title: When and by whom is concern first expressed for children with neuromotor problems?
abstract: OBJECTIVE
  To describe when and by whom concern is first expressed for children referred to rehabilitation because of neuromotor problems.
  
  
  METHODS
  We conducted a survey of parents of 92 children (aged 0-6 years) who were on the waiting list for physical or occupational therapy services at rehabilitation centers in Montréal, Québec. We compared age of child at initial concern with who first expressed concern for children who were considered at risk due to their perinatal history of prematurity and those who were not born prematurely but were later diagnosed as having neuromotor problems.
  
  
  METHODS
  Parents were interviewed regarding their child's medical history and utilization of health care services.
  
  
  RESULTS
  Parents were concerned later than physicians were regarding their child's development (mean difference, 8.2 months; 95% confidence interval [CI], 3.7-12.6 months). There was no significant difference in time of recognition of problems between the premature (10.2 months) and full-term (11.9 months) groups. Even after controlling for risk group, parental concern occurred later than physician concern (beta coefficient, 7.3; 95% CI, 2.5-12.2). The child's age at the time of initial concern was associated with the child's age at referral to rehabilitation (beta coefficient, 0.04; 95% CI, 0.01-0.06).
  
  
  CONCLUSIONS
  Early recognition is important if a child is to benefit from early rehabilitation. It may be important to improve primary care screening of children for neuromotor problems and to increase parental awareness regarding normal motor development of their children. Prompt, simultaneous referral to medical evaluation and rehabilitation resources may decrease delays in rehabilitation.
authors.affiliation: Ecole de Réadaptation and Groupe de recherche interdisciplinaire en santé, Université de Montréal, Québec, Canada. debbie.feldman@umontreal.ca
authors.forename: Debbie
authors.initials: D
authors.lastname: Ehrmann Feldman
authors.forename: Mélanie
authors.initials: M
authors.lastname: Couture
authors.forename: Lisa
authors.initials: L
authors.lastname: Grilli
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Simard
authors.forename: Laurent
authors.initials: L
authors.lastname: Azoulay
authors.forename: Julie
authors.initials: J
authors.lastname: Gosselin
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis* / Q000534:rehabilitation; D009068:Movement / Q000502:physiology; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000534:rehabilitation; D009460:Neurologic Examination; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010372:Pediatrics; D026761:Physical Therapy Specialty; D011792:Quebec; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors