Introduction to Algorithm and Case Examples Nancy Swigonski, MD, MPH I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity.

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Case Studies

Using the algorithm, decide what the next step(s) should be... u An 18 month old, who you have followed since birth comes in for well child care. The child was born at term and has previously met all developmental milestones. The toddler stays at home with mother who has a high school education. Mother has no concerns about the child. The family history is negative. u What developmental surveillance or screening should be done at this visit?

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Using the algorithm, decide what the next step(s) should be... u A 12 month old, who you have followed since birth comes in for well child care. The child was born at term, has normal growth and has previously met all developmental milestones. The baby stays at home with mother who has a high school education. The family history is negative. You ask the mother if she has any concerns about the child’s development, behavior or learning. She is worried because this child seems “slower” than his siblings did at this age. u What should be done at this visit?

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Using the algorithm, decide what the next step(s) should be... u A 24 month old, who you have followed since birth comes in for well child care. The child was born prematurely (34 wk AGA) to a teen parent. The child was last seen at 12 months where a developmental screen was negative for delays. The family history is positive for school “dropouts”. You ask the mother if she has any concerns about the child’s development, behavior or learning and she does not. u What should be done at this visit?

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Using the algorithm, decide what the next step(s) should be... u An 8 month old, who just moved to your area comes in for well child care. The child was born prematurely (28 wk AGA). The family history is negative. Mother is concerned about when the child will “catch up”. Direct observation shows that the baby fixes and follows, bats at objects but does not yet roll over. Tone in the lower extremities is somewhat increased. u What should be done at this visit?

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Questions / Discussion