Speech and language initial assessment

B was referred to speech and language in October 2009. He was on the waiting list for a long time and seen on 24 March 2010 (day before his 2nd birthday).

B was referred by his consultant paeditrician for assessment of his communication skills. The following results were recorded.

B can stand but is currently unable to walk unsupported. He is late achieving all his developmental milestones.

Hearing checked and passed. He appears to be hearing. Short attention span but consistent with global developmental delay.

Mimicked using a phone. Hugs a teddy and pretends to feed a doll. B understands familiar routines and situations. Has not yet made link between words and objects. I do Makaton with him but he does not copy.

B says "ga" when he puts a phone to his ear. But otherwise is very quiet.

No concerns regarding his use of language and communication skills.

B's pre-language skills are developing in expected order but are delayed. He needs to be taught everything specifically as he has not learned to generalise.

Encourage pretend play. B would benefit from a group for children at his level and will be placed on list for a group. Then we are given a 'care plan'.

Speech and Language assessment

B has his first speech and language assessment today. He will be joining an early language group. The group will focus on his vocabulary skills, develop his comprehension of language and improve his ability to follow adult led activities. It's quite far away and I'm not happy about driving so far for a half an hour group.

I manage to persuade them to change his appointments to a more local clinic.

Delayed Motor Milestones

We're back at the consultant Paediatrician today for a review. The problem is still 'delayed motor milestones'. Thank goodness they have given up on the old faltering growth angle.

B is one year and nine months old now. He is pulling himself up to stand, cruising around furniture and walks when led by both hands. However he is still not walking independently. He is crawling well although this is slightly asymmetrical with his left leg lagging behind.

He passed his audiology hearing test and he is on the waiting list for speech and language therapy.

Clinical examination was similar to previous findings with hyper extensible knees, ankle joints as well as mildly asymmetrical brisk deep tendon reflexes. There is no ankle clonus and plantars are down-going. She wants to keep observing him. And see him again at age 2 years. Considering doing creatine kinase enzymes and a CT brain if his motor skills have not made the anticipated progress. I'm happy with the current plan. He should continue physiotherapy.

Swine Flu

I've got a letter this week from the Department of Health recommending children at risk of contracting swine flu aka H1N1 are vaccinated as a matter of priority to protect them from the swine flu epidemic. That's nice.

Your child may qualify if they have one or more of the following conditions and then a long list of conditions. I'm presuming B got in the list under the "children with significant chronic neurological conditions such as children with cerebral palsy"

It's interesting that B has been included without a diagnosis of anything in particular. I'm glad they aren't leaving him out just because he does not have an official diagnosis.

Hearing test take 1

B has his first hearing test today at the audiology clinic. He will not cooperate though. I have no concerns about his hearing because he does respond to sounds but we've got to check his hearing to rule it out as a cause for delayed speech. We're in the TARDIS box (which is not bigger on the inside). They make sounds behind B's back and expect him to turn his whole head around to see the source of the noise. B chooses to flicker his eyes acknowledging the sound but refusing to turn his head. The staff know he can hear the noise but they don't pass him this time because he is not "ticking the boxes". He is like that B he is wants things on his terms and makes everything more awkward.

B gets referred to Speech and Language

I get a letter saying that B has been referred to Speech and Language Therapy for an assessment. The waiting time is currently 5 months. And they promise they are doing all they can to reduce the waiting time. Speech and Language Therapy takes a number of different forms. According to the child's needs, I might get general advice and support, a home programme, sessions of group or individual therapy or a combination of all the above.

Dietician

We are seen in the dietary clinic today by the dietician. I'm not feeling too happy about this appointment. I'm feeling a bit judged. I know my children are getting a good balanced diet and I don't need a professional to tell me if I'm doing it right or wrong. My feelings are confirmed when the dietician takes one look at B and wonders why we are wasting their time! I do so love being right.

Due to the lack of measurements it's difficult to gather a clear picture of his weight and length history and plotting errors on his chart (apparently). He has decreased in length which is not true! They made a note of his feeding history and we reported a good appetite and a detailed food diary. His diet is nutritionally balanced and varied. The dietician feels his diet his adequate for appropriate growth and therefore if his growth remains an issue then it may not be due to his eating problem. His weight gain is starting to increase and she hopes the trend will continue. The goals: include at least two iron rich foods per day and ensure regular meals are given including high fat foods such as oil, cream, full fat dairy products. They are satisfied and a follow up appointment has not been arranged.

I'm feeling slightly smug at this point but still none the wise as to what the true extent of B's problems are and it's back to the drawing board.