Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary

4. GI

5. GU

6. Orthopedics

7. Neurological
--Breath-Holding Spells
--Benign Febrile Seizures
--Treating Children with Seizures
--ADHD
--Occupational Therapy
--Pediatric Physiatry 

Developmental Delay: When to Refer

Introduction: Parents look at well check-ups as an opportunity to be reassured that their child is doing well, to ask their many questions, and to feel good about their child.  When problems come up during the exam: whether they be behavioral, feeding problems, or physical, the interaction becomes something it was not supposed to be: stressful.  The most stressful thing that can be told parents is that their child is not meeting normal motor or mental milestones.  On the other hand, most of the time, when you bring up a possible problem, most parents will have had some awareness of this situation.  So if you don’t mention anything, you are considered negligent or at best unobservant.  How you handle this situation is how you practice the ART of medicine. 

Consultants Needed for Children With Clear-Cut Developmental Delays: (found only in tertiary centers): Developmental pediatricians; Orthopedists; Audiologists and Speech Therapists; PT/OT/Infant Stimulation Specialists; Pediatric neurologist; Educational specialist; pediatric surgeons, pulmonologists, cardiologists, etc.

Children Who All Need to Be Referred to Such Centers: Most are self-evident (such as the first 3 groups of patients).

1. Children with chromosomal abnormalities, cranio-facial abnormalities
2. Ex-preemies, or severe SGAs who have not grown or developed well
3. Children who have had prolonged neonatal stays for whatever reasons, and who do not seem to be developing normally.
4. Children who seemed normal at birth who do not do well.  These are the children in question.

How to Determine That a Child Needs a Referral:

1. Growth chart and visual exam: see earlier discussion.
2. Developmental milestones: since you are dependent on the parents for this history, use the Denver Developmental testing kit.  Some groups do this on all children.  Some just complete these children are delayed because of benign congenital hypotonia; most floppy children will have a problem.  Distinguish the two by trying to determine mental milestones for the child.  Remember body tone in former prematures may not be normal until 15-18 months of age.

Who Refer a Child to?

1. If clear-cut, then refer to the team listed above.
2. If not clear-cut, refer to Infant Stimulation person, who is usually a PT.  They can either confirm or not your concerns.

What You Tell the Parents? You must be forthright, but not brutal.  If you think child is delayed, tell them you are concerned about the child’s development; if you aren’t sure, tell them you need another opinion, and refer to IDP.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004