Early Detection: Why It Matters in Pediatric Development

Children grow and develop in unique ways—but when delays in movement, coordination, or muscle tone arise, identifying them early is key.

As a pediatric physiatrist, Dr. Kelly Pham helps recognize neuromuscular and developmental challenges even before a formal diagnosis. Her mission is clear: ensure children receive timely support to thrive and reach their full potential.

Early detection refers to recognizing signs of developmental or physical delays in infancy or early childhood—ideally before age 1 or 2—so that supportive interventions can begin as soon as possible.

It includes identifying issues such as:

• Delayed motor milestones (e.g., rolling, sitting, crawling, walking)
• Muscle tone differences (stiffness or floppiness)
• Asymmetrical movements or favoring one side of the body
• Persistent toe walking
• Poor head control or difficulty with balance

Sometimes early signs are subtle. That’s why awareness from parents, pediatricians, therapists, neonatologists and physiatrists working together is essential.

Physiatrists are uniquely trained to assess movement, muscle tone, posture, and function. Dr. Pham often evaluates children when:

• Parents or pediatricians notice something “off” with movement or posture
• Physical or occupational therapists raise concerns during sessions
• A child is at risk due to prematurity, NICU stay, or a known medical condition

Dr. Pham’s assessment may include:

• A review of birth and developmental history
• A neuromuscular exam to assess muscle tone, reflexes, strength, and symmetry
• Observation of motor skills and play behaviors
• Input from therapists or early intervention teams
• Use of standardized tools such as:
  • General Movements Assessment (GMA): a non-invasive tool that evaluates spontaneous movements in infants to help detect early signs of cerebral palsy
  • Hammersmith Infant Neurological Examination (HINE): a structured exam used between 2 and 24 months of age to assess neurological function and identify early developmental concerns
• Collaboration with specialists such as pediatric neurologists or geneticists, if needed

According to Novak et al. (2017), children with signs of cerebral palsy can often be diagnosed as early as easily as 3-6 months of age with proper evaluation. Early diagnosis leads to early intervention, which is shown to improve functional outcomes significantly.

Therapists—especially physical, occupational, and speech-language pathologists—are often the first to observe subtle delays or motor concerns.

If a therapist notices:

• Unusual muscle tone patterns (e.g., persistent stiffness or floppiness)
• Delays in gross motor development (e.g., not sitting by 9 months)
• Asymmetries in posture or movement
• Challenges in transitions or motor planning

…they should recommend a referral to a pediatric physiatrist for comprehensive evaluation.

Early concerns do not always indicate a long-term condition, but a timely assessment allows for appropriate intervention, therapy guidance, and peace of mind.

The brain is most adaptable (or “plastic”) in the early years of life. This means:

• Skills learned during early childhood can become more permanent
• Therapy is more effective when started before habits are ingrained
• Parents can receive coaching to support development at home
• Equipment and orthoses can be introduced proactively, not reactively

In a large review, Spittle et al. (2021) concluded that early intervention in at-risk infants significantly improves motor and cognitive outcomes by school age.

You should consider a physiatric evaluation if:

• Your child is missing key motor milestones
• A therapist has expressed concern about muscle tone or coordination
• Your child was born prematurely or had complications during birth
• You’ve been told “wait and see,” but your gut says something more is going on
• You want a coordinated plan for therapy, referrals, or equipment

At The Reach Center, Dr. Kelly Pham provides compassionate, early assessments and clear guidance for families. Whether your child is showing signs of a delay or you simply have questions, we are here to support your journey from the start.

References:

• Novak, I., Morgan, C., Adde, L., et al. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment. JAMA Pediatrics, 171(9), 897–907.
• Spittle, A. J., Orton, J., Anderson, P. J., Boyd, R. N., & Doyle, L. W. (2021). Early developmental intervention programs post-hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005495.
• Fehlings, D., Switzer, L., & Fehlings, L. (2021). Physiatry in the management of children with cerebral palsy: An integrative approach. Physical Medicine and Rehabilitation Clinics of North America, 32(2), 201–214.

Centers for Disease Control and Prevention (CDC). (2023). Developmental Milestones. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/