Medical Needs Assessment

Preschool Case Study

Name: Rosa
Age: 4years 9 mos.
Reason for ECSE services: Down syndrome, intellectual disability requiring constant support, complex communication needs
Medical Information: Down syndrome, thyroid deficiency (takes synthyroid), strabismus, atlanto-axial subluxation, ventricular septal defect repair, feeding difficulties (aspirates on thin liquids, has difficulty chewing solid foods).
Family History: Rosa lives with her parents and grandmother. The family is from Puerto Rico. They moved here when Rosa was two years old. Rosa has no siblings. The family is deeply religious. The family travels back to Puerto Rico several times a year. The family is bi lingual. Rosa has had most of her medical interventions here in the United States. She did not participate in EI services. Family was reluctant to send her to preschool but finally agreed to do so when Rosa was 3 and half.
Medical History: Rosa was born full term. She was diagnosed with Down syndrome shortly after birth. Rosa was being monitored in Puerto Rico for her heart condition (ventricular septal defect) as well as for her overall developmental delays. Her parents report that she had frequent bouts of pneumonia as an infant. It was determined through medical tests that Rosa was aspirating on thin liquids like formula. She was NG fed for a few weeks, and then she did fairly well with formula that was thickened to nectar consistency. Her family moved here right before her second birthday. Rosa had heart surgery to repair the VSD at age 29 months. She continues to have difficulty with thin liquids, however, when liquids are thickened to nectar consistency she does not aspirate. She also has difficult chewing solid foods so right now her food is ground up. She still needs assistance with feeding herself. She has very low muscle tone. She walked at 30 months of age. She has been diagnosed with atlanto axial subluxation so she cannot participate in any rough and tumble play activities. She is also near sighted and will need surgery in the near future to correct strabismus. She does not like to wear her glasses. She has frequent ear infections that respond to antibiotics.
Educational History: Rosa attends her LEA inclusive preschool classroom. She enjoys coming to school. She receives the services of a preschool intervention specialist, an OT, a PT and an SLP. She attends 4 half days per week. There is also a nurse in the building for the program. Rosa walks although she tends to fall a lot. She is learning how to go up and down steps. Her fine motor skills are also delayed. She is able to pick up objects like small blocks but has difficulty picking up smaller objects. She finger feeds but does not yet use utensils consistently. She drinks from a cut out cup and a staff member must assist her with this because of the aspiration issues. She communicates using facial expressions, pointing, and vocalizations. Her parents speak Spanish to her at home and she hears English in school. Rosa has said 1 or 2 words in Spanish at home according to her parents. In school, she says hi to her peers during circle time. She can make choices of what she wants to play with by pointing to the objects. She uses gestures to communicate, for example she turns her head when she does not want any more food. She pushes an object away when she is done with.

Her IEP team including the parents has identified the following areas of need for Rosa:
1. Develop self help skills of using utensils
2. Improving motor skills so that she can walk up and down steps
3. Communicate using signs, pictures or words