Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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Case in Progress

Cameron at her second birthday

Cameron is turning two years old. This is an exciting and busy time for she and her family. Cameron is a little girl with Down Syndrome that you have been able to read about since her heart surgery almost 18 months ago. Cameron and her family have endured, grown and change remarkably since we first met them. At five and half months Cameron had surgery to correct her endocardial cushion defect, and since that time has received ongoing, twice a week therapy, including physical, cognitive, aquatic, occupational, and speech.

Cameron is a darling girl with a great personality and a wonderful sense of humor. Her family is very supportive and have been instrumental in helping her achieve many goals during the second year of her life.

At each birthday, a team meeting, or IFSP Individual Family Service Plan, is held to discuss services, options, concerns and priorities. It is a time to take stock of what goals have been achieved, what concerns the parents have for their child’s development, and what services might be appropriate for meeting new goals and objectives.

At her first birthday, Cameron’s mother expressed concerns because Cameron was not yet crawling. Although this delay in learning to crawl is common for a child with Down Syndrome, due to low muscle tone throughout their body, it is still a family concern. Decreased muscle tone delays the acquisition of trunk stability, which is necessary for crawling. We set new 6 month gross motor goals for Cameron were to 1)crawl for mobility, 2) pulling to stand using furniture for support.

Cameron had previously learned how to perform some self-feeding tasks, and the family wanted to build on these skills. Cameron exhibits a very strong tongue thrust, which is also common in children with Down Syndrome. She often uses her tongue to perform tasks for which she needs to utilize other muscles in her mouth. Some of these tasks include chewing, lip closure and controlled movement of foods from the front of her mouth to the back for preparation to swallow. Cameron has significant difficulty in chewing. To address this problem we started to use desensitization methods for her oral motor development. Her family was also trained in these methods to optimize their effectiveness for Cameron. Some of these methods included using a toothbrush, wash cloth, a Nuk brand chewing brush (provided by her speech therapist), and increasing textures.

Perhaps the most difficult of these was increasing food textures. Although Cameron has very happy disposition, she has a very definite likes and dislikes. One of the things she doesn’t like is food with texture, preferring Stage 2 baby foods. At 18 months of age, it was decided that an occupational therapist would join her team of therapists to encourage tolerance for different textures, and to assistance with teaching the mechanics of eating. In the past just a few months Cameron has begun to tolerate more and varied textures and foods. She can also now use a spoon independently.

Another area that was targeted was communication. Cameron’s parents were feeling that some of Cameron’s frustration was due to an inability to communicate her needs and feelings. At 12 months of age, speech on a consult basis, but by 18 months speech therapy increased to a once-a-week therapy. Now at the age of two, Cameron is able to say several words, including a very happy and chipper "Hi!" to everyone who comes in the room. She also has some signs that she uses appropriately. Her family is pleased with her growing abilities. Every day she seems to learn something new, and she particularly loves to learn how to say people’s names.

As is typical of any two year old, Cameron has been exhibiting spells of "behaviors". Children with Down Syndrome are no different. Cameron gets frustrated when she’s overtired or hungry, and when someone takes something away from her that she wanted. However, overall she has a sunny personality and can be redirected from a tantrum. Consistency on the part of her parents has been very beneficial in this area, and is helping to move Cameron through this typical, but difficult phase of development.

One of Cameron’s new strengths this year emerged during our aquatic therapy program. She developed an aptitude and love of the water and swimming. Pediatric Services had a "swim team" this spring and summer which provided some physical therapy and an overall introduction to the water. Cameron learned and mastered water skills quickly. She was also participate in another swim group sponsored by our local Parents Helping Parents group, so her swim season was quite long this year..

The other big change in Cameron’s life has been the addition of a new little sister. She is now the middle child, and she wasn’t too sure about this new situation. She wasn’t too happy that there was someone sharing Mom’s lap, but she quickly adapted and really likes her little sister. They spend a lot of time together, and both of them are able to teach the other things.

Cameron had her two year IFSP last week. Her mother expressed her concerns and the areas that she would like to see addressed over the next six months, particularly those of walking and eating well, increasing her communication. Cameron will continue to have speech and occupational therapy weekly. Physical therapy will continue to consult with the family to address her progress towards walking. She now crawls so well and quickly that she is not quite ready to transition to walking yet.

In six months, when she is 30 months old, we will explore with the family the preschool options for Cameron, and look for the best placement for Cameron when she turns three. Until then, we know she will continue to bloom and to learn new developmental skills.

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Last modified: January 26, 2013