After performing a developmental assessment on a child and diagnosisng grossmotor delay, it is important to look for an underlying cause and institute management. To do this we propose the following plan;

1) Take a general history involving personal, family  and social history

2) Perform a detailed physical examination to look for an underlying cause

3) Assessment for possible chromosomal abnormality
a. Karyotype
b. Testing for fragile X
c. FISH studies for subtelomere abnormalities

4) Investigate possible muscular dystrophy
a. CK
b. Molecular/genetic  tests

5) Brain imaging- CT/MRI scan

6) X-ray and  bone profile in cases of suspected rickets
a. X-ray of the wrist
b. Calcium
c. Phosphate
d. Vitamin D, Parathyroid hormone, alkaline phosphatase

7) Metabolic screen
a.  urine organic acid screen, quantitative serum amino acids, serum lactate and ammonia levels, capillary or arterial blood gas, thyroid function studies

8) Ophthalmology referral if suspected metabolic condition

9) Referral to Community paediatrician, Occupational therapist, Physiotherapist, Orthopaedic surgeon, Orthotics, School/ teacher, nurse, Geneticist, Neurologist, General practitioner, social worker, portage as required