Reference no: EM133276581

Assignment:

Matthew is a 12 month-old male who came for a well child visit. He was born at 37 weeks age of gestation by spontaneous vaginal delivery to a 39 year-old primigravid. His mother was treated for a yeast infection during her second trimester. Labor was induced at 37 weeks age of gestation because of a diagnosis of pre-eclampsia.

Matthew was roomed-in and passed his hearing screening test. His expanded newborn screening panel result was unremarkable. He was exclusively breastfed until complementary feeding was started at 6 months old, after which breastfeeding was continued until the time of this visit. Matthew, according to his parents, eats a diversity of foods. His weight is measured at 9 kg, his length at 73 cm, and his head circumference at 45.5 cm.

Matthew has never been hospitalized, nor has he had any surgery. He had one episode of ear infection at around 10 months old which was treated with antibiotics, but otherwise his medical history is unremarkable. Matthew's immunizations are up-to-date.

The parents expressed some concern that he is not talking enough. They mention that they read to him often especially during bedtime. They occasionally show him educational videos to preoccupy him while they attend to house chores. Matthew's father is half-French. He would speak to him in Filipino, English, and French. In addition, Matthew has a 4 year-old cousin who was diagnosed with autism. His parents recall that she was brought for a consultation because she wasn't speaking.

During the interview, Matthew sees a toy that interests him. He reaches out for it while saying "tatata." He drops the toy a few times, each time pausing to look for it then looking at his mother to ask for help. He hands the toy to his father when asked "Give that to me please." He is able to cruise easily, but prefers clinging to either of his parents to take a few steps.

Matthew's physical examination is unremarkable. He does not have dysmorphic features or any neurologic abnormalities.

He waves "bye-bye" at the end of the consultation.

Case Guide Questions:

1) What is developmental surveillance? How is it different from developmental screening? During which health visits are these advised to be done? Which among the two (surveillance or screening) applies to our case?

2) Identify the pertinent points in our case. Are there any identifiable risk factors that would affect Matthew's growth and development? What other information would you want to have included in the patient's history?

3) Is Matthew growing well, based on his physical exam? Plot his measurements out in the proper growth charts.

4) What are the expected developmental milestones for his age? What findings for his age would be considered red flags and would prompt further evaluation?

5) What tips can be given to Matthew's parents to further support his development, especially his language skills? What anticipatory guidance can be provided? (You can include the milestones that he should achieve by the time he is 15 and 18 months.)