charlotte and walking (answers)

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Charlotte is 20 months old and has just had her 18-month health visitor check.  There is some concern because she is not yet walking.

Charlotte was a breech delivery and her health and development have never until now given cause for concern. She was smiling at 6 weeks and sitting at 9 months.

On examination, Charlotte does indeed have good sifting balance and travels at remarkable speed across the floor by “hitching” herself along on her right hand and left foot. When you try to stand her up, she refuses to weight bear and stretches her legs out horizontally.

In other respects, her development is normal, and she demonstrates that she can build a tower of three bricks, enjoys scribbling and can say, Mama, Dada, cat, dog and “moo” for cow.

Case discussion: Delayed motor development

Charlotte is a variation on the theme of “bum-shuffling”. These babies are often slightly ‘floppier” than you would expect and they tend to dislike being placed prone. When held vertically they refuse to weight-bear and adopt the “sitting on-air” position. They are often late to walk and may “hitch” along or bum-shuffle. There is often a family history(which is reassuring) and inheritance is probably dominant.

Gross motor development, in general, is extremely variable but tends to follow the same pattern within families. 98% of children walk by the age of 18months, but “bum-shufflers” may be delayed up to two years or more. The age at which the “affected” parent walked is often a good prognostic indicator.

Reassuring factors also include an otherwise normal pattern of development, good sitting balance, a straight back and good”mobility”.

Pathology which may present with delayed motor development includes:

  1. Congenital dislocation of the hip
    Risk factors include breech presentation, family history and foot deformities. Look for limitation in abduction and asymmetry.
  2. Cerebral palsy
    General ability in these children is also important and children with normal IQ and milder forms of hemi- or diplegia may have “normal “motor development. Hemiplegia may mimic a dislocated hip.
  3. Neuromuscular problems
    Rare. The commonest is muscular dystrophy.
  4. Global developmental delay
    Usually obvious.
  5. Severe special sense deficit
    In particular blindness, but severe hearing loss can have a detrimental effect on motor development too.
  6. Dyspraxia
    Also known as “motor organisation problem” or just plain clumsy. Practice makes perfect.
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