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

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Case in Progress

Riley - Year 1

Riley was born at the local hospital on August 16th. Riley was born just short of full-term, at 38 weeks gestation, following 18-19 hours of labor. He weighted 8 lbs., 8 oz., and was 20 inches long.

During her pregnancy his mother experienced much nausea and vomiting , more intensely than her previous pregnancy. She was able to take prenatal vitamins and Phenargen, which helped the nausea. During the pregnancy there was some concern of possible unilateral hydronephrosis, (unilateral meaning one of his two kidneys; hyronephrosis which is the collection of urine in the kidney due to obstruction causing a cyst to form). A renal ultrasound at birth showed both kidneys were normal.

At birth Riley had a transient tachypnea for one day, (tachypnea is abnormal rapid breathing). He went home from the hospital with his mother, father and big sister, after his first 24 hours of life.

From the very beginning, Riley had difficulties with feeding - with a poor ability to develop a strong suck at the breast. At 5 days old he was switched from breast milk to a cow’s milk formula. He immediately developed significant signs of colic and malabsorption. He was then changed to a soy-based formula, but there was little change in his symptoms.

At 4 months Riley was seen by an pediatric ophthalmologist. He was having problems fixating and tracking. He was diagnosed with hyperopia, (farsightedness) astigmatism, (Refractive error which prevents light rays from coming to a point or focus on the retina,) and right exotropia, (tendency of the right eye to turn outward). He was prescribed glasses at that time as well as a patching routine to strengthen his eyes.

Riley was continuing to have poor weight gain and vomiting so his formula was switched to Alumentin, which is easier for him to digest. He tolerated this well and began to show signs of improved growth. At the age of 5 months he was diagnosed with gastroesophageal reflux following a series of tests of his gastro-intestinal system, (GI). There was also evidence of mild gastritis.

Because of the reflux his formula was again switched. This time to Nutramigen, a special pre-digested formula. He also began taking Zantac and Propulsid for the reflux and stomach acid problems. Riley was now termed "failure to thrive".

Although his growth appeared to be improving, at 8 months of age Riley was 26.5 inches long (7th percentile) and weighed 14.4 pounds (below the 5th percentile). It was also noted at that time that Riley was showing delays in the areas of fine and gross motor development of approximately three months. In the area of language and communication, cognitive skills Riley was also showing a delay scattering from 2 to 3 months.

Riley was very susceptible to colds and other illnesses due to his failure to thrive. His demeanor was irritable and cranky and his Mom often did not take him outside. She also kept Riley’s older sister out of preschool because of the germs she would bring home. His disability was now affecting the routine of his entire household.

Riley was referred to Pediatric Services for in-home therapy at this time. His mother had been taking Riley to a center-based program, but did not feel it met their needs. Riley was a medically fragile child who presented with general developmental delays in all areas. He demonstrated low tone throughout his body, with laxity in his joints. He had a general flattening of the rib cage, that appeared to limit his capacity for making sounds. He had a very limited tolerance for therapeutic handling and tired quickly.

With the initial evaluation finding we recommended a comprehensive home program. We began providing Riley with weekly physical therapy, nutritional consultation, and parent and child education.

Also at this time Riley began at the gastro-intestinal (GI) clinic for his reflux, gastritis and malabsorption. Riley was also being followed by California Children’s Services for occupational therapy, oral-motor, and feeding issues.

Just prior to his first birthday, a speech assessment was completed. He remained delayed in all areas, with oral motor and feeding difficulties impacting his acquisition of language. He was now tolerating intervention services, was friendly, social, and engaging.

His receptive language was progressing, with the ability to focus on people and objects, beginning to understand such commands as come, stop, and he responded to his name. He attempts to imitate games such as peek a boo, and pat a cake(clapping his one hand on his leg). In vocalizing, he primarily used elongated vowel sounds, with some consonant sounds, and limited consonant vowel combinations, such as dada and "num num". He expressed himself mostly with happy and unhappy "sounds" and crying.

At the time of his first birthday, his fine motor skills were at 28-32 weeks, gross motor and self care skills were at 32-36 weeks, communication and cognitive skills were at 24-28 weeks. He had learned to tolerate the stimulation provided during intervention, and even enjoy it. He was learning to work through some frustrations and would even pursue a toy not in his immediate reach. He performed for social attention and his parents reported he was a much happier baby.

His family was very pleased with the progress he was making. We were all eagerly anticipating the second year of Riley’s life with all the challenges and success we predicted.

Return here next month to see how Riley is growing!

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Last modified: January 26, 2013