20-month-old: Delayed language and motor development

Case History

J was a 20-month-old seen for the first time by his PCP after the family moved to a new city. He had delayed developmental milestones, but was making slow developmental progress. He rolled infrequently. Recently he had learned to say a few words and clap his hands. He was not sitting or bearing weight on his legs. He was receiving physical therapy and developmental stimulation through Early Access prior to moving, and was to continue to receive these services in the new city.

J was born at term. His neonatal course was complicated by fetal hydrops, respiratory failure, hepatic failure and evidence of diffuse hypoxic injury on head CT. He also had neonatal seizures treated with Phenobarbital.

What should have occurred, based on J’s developmental history? Now read what happened.


J’s PCP correctly identified that his delays likely resulted from an early injury to the brain. He made appropriate referrals for management.