Occupational therapy referral

I've got a letter today from children's occupational therapy service. B's Physiotherapist has referred him to OT about his difficulties with developmental delay. They offer an initial assessment and intervention in the form of therapy sessions and home or school therapy programmes. There is a high demand for this service and there is a long waiting list (bla bla bla- where have I heard this before!) They aim to offer an appointment within 18 weeks. I've got to fill out a questionnaire and send it back.

Paediatrics

We're back in the paediatric today for a review of B's motor progress. He is just over 2 years old now. Pulling himself up to stand and cruising around furniture. He takes some steps when held by both hands but his gait is asymmetrical with a slight dragging of his left leg.

He has marked hyper-mobility and his reflexes remain exaggerated. Muscle tone is slightly low but  this might be related to his hyper-mobility.

I've been researching cerebral palsy and ask the paediatrician about this. She decides to organise an MRI brain scan and do creatinine kinase enzyme levels. Physiotherapy to continue and a review of B once the results of the tests have been received.

Hearing test take two

B has another hearing test today because they had trouble testing him the first time. In the Audiology Clinic they put him in a box like the TARDIS but it's not bigger on the inside. It's sound proofed inside. I had no concerns about his hearing but he is still not saying any words. He vocalises sounds when interacting. He passed the distraction test today with better and faster responses then his first test in December 2009. Consultant Community Paediatrician in Audiology says B's hearing appears to be adequate for his speech to progress further and he is discharged from the Audiology Clinic.

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.