Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.

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AimThis study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses’ SOMP-I assessments and the actions taken when motor problems were suspected.MethodInfants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants’ motor development was reassessed at 18 months of age through review of medical records or parental report.ResultsThe assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.InterpretationThe use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

Despite brief experience with SOMP-I, the agreement was excellent when assessing the level of motor development, but was less satisfactory for the assessment of quality of motor performance. More extensive education and training may be necessary to improve the nurses' ability to assess quality, as this domain was an entirely new concept to the nurses. Further research is warranted to determine the applicability of SOMP-I as a standardized method for nurses to assess motor development within the CHS.

Rational and aims: Early intervention is considered best practice for children with Cerebral Palsy (CP). Given that access to such intervention is known to vary, we aimed to investigate whether children with CP in Uppsala County, Sweden, have equal access to timely physiotherapy. Furthermore, we describe their birth history and CP profile to learn more about typical features that might enable earlier identification. Method: We conducted a retrospective chart review study including children born in the county from 2010 to 2016, who received a CP diagnosis by December 2018. Entries by doctors and physiotherapists working at Uppsala University Children's Hospital were reviewed. Results: Thirty-eight children were included (21 girls). Twenty-two (58%) were term born. Age at first visit to physiotherapy varied greatly and depended on referral source (p<0.000) and number of risk factors for CP (p<0.000). Children considered at low risk for CP received therapy later. Severity of motor impairment (p=0.001) and number of risk factors (p=0.014) influenced age at referral to habilitation services. Twenty-eight (74%) children were ambulatory at 2 years of age. Unilateral (n=16) and bilateral (n=17) spastic CP was most common. Children referred from the child health services (CHS) had milder forms of CP. Conclusion: Children with CP have unequal access to timely physiotherapy, and children referred from the CHS have the most delayed access. All professionals performing developmental surveillance and health monitoring should receive proper training and use evidence-based assessment methods when available to provide safe and equal care. Physiotherapy should be available prior to formal medical diagnosis.