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A letter from the developmental doctor to Nathan’s GP
Re: Nathan Windisch d.o.b. 8.9.98
Problems:
1. Pre-term 26 weeks gestation birth weight 880 gms.
2. Chronic lung disease.
3. Bilateral inguinal hernia repaired 26.2.99
4. Slow weight gain
5. Mild left/alternating convergent squint.
6 Borderline developmental delay
I reviewed Nathan now aged two years, corrected age 21 months,
at the Dingley Centre on the 18th
September when he was accompanied by his father. His father
reported general pleasing progress and no specific concerns.
Nathan is currently awaiting surgery for an undescended testes.
However, his general health has been good. Feeding remains an issue
and he has been slow to gain weight, however he is slowly expanding
his range of foods, he now eats crackers and fruit and is starting
to experiment with yoghurt. Constipation is also a problem and he
has been referred to the dietician in this respect. He has been
commenced on Lactulose 5 mls bd. He remains under ophthalmoiogical
review for his intermittent squint.
His parents have been particularly pleased with his developmental
progress. They report particular progress in the area of speech
and language. Nathan has many single words and is starting to put
words together, e.g. "bye-bye car". He knows several body parts
and is starting to learn simple rhymes e.g. "rain rain go away".
From the gross motor standpoint Nathan is still not walking alone.
His father feels that this is more a problem of balance as he is
able to take his own weight. walking with minimal support. He is
able to pull to stand and play standing up He will also now crawl
upstairs. He is able to build a tower and enjoys putting Duplo together.
He is particularly fond of cars and will play for a long time with
them. Socially he is very alert and responsive. He will finger feed
and hold his own spoon. Although he will not use a cup at meals!
he is described as drinking the bath water from an old cup !! He
will pull his socks and shoes off. He will not yet indicate when
his nappy is wet or dirty, and has no anticipation of his toilet
needs.
He continues to see the physiotherapist regularly.
It is planned that he will attend Maiden Erleigh Nursery two mornings
a week once he reaches three years of age.
On examination his weight was 9 kilograms (well below 3rd centile)
with a height of approximately 77 cms (around 3rd centile) and a
head circumference of 47 cms ( 10th centile). Neurologically he
had good tone with symmetrical reflexes. I could find no evidence
of squint on light reflection and colour testing today.
His development was assessed using the Schedule of Growing Skills
2. He was able to build a three brick tower with encouragement and
showed considerable interest in books, turning pages several at
a time. He demonstrated neat pincer grip but was unable to grip
a crayon and did not engage in any drawing. He was able to complete
the shape form board with ease. He was able to select two out of
four objects and point to his own named body parts, but was not
able to translate this to a doll. He was unable to follow a two
step command but showed good understanding of verbs using action
pictures. He copied language readily using many single words. I
was impressed that he was able to name accurately six pieces of
the bus puzzle - however he was unable to replace these or orientating
them correctly on request. He played contentedly, particularly when
play involved cars! Evaluation of his skills revealed developmental
age predominantly at an eighteen month level, apart from vision
and expressive language where he scored at the 24 month level, and
his locomotor skills which are more specifically delayed to the
15 month level.
Nathan certainly seems to have made some progress over the last
four months although this has been more apparent in language than
other areas of development. I am recommending that Nathan continue
with his regular physiotherapy and have advised his parents to encourage
more manipulative skills. We will review Nathan in six months time
at the Dingley Centre.
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