Ahhh, here we are. Time for another lovely, happy, encouraging, depressing EI quarterly report. This one, the first after the IFSP in October.
Let’s recap. Eating has improved maybe a half millimeter. Sometimes. Gross motor stuff is good. Fine motor coming along.Shall we start with feeding? Pull it off quickly like a Band-Aid?
Speech/Feeding, 1x week- 45 minutes. D has been receiving this service for – gasp – almost a year.
Continue to increase independent bottle feeding – Moderate Progress
Continue to increase her volume of crunchy, chewable, spoonable foods: Moderate Progress
Continue to increase the speed and transition to swallow of purees and chewables: Moderate Progress
Continue to increase her repertoire of foods: Moderate Progress
Continue to increase her acceptance of spoon-feeding: Moderate Progress
Currently, Daphne continues to exhibit severely delayed and disordered feeding skills. She continues to receive the largest percentage of her nutrition from bottle-drinking. She is intermittently holding the bottle independently. Her intake of self-fed solid, chewable foods and adult-fed spoonable foods remains highly inconsistent. Her transition to swallow of these foods is highly variable. At times, she will accept or take bites of food, chew them bilaterally and retain in anteriorly and allow the bolus to drip out of her mouth or eject it via lingual expultion. Fancy way to say: she spits. At other times, she will demonstrate appropriate and efficient transition to swallow of the same food items. She continues to demonstrate an increased interest and awareness of food and asks for foods that others are eating in her environment.
Goals for the next quarter remain exactly the same. Tomorrow I will show this report to her GI – weather allowing.
OT – Daphne started with a new therapist at the end of October. She gets services 2x week, 45 mins
Improve Grasping and visual motor skills for improved interaction with toys: Moderate Progress.
Improve problem solving and exploratory skills for more age-appropriate play skills: Moderate Progress.
Daphne is a friendly little girl who enjoys her OT sessions. She requires verbal and tactile cues to use two hands in play. Her grasping patterns are immature and weak. She has a low frustration tolerance and asks for help quickly after facing a problem. Her decreased strength affects her ability to interact with age-appropriate toys as her stamina is low and she uses one hand/arm to prop her trunk rather than using two hands to play. Her attention is age-appropriate and she loves to interact with new activities, although she would rather be shown how to play than explore independently.
Outcomes for OT will also remain the same. I have to add here that in talking to her OT, she feels that Daphne’s size (or lack thereof) affects her ability to play. Her hands are tiny. As for her asking for help quickly, I suspect she suffers from the same syndrome as Lucy: she wants to do things right, or not at all. Something to work on, clearly.
PT – One 45-min session/week
Improve balance, stability and gait when standing and walking: Great Deal of Progress.
Beginning stair management: Moderate Progress.
Monitor asymmetry: Moderate Progress.
Daphne has made significant progress in gross motor skills during the past few months. She now walks freely with a narrower base of support, can stand up from the floor, squat to retrieve objects and stand back up without arm support. She can creep up and don stairs, and was able to walk down a few steps with support from examiner’s fingers. She still has a tendency to initiate movement with her right lower extremity, but is more easily facilitated to initiate with the left. She continues to demonstrate low normal muscle tone with associated mild overall weakness, decreased stamina and small stature. When screened with the locomotor section of the Peabody Developmental Scales, D scored at approximately the 16th percentile for her corrected age of 19 months and 2nd percentile for her chronological age of 22 months. She is functioning at about a 16 month level at this time.
Increase strength and endurance. Continue to improve speed, control and gait when walking. Improve walking in all directions, including backward. Continue work on stair management
Now, I realize this may all sound awfully depressing. It does. Thing is, she has made progress. Even moderate progress is progress. And, and as her PT reminded me, they have to make pretty clear to the County that the child needs services. We know she does, and I am grateful that she has access to them.
PS: If you’ve made it down this far, enjoy some cuteness: