- re: neurologist

[Guest guest]

,

Neurologists deal with the nervous system. My visit entailed 2.5 hours . . .

paperwork was filled out prior to my visit and doctor reviewed day of our exam.

There were various tests given, no blood was taken. Since my son did not show

any signs of seizures, there was no need to do an MRI. There were no signs of

apnea or epilepsy. Neurologist agreed on diagnosis of apraxia and within three

weeks I received a report of neurologist's finding in wriitng and proper

treatment plan which helped with receiving services through the preschool

disabled program. Neurologists tend to ask a lot of questions about

development and any suspected seizures, plus medical tests already done. Did you

consider a neuropsychologist for testing rather than a neurologist? They can

sometimes be better about diagnosing, but they may not be covered by insurance.

Good luck.

Joanne Mulholland

As stated on the www.mayoclinic.com website - A baby born more than three weeks

early is considered premature. A premature baby is often at increased risk of

medical and developmental problems.

It is important to keep in mind that for each milestone, there is a range of

ages during which a child will normally meet it. For example, some children may

walk as early as 11 months, while others may not walk until they are 15 months

old, and it is still concerned normal.

Parents are usually the first ones to think that there is a problem with their

child's motor, social, and/or speech and language development, and this parental

concern should be enough to initiate furthur evaluation. In addition to a formal

hearing test (for children with speech delays), neurological exam (which will

look at your child's muscle tone, strenght, reflexes, coordination, etc), and

developmental assessment by their Pediatrician, children with developmental

delays should be referred to an early childhood intervention program (for

children under 3), so that an evaluation can be initiated and a treatment plan

developed, including physical therapy, occupational therapy and possible speech

therapy. He may also need a referal to a Pediatric Neurologist and/or a

Developmental Pediatrician for furthur evaluation and treatment.

In addition to the screening tests described above, your Pediatrician may be

able to calculate your child's motor quotient (MQ), which is his motor age (his

age as calculated by what milestones he has met) divided by his chronological

age and multiplied by 100. A motor quotient above 70 is considered normal, and

between 50-70 is suspicious and requires furthur evaluation, although it is

probably normal, and below 50 is considered abnormal. For example, if your child

is 12 months old and has just begun to pull to a stand (motor age of 9 months,

the age when most children are pulling to a stand), his MQ would be (9/12)*100

or 75, which is probably normal. On the other hand, if he has just begun to roll

over (motor age of 5 months), then his MQ is (5/12)*100 or 42 and this is

probably abnormal.

This information was given to me by my cousin who had premature twins. It is

not to scare you but to make you aware of issues involving preemies. A

neonatologist would have (or should have) given you information in the hospital

when you took your baby home. If there were no issues involved during birth and

your baby did not have to stay in the hospital longer than needed, that is

wonderful news! How was your NICU stay?

Early speech and language milestones:

a.. Newborns can localize a sound to their right or left side shortly after

being born and will turn their head or look in the direction of a sound. This

works best with loud noises when your baby is awake and alert, but they should

also be able to hear soft sounds. They can also begin to smile spontaneously and

in response to someone by 1 month. Infants learn to recognize their parents by

1-2 1/2 months.

b.. Infants can imitate speech sounds by 3-6 months.

c.. Monosyllabic babbling, or making isolated sounds with vowels and

consonants (ba, da, ga, goo, etc) usually begins by 4-8 months.

d.. Polysyllabic babbling, or repeating vowels and consonants (babababa,

lalalalala, etc) usually begins by 5-9 months.

e.. Comprehending individual words (mommy, daddy, no) usually occurs by 6-10

months.

f.. By 5-10 months, most infants can say mama/dada nonspecifically, using the

words as more than just a label for his parents.

g.. Many infants can follow a one step command with a gesture (for example,

asking for an object and holding your hand out) by 6-9 months. He should be able

to follow a one step command without a gesture by 7-11 months.

h.. The correct use of mama/dada as a label for a parent usually occurs by

7-12 months.

i.. The first word (other than mama/dada) is usually spoken by 9-14 months.

j.. By 10-15 months, he should be able to point to an object that he wants.

k.. Your child will be able to say 4-6 words (other than mama/dada and names

of family members or pets) by 11-20 months.

l.. He should be able to follow a two step command without a gesture by 14-21

months.

m.. Two word combinations or sentences are used by 18-22 months and can

include phrases like 'Want milk', 'More juice', etc.

n.. A vocabulary spurt leading to a 50+ word vocabulary occurs by 16-24

months.

Learning Problems

Premature babies are more prone than most to face complications --

both short- and long-term. Learn about which long-term complications might

arise, according to the University of Wisconsin Center for Perinatal Care, and

what you can do about them.

Former preemies are more likely than full-term babies to suffer from

learning deficits or learning disabilities at school. Up to 45 percent of

infants weighing less than 3 1/4 pounds at birth have one or more abnormalities

on testing at school age. It's usually not possible to predict at the time of

discharge or during early development who might develop these difficulties.

Common problems include:

a.. Coordination problems: Difficulty writing, drawing, or doing

jigsaw puzzles

b.. Language problems: Difficulty following directions, learning

to read, or remembering words

c.. Thinking problems: Difficulty with memory, spatial

relationships, or abstract concepts

Behavioral Problems

According to the Journal of Developmental and Behavioral

Pediatrics, behavioral problems are in many ways intertwined with learning

problems. Both are more likely to occur in former preemies. Sometimes parents of

preemies have a tendency to be overprotective of their child and avoid

discipline. This can lead to or worsen any behavioral problems that may arise.

These issues usually start before school age and often include:

a.. Overly aggressive play

b.. Temper tantrums

c.. Refusal to comply

d.. Excessive loudness

e.. Inability to stay still for any period of time

f.. Difficulty paying attention

g.. Extreme shyness

Some parents of preemies are reluctant to set limits or

enforce rules because of the difficulties that the child had to go through in

the early months of life. However, providing structure and defined limits can

often lessen or eliminate some of these behavioral problems.

If behavior problems persist or get worse, discuss them with

your child's doctor or teacher.

Vision Problems

Former preemies can have any of a number of vision problems.

These include:

a.. Amblyopia (lazy eye due to unequal vision)

b.. Decreased color vision

c.. Nystagmus (frequent jerking movements of the eye)

d.. Poor vision

e.. Smaller field of vision

f.. Strabismus (inward or outward turning of one or both

eyes)

Symptoms can include:

a.. Constant movement of eyes

b.. Frequent crossing of eyes, beyond 3 months of age

c.. Appearance of a cloudy or white texture on the surface

of the pupil

d.. Abnormal head tilt

e.. Inability to fix his eyes on an object or a face

f.. Drooping eyelid

g.. Oversensitivity to light

Contact your doctor if you suspect that your baby suffers from

any of these vision difficulties. Most of these problems can usually be

corrected with glasses, contact lenses, or eye patches.

Hearing Problems

Preemies are considered at high risk for hearing problems.

Watch out for these symptoms as your baby gets older:

a.. 3 months: Baby doesn't recognize mother's voice or turn

his head toward the direction of a sound.

b.. 6 months: Baby doesn't enjoy vocal play or make noise in

numerous tones.

c.. 9 months: Baby doesn't turn his head when you call.

d.. 12 months: Baby doesn't babble or isn't able to say

" mama. "

e.. 18 months: Baby doesn't respond to requests or move to

the rhythm of music.

f.. 24 months: Baby's speech is difficult to understand, and

he can't follow simple directions.

Speech and hearing therapists can help improve communication

with a child who has hearing problems. Most hearing difficulties can be treated

by hearing aids. If the loss is severe, children can be taught other forms of

communication such as sign language or lip reading

Dental Problems

Preemies have a greater tendency than other babies to suffer

from dental problems. This may be a result of delayed tooth formation or gums

that are altered by breathing tubes.

The dental problems a preemie is susceptible to include:

a.. Abnormal enamel formation

b.. Slow or delayed teething

c.. High arch or groove to the palate

d.. Abnormal bite

Often small abnormalities in enamel formation aren't visible.

More severe abnormalities are noticeable, such as a gray or brownish color or an

uneven surface and abnormal shape. The baby teeth are most often affected with

enamel problems. Sometimes the first permanent teeth are affected, but usually

to a lesser degree.

A high arched palate, often the result of breathing tubes, can

affect a child's speech and bite. Most children seem to adapt to the shape of

their palate. However, a preemie may be more likely to need braces when she's

older.

Often dental problems look worse than they actually are. Teeth

with enamel problems tend to be prone to cavities, but dental care and regular

brushing can prevent this problem. Here are several ways to prevent tooth decay:

a.. Bring your baby for a dentist's appointment around her

first birthday, recommends The American Academy of Pediatric Dentistry.

b.. Develop good toothbrushing habits as soon as the teeth

break through the gums. The teeth should be cleaned two times a day -- first

thing in the morning and before bedtime.

c.. Avoid the habit of letting your child sleep at night or

nap with a bottle. It can cause decay so severe that it destroys the teeth.

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