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Deborah Howell (Host):  Welcome. And thanks for joining us. Today, we'll be finding out what a Developmental Clinic is. And how a special clinic like this can help children with developmental delays. This is the podcast series from Deaconess, The Women's Hospital, A Place For All your Life. I'm Deborah Howell and our guest today is Jordan Wassmer an Occupational Therapist at High Point Therapy at the Women's Hospital. Welcome Jordan.

Jordan Wassmer, OT (Guest): Hi, it's nice to be here.

Host: Wonderful to have you. Let's jump right in. What is a Developmental Clinic?

Jordan: So, a Developmental Follow-up Clinic is a specialty clinic that sees infants from birth to two, who are at a higher risk for developmental delay. So, at a typical visit, these patients will be seen by a team consisting of a nurse practitioner, a registered dietician and an occupational therapist who have all been trained to assess infants and toddlers at these ages. So, this clinic monitors patients to help make sure they're staying on track, developmentally. And if they are not, the nurse practitioner will make the appropriate referrals to make sure they get the services they need. Our team does an in-depth assessment each visit and makes recommendations based off their current developmental skills.

And we address any current concerns that a parent might have. As a team, we monitor and assess any medical, nutritional, functional, feeding and developmental needs. The goal is to make sure that these kids, that we are monitoring, are monitored more closely in relation to their development because they're at a higher risk for delays. We do this because monitoring from an early age and helping families get in touch with the services their child may need at that early age is very beneficial to support positive developmental outcomes. Our goal is to make sure that these kids are receiving all the services they need and making positive developmental gains by the age of two when they graduate from Developmental Follow-up Clinic.

Host: That's wonderful work you do. So, you said early age, but at what age do we really determine if a child needs developmental help?

Jordan: So, we typically see our patients at certain intervals, and these are at four months, nine months, 12 months, 18 months, and 24 months. Sometimes if infants leaving say the NICU have feeding difficulties or increased risk of developmental delay, they will be referred at only a few weeks old for early followup to Developmental Clinic to be assessed at that, like a couple of weeks after they're discharged from NICU to home. Occupational therapy's role at this clinic is to screen and make observations of feeding skills, motor skills, head shape, and overall developmental skills at any of these ages. But the whole team works together to make decisions and recommendations.

And we each have our own part. Oftentimes our patients are born prematurely, which can affect the overall progress of their development. And to really answer the original question. I think my best answer would be that at an early age, you can start to observe movement patterns, maybe even say at birth and you start to observe those movement patterns, their tone, their play skills, and you compare those to what is expected for that child's age.

And that is how you can determine if a child may need some developmental support. And each baby or toddler is different. So, the need will always be different just depending on what that child may be having a hard time with. But that's the beauty of this Developmental Clinic. We get to monitor these kids to make sure they're addressing their needs at an early age, in order to help them and their families get the services they need and to take advantage of helping them receive interventions at that early age.

Host: Yeah, it does sound like the monitoring is key. Now, Jordan, are there any signs you can look for to know if a child needs developmental help?

Jordan: So, at the Developmental Clinic appointments, each member of the team does an assessment on the child. Then we come together to make recommendations in regards to feeding, nutrition, development, et cetera. If we're talking from a motor perspective, in relation to development, the therapist uses a developmental screening tool and clinically observes movement and play patterns to assess how the child is doing developmentally for their age or for their adjusted age.

And this happens at every appointment. If I were to give an example at the four-month appointment, some developmental skills that we would look for while a baby is playing on their back. Can the baby visually track an object smoothly from one side to the other crossing midline or the middle? Can the baby bring one or two hands up to a rattle held at midline? Or is the baby starting to kind of do that and swat it toys? If you put a toy in your baby's hand, are they grasping it intentionally? And then will they bring it to their mouth to explore it? We also look at can a baby lift their knees and their feet up off the ground and kick their legs.

And then if a baby's on their stomach, we look at their cervical extension through their neck, how much they can lift their head up to look around, and how they support themselves on their forearms. Like up on their arms while they're on their belly. And that's not everything we look for, but that's an example of some pretty standard developmental skills we look at that four-month appointment.

So, then based off observations, like those examples I just gave, we then can make a recommendation on if a child is in need of further services. While talking about that too, I think it's important to mention that even if a child comes in at their four month Developmental Clinic appointment and is doing well at that time, or even if they come in at their four month and their nine month appointment and is doing well at that time, they still may need developmental support at a later time, say that 12 or 18 month appointment. So, for that reason, we follow our children until age two, even if they're on track at every appointment.

Host: This is unbelievable. I didn't know. So, young that there were signs. Now, can you explain some ways you would treat a child who needs developmental help?

Jordan: So, at Developmental Clinic, if a child is presenting like he or she is behind for their age or for their adjusted age, we will, as a team, make a recommendation to therapy services, or other services based off the needs of that child. The recommendations that we make depend on the severity of the delay, the other observations we've made and the needs of the family. We also have individuals as part of our developmental team who help with coordinating appointments and contacting resources for families. For example, if a family is coming to our Developmental Clinic appointment from a different town or further away, we will try to find qualified services and resources close to their home that they can take their child to that is more convenient, closer to them.

Host: Got it. Now, what are some causes that contribute to developmental delays?

Jordan: So, the children that are referred to us, that we typically see, are statistically at a higher risk for developmental delay. These infants benefit from monitoring and sometimes assistance to help encourage appropriate development. So, this might be prematurity and a long NICU stay with any co-morbidities as well as being born with a birth condition or a genetic disorder.

And those are all causes that can contribute to potential developmental delay. Children born who withdraw from drug exposure may also be at a higher risk for some potential delays. Our Developmental Clinic monitors children who are referred to us who meet a certain criteria at NICU discharge based off a recommendation from the state. However, we also receive referrals for infants who may not meet that criteria, but their primary care or discharging physician has noted some concern and they want extra eyes on them. Those are primarily the type of infants or toddlers that we see. But if a parent has concerns, they can always ask their physician for a referral to Developmental Clinic.

And to kind of answer the original question too, in general, with developmental delay, sometimes there may not always be a straightforward underlying cause. Like the ones that I mentioned above it's like an older kid, sometimes kids just fall behind a little bit and need a little extra support to get them back to where they need to be.

Host: Now on average, I know everybody's different, but how long does a child stay with the Developmental Clinic?

Jordan: So, our Developmental Clinic is from birth to age two. We see kids until they are age two. Because that's where, like, if they were premature and adjusted, they're no longer adjusted for their prematurity. We also hope that at that time, these kids are already involved in any services that they might need to help support their development.

Host: I have a final question for you, Jordan. What is the end goal of the Developmental Clinic?

Jordan: Our main goal with Developmental Clinic is to make sure that these higher risk infants that are referred to us are receiving all the services and care that they need. We monitor their development closely at those age intervals I mentioned earlier to make sure that we are periodically checking on these kids, to make sure they're staying on track developmentally. And if they're not, we want to make sure that at that time, we help support families in finding and beginning any services or resources that their child might need. Early intervention is very beneficial in supporting development for children who might need it. So, we want to make sure that we closely monitor these infants and toddlers until they're two years old with the goal that at that time, they're involved with everything that they need.

Host: Got it. Well, thank you so much, Jordan, for shedding some light on Developmental Clinics and the important work they're doing. It's been great to have you on the podcast today.

Jordan: Thanks. It was nice to be here.

Host: And that wraps up this episode of the podcast series from Deaconess The Women's Hospital, A Place For All Your Life. For more information, head on over to deaconess.com/highpoint or call (812) 842-0283. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.