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September 2005

When and by Whom Is Concern First Expressed for Children With Neuromotor Problems?

Author Affiliations

Author Affiliations: École de Réadaptation (Drs Feldman and Gosselin, Mss Couture, Grilli, and Simard, and Mr Azoulay) and Groupe de recherche interdisciplinaire en santé (Dr Feldman), Université de Montréal, Centre de recherche interdisciplinaire en réadaptation (Dr Feldman and Ms Grilli), Department of Physiotherapy, Montreal Children’s Hospital, McGill University Health Centre (Dr Feldman and Ms Grilli), and Centre de recherche Hôpital Sainte-Justine (Mss Couture and Simard, Mr Azoulay, and Dr Gosselin), Montréal, Québec.

Arch Pediatr Adolesc Med. 2005;159(9):882-886. doi:10.1001/archpedi.159.9.882

Objective  To describe when and by whom concern is first expressed for children referred to rehabilitation because of neuromotor problems.

Study Design and Setting  We conducted a survey of parents of 92 children (aged 0-6 years) who were on the waiting list for physical or occupational therapy services at rehabilitation centers in Montréal, Québec. We compared age of child at initial concern with who first expressed concern for children who were considered at risk due to their perinatal history of prematurity and those who were not born prematurely but were later diagnosed as having neuromotor problems.

Intervention  Parents were interviewed regarding their child’s medical history and utilization of health care services.

Results  Parents were concerned later than physicians were regarding their child’s development (mean difference, 8.2 months; 95% confidence interval [CI], 3.7-12.6 months). There was no significant difference in time of recognition of problems between the premature (10.2 months) and full-term (11.9 months) groups. Even after controlling for risk group, parental concern occurred later than physician concern (β coefficient, 7.3; 95% CI, 2.5-12.2). The child’s age at the time of initial concern was associated with the child’s age at referral to rehabilitation (β coefficient, 0.04; 95% CI, 0.01-0.06).

Conclusions  Early recognition is important if a child is to benefit from early rehabilitation. It may be important to improve primary care screening of children for neuromotor problems and to increase parental awareness regarding normal motor development of their children. Prompt, simultaneous referral to medical evaluation and rehabilitation resources may decrease delays in rehabilitation.