o Kim usually spends her day at home with her mom and sister.
o Kim’s maternal grandparents spend time with Kim and her family almost every Sunday after the family returns from church. Her grandparents are helpful with Kim and Jana.
o Transporting Kim to the store, church, etc. is easy.
o Kim spends about 30 minutes 2x/day playing on the living room floor with her sister.
C. Child Developmental Information
Child Strengths: At 17 months of age, what’s working well for Kim is she is able to drink from a spouted cut (about 1 oz. of liquid) if the cup is held for her. She accepts a variety of foods (different tastes, textures) by spoon when fed, holds a spoon when placed in her hand and waves and bangs it. She is swallowing liquids of varying consistencies, as well as soft foods, without choking. Kim watches people and is very interested in what is happening around her; recognizes and enjoys familiar people and children, likes toys that make sounds, shows recognition of toys and objects by looking at them when named. Kim plays by reaching for and batting toys, patting pictures, holds toys when placed in her hand. Kim is able to hold her head up when in her adapted seat, held supported in a sitting or standing position or when on her tummy or her side; sits momentarily when propped in a sitting position, She lifts her head and uses her abdominals to help get to sitting. She is able to roll from her back to her stomach and moves short distances forward, sideways and backwards lying on her stomach (twisting her body to inch along. She is motivated to move to get her toys, although she is not able to move very far. Kim is able to make throaty sounds and gestures to let her family know when she wants to be picked up, when she is full or doesn’t like a particular food; sometimes makes sounds and gestures to indicate what books she wants read to her; enjoys sound play with familiar adults and children and attempts to imitate sounds. Kim enjoys being with familiar adults and children; she watches other children, frequently laughing and smiling at others, cries and fusses when she is not understood (several times a day).
Child Concerns: Some of Kim’s challenges or needs include choking or gagging when new foods are introduced, does not scoop food or bring spoon to mouth, does not finger feed, needs assistance when drinking from a cup, is not able to assist with dressing or bathing.
Assessment Summary: Assessment included observations, interview with mother and use of the Early Learning Accomplishment Profile (E-LAP) as the primary source for estimated developmental age in months.1
Expressive and Receptive Language: (5-6 months) Kim is making throaty sounds and gestures to let her parents know when she wants (i.e., when she wants to be picked up, is full or doesn’t like a food, or wants a particular book). Kim enjoys sound play with adults and children and attempts to imitate sounds and toys that make sounds. Her ability to make sounds may have been affected by the presence of the NG tube.
1 Use of the E-LAP in this case study is not intended to be a specific endorsement of a specific tool, nor a statement of the quality of the tool for use in the outcomes measurement or IFSP planning process.
Early Intervention (Part C) Child Example Case Study: “Kim” at 17 Months of Age 6
Gross Motor: (6 months) Kim is able to hold her head up when in her adapted seat, is held in a sitting or standing position and when on her tummy or sided. She is able to sit momentarily when propped in a sitting position with hands on floor. She is able to roll by herself from her stomach to her back with difficulty. She is able to move short distances forward (twisting her body to inch along) and is motivated to get her toys. Kim is challenged by her limited movement to be able participate in independent feeding and/or dressing.
Fine Motor: (4 months) Kim plays by reaching for and batting toys, patting pictures and banging toys, holds toys when placed in her hand. She is able to hold objects (toys, spoon) if placed in her hand. Kim is challenged by her limited movement to be able to explore her environment and play.
Cognitive: (7 – 8 months with scattering to 14 months) Kim watches people and is very interested in what is happening around her; looks for toys when dropped or rolled from view; likes toys with sound, and shows some recognition of objects when named, and recognizes mom, dad, sister, grandparents. It is difficult to determine Kim’s level of understanding due to her motor challenges and limited ways of communicating thoughts, wants and needs.
Social-Emotional: (6 – 9 months) Kim enjoys being with familiar adults and children. She watches children and adults, laughs and smiles at others. She cries and fusses when she is not understood. The NG tube affects her sleeping at night, which leaves Kim fussy during the day.
Adaptive: (Under 6 months) Kim is able to drink a 1 ounce of liquid at a time out of a cup held for her. She is accepting a variety of foods (different textures and tastes) by spoon; however, while she is holding a spoon, she is unable to bring it to her mouth. She is not able to assist in dressing or bathing due to her motor challenges.
Hearing: (Normal) Passed Newborn Hearing Screen and subsequent screens by her physician. Next well-baby check is at 18 months
Vision: (Normal) physician checks vision at each well-baby check and no concerns. Next well- baby check is at 18 months.
Health: Kim has been hospitalized off and on out of town for the majority of her first 16 months of life due to seizures, numerous viral infections and significant nutritional issues. Kim has had an NG tube since 6 months of age. Repeated efforts have been made to wean Kim from the NG tube, however, her illnesses prevented that from occurring. Kim has been home from the hospital for the past 3 months and has been healthy since that time. Her primary care physician and his nutritionist have made significant gains in weaning Kim from the tube feedings since that time due to improved health and weight gain. Kim is currently is tube fed twice daily – at noon and during the night. The goal is to ensure sufficient weight gain and removal of Kim’s NG tube by late summer. She is being weaned off her seizure medication. Recent EEG shows no seizure activity.