Question

BJ is an 8mos old Caucasian infant. He was born at 27 wk gestation weighing 1.2 kg to an 18yo single mother. His mother brings him into the office today for his routine immunizations. She is teary-eyed as she gives the history to DR. BJ continues to have significant head lag, never has rolled over and is unable to sit up. Recently, mom has noticed feeding difficulties during meals. When BJ's diaper is being changed, mom has noticed increased stiffening and scissoring of his legs at times. On physical exam, Dr. Feelgood noticed persistence of primitive reflexes. BJ continues to have a tonic neck reflex, and a persistent Moro reflex. BJ has not met any developmental milestones. Dr. Feelgood referred BJ and family for early intervention.

1. What fine and gross motor skills should an 8mos old achieve?

2. What suggestions can you give mom regarding feeding BJ?

BJ is now 14mos old and weighs 8 kg and has been diagnosed with spastic cerebral palsy. He is unable to meet any of his developmental milestones. He continues to go to the multidisciplinary CP clinic. His spasticity continues to increase and the clinic recommended that a baclofen pump be inserted intrathecally. BJ has also developed seizures.

3. What fine and gross motor skills should a 14mos old achieve?

4. What is a baclofen pump? How does the drug baclofen help reduce spasticity?

5. What other drugs are given to reduce spasticity?

6. BJ has been prescribed Tegretol for his seizures. The drug book states 10 - 20 mg/kg/day divided twice a day. The physician orders Tegretol 70mg BID. Is this safe?

7. The early intervention clinic is multidisciplinary and offers many services. What providers and services would be useful for a child with cerebral palsy?

8. What are mom's unique psychosocial needs as an 18yo single mother of a child with a chronic disability. What are some interventions that could better support mom?

Answer 1

1.Gross motor skills at 8 month old :sitting without support.

Fine motor skills at 8 month old :plays by picking up and dropping objects.

2.The care should be taken while feeding because there is a more chance for aspiration. So mother should be given knowledge regarding the risk of aspiration and the subsequent complications of it, like aspiration pneumonia. To prevent this we can suggest a nasogastric tube feeding.

3.Gross motor skills at 14 months :stands without pulling up, walks well and falls by collapse

Fine motor skills at 14 months :add third cube to a two cubed tower, put round peg in and out of hole, imitate back and forth scribble.

4.Baclofen pump consists of a pump and a catheter that is used to deliver baclofen intrathecally. Pump is a metallic disc that is implanted under the skin of the abdomen. There is a reservoir for medication and a battery. Baclofen is a muscle relaxant that inhibits both monosynaptic and polysynaptic reflexes at spinal level which helps to reduce spasticity.