Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 1
Early Intervention (Part C) Child Example Case Study “Kim” at 17 Months of Age
A. Medical and Developmental Background Kim Doe, who is currently 17 months of age, was referred to the early intervention program by David Johnson, MD, her pediatrician, one month ago due to failure to thrive associated with cardiac anomalies, encephalitis, spasticity (most likely cerebral palsy) and seizures. Kim is followed by neurology and cardiology in addition to her pediatrician, Dr. Johnson.
Mrs. Doe reported that she was very stressed by Kim’s hospitalizations, especially since she was unable to stay with her near the hospital (out of town) due to her need to care for Kim’s sister, Jana. Jana is 4 and does not attend school. Mrs. Doe shared that her parents live nearby and that they have helped care for Jana when she was with Kim. Her parents are not in good health and it is difficult for them to help for long periods of time with Jana and/or Kim. Her greatest concern for Kim is her health. She also wants Kim to continue to gain weight so she can get off the NG tube. Mrs. Doe reports that she has not had a complete night sleep since Kim came home from the hospital due to the night tube feeding.
Kim was last seen by Ms. Davis, her hospital occupational therapist, 2 months ago when Kim had her follow-up neurologist appointment at the hospital out of town. The following developmental information was shared by Ms. Davis based on her evaluation of Kim at that time:
Kim was able to drink about one ounce of liquid from a spouted cup when it was held for her. She accepted a variety of foods (different tastes, different textures) by spoon and she was able to move the food around in her mouth with her tongue. She had good lip closure. Kim was taking between 5-10 spoonfuls of food per meal (mostly baby food) when seated in an adapted high chair. Mrs. Doe told Ms. Davis that Kim was not eating the same foods that her family eats during mealtime. Kim was starting to make munching motions. She was swallowing liquids of varying consistencies, as well as soft foods, without choking. When new textures or foods were introduced Kim choked/gagged initially. It was not clear if her gagging and choking was due to oral hypersensitivity as a result of her NG tube or due to neurological concerns. She was holding a spoon and waving it when it was placed in her hand; however, she was not controlling the spoon to scoop food or bring food to her mouth or to finger feed. Kim had continued to gain weight, though Mrs. Doe reports that Dr. Johnson wants Kim to gain more weight before she can come off the night feeding tube.
This example case study was developed by NECTAC and ECO. This case study and other related documents may be found on the ECO website at http://projects.fpg.unc.edu/~eco/pages/training_activities.cfm and on the NECTAC website at http://www.nectac.org/knowledgepath/ifspoutcomes-iepgoals/ifspoutcomes- iepgoals.asp
The National Early Childhood Technical Assistance Center
Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 2
Kim was not able to assist with dressing due to significant challenges in moving her arms and legs. She attempted to move her arms and legs when dressing but due to spasticity was unable to control her movements. Mrs. Doe reported that Kim enjoyed bath time.
Kim was playing by reaching for and batting toys, touching pictures and making sounds, and watching and making sounds in response to what happened around her. Mrs. Doe described the sound as a “gutteral sound in the back of her throat.” She was attempting to engage in imitative sound play by making throaty sounds following sounds made by others. She was not babbling or making consonant sounds, which Ms. Davis believed was most likely due to her NG tube since she appeared to have good movement of her lips and tongue. Mrs. Doe reported that Kim sometimes used gestures and sounds to let her mom and dad know when she wanted to be picked up, when she was full or didn’t like a particular food. Kim sometimes made choices about which book she wanted to have read to her. Mrs. Doe informed Ms. Davis that Kim cries and fusses when she is not understood (and this was happening several times every day):