Quality statement 2: Referral for children with delayed motor milestones

Quality statement

Children with delayed motor milestones are referred to a child development service.

Rationale

The diagnosis of cerebral palsy is typically based on observations and parental reports on the attainment and quality of motor milestones. Referral to a child development service will enable early diagnosis of cerebral palsy, guide interventions, inform prognosis and let family members know what to expect.

Quality measures

Structure

Evidence of local arrangements to provide child development services for children with delayed motor milestones.

Data source: Local data collection, for example, service protocols.

Process

Proportion of children with delayed motor milestones who are referred to a child development service.

Numerator – the number in the denominator who are referred to a child development service.

Denominator – the number of children with delayed motor milestones.

Data source: Local data collection, such as the Royal College of Paediatrics and Child Health personal child health record ('red book').

Outcome

Number of children and young people with cerebral palsy who were diagnosed by age 2 years.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as primary care services) ensure that they provide healthcare professionals with training to enable them to identify delayed motor milestones in children.

Healthcare professionals (such as GPs, practice nurses and health visitors) are aware of motor milestones in children and refer children with delayed motor milestones to a child development service for multidisciplinary assessment.

Commissioners (such as clinical commissioning groups and local authorities) ensure that child development services are available to provide an assessment of motor milestones to help early diagnosis and intervention in children with delayed motor milestones.

Children with unusual signs that suggest possible cerebral palsy are referred to a specialist team at the local child development service for more checks to find out whether they have cerebral palsy. Examples of unusual signs are not sitting by 8 months, not walking by 18 months, or using one hand more than the other before 12 months.

Source guidance

Cerebral palsy in under 25s: assessment and management (2017) NICE guideline NG62, recommendation 1.3.6

Definitions of terms used in this quality statement

Delayed motor milestones

The following are the most common delayed motor milestones in children with cerebral palsy:

  • not sitting by 8 months (corrected for gestational age)

  • not walking by 18 months (corrected for gestational age)

  • early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age).

[NICE's guideline on cerebral palsy in under 25s, recommendation 1.3.5]

Child development service

A service that offers multidisciplinary assessment for children and that:

  • provides the following expertise, as appropriate, though a local network of care:

    • paediatric or adult medicine

    • nursing care

    • physiotherapy

    • occupational therapy

    • speech and language therapy

    • dietetics

    • psychology

  • can enable access to other services within their local or regional network as appropriate, including:

    • paediatric or adult neurodisability, neurology, neurorehabilitation, respiratory, gastroenterology and surgical specialist care

    • orthopaedics

    • orthotics and rehabilitation services

    • social care

    • visual and hearing specialist services

    • teaching support for preschool and school-age children, including portage (home teaching services for preschool children).

[Adapted from NICE's guideline on cerebral palsy in under 25s, recommendation 1.5.3]