M.V. was a 2-year-old male I had been sent in to do a well child visit on. The patient was playing when I entered the room but quickly went to his mother after I sat down. I introduced myself to the mother and grandmother and informed them I would be performing the well child exam today and reviewing the ASQ questionnaire with them. The patient has been delayed in reaching his developmental milestones especially in the area of speech. The mother reported the patient has been in speech therapy (ST) since he was 18 months old because he was not speaking at all. At 18 months a pediatric patients vocabulary is still limited but should be able to speak 6 words (Hagan, Shaw, & Duncan, 2008). The patients vocabulary was still quite limited, roughly 15-20 words. At 2 years of age the expected vocabulary is a least 50 words (Hagan, Shaw, & Duncan, 2008). The mother also informed me the patient had just started with occupational therapy (OT) just this week due to having a sensory disorder. After some digging I found out the patient had been referred to OT by his ST. All the mother could tell me was the patient had anger outburst and shoveled too much food in his mouth as to why OT was coming. The patient was cooperative with the exam while in his mothers lap but became upset when I had to assess his skin and diaper area for rashes. Once I was done with my assessment the patient was immediately calmed by his mother holding him.
I reviewed the ASQ questionnaire with the mother and found out the patient was actually adopted (the adoptive mother’s brother is the patients biological father). This opened up a can of worms for me, I had felt something was off but I refrained from becoming too question happy. The mother and grandmother were very quiet during the visit and answered all my questions with yes or no, even my open ended ones. I had to pull a lot of the information out of them. I knew I did not need to keep pushing. Once I completed my assessment and review of the paper work I met with my preceptor. My preceptor informed me the adoptive mother has been caring for the patient since he was 10-12 months old. The biological mother and father were not in the best of situations, the baby was being neglected, and there were drugs involved. It all made sense (aha!), I knew something was off – I had felt it in my gut. Sadly, this precious baby was behind due to the neglect and poor interaction in his first year of life but he is with a family that is making sure his needs are met and that he is taken care of.
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2008). Early childhood: 18 month visit. In Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed., pp. 407-417). Elk Grove Village, IL: American Academy of Pediatrics.
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2008). Early childhood: 2 year visit. In Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed., pp. 419-428). Elk Grove Village, IL: American Academy of Pediatrics.