neck evaluation

The peeps from the Montgomery County Infants & Toddlers Program (MCITP) came out to assess Josiah. They actually assessed him over several areas, not the 4 that I had originally thought from the initial intake. Josiah did well in all areas except 3, where he scored more than a 25% delay.

The first area was "expressive language." He scored more than a 25% delay b/c he was really quiet during the evaluation (understandably so) and didn't "vary vocalizations." (Whatever.) The second area was "social-emotional." He was shown to be delayed b/c he hasn't yet started to reach for familiar people or smile spontaneously or smile at his face in a mirror. And the third area was "self-care" (feeding). This was b/c he hasn't started solid foods yet (a situation that will soon be remedied). I have no clue where his neck evaluation fits in with any of this, but since he's delayed in the other areas, he qualifies for services.

They will be observing for any progress in the above 3 areas, but will mainly be doing physical therapy to improve Josiah's neck muscles. (Can I just stop here and say how baffling it is to me that he's receiving services for something that doesn't fit what he's supposed to be receiving services for?) The physical therapist identified him as having a moderate case of left positional torticollis, with a slight tilting of his head to the left. So she gave us positioning ideas for him (which are ways we can lay him down to encourage him to look to his left more), 2 different stretches to do with him at every diaper change, and tummy time at least a few times a day (which, unfortunately, I had not made a big priority of in the past). The physical therapist said she'd be coming out more often in the beginning to see how we're doing with the stretches, so it seemed more about teaching us what to do with Josiah on a daily basis, rather than having the focus be on the physical therapy sessions. As we get the hang of doing the stretches and letting her know how we're doing at home, she will come by less and less often. But she did say that if we are faithful to doing the exercises, Josiah should have full range of motion in his neck at the end of 6 months.

As for the flattened, right side of his head, the physical therapist said that there are 2 schools of thought: let it naturally re-shape with time as he sits up more and spends less time on his back or use a helmet. She didn't seem inclined to influence us one way or the other, or communicated a personal preference for one or the other. But after talking with Josiah's pediatrician, we are going to let his head naturally re-shape. I don't remember what she said exactly, but the basic premise is that the research she's read indicates that it doesn't make a difference.

So Josiah's first physical therapy session will be in a couple of weeks. I don't know how consistent we'll be able to be with the exercises since Jimmy is coming home to visit for our faux family vacation, but we'll do our best. =)