Feature Articles: Developmental Disorders

Guest Editor's Note:
David W. Bailey, M.D.
Associate Clinical Professor, Pediatrics and Family Medicine,
University of Florida Health Science Center / Jacksonville

The agencies and professionals serving families in the Jacksonville area with developmentally disabled (DD) members have improved both quantitatively and qualitatively over the past 15 years. Our strong suit has been helping those with motor handicaps, but our skills in the socioadaptive, behavioral, and language areas are growing rapidly. Also, our schools are improving their services for those with cognitive deficiencies as well as other handicaps.

The contributors to this issue of Jacksonville Medicine have been asked to focus on DD in infants and toddlers. Our community is increasingly receptive to the concept that early recognition and intervention can enhance the outcome of the developmentally challenged.

Prevention of developmental disabilities deserves a comment. The numbers of DD children would be substantially reduced if we could help people have intended pregnancies in the informed sense of the word `intended'. Currently, over 70 percent of Medicaid-funded deliveries in Florida are of unwanted babies.¹ The likelihood of neglect and/or abuse, both ante- and postnatal, is strongly correlated with the unwantedness of the baby. A DD child is the frequent outcome.

A final plea is that we be fair to our premature friends. Biologically speaking, life begins when the fertilized ovum implants in the wall of the uterus and starts to divide. The day that the fetus happens to exit the womb does not determine its true age. And surely no one would suggest that spending a substantial portion of its gestation in the NICU gives the premie a `leg up' over its term counterpart. It seems reasonable to look at babies in terms of their true (often called `corrected') age, especially when considering their growth and development.

Not everyone agrees with this approach to age correction of the prematurely born. The Early Intervention Programs in Florida are instructed to fully correct the ages of all tested babies up to the postpartum age of 24 months, with zero correction thereafter. Other experts advocate half correction during the first 24 months.² Why not just do our best to accurately estimate the actual age of our younger patients, and monitor their progress in growth and development accordingly?

REFERENCES

1. Hopkins RS, Marshall H, Hoecherl S. Medicaid costs of live births from unintended pregnancies in Florida. J. Florida MA 1995; 82:540-543.
2. Blasco PA. Preterm birth: to correct or not to correct. Dev Med Child Neurol. 1989; 31:816-821.

Jacksonville Medicine / March, 2000

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