“Kim was able to support her head well when in an adapted seat, when she was held either in sitting or standing supported at her trunk, and when on her tummy or side. She was able to balance momentarily when propped in the sitting position (hands on the floor or on her knees), but was not able to regain her balance or get herself into the sitting position. She lifted her head and used her abdominals to help get to sitting when assisted to sit toward one side. Kim was able to roll by herself from her stomach to her back but with some difficulty. Kim was also able to roll from her back to her stomach. She moved short distances forward, sideways and backwards lying on her stomach mostly by twisting her body to inch along, though she was trying to pull with her arms and to push with her legs. She was motivated to move to get her toys although she was not able to move far.
Kim appeared to enjoy being with adults and other children. When with other children, especially her sister, Kim watched them, laughed, and attempted to imitate sounds they made. Kim enjoyed sound play with her sister and her mother. She had a preference for toys that made sounds (by moving to, looking at and/or smiling when the toy was presented to her). She especially liked ones that played tunes. She showed recognition of a number of toys and objects by looking at them when they were named.
Kim reached with both hands and was able to move objects by swiping at them. She patted pictures and banged toys. She was able to grasp toys and other objects that were placed in her hand, but was not able to consistently open her hand to pick up an object by herself. She did not bring toys or hands to her mouth due to spasticity.”
B. Family Routines and Priorities What are the daily routines/activities of your child and family (where and with whom your child spends time)?
o Jana usually is up before Kim in the morning so Mrs. Doe has time to feed Jana and get her dressed before Kim gets up.
Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 3
o During the week when Mr. Doe is working, Mrs. Doe spends most of the time at home during the day with Kim and Jana. She is beginning to do some errands with the girls during the day now that Kim is healthy – she had been doing shopping at night when Mr. Doe could be at home with Kim.
o Kim eats small meals every 3-4 hours. She is tube fed twice a day, around 1:00 AM and around 1:00 PM – she will be weaned from the lunch feeding within the next week or so. Mrs. Doe prepares different foods for Kim than the rest of the family.
o Kim likes to play on the living floor with Jana. She does so several times a day. Jana likes to interact with Kim during the play time, showing her books and toys, and attempting to engage her in play.
o Mrs. Doe’s parents live close by and visit several times during the day each week. They almost always spend time with Kim and Jana after church on Sundays.
o Jana plays with neighborhood children almost everyday and Kim likes to watch them play and seems to want to play with them.
o Jana usually naps around 2:00 PM everyday and Kim naps around 3:00. Mrs. Doe has about an hour each day to do chores at home when both girls are napping.
o Jana goes to bed at night around 8:00 and Kim goes to bed around 9:30. Mr. And Mrs. Doe usually go to bed around 10:00.
o Mr. Doe and Kim’s grandparents are “uncomfortable” feeding Kim and spending long periods of time caring for her. Mr. Doe is not home a lot due to his long hours of work.
Are there other routines or activities you would like to establish? These can be routines or activities that your family would like to do now or in the future.
o Mrs. Doe would like to be able to have the family eat the same foods at mealtime and not have to feed Kim different foods. Mrs. Doe has been working on introducing new textures and different foods over the past several months. Kim still gags when new textures/tastes are introduced but gagging reduces as she adjusts to the foods.
o Mrs. Doe would like the girls to be on the same sleep schedule so she has some time to herself and to do household chores.
o Mrs. Doe would like Kim to be around children her own age, especially since she really enjoys watching Jana play with neighbor children. Mrs. Doe would like to explore some child care, respite care opportunities for Kim.
o Mrs. Doe would like to have more support from Mr. Doe and Kim’s grandparents in caring for Kim and Jana. She is hoping that Kim’s grandparents will be more willing to help with Kim when she is able to eat table foods and not gag. Mrs. Doe understands their reluctance and also recognizes that they are not in the best of health. She knows that caring for Kim is stressful for them – they are afraid they will do something to ‘hurt” Kim.
Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 4
Who are the people and what are the toys, activities, routines, and places your child enjoys the most?
o Kim likes riding in the car. The Doe’s have a car seat for Kim that with guidance from the OT at the hospital they have adapted.
o Kim likes to be read books by her grandparents. She also enjoys playing games with them (peek-a- boo, pat-a-cake)
o She likes toys that make sound.
o She likes to watch Jana and the neighbor children play. She especially likes Jana to interact with her, showing her toys and books.
o Kim enjoys being with most adults, especially her grandparents.
Which routines or activities are challenging for you or your child?
o Nap and bedtime
What are your family concerns related to your child’s development (Including anything your family identifies that would help to improve your ability to meet the needs of your child)? o Kim gags and chokes when new foods/liquids are introduced and Kim’s mom has to spend a good
amount of time working to help Kim overcome her dislikes of new foods and textures – Kim’s mom is concerned about how long it will take to transition Kim to table food that the rest of the family eats.
o Kim and her sister are not on the same sleep schedule (going to bed, awaking in the morning or napping during the day) so Kim’s mom doesn’t always finish all of her chores and is frequently tired as Kim does not yet sleep through the night.
o Several times a day, Kim cries and fusses because Kim’s parents and sister do not always understand what she wants or needs.
o Kim attempts to initiate play with her sister but is unable to move very far around the living room on her own and is unable to tell her sister what she wants to play with.
o Grandmother doesn’t like to feed Kim because she gags/chokes on new foods.
o Kim is fed every 3-4 hours during the day and is on a feeding tube at night.
o Kim wakes several times during the night taking 10-15 minutes to get back to sleep.
What are your family priorities related to your child’s development? Kim’s mom has prioritized the following concerns to be addressed immediately by the team:
o Would like Kim to sleep through the night and get both Kim and her sister on the same sleep routine so Kim’s mom feels rested and better able to do daily chores.
o Would like Kim to be able to gain enough weight to be off the night tube feeding and for Kim to be able to eat table foods with the rest of the family at meal times.
o Would like Kim to be able to let people know what she wants.
Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 5
What are your family resources, including family, friends, community groups, financial supports, etc., that are helpful to you?