CASE IN PROGRESS • Last updated January 13, 2018
Tyler - Year 1
Tyler was born on July 18, 1996, the first child of his parents. Tyler’s parents were both young when he was born, his mother being eighteen years old, his father being nineteen years old. His mother’s health at the time of Tyler’s conception was good, and prenatal care started in the third month of the pregnancy. Prenatal care included taking prenatal vitamins and not using any tobacco, alcohol, or drugs. His mother had an AFP (amino-fetal protein) and ultrasound studies in mid-pregnancy with normal findings.
Tyler was carried 41 weeks by the dates. Labor lasted for eight hours and the birth was vaginal vertex. Tyler weighed 8 pounds, 8 ounces, and was 20.5 inches long. His apgar scores were 9 at 1 minute and 9 at 5 minutes.
Apgar scores rate the physical appearance and vital signs of the newborn at 1 minute 5 minute, and the 10 minutes if there are concerns. The maximum score is 10. Heart rate (less than 100, more than 100), respiratory effort (slow irregular, good cry), muscle tone (limp, some flexion, active motion) , reflex irritability (none, grimace, or cry), color of the baby (pale, body pink but extremities blue, all pink).
Tyler had transient tachypnea (heart murmur) for the first day and a half. He remained in the hospital for three days and two nights for observation. At the time of discharge his tachypenia had resolved, a cardiac echocardiogram results were normal, and he was eating well. The attending pediatrician did tell the mother that if Tyler showed any signs of respiratory distress, fever or poor feeding she should contact her physician immediately.
His mother tried breastfeeding for the first ten days, but was concerned that Tyler was not getting the nutrition he needed. She then switched to formula, Enfamil with iron. Tyler received all of his first immunizations on time.
By the age of three months, it was noted that Tyler was having tremors, particularly in his shoulders and hands. His pediatrician recommended that the watch and wait tactic. At the age of four months he was admitted to the hospital with generalized intentional tremors. It is unclear what diagnostic tests, if any, were done at this time. It was also noted that Tyler had trouble gaining weight and was hypo-responsive (decreased) to stimuli.
Tyler’s parents state that he rolled for the first time at 6 months, sat when placed at 8 months, and got himself to sit for the first time at 9-10 months, and began to crawl at 12 months. At this point is was becoming apparent that Tyler was not achieving typical developmental milestones in a timely fashion.
At his first birthday he weighed 16½ pounds which was below the 5% and was 28 inches long, which was between the 5-10%. This was of great concern to the family , as was Tyler’s general unsteadiness, even in sitting.
Despite all these concerns Tyler was not referred to Early Start for services for another 6 months. Come back next month and watch Tyler grow and develop.
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