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Jason (References (Medscape. (2017). Prune belly syndrome. Retrieved from…

- - - - Mother concerned with this delay
        
        Jason does not have postural control or strength to sit unsupported so that hands are free to feed
  - - - Jason only eats soft food textures and thick puree
        
        Jason cries when given to noxious textures
    - - Sensory modulation issues, no structural basis for gagging and vomiting as determined by MBSS
  - - - He will scream and cry at restaurants which limits community outing for his family
      - Jason does not interact with sisters while in play; if they take away his favorite toy or give him a new one to share, he will begin to scream and cry
      - He experiences melt downs at home limiting his family interactions during play and mealtime
      - Jason is dependent on his caregiver to feed, bathe, and transport him, as well as change his diaper
- - - - Intervention activity: Introduce new textures gradually to preferred foods
        
        Begin with familiar foods and introduce new textures within these foods. Examples: placing cereal into pudding, making lumpy mashed potatoes, placing mashed strawberries into oatmeal
      - Intervention activity: Reduce hyperreation of contact between teeth with food and toys by using a vibrating toothbrush to stimulate mouth; begin with toothbrush at chin and cheeks, until Jason parts his lips to allow the toothbrush in to his mouth
        
        Grade down: Use old batteries that will provide a low frequency of vibration
        
        Grade up: Use more powerful batteries to enhance stimulation
      - Parent education: Provide education on Jason's nonverbal cues so they understand when a tantrum is about to happen and to remove the stimulus; provide empathy during stressful times rather than expressing frustration; do not push Jason to eat new items so there is no power struggle
    - - Intervention activity: Create a calming, supportive environment with decreased distractions and calm music to inhibit overload during eating. This will be a safe place for the child to retreat and calm down in times of stress. Take time to create positive association with foods and mouth
        
        Grade up: Bring family members into the room to eat with Jason
        
        Grade down: Focus on getting Jason comfortable within the room, do not provide feeding
      - Intervention activity: Use appropriate mealtime-related distractions during introduction of new textures. When feeding Jason a noxious texture, begin singing a song or let the child play with a favorite toy to prevent overreactions and relieve anxiety. If Jason begins to gag, ignore him by using a gag distrction. Provide parent education on this technique.
  - - - Grade up:
        Incorporate 15 second intervals of unsupported static sitting balance while child manipulates and reaches for toys
      - Grade down: Practice supported sitting balance c truncal and head support; child will not participate in play
  - - - Intervention activity: Offer Jason food at meal-appropriate times. Sit Jason in the highchair with small, cut up portions on his plate to promote finger feeding. Demonstrate finger feeding and have Jason mirror it.
      - Intervention activity: Allow Jason to play in food to explore different textures then bring food up to mouth. Provide smooth textures and crunchy textures mixed within.
        
        Grade up: Incorporate more noxious textures within play with food, such as crunchy cereal or crackers
        
        Grade down: Allow child to play in food, but caregiver provides mod A to assist child in bringing food to mouth
    - - Intervention actviity: Incorporate spoons and forks into play to work on palmer grasp by having Jason stab cheese blocks with fork while sitting supported at table
        
        Grade down: Have Jason free play with spoon and fork to get comfortable with grasp
        
        Grade up: Place utensils further away to promote reach and grasp
      - Intervention activity: Have Jason sitting supported at a table and work on pincer grasp by having him play with play dough. Encourage him to squeeze into the play dough with this thumb and index finger to promote fine motor skill development and increase hand strength.
  - - - To encourage Jason to begin IND dressing, have him put clothes on his favorite super hero toys (The OT Toolbox, 2016). Use a song that the caregiver and Jason will sing during this play, then incorporate it into dressing. This will increase self confidence and build fine motor skills needed for dressing and grooming.
        
        Grade up: After Jason places the article on the toy, he will point out his same article of clothing and assist the caregiver with dressing himself
        
        Grade down: Jason will assist the caregiver in dressing his toy
- - - - They want him to be more like other kids his age
- - - - Focus on client participation meaningful activities
  - - - Recognize environment and person relationship as dynamic and reciprocal
- - - - D/C home on O2 and NG tube for nutrition
        
        8 mo: readmitted to hospital due to O2 needed - required intubation and 2.5 week hospital stay - refused oral feeding and pacifier
- - - - Clinical findings: Jason shows delays in developmental milestones. Raking and palmer grasp are present, but are signs of fine motor delays for his age. Jason presents with hypotonia, poor postural control, developmental delays in crawling and walking, poor strength, low initiation of new tasks, age appropriate play with favorite toys, but does not explore other toys or items within the environment; he is able to drink from a sippy cup but does not self feed
        
        Jason shows developmental delays in fine motor skills, gross motor skills, dressing skills, feeding skills, grooming skills, and static sitting balance. Jason would benefit from skilled OT services to address these developmental delays to promote IND in ADLs
  - - - Clinical findings:Based on Jason's scores on the SP2, he is sensory avoiding and experiences sensory sensitivity. Jason does not like new textures of food or toys, he does not walk or crawl, he finds loud environments stressful and often lashes out as a result, he does not explore new food and will cry when his hands are messy, he shows no interest in self care tasks such as dressing, bathing, grooming, and self feeding.
        
        Jason would benefit from skilled OT services to address sensory systems and promote sensory modulation during eating, play, and grooming.