Normal motor development and developmental variation — formative SAQs

SAQ 1 (10 marks)

Parents of an 11-month-old say their child “never crawls” and only bottom-shuffles. Sitting is independent, tone is normal, both hands reach and transfer, and there is no skill loss. They want an MRI “to be sure.” ^{[1] [3]}

1. Place this presentation using WHO motor windows and the concept of healthy variation. (3) ^[1]
2. Outline your bedside motor assessment for this visit. (4) ^{[2] [3]}
3. Give your plan, including what you will and will not order today, and one safety-net. (3) ^{[1] [5] [10]}

Model answer

About 4.3% of healthy WHO cohort children never show hands-and-knees crawling; walking alone still has a wide window (8.2–17.6 months). Bottom-shuffling with good sitting, tone and hand use is often healthy variation, not automatic pathology. ^[1] Observe spontaneous movement first, then examine head/trunk control, transitions, locomotion style, fine motor, tone, power, reflexes, symmetry and any residual obligatory patterns; use corrected age only if preterm and early. ^{[2] [3]} Reassure with the specific window language, promote floor play, do not order MRI for isolated non-crawling with a normal exam, set a timed review of walking progress, and safety-net return for regression, asymmetry, stiff or floppy tone, or no efficient progress toward standing/walking. ^{[1] [5] [10]}