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The little girl who loved red and blue Lego

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Charlotte, aged 30 months, was brought by her mother to the clinic because she was concerned about her development which did not seem to match that of her older cousin. She seemed slow to talk and not interested in socialising with other children. She was also prone to temper tantrums. She was born prematurely at 35 weeks and had an Apgar score of 9. She walked at 12 months, had a good appetite, could activate electronic toys and games as well as make excellent Lego constructions. On examination including a neurological examination Charlotte was very healthy but was reluctant to engage with us. Although her general milestones were satisfactory we took cognisance of mother’s concerns and arranged to review her in three months.

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At review there were further concerns. She was still slow to talk, slow to toilet train and socialise. The director of the childcare centre was concerned about her tendency to play by herself and seek out a particular red toy and play with Lego particularly with red and blue blocks.

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She got frustrated easily and fell to the floor when adults could not understand her wants and the temper tantrums were more dramatic. We still observed her poor eye contact; she tended to avoid looking at a person by directing her gaze elsewhere. She would not engage with relatives and strangers unless she wanted something. By now we suspected an autism spectrum disorder and referred her to a specialist paediatrician. She diagnosed Asperger syndrome and recommended a multidisciplinary rehabilitation program with the emphasis on development of language and social skills.

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DISCUSSION AND LESSONS LEARNED

  • The diagnosis of behavioural developmental disorders in early childhood is not easy so early referral to a disability unit or specialist is advisable especially as early intervention can produce significant improvement.

  • Once again the principle of taking notice of parent’s concerns and follow up for such a concern is important.

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Beware the childhood dysplastic hip

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We have all spent anxious moments wondering whether we have misdiagnosed developmental dysplasia of the hip and some of us have experienced nervous moments due to a delayed diagnosis.

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CASE 1

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Dr Helen Fitzgerald writes about a full-term healthy baby girl who was checked by a paediatrician at birth and at six weeks post partum. No problems were identified. She attended at eight weeks for her first immunisation and was examined by another doctor who recorded a normal physical examination. At eight months she developed a febrile illness due to a urinary tract infection. The radiologist who performed a renal tract ultrasound contacted the practice to report that the toddler’s left hip was dislocated and the acetabulum and femoral head were abnormal.

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CASE 2

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Dr David Howard records the case ...

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