Clinical Review Evidence based case report

Assessing developmental delay

BMJ 2001; 323 doi: (Published 21 July 2001) Cite this as: BMJ 2001;323:148
  1. Jon Dorling (, specialist registrara,
  2. Alison Salt, consultant paediatricianb
  1. a Jenny Lind Children's Department, Norfolk and Norwich University Hospital Trust, Norwich, Norfolk NR1 3SR
  2. b Neurodisability Service, Wolfson Centre, London WC1N 2AP
  1. Correspondence to: J Dorling
  • Accepted 11 April 2001

An 18 month old boy was referred to the local child development centre because he was not walking independently. He walked around by holding on to furniture; he had first crawled at age 11 months.

We wanted to use an evidence based approach to guide our assessment and management, so before seeing him, we considered three issues. Firstly, we wanted to know whether, in an 18 month old child referred to a community paediatrician because he cannot walk independently, the most likely outcome is cerebral palsy, a primary muscle disorder, another neurological abnormality, or simply delayed motor development. Secondly, we wanted to know how many children with Duchenne muscular dystrophy present with delayed walking at 18 months. Thirdly, we wanted to know whether a creatine kinase level is a worthwhile screening test if there are no abnormal signs.


To determine the most likely outcome, we used a Medline database to obtain evidence (at We used a filter to select articles dealing with prognosis (from We found additional papers by using the exploded form of “prognosis” (“exp prognosis”) instead of the text word. We combined …

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