Paige rubs her eyes and pulls her blanket close. She tickles her nose and sniffs the blanket, her nostrils inhaling deeply and flaring back out erratically. She sucks furiously on her pacifier.
“I know you’re getting tired, Sweetie,” I whisper, kissing her temple. “We’ll be done soon.”
Dr. Hertford comes back and sits down at the desk with a small stack of paperwork. “Paige is average in her cognitive, language and fine motor skills,” says Dr. Hertford, pointing at each score with the tip of her pen. “However, her gross motor skills are delayed by two months.”
Dr. Herford’s medical report states the following:
- Paige is a 6-month-old… exposed to multiple prescription and illicit drugs. She suffered significant withdrawal symptoms requiring pharmacologic treatment. She is being adopted.
- Weight gain is poor possibly related to the reflux and her inability to keep down enough calories. Daytime hunger may be contributing to her fussiness and poor napping.
- Paige has abnormalities of muscle tone, with decrease in her trunk and increase in her limbs, especially the legs. This contributes to the delay in motor development. She also has a very mild paresis of her right arm from which I expect her to recover.
“Stiffness is common in drug-exposed babies,” Dr. Hertford explains.
“Could an infant have stiffness if the mother only used drugs once?” Ruth’s insistence during labor that she used meth only once during pregnancy echoes in my memory.
“It’s possible, but not likely. If the mother is addicted to the point of using even once during pregnancy, she probably used more than that.
“Unfortunately, Paige isn’t eligible for stated-funded therapy because her score isn’t low enough. Some of her abnormalities are seen in cerebral palsy; however, she’s missing some key symptoms for that diagnosis.”
My stomach drops and I shake my head sadly. Paige is screwed because her delays aren’t severe enough.
“If she continues having muscle tone abnormalities and delays, I’d consider giving her a diagnosis of mild cerebral palsy. That would automatically qualify her for state-funded services.”
Dr. Hertford advises me to massage and bicycle Paige legs and arms to help with stiffness. “She needs to have tummy time for at least 15 minutes a day, even if she doesn’t like it.”
I agree to try but doubt anything will come of it. Paige’s intense protesting during tummy time results in nothing more than a face-plant on the carpet and a temper tantrum.
“I normally see my patients for a follow-up exam in six months but I can only see Paige while she’s a CPS case. When do think her adoption will be finalized?”
“Probably in four to six months.” I hug Paige closer, smile and kiss her head.
“That’s cutting it close,” Dr. Hertford muses. “I’ll go ahead and schedule another appointment in four months just in case her adoption finalizes on the earlier side.”