Case 1:
Sophie

Sophie is a 10-month-old NICU graduate referred for a developmental assessment. Her corrected age is 7 months.

Her past medical history is significant for the following:

  • Premature birth at 29 weeks gestation
  • Mechanical ventilation in the NICU for 4 days
  • Normal head ultrasound in NICU
  • ALGO hearing screen passed on discharge

Her mother has no concerns about her development.

QUESTION 1: Based on Sophie’s history, what referrals to community agencies would you make?

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ANSWER: Early Start Program through the Regional Center

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QUESTION 2: List the eligibility criteria that Sophie meets for each referral.

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ANSWER: 

Prematurity <32 wks or BW <1500g

Ventilation >48 hrs

Infants and toddlers from birth to 36 months may be eligible for early intervention services if they meet one of the criteria listed below:

  • Developmental delay of 25% in one or more of the following areas: cognitive, physical, communication, social or emotional, or adaptive
  • Established risk conditions of known etiology, with a high probability of resulting in delayed development (e.g. Down Syndrome, Fetal Alcohol Syndrome)
  • High risk of developing a developmental delay

 

High risk of having a substantial developmental disability due to a combination of risk factors. Two or more of the following are required to be considered high risk in California:

  • Prematurity <32 wks or BW <1500g
  • Ventilation >48 hrs
  • SGA
  • Asphyxia
  • Neonatal seizures
  • Metabolic abnormalites
  • CNS lesion
  • CNS infection
  • Neonatal or nonfebrile seizures
  • Biomedical insult
  • Multiple congenital anomalies
  • Fetal alcohol syndrome
  • Significant failure to thrive
  • Persistent hypotonia or hypertonia

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Background:

In gathering your history, you discover that Sophie’s mother is a single parent, currently completing her high school education and receiving government assistance. Sophie and her mom live in San Mateo County.

QUESTION 3: What other program referrals would you make?

 

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ANSWER:

  • Izzi Early Education (referred to as Head Start in other counties)
    • A child-focused program aimed at increasing the school readiness of children from birth to 5 years    
    • Eligibility is based on financial income and residence in San Mateo County
    • Services include:
      • Home visiting
      • Family Child Care
      • Early Education
      • Health and nutrition

 

 

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Background:

After taking a history, you go on to perform a developmental assessment and physical exam, which are significant for the following:

  • Just starting to roll
  • Not sitting independently
  • Low truncal tone
  • Brisk DTRs (3+)
  • Asymmetrical Tonic Neck Reflex (ATNR) still present

As you point out some of Sophie’s abnormal findings, her mother asks whether she has cerebral palsy.

QUESTION 4:  What would you tell Sophie's mother?

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ANSWER: 

  • Some of Sophie’s exam findings suggest that she may be at risk for cerebral palsy, but the diagnosis is not usually made until a child born prematurely is 15-18 months old.
  • Over the next several months, you will observe closely for abnormalities of the following:

P – Posture

O – Oralmotor function

S – Symmetry on neurologic exam

T – Tone in the trunk and extremities

E – Evolving primitive reflexes

R –Reflexes (DTRs)

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QUESTION 5: Given Sophie’s abnormal motor development and exam findings, what additional steps would you take?

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ANSWER:

  • Ensure that she is connected with the High-Risk Infant Follow-up Clinic at LPCH
  • Ensure that the High-Risk Clinic, a neurologist, or other CCS-paneled physician has referred her to the California Children’s Services (CCS) Medical Therapy Program

 

The California Children's Services Medical Therapy Program (CCS MTP) is a special program within CCS that includes Occupational Therapy, Physical Therapy, and Medical Therapy Conference services for children with eligible conditions. Services are provided within a Medical Therapy Unit (MTU) within a public school site. 

Eligibility criteria for the CCS MTP include:

  • Neuromuscular or musculoskeletal disorders, including cerebral palsy
  • Exam abnormalities suggesting high risk for cerebral palsy in children <3yrs

 

 

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Case 2:Mark
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