Being a GP at a practice committed to continuity of care reminds me of the vital role we as primary care health professionals play when a newborn baby is brought in for check-ups at the start of their journey through childhood, adolescence and into adulthood.
One aspect of particular importance at this stage is that of a baby’s movement or motor skills development, as failure to reach these movement milestones may indicate possible early signs of neuromuscular disease that can present in the first few months of life.1 Neuromuscular disease, while rare, can be fatal and any damage that occurs before treatment can be irreversible,2 so prompt diagnosis is vital.
A recent survey illustrates a pressing need for further awareness around this issue as it found only 4 in 10 new parents were aware of the three key movement milestones their baby should be achieving within the first three months: raising their head when laying on their tummy, kicking their legs and waving their arms when on their back, and reaching for things.3 Although children develop at different rates, within the first three months of life their progress on all three fronts should be clear. Of additional concern is that only 1 in 10 surveyed said they would speak to, or had spoken to, a practice nurse straight away if they felt their baby was not making these expected movements.3
Yet we are uniquely placed in primary care to spot early signs of neuromuscular disease as we see babies at check-ups and for immunisations. An ideal time that a practice nurse can look out for signs is when a baby is presented for their first round of immunisations at eight weeks and then again at 12 and 16 weeks. While there’s plenty to be done already in providing immunisations themselves, it is also a chance for practice nurses to ask parents specific questions and flag up any concerns. They can then escalate to a GP for further assessment if needed.
This topic is central to a newly launched campaign by Novartis Gene Therapies, ‘Think 3 for NMD’, which provides further information for healthcare professionals, and has a range of educational materials on movement milestones and checking for neuromuscular disease including a video and discussion guides at www.Think3NMD.co.uk.
There are three signs that should be monitored up to three months of age: head lag, hypotonia and inability to reach. Three simple checks can be performed. For head lag,1,4 a baby should be able to hold their head up for a short period of time, when either being brought to a sitting position from lying on their back, or when placed on their tummy. A baby with hypotonia1,5 may feel limp when held. Lastly, by three months, a baby should begin to reach for toys and objects placed in front of them.1,4
Time is precious. I would ask, if you suspect neuromuscular disease, act immediately and refer to a GP urgently who can expedite the referral to a paediatric neurologist. Often, the faster a baby is identified and diagnosed, the sooner they receive support and the better their outcomes.
Medical writing support for this article was provided by Havas Life Medicom with funding from Novartis Gene Therapies.
Dr Richard Pratt, General Practitioner
References
1.McDonald CM. Phys Med Retail Clin N Am. 2012;23(3):495–563.
2.Glascock J, et al. J Neuromusc Dis. 2018;5:145–58.
3.Novartis Gene Therapies Data on File
4.Great Ormond Street Hospital for Children NHS. Brief Developmental Assessment (BDA). Available at: http://www.gosh.nhs.uk/file/1841/download?token=oTvMwb9q. Accessed: October 2020.
5.National Health Service 2018. Hypotonia. Available at: https://www.nhs.uk/conditions/hypotonia#:~:text=Hypotonia%20present%20at%20birth%20is,their%20head%20tends%20to%20flop. Accessed: October 2020.