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

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Case in Progress

Tyler - Year 2

Although a full term vaginal birth, Tyler he was failing to achieve typical developmental milestones. He was also falling off the growth chart, even though the family was working very hard to feed him.

At the age of 17 months he was referred by the family pastor to his local regional center. At that meeting his weight was 19 pounds, so he had gained only 2 pounds in 5 months, and his height was approximately the same. His parents reported his appetite as good. His vision and hearing had not been tested, but were not a concern to the parents.

Tyler had recently been hospitalized with flu-like symptoms and had been very weak and shaking. At that time, his pediatrician had recommended that his parents take him for a neurological evaluation, and had ordered at CT scan and an MRI to be done in January 1998, when the family’s insurance would became effective.

Pediatric Services saw Tyler for the first time on December 31, 1997. At the age of 17 months he was assessed with gross-motor skills at 36 - 44 weeks; fine motor skills at 36 - 44 weeks; cognitive skills at 44 weeks; communication skills at 36 weeks receptively and 28 - 32 weeks expressively; social-emotional skills at 36 - 52 weeks; and adaptive self-help skills at 36 - 40 weeks. This represented a significant developmental delay across the board.

It was decided to begin intervention on a twice-weekly basis, with physical therapy to address the significant motor delays and child & parent education services to address overall developmental issues. Tyler received a speech-language evaluation at the end of the following month, and it was decided that he would also receive speech-language services.

The following month, in January, Tyler was evaluated by a pediatric neurologist. This examination showed that Tyler has a lopped right ear, intact cranial nerves and a peripheral sensory exam proved to be normal. Motor examination showed mild diffuse hypotonia. His coordination showed a mild degree of ataxia while reaching, and even while seated, he tended to wobble - also when he was standing at a stationary object. The neurologist stated that he was uncertain what was causing the global developmental delays, but felt that his ataxia was the contributing factor. A MRI was performed, but there were no immediate and apparent causes exhibited on the MRI. It was also decided to perform some chromosomal testing to rule out Fragile X Syndrome. This was performed, and it was noted that he does not have Fragile X. Another test that was performed was a sweat chloride test which ruled out Cystic Fibrosis.

The first six months that we worked with Tyler we were able to see a lot of progress. It was winter, and Tyler often had upper respiratory infections and ear infections, which did impede our ability to work with him at times. his parents were very anxious to have therapy, and they and Tyler enjoyed it a great deal.

At his second birthday, and after six months of therapy, Tyler’s development levels tested as follows: fine motor skills - 14 - 15 months. Tyler’s tremors were noted to interfere with the ability to perform some fine motor functions. Cognitive skills were at 21 months and scattered to 24 months - Tyler was noted to have a good memory and good concentration. Communication skills were noted to be at 18 months receptively and 12 months expressively. Tyler had six signs that he would use in addition to pointing to communicate, along with saying mama, dada, and a word for bottle. Social-emotional development was complete at 24 months, age appropriate and a strength of Tyler’s. Self-help skills were scattered to 15 months - primarily due to difficulty in self feeding due to upper extremity tremors, and the use of a bottle for increased nutrition. Gross motor skills were at 44 weeks, scattered to 52 weeks - by this time he could walk with two hands held, cruise along furniture with one hand, pivot in sit, and get from stand to sit. He continued to use crawling for mobility, as is was less difficult for him and more efficient.

At this time we began to pursue an orthopedic evaluation, either through California Children’s Services or the family’s private insurance. In addition, we recommended that the family receive a nutritional consultation, as Tyler was still noticeably underweight and burned a lot of calories just by virtue of his tremors and increasing mobility. The family refused the nutritional consultation at this time, preferring instead to use Ensure and Pediasure to increase Tyler’s calories.

At this second birthday Tyler’s services were to continue, speech, physical therapy, child and parent education. Additionally we requested an evaluation appointment with the regional center’s diagnostic pediatrician.

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Last modified: January 26, 2013