I-CAN-development
Infant and Child Assessment of Neuro-development
Comprehensive neurodevelopmental assessment and follow-up for infants and children
What neurodevelopmental assessments and services are offered?
We offer a range of services depending on your situation and preferences. This could be a one-off General Movement Assessment at 3 months or a comprehensive 2-year neurodevelopmental assessment for children already receiving NHS neonatal follow-up but where these are not included.
Alternatively you could opt for a tailored follow-up programme with regular assessment of neurodevelopment if your baby is not included in local NHS follow-up programmes or if you prefer a more detailed and bespoke approach where appointments are less rushed and more flexible.
Assessments and services
Depending on your child's age and needs, as well as your preferences, assessment may include one or more of the following:
Initial consultation
Initial consultation includes finding out about parental concerns, taking a full history including details about pregnancy, birth and any newborn problems, and determining what further assessment is recommended, helping you make an informed decision. Consultation includes neurological examination.
Neurological examination
A full neurological examination allows an evaluation of a child's nervous system and is specifically modified depending on the age of the infant or child. This is included in an initial consultation. Serial neurological examination is useful in infants at risk of neurological problems.
General Movement Assessment
This assessment is a standardised test of movement that is scored by a certified assessor observing and analysing a video recording of a baby's movements at 3-4 months of age. NICE recommend it's use during routine neonatal follow‑up assessments for children who are at increased risk of developing cerebral palsy.
See below
1 & 2-year assessments
The Bayley Scales of Infant and Toddler Development (BSID) is play-based and examines children’s motor (movement), language, problem-solving ability and social skills; it usually takes approximately one to one and a half hours.
The BSID is viewed as the gold standard assessment tool for assessment of infants and toddlers. See below
Reports
Following every clinic visit or assessment a clinic letter or written report is produced; if relevant this will include results and explanation of standardised assessments with a detailed profile of strengths and difficulties. Reports include professional opinion, advice and recommendations for further support.
Home visits
Occasionally parents request that developmental assessments are carried out in their home environment; this can be accommodated within a reasonable distance and incurs an additional charge.
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General Movement Asasessment
(age 3- 4 months)
General Movements (GMs) are predictive of how the young central nervous system is developing. They can identify neurological issues which can predict cerebral palsy (a disorder of movement) and other developmental disabilities. The purpose of identifying a potential movement disorder early is to ensure that any intervention can be started as early as possible, with the aim being to achieve the best outcome for your child.
NICE state: "Consider using the General Movement Assessment (GMA) during routine neonatal follow‑up assessments for children ...... who are at increased risk of developing cerebral palsy"
Risk factors for cerebral palsy include preterm birth (with risk increasing with decreasing gestational age), maternal chorioamnionitis, low birth weight, neonatal encephalopathy, sepsis and meningitis.
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More about the General Movement Assessment
What is a General Movement Assessment?
This assessment allows observation of how your baby is moving. It is a standardised test of movement that can be scored, based on observation of your baby’s movements, by certified assessors trained by the General Movements Trust. Between 12 and 16 weeks of age normally developing babies will have developed a type of underlying movement known as fidgety movements. Babies who have fidgety movements are highly likely to have a good outcome in terms of their general motor (physical) development. Absent fidgety movements indicate that there is a high risk that they will have an underlying movement disorder.
What is a Motor Optimality Score (MOS)?
The Motor Optimality Score (MOS) is a detailed GMA that evaluates age-specific motor repertoire including fidgety movements and other movements and postural patterns expected to be present in this period. Scores are predictive of motor and cognitive impairment.
Benefits of having the assessment
Babies who clearly demonstrate the presence of fidgety movements are highly likely to have normal physical development and therefore not require further intervention; this can be very reassuring to parents who have been informed that their baby is at risk of developmental problems due to prematurity or medical problems around the time of birth.
Early detection of a movement problem means that early intervention such as physiotherapy can be started as early as possible to give your child the best possible opportunity to reach their optimum potential.
What does the assessment involve?
The assessment involves your baby being videoed whilst lying comfortably on their back wearing just a nappy. They need to be awake so natural movements can be observed, and it is important that your baby is not distracted during the recording as this will alter the movements. The length of the video depends on how old your baby is.
The video assessment can be recorded during a face-to-face appointment with a consultation, alongside a neurodevelopmental assessment or you can record your baby in the comfort of your own home and send the video for review.
Once the video has been reviewed and reported by Dr O’Brien, you will be contacted to let you know the results. This will usually be done over the phone to allow you to ask any questions you may have about the results and what this may mean and to save you from needing to wait to make an additional appointment. However, you are welcome to make a face-to-face appointment should this be your preference.
This assessment tool has a high predictive value relating fidgety movements to physical outcome but no tool is (currently) 100% predictive.
Standardised neurodevelopmental assessments
The goal of a neurodevelopmental assessment is to assess all aspects of a child’s development including cognition, language, motor and social skills using play-based tests as well as assessing neurological examination and physical health.
By using standardised neurodevelopmental assessments the aim is to determine whether a child is developing as expected and provide detailed information about all areas of development.
1- & 2-year assessments
Bayley Scales of Infant and Toddler Development
This developmental assessment is a national recommendation for babies who were born very prematurely or who received hypothermia treatment or who have had an illness or brain injury which could affect their development. It is also useful for children born moderate- or late-preterm who are also more at risk of developmental impairment than term-born children.
The assessment is carried out at around 2 years of age (corrected for prematurity if relevant). Children undergo a play-based assessment including gross and fine-motor (movement), social development, language, and learning ability.
You will receive a report about your child’s development and if you wish receive a follow-up appointment with a Dr O’Brien to discuss the findings. If a child needs further specialist input then referrals can be made eg to a Speech and Language Therapist or Physiotherapist.
Follow-up programme
Regular follow-up for children at risk of developmental delay
Babies who were born very preterm or who had medical conditions at birth or immediately after their birth and who were admitted to the Neonatal Intensive Care Unit (NICU) may be at risk of delayed development. Regular review of developmental progress, neurological and general examination, and neurodevelopmental assessment is recommended by NICE from NICU discharge until 2 years of age when a formal neurodevelopmental assessment is recommended.
Infant plans
All children are different and we are happy to discuss the services on offer. You may wish to choose one of the services above as stand-alone assessments depending on your child's age and needs, or you may prefer to opt for a combination of assessments or a follow-up service which covers the first two years.
Recommendations
and referrals
Following each assessment or clinic visit a written report or letter will be sent to you; where relevant this will include results and explanation of standardised assessments with a detailed profile of strengths and difficulties. You will receive advice about appropriate play-based activities to build on neurodevelopmental strengths to optimise development.
Reports may also include recommendations for further support and / or referral to other appropriate health professionals. For instance babies who have sub-optimal Motor Optimality Scores following a General Movement Assessment might benefit from input from a Physiotherapist or a Speech and Language Therapy referral could be useful for a child with communication difficulties .
Depending on your preference, formal referrals can be made to appropriate allied health professionals (therapists) or suggestions made regarding local private practitioners. Alternatively you may wish to make your own enquiries for ongoing therapy.
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Infant and Child Assessment of Neuro-development
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