Discussion – Gross Motor Delays Case
An Infant with Gross Motor Delays Case Presentation and Discussion Questions: MC is a 9-month-old African female who comes to your outreach family practice clinic for an initial evaluation. She is accompanied by her mother who speaks Arabic and English. The mother is concerned MC is not developing like other children her age. The family emigrated from Sudan one year ago through a church program. They now live in low-income student housing because the father is in graduate school. This is their first child. The maternal grandparents are also temporarily living in the household and help with MC. Further Information: Your review of MC’s birth history reveals the following information: MC was born 11 weeks early and weighed only 2 ½ pounds. According to the mother, the doctors were surprised to see what a strong and active girl she was. However, when MC was just a few days old, she stopped breathing and was put on a ventilator. After 24 hours she was able to breathe on her own. According to the mother, the doctors ran several tests to find out what had happened, but they couldn’t find anything wrong. The remainder of MC’s time in the hospital was uneventful and she went home after 2 months. Once at home, MC’s mother noted that MC drooled and choked easily when she drank from her bottle. As months went by, MC’s mother noted other findings that were odd. MC couldn’t hold her head up straight, roll, or sit with support. In fact, she still can’t do these things. She cries a lot and becomes stiff with rage. MORE INFORMATION The mother responds that she had limited access to prenatal care. She denies use of alcohol, cigarettes, or drugs. The pregnancy progressed normally except for onset of premature labor and rupture of membranes. MC spent 2 months in the NICU. Since discharge MC has not had any hospitalizations, surgeries, or injuries. MC is frequently congested and easily becomes ill with respiratory infections. The family history of diseases is unremarkable. The infant is currently not taking any medications. She is behind in her immunizations because MC has not received her 6-month series. She previously received immunizations at a local health department, but medical care has been sporadic because the family moved shortly after MC came home from the NICU. The family has limited resources and has been unable to locate a primary care provider. Interim care has been obtained through multiple urgent visit clinics or emergency departments. The mother gives MC baby formula (20cal/oz) and offers baby food two to three times daily. She believes MC doesn’t like the baby food because she frequently coughs while eating and/or drinking and drools a lot. As for elimination, the mother reports five wet diapers a day with a bowel movement consisting of balls of stool every other day. MC’s sleep has improved although she continues to wake during the night, crying and arching her back. The mother notes her legs become stiff. Developmentally, MC has a social smile, makes a few vocalizations, and enjoys being held. She is able to pick up small objects with her hands but does not transfer them. The mother feels she makes good eye contact and tracks objects. Her motor and oromotor skills were described earlier. Maya is cared for by her mother and grandparents during the day. The mother has a few neighbors with children of similar ages but does not share babysitting time or interact socially with them. Questions 1.What part of the physical examination will be particularly important for this child? 2. Dose MC have development delays for a 6-month corrected age infant? If so, in what areas? 3. List the five categories of development milestones. 4. Describe the management of an infant with a motor delay.
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