achieved.

What does weakness in pull to sit look like?

Discussion

If a child has head lag at 4 months, carefully inspect neck flexors and evaluate other age-appropriate motor milestones (e.g., scores on standardized motor screening). Communicate concerns to family and referring provider and re-evaluate within one month.

Tip: When evaluating pull to sit, consider decreased endurance of head control, such as decreased head control when carried, during eating, and when dressing.

Yellow Flag
Head lag may present as torticollis.

Red Flag
A child who has significant head lag at 5 months needs further evaluation.

Therapist Response to Red Flag

Communicate specific concerns about head lag (in context of overall development and relevant environmental factors) to the family and referring provider. Encourage a referral to a specialist (consider pediatric neurology) to evaluate weakness.

Specialist Response to Red Flag

Draw a CK and refer for diagnostic workup.

Download a pdf of the Surveillance and Referral Aid for Therapists and Specialists. This Aid includes signs of weakness by age, red flags and warning signs for muscle weakness, and referral recommendations.

Infant+: Breathing

All ages (infancy +): Breathing

Description

Look for sternal retraction, paradoxical breathing, abdominal breathing and accessory muscle use, nasal flaring, bell-shaped chest, and/or increased work to breathe.

What does abnormal breathing look like?

Discussion

None of these signs should be present, and the identification of these signs may indicate an urgent concern. Reasons for troubled breathing include (but are not limited to) neuromuscular disease, heart disease, and lung disease; some causes are transient and some are permanent.

Red Flag
Any finding noted under the description is a red flag.

Therapist Response to Red Flag

Immediately contact the parents and referring provider and request that the provider evaluate the child’s breathing.

Specialist Response to Red Flag

Evaluate the need for urgent treatment/support and make immediate referral to specialists for further evaluation.

Download a pdf of the Surveillance and Referral Aid for Therapists and Specialists. This Aid includes signs of weakness by age, red flags and warning signs for muscle weakness, and referral recommendations.