Exceptions to Developmental Milestones: Thirteen to Eighteen Months
If your infant has required lengthy or frequent hospitalizations since discharge from the NICU, or your infant is still on supplemental oxygen, feeding tubes, and/or a large number of medications, she may not be able to put forth much effort to accomplish developmental milestones at this time (just like you would be unlikely to get up and learn a new dance step if you were home in bed with the flu or just recovering from surgery). If your child is still in the NICU at this time her developmental progress will definitely be affected by her health status.
If your child has Cerebral Palsy (CP) her motor problems will have an impact on her learning. It is important to work with qualified therapists to help maintain and hopefully improve your child's mobility. However, do not neglect play and learning through play. Children learn best through play. A child's need for play is not different because she has CP, though she may need help in getting this need met adequately. Encourage your child's therapists to help you figure out ways to support your child in expanding her ability to play.
When someone physically needs help to do many things it is hard to be independent. Whenever possible let your child choose between two acceptable choices. You want to find ways to encourage your child's autonomy. It can sometimes be difficult to be sure what a significantly motor impaired child knows and what she is learning. It is wise to assume any young child can learn if we figure out a way to support their learning. As the child gets older it will be easier to understand what her level of cognitive functioning for school will be. It may be helpful to become involved in a program that can help children and their families find adaptive toys and ways to play. One such program is Lekotek, a toy-lending library for children with disabilities (1-800-366-PLAY, http://www.lekotek.org).
If your child is having significant problems developing a communication system and learning to talk, there are several things you should be doing. A thorough hearing evaluation needs to be done by a pediatric audiologist. Once hearing has been ruled out as a cause for a child's language delay a speech evaluation should be done. If a hearing loss has been documented it would be appropriate to contact Georgia PINES for assistance both with securing hearing aids, if required, and for help providing appropriate stimulation for your child. Your child will automatically be eligible for the Babies Can't Wait Program if the hearing problem is severe. It will be helpful for your child to work with a speech therapist experienced in working with hearing impaired children. In the meantime it is important to develop a communication system for your child. See ideas outlined under 10-12 month exceptions.
If your child has feeding difficulties and is not growing appropriately, an oral motor evaluation may be needed. It is important to determine the cause of a feeding problem. This allows for appropriate medical intervention and referral for therapies. If feeding problems persistent, working with a nutritionist to increase caloric intake, or possibly consideration of a gastrostomy tube may need to be explored. Children who are undernourished risk impaired brain growth. Also, without proper nutrition a child may be very tired, irritable, and lack the muscle mass to get around, explore and learn. This is an area that should be under close supervision by your primary health care provider.
Visually impaired children will need to be followed by a Pediatric Ophthalmologist. In addition, there are several programs that can provide vision therapists to work with families and help you understand how best to stimulate your child's development. Begin and Georgia PINES are two such programs available in Georgia. If your child's visual impairment is severe she will automatically be eligible for the Babies Can't Wait Program.