Wow... sounds like you provided much skilled nursing care for this pediatric client so his medical condition improved -off vent, oral feedings, full ambulatory -- great work. So now the goals have changed to focus on clients cognitive and physical development-- quite appropriate for nursing care in client with developmental delays IN ADDITION to them receiving PT/OT via early intervention program if not yet able to attend school. You still would be assessing for respiratory+ feeding issues, medical complications but main focus has shifted.
I cared for 19yo client vent dependent@night/sleeping, had severe vision issues, wheelchair bound but our main focus was to developmentally improve their skills. I worked days/evening shift while mom worked. Built into daily schedule time with computerized vision screen to improve reading, participate/encourage them in making crafts so they could transition to attending adult workshop, instructing/observing them to make own lunch to improve hand dexterity + proper nutrition, transferring them to wheelchair for me pushing them for stroll around block to get sunlight/vitamin D as lived in basement room while encouraging them to interact with neighbors. All this was in addition to RN skilled assessment, trach + vent care, incontinence mgmt and medication administration. It was one of the most fullfulling home care assignments to see this client become slightly more independent over 2 years I was involved with them, transitioning to adult services at age 21.
Maybe you can rethink this type request going forward as pediatric clients medical issues resolve and focus changes to cognitive/developmental growth.