title: Age at Referral of Children for Initial Diagnosis of Cerebral Palsy and Rehabilitation: Current Practices.
abstract: OBJECTIVE
  This study describes current practices in the age at referral for diagnosis of cerebral palsy and factors that influence earlier referral.
  
  
  METHODS
  Retrospective chart review (2002-2012).
  
  
  RESULTS
  Of 103 children referred for diagnosis, 81 were referred to a neurologist by other medical specialists at a mean of 13.6 ± 15.7 months, whereas primary care providers referred much later (mean = 28.8 ± 27.1 months). Children admitted to the neonatal intensive care unit were referred earlier (mean = 9.3 ± 10.2 months) than those not (28.1 ± 24.9 months). Referral to rehabilitation was similarly delayed.
  
  
  CONCLUSIONS
  Primary care providers generated a minority of referrals, of concern given their role in developmental surveillance. Remarkably high variability suggests knowledge of cerebral palsy attributes varies widely among service providers. Half of children with cerebral palsy do not have a complicated birth history; subsequently, referrals for diagnosis and management are often delayed. New strategies are needed to optimize prompt referral by primary care providers.
authors.affiliation: Department of Psychology, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Lara
authors.initials: L
authors.lastname: Hubermann
authors.affiliation: School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Quebec, Canada Montreal Children's Hospital-McGill University Health Centre, Montréal, Quebec, Canada.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Boychuck
authors.affiliation: Montreal Children's Hospital-McGill University Health Centre, Montréal, Quebec, Canada Departments of Neurology/Neurosurgery & Pediatrics, McGill University, Montréal, Quebec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Shevell
authors.affiliation: School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Quebec, Canada Montreal Children's Hospital-McGill University Health Centre, Montréal, Quebec, Canada Departments of Neurology/Neurosurgery & Pediatrics, McGill University, Montréal, Quebec, Canada annette.majnemer@mcgill.ca.
authors.forename: Annette
authors.initials: A
authors.lastname: Majnemer
mesh_terms: D000367:Age Factors; D002547:Cerebral Palsy / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: cerebral palsy; diagnosis; early identification; referral; rehabilitation