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

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Case in Progress

Riley - Year 3

At Riley’s second birthday last August, he had made great strides in his development. He could walk, run (falling periodically), climb onto adult size furniture, stoop to play and stand back up again. He could eat with a spoon and drink independently from a cup. He could remove several pieces of clothing by himself, and he had a few words (Mama, Daddy, Sissy, more, baby, please, thank you).

He has a wonderful personality, and loves to play. He would greet his therapists at the front door when they arrived. Holding on to their toy bag, he would walk them into the living room and then wait expectantly for the first toy to be brought out. Riley preferred that ALL the toys be brought out immediately, which is typical, but that would not teach him the skills we wanted. One of his skills we were working on was to learn turn taking and to ask for more. In working with one object at a time we could better facilitate his learning.

Riley began to attend a home daycare in the fall, so his mother could work one day a week at his sister’s school. Riley enjoyed this situation, and interacted well with the children. His mother reported that he would often imitate the other children’s mannerisms and actions (even the ones she didn’t want him to imitate!) He loved playing with all the kids, but particularly Cameron, ( the same little girl you have read about on this site).

Also, in the fall, Riley’s family made another trip to see Dr. Susan Winter at the Diagnostic Center in Fresno. At this time Riley was diagnosed with lactose intolerance. Subsequently his mother immediately began making changes in his diet, and there were some digestive improvements. Riley’s stomach, which often looked distended, seemed to shrink, and his breathing was somewhat better.

He also saw the diagnostician for the Regional Center, who placed him below the 5th percentile for height and weight, but growing along a parallel curve. Riley had been diagnosed with hydronephrosis before his birth, so the doctor recommended that he receive another renal ultrasound to be sure that there were no residual effects. He recommended continued use of orthopedic shoe inserts to improve his stability in walking, as well as help Riley’s overall gross motor growth. It was decided that Riley would see him again at about his third birthday to gauge his progress and see if he would still be eligible for Regional Center services.

In January of this past year, it was discovered that his tonsils were so enlarged that they were impeding air flow and his ability to move his tongue correctly. Riley also continued to get ear infections. Due to his continual illness through the winter his family removed him from the daycare setting. It is quite common for children to experience an increase in illness’ when they first enter daycare. Unfortunately for Riley, his illness were having a negative impact on his overall growth and acquisition of developmental milestone. It was finally decided that he would have his adenoids and tonsils removed.

The week before his surgery was scheduled, Riley was hospitalized with RSV. Riley spent five days in the hospital. At his age, 2 years old, it is very uncommon for children to contract RSV. Also due to his age, he had not received the RSV vaccination. This vaccination is very costly but a life-saving vaccination in many cases, especially pre-term infants with respiratory complications. This hospitalization was very difficult on the whole family. Riley found it hard to sleep lying down so he needed to be held upright nearly 24 hours a day. He was coughing so much it would his stomach and make him vomit. His mother spent almost every hour at the hospital. She was fortunate to rely on her extended family to care for her older daughter, and spell her some with Riley so that she could sleep. This was a difficult time for her also, as she was pregnant with her third child.

Following the RSV hospitalization, it was necessary to allow Riley time to get his strength back before performing the adenoid and tonsil surgery. This was a gamble, as Riley’s breathing problems made him more susceptible to colds and flu. Unfortunately he did get another cold, and surgery had to be postponed again. Two months following his hospitalization, he was finally able to have the adenoids and tonsils removed. After a short recovery time he was a new child. It made a big difference in his ability to breathe and sleep well, with his snoring decreased dramatically. During this time his therapists (child education and speech/language) strived to keep his appointments on a regular basis so that he would not lose too much developmental ground. He had spent the better part of the previous six months either getting sick, being sick, or getting well from being sick. It was a long and difficult time.

At Riley’s 2 year old assessment in February, just prior to his hospitalization for RSV, it was ascertained that his levels were: gross motor - 21 months; cognitive - 21 months; fine motor - 18 months; self-care - scattered to 24 months; communication - scattered to 30 months; and social/emotional - 24 months.

Also 2 years old we begin to seriously discuss with the family their options for pre-school and services once Riley is 3 years old. There are different options for each child, based on the child’s need and family choice. Due to Riley’s illness, he had not continued to progress as well as the previous 6 months, this made it unclear which program he would qualify for and would best meet his needs. We agreed to visit a variety of programs with the family and decide closer to his third birthday.

In May, an individual educational plan (IEP) meeting was called to prepare for Riley’s transition into preschool. In the school district where he lives, there is a special needs intervention preschool (SNIP) that provides speech/language, and socialization twice weekly for 45 minutes in a small group setting. Riley was clearly eligible for this preschool. At the age of 33 months, Riley’s speech was placed, at 22 - 24 months receptively (what he understands) and the 16-18 month level expressively (what he says). His combined skill level was 19 - 21 months. His speech therapist noted that Riley’s expressive language ability continues to be compromised by his articulatory dysfunction, although since his surgery he has demonstrated consistent increases in his lingual motility (ability to move his tongue) and subsequent increases in his verbal attempts.

Although Riley technically qualified for the more intensive county pre-school program, his family felt that the SNIP program was the best choice for him. Riley’s parents also wanted him to have a more typical preschool experience, and decided that on Mondays and Tuesdays, beginning in September, he will attend a local recreation departments’ Teeny Tiny Program for young children. This will allow Riley to interact with other small children in a fun setting, and while not interfering with the two sessions of group setting of speech therapy. Riley’s parents are interested in pursuing additional individual speech therapy for him.

As Riley will turn 3 years old this week, it is necessary to determine continual eligibility for Regional Center services. The physician addressed Riely’s overall developmental levels and stated his recommendation for eligibility based on his developmental functioning levels and need for services in all areas of development (oral aphasia, motor apraxia, and mixed developmental delay). He also spoke at length about tests that had been performed on Riley in order to assist with determining a diagnosis. No answers have come forth to determine a definitive diagnosis. Riley had been tested at the age of 3 months for Cystic Fibrosis, using a sweat chloride test, which was negative. It was recommended that he receive another of these tests to rule out CF at this time.

As Riley celebrates his third birthday, it is impressive to see how much he has changed since he came to us at the age of 8 months. He is a self assured and happy little boy. He is now able to run without falling, understands what communication is for and works hard at it every day. He sleeps in a big kid bed and has a new little sister. He is no longer the baby, which his mother states is a wonderful thing. He loves both of his sisters. Chasing the older one trying to keep up and gently playing with the baby.

If you would like to know more about Riley or speak to his family you may contact them through this web site. I am happy to say that they will all remain a part of Pediatric Services, for re-unions, park days, water therapy, or whatever else is happening that Riley and his family could benefit from.

We will miss seeing them every week, but they know we are here anytime they call.

Julie, Leigh, Karen, Linda, and Nancy

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Last modified: January 26, 2013