'Clumsiness'

'Clumsiness' is a term that is used sometimes in lay language to describe a child with motor abilities that are less compared to their age-matched peers. Healthy normal young children as a feature of their developmental stage may be prone to falling or unable to perform tasks requiring manual dexterity. It is important therefore to be aware of normal development and motor milestones. 

The child who is well, without pain and has no limitation in function (play or walking) and has achieved normal milestones, is unlikely to have pathology. 

Indications for concern include:

• Delay / regression in achieved milestones (especially major motors skills).
• Regression of achieved milestones is more likely with acquired pathology (including inflammatory joint or muscle disease).
• Impaired functional ability (ask about play, sport, schoolwork, handwriting, ‘dressing’).
• Marked hypermobility.
• Learning difficulties.
• Dyspraxia, co-ordination difficulties.
• Limping (intermittent or persistent).
• Morning symptoms (other than tiredness after disturbed sleep) suggest inflammatory disease.
• Widespread pain (such as upper limbs and back).
• School absenteeism.
• Indicators of joint or muscle disease (e.g., pain, swelling, stiffness, gelling after rest, weakness or limping).
• Systemic illness ('red flags').

Consider a referral to neurology / neuromuscular service if there is suspicion of muscle disease or a neurological cause. 

Consider referral to paediatric rheumatology if there is suspicion about joint disease.

Consider referral to general paediatrics, which is often warranted, to exclude other causes of 'clumsiness'. 

Developmental Co-ordination Disorder is a common cause of a child being clumsy and there are often other issues such as dyspraxia, concentration and learning difficulties. These children are also often hypermobile.