Case Study #1 Brittany 16 months old, failure to walk independently:
Brittany IS cruising. Cruising means she is walking around holding onto the furniture; however, she reverts to crawling when she no longer has a stable object to hold onto. In addition, all her other developmental milestones have been met pretty much on time. Looking at this clinical picture, I do not see a neuromuscular issue with Brittany. Therefore, it is reasonable to wait a couple of months. Early Intervention evaluation with P.T. is not a bad idea. And it will take time to get her evaluated, thus putting in a referral now would not hurt.
There is another issue to consider with Brittany. Brittany is in the 75th percentile for weight. This makes her overweight. She is drinking 24 oz. of whole milk and eating table food. Clearly, she is being set-up for childhood obesity.
Childhood obesity impacts the physical ability of children who do not develop strong muscles due to the exertion of moving too much weight. Brittany is on this path.
Her mother needs to reduce the amount of whole milk she is eating, and a careful diet journal of what Brittany is eating needs to be implemented.
Please also note: A clinician who suspects a developmental delay should never wait to act upon it without good cause. If Brittany was not cruising at this age, Brittany’s inability to walk must be investigate in its earliest presentation(Dosman, Andrews & Goulden, 2012). There is an argument to be made that at 16 months we could wait for her 18- month visit before deciding. However, if at her 18-month visit she remains non-ambulatory then the FNP MUST act.
According to the American Academy of Pediatricians:
“All children with suspected neuromotor delay should be referred to early intervention or special education resources. Additionally, concurrent referrals should be made to physical and/or occupational therapists while diagnostic investigations are proceeding.29 Even when a specific neuromotor diagnosis has not been identified, children with motor delays benefit from educationally and medically based therapies” (American Academy of Pediatrics, 2017, Resources para 1).