Case in Progress
Salvador - Year 2
It was time to set new goals for Salvador for the next 6 months of therapy. California Children's Services (CCS) were monitoring his development on a bi-annual basis. It was determined that Salvador needed to continue to receive in-home therapy services because he was still considered somewhat medically fragile. CCS would continue to monitor his developmental progress as a high risk infant.
At the chronological age of 50 weeks and adjusted age of 32 weeks, Salvador's skills were as follows: Gross motor, cognitive, 30 weeks, fine motor 36 weeks, communication at 24 weeks.
In March, at the chronological age of 16 months old, Salvador became very ill. It began as a heavy cold, but then quickly went into his chest. Due to his chronic respiratory illness, we had recommended that he receive the RSV immunization. This vaccination is a 3 to 5 series given in the fall and winter, primarily to high risk infants, and those under 12 months of age. Salvador's pediatrician did not agree that it was important for him since h was over a year old.
Salvador was sent to the pediatric ICU department at the hospital where he had been born. It was necessary for him to be placed on a respirator. He remained hospitalized for two weeks, and then was sent home with a nebulizer, steroids, and two very exhausted parents.
Following this illness necessitating Salvador's hospitalization, his parents felt it would be in their child's best interest to change pediatricians. They consulted a local pediatric pulmonologist, who recommended that Salvador stay on his prescribed medications. He also recommended that they stop giving him a bottle to reduce the chances of his aspirating any milk into his lungs, and decrease the chance of ear infections. He told them to use a HEPA filter vacuum bag and get a dust mite free mattress cover to reduce his exposure to air born allergens.
Due to his weakened physical state following his illness of RSV, Salvador became ill two more times this spring. Although not quite as seriously, he was hospitalized briefly two more times. It took almost two months to get back to a normal therapy regimen, and even then his tolerance was poor.
In June Salvador was again assessed at the chronological age of 18 months. He had made some excellent progress, especially in light of all of his illnesses and hospitalizations. He was almost walking on his own, and loved to cruise along the furniture, which put him at a 44 week level. Salvador's cognitive and fine motor skills were at 40 weeks - he could wave a bell to make noise and uncover a toy. Self-care and social-emotional skills were at 44 weeks. Salvador had begun to feed himself, to use a cup only, and to initiate game playing.
We were concerned about his communication skills, which were at 36 weeks. Salvador still had not received his hearing aids due to the red tape of his medical insurance, Medi-Cal. It was still in the process of being sorted out.
During the next six months we were pleased that we could begin to offer Salvador therapy in his native language of Spanish. He began to run and to climb. He finally began to babble more once he received his hearing aids. After receiving his hearing aids speech/language therapy was began on a weekly basis. Our goal was to increase Salvador's ability to speak and to lessen some of the frustration that he was feeling in his limited communication. We also targeted parent education to help them increase their expectations regarding Salvador's ability to communicate and teach them how to promote this skill.
By the time of Salvador's second birthday in November, it was noted that he had received his hearing aids, a new pair of glasses and was doing much better health-wise. Although still prone to heavy colds and upper respiratory infections, he was more resilient. His intent to communicate had gotten much better, and he was verbalizing more.
When he was assessed at his adjusted age or 20 months, and chronological age of 24 months his skill levels were as follows: fine motor; 52 weeks (12 months), scattered to 14 months. Salvador could grasp two small objects in one hand, and remove the cover of a small box. Cognitively, Salvador was at 14 months - he could find a toy that had been hidden under three covers, release 9 cubes into a cup, and get a toy out of a container after it had been dropped through the top. Socially/emotionally Salvador was at 14 months, emerging at 15 months. Salvador was beginning to make more choices in what he wanted to do and to interact more with children. In terms of self-help Salvador was at 12 months, with 75% of the skills at 13 months. His drooling had ceased and he could hold a cup and drink with help. Salvador's gross motor skills, long an area of strength, was at 18 months. Salvador was walking and running well, climbing onto adult furniture, and climbing one step. His speech therapist found him to be at 14 months receptively and at 11 months expressively, although he had some skills scattered higher.
Our focus was about to shift to helping him pay attention to tasks, following directions, and and reinforcing his good behaviors. It was now time to start working closely with Salvador on preschool readiness. In our last year to provide Early Intervention services to Salvador and his family we had a lot to accomplish. This is the time we educate the family on their choices for pre-schools for Salvador and prepare Salvador to succeed in a group setting.
After Salvador turns 3 years old in November we will let you know all that has happened in his life in the last year, and the choices his parents have made for his future.
CONTENTS (except as noted) ©2003-8 by Pediatric Services
Corporate Office in Morro Bay, California (San Luis Obispo County)
Click here to ask a question.
DESIGN ©2003 by William Blinn Communications
Worthington, Ohio 43085
Articles written by Pediatric
Services staff are copyright by Pediatric Services.