Language Regression in 10 month old - case management advice?

  1. Hi, not sure what section to post this in! I'm a Public Health Nurse, I do home visits to pregnant women and infants under 1 year old. I've already done a lot of research on the topic, so I just wanted to hear some personal experience stories or just any opinions.

    I could use some advice on a case. yesterday supervisor out of town, coworkers not helpful lol. I have been seeing a baby once a month since birth, normal pregnancy and c/s delivery, normal healthy infant with normal, if not advanced, development (as evidenced by my ASQ assessments). I charted his anterior fontanel to be closed at 7 months, which i was taught was within normal limits, especially since his developmental milestones were excellent and head circumference was progressing perfectly. At 8 months he lost significant weight (possibly b/c he was crawling all over the place and burning calories!) and I referred her to PCP appt regarding wt loss. PCP said omg his fontanel is closed, he might have craniosynostosis, he needs to see a pedi neurosurgeon. Seen by pedi neurosurgeon, who said while he cannot completely rule it out 100 % but this baby has no neuro symptoms and x rays look good, no s/x of ICP or developmental delay. no hx of seizures.

    Now this currently 10 month old who stopped saying consonants in the last 4-6 weeks (hasnt said dada like he used to since 6 months, and ba, ka ga,) but still coos and vocalizes lots, shakes his head no with meaning, stops activity when mom says no, and also in these last 4 weeks he learned to walk on his own, and other skills like clapping.

    SOOOO.... my question is - I understand that regression is ALWAYS a concerning sign, right? I am thinking to refer to the regional center for a complete development eval for sure, but should I also refer to PCP immediately?? (get new x rays, blood tests, possible audiology referral?) The next PCP appt is about 8 weeks from now, and its hard for them to get to doc office d/t 1 car and dads work schedule. Of course they will go if I say you need to see doc sooner than 8 weeks from now... but maybe I could check his language skills again in like 2-4 weeks and reassess to see if this was just a wierd phase for the child? Any chance its just a weird phase for an infant to stop saying dada and all other consonants, after the infant was already saying them from 6-9 months? And at the same time learned to walk and gained other skills? He has no other signs of complications of craniosynostosis yet, but if theres any chance there is restricted head growth that is causing the language issue, i would want it to be seen immediately by the neurosurgeon. head circumference grew 0.5 cm in last 4 weeks and is still at 50% percentile...

    AAAA I hope it turns out to be nothing serious? :/

    Thank you for any input!!! Nothing I wrote has any hippa concerns right??
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    About Mia415, BSN, RN

    Joined: Feb '14; Posts: 106; Likes: 134


  3. by   JustBeachyNurse
    Refer to regional comprehensive developmental pediatric center for a full evaluation. Which should include speech & language pathology, developmental pediatrics and if needed audiology. Refer to your county early intervention. Do not try and diagnose. Alert the PCP of your concerns but the regional evaluation center should be a one stop shop and comprehensive assessment
  4. by   JustBeachyNurse
    Sometimes one skill is put on a back burner when another skill develops
  5. by   Mia415
    Thank you! Yes I will fill out the referral on Monday - even though mom said she would prefer to wait a month or two to see if he improves. But after everything I have read, I think it does prompt an immediate referral... Our regional center works together with early head start for all referrals 0-3 yrs old, and they come as a team for the initial evaluation. I'm not trying to diagnose, sorry if it came off that way, just thinking of all possible causes and what else I can do for this family!
  6. by   Jolie
    He has had recent visits to both the PCP and peds. neurosurgeon. Can you relay this information to them and ask if they would like to see the baby, or have you reassess and report back to them?
  7. by   JustBeachyNurse
    Regional centers may have a month wait
  8. by   Mia415
    Yes I can call them. I was planning on at least calling the PCP. I think I knew everything I need to do, I guess I just wanted some reassurance that this is indeed concerning. We work so independently in my department there is often no one around to get advice from except google. Its my first nursing job, I've been here 2 years, and even though I feel like I'm doing a good job, I sometimes tend to doubt my knowledge. Just out of curiosity I was also hoping to hear other possible organic causes of language regression besides autism, since thats most of the information I am finding (and besides trauma or abuse/neglect).
    Thank you guys for your input!
  9. by   JustBeachyNurse
    Simplest happened to my own child. It was a temporary regression while his brain and body hyper focused on developing gross and fine motor skills (walking/cruising ). The are low risk but more life altering diagnosis such as a brain malignancy or progression of a genetic chromosomal mutation or other neurodevelopmental disease. If you look hard enough you will find plenty of potential devastating diagnosis.

    It's not our job to diagnose. It's our job to evaluate and refer for comprehensive interdisciplinary neurodevelopmental assessment. Contact the PCP and let him/her decide where to refer or the urgency of a specialty referral. If they have not been already at least a referral for a 0-3/early intervention assessment seems warranted.
  10. by   Mia415
    Thank you justbeachynurse. That is helpful. I've been brushed off in the past by busy PCPs who telling me "that's all normal" in other situations. So I just needed some assurance that my concerns and moms concerns are warranted, especially since he was just seen 3 weeks ago. Again, I understand it's not my job to diagnose - I am just personally curious and trying to learn more about various causes of altered development and standard recommended referrals. Thank you again!
  11. by   JustBeachyNurse
    Look at your state or county 0-3/EI program online they have lots of info. This is why a new grad cannot take a job like that in my state. They must have 2-5 years relevant hands on paid nursing experience in the area they are case managing (maternal/child, pediatrics, NICU ).

    It may be nothing just a weird normal variant. You don't want to alarm new parents with what ifs either. If not familiar with your state/county EI program look online and maybe ask to do a visit with intake and assessment to understand what goes on.

    The school referred my son for a state intake program a while back "it's free" everyone is guaranteed a comprehensive assessment and free treatment.

    It wasn't. There was a screening and if you don't meet the clinical criteria that's the end. It's not free insurance or the state CHiP plan is billed so you may or may not have a copay.

    EI is cost sharing in my state on a sliding scale. Copay may be $0, $1 and I think it maxes out to $20 or $25 with a cap (so a child getting three therapy sessions three times a week won't have a $250/wk copay it would be a lower maximum
  12. by   nurse2033
    Thought it might be Rhett syndrome but that only occurs in females.
    Last edit by nurse2033 on Jan 1, '16 : Reason: error