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Abnormal Motor Milestones

A delay in reaching motor milestones has many potential causes, such as:

  • Neuromuscular problems - e.g., Hypotonia, Cerebral Palsy, Muscular Dystrophy.
  • Metabolic problems e.g., Rickets, Mucopolysaccharidoses.

Referral to a paediatrician or specialist in muscle disease is recommended if muscle disease is suspected and if any of the following are present:

  • Walking delayed (18 months) or a waddling gait - consider muscular dystrophies.
  • Delay in other milestones (e.g., speech, communication, feeding).
  • Clumsiness or prone to falling.
  • Family history of delayed walking or muscle disease.
  • Muscles appear 'bulky'.
  • Difficulty getting up from the floor (Gower's sign).

Regression of achieved motor milestones is consistent with inflammatory joint or muscle disease but can be due to other causes. Check for any of the following: 

  • The child can no longer do activities that they had previously achieved.
  • Regression may be subtle, such as a child no longer able to do up buttons on clothes due to finger pain or swelling or a toddler wanting to be carried up and down stairs.
  • Regression can manifest as the child becoming 'clumsy'; it is important to ask about activities at home, school and play and consider walking, running, handwriting and ability on stairs.
  • Joint swelling may be subtle and easily missed.
  • Inflammatory joint or muscle disease can be indolent.
  • Referral to paediatric rheumatology is strongly recommended.

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