Developmental Delays and MayRose

As a result of the diffuse brain damage that MayRose suffered when she went into anemic shock, she now has Developmental Delays. Although she is 2 years old, she does not have the muscle control to sit-up or walk. She wears leg braces that will help her with her leg positioning. She also suffers from siezures which have to be controlled with medication.

Overview: Developmental Delays is a group of disorders involving movement, learning, hearing, seeing, and thinking that occur due to problems with brain development.

Symptoms: Injury to the largest part of the brain (cerebrum) can lead to the loss of nerve functions in different areas. Many children with this condition have increased muscle tone (spasticity). Spasticity may affect:

• One arm or leg
• One side of the body (spastic hemiplegia)
• Both legs (spastic diplegia)
• Both arms and legs (spastic quadriplegia)

Symptoms are usually seen before age 2. In severe cases, they may appear as early as 3 months.

Symptoms may include:

• Abnormal movements
• Abnormal sensations
• Abnormal muscle tone
• Decreased intelligence
• Difficulty sucking or feeding in infants
• Hearing problems
• Increased drooling
• Irregular breathing
• Learning disabilities
• Limited range of motion
• Pain
• Partial or full loss of movement (paralysis)
• Peg teeth
• Problems swallowing (at all ages)
• Seizures
• Speech problems (dysarthria)
• Urinary incontinence
• Vision problems
• Vomiting or constipation

Treatment: There is no cure for developmental delays. The goal of treatment is to help the person be as independent as possible.

Treatment requires a team approach, including:

• A primary care doctor
• A social worker
• Nurses
• Occupational, physical, speech and vision therapists
• Other specialists

Treatment is based on the person's symptoms and the need to prevent complications.

Self and home care include:

• Getting enough food and nutrition
• Keeping the home safe
• Performing exercises recommended by the health care providers
• Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
• Protecting the joints from injury

Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

Many adults are able to live in the community, either independently or with different levels of help. In severe cases, the person will need to be placed in an institution.

The following may help with communication and learning:

• Glasses
• Hearing aids
• Muscle and bone braces
• Walking aids
• Wheelchairs

Physical therapy, occupational therapy, orthopedic help, vision therapy or other treatments may also be needed.

Medications may include:

• Anticonvulsants to prevent or reduce the frequency of seizures
• Botulinum toxin to help with spasticity and drooling
• Muscle relaxants (baclofen) to reduce tremors and spasticity

Surgery may be needed in some cases to:

• Control gastroesophageal reflux
• Cut certain nerves from the spinal cord to help with pain and spasticity
• Place feeding tubes
• Release joint contractures

Stress and burnout among parents and other caregivers of developmentally delayed patients is common, and should be monitored.

Causes: Developmental delays are often caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb, but they can happen at any time during the first 2 years of life, while the baby's brain is still developing.

In some people with developmental delays, parts of the brain are injured due to low levels of oxygen (hypoxia) in the area.

Types of developmental delays can result in:

• Spastic cerebral palsy is the most common type.
• Dyskinetic (athetoid) cerebral palsy involves abnormal movements (twisting, jerking, or other movements).
• Ataxic cerebral palsy involves tremors, unsteady gait, loss of coordination, and abnormal movements.
• Hypotonic cerebral palsy involves floppy muscles, especially at rest, and increased range of motion in the joints.
• Mixed cerebral palsy involves any combination of symptoms.

Tests & diagnosis A doctor's examination may reveal:

• Abnormal walk (gait), with a tendency to tuck the arms in toward the sides, make "scissors" movements of the legs, and walk on the toes
• Abnormal slow, writhing movements that get worse with stress and don't occur during sleep
• Delayed development of motor skills (reaching, sitting rolling, crawling, walking)
• Infant reflexes (such as sucking and startle) that continue past the age where they usually disappear
• Joint contractures
• Muscle contractions
• Muscles that do not stretch (spasticity)
• Muscle tremors
• Muscle weakness

The following tests may be performed:

• Blood tests
• CT scan of the head
• Electroencephalogram (EEG)
• Hearing screen
• MRI of the head
• Vision testing

Cerebral palsy is a lifelong disorder. Long-term care may be required. The disorder does not affect expected length of life. The extent of disability varies.