Nico

Build / Stature

- Preemie at 35 weeks - Birth-5 pounds 13 oz 19” long
- Small for age (35 pounds 39inches at 7years old)
- Floppy baby with hypotonia in upper trunk

Head

- Hydrocephalus
- Head has triangular shape (wide in the back and narrow in the front)
- Frontal Bossing of forehead

Face

- Midface hypoplasia

- Microganthia

Ears

- Small pointed ears (described as elfin ears)
- Small ear canals

Eyes: - Downslanting palpebral fissures
- Bilateral Ptosis
- Epicanthel folds in corners of eyes
- Strabismus
- Farsighted

Nose: - Upturned nose w/ bulbous tip
- Wide low set nasal bridge

Mouth: - Slight mandibular prognathism (slight projection of the lower jaw)
- Long philtrum
- Thin upper lip

Teeth: - His teeth were late to erupt and did not come in order. They have been early to fall out and the new ones are not coming in quickly at all. He is also missing one or two permanent teeth according to x-rays

Skin: - Recently started having skin issues such as small pimply rash described as keratosis.

Hair: - Multiple hair whorls and curly sparse hair very fine.

Chest: - Widely spaced inverted nipples
- Very Mild pectus excavatum

Upper Limb: - He has hyper extended thumbs and long tapered fingers that turn in slightly (especially his index fingers)

Lower Limb: - His feet are long and thin and his second and fourth toes are overlapping the ones next to them, he also has a wide space between the big toe and the second toe.

Spine

- Recently had a C1 laminectomy to relieve spinal stenosis

Alimentary Tract: - GERD; - Hernias – inguinal and diaphragmatic and he had a herniated belly button as an infant

Cardiac: - Heart murmur
- Had previous Cardiomyopathy
- Pulmonary valve stenosis repaired in Aug. 04
- PDA (patent ductus arteriosus) (repaired in May of 03)

Neurological Functional: - Possible ADHD and some autistic like tendencies according to psychologist
- Sensory integration issues, tactile defensiveness especially feet

Development: - Developmental delay he is six but acts as though he is four or younger at times cognitively and sat at 10 moths, crawled at 15 months, walked at 27 1/2 months
- Speech/Language delay (especially expressive language, can be difficult to understand him especially if you are not familiar with him) and lately he's been stuttering (atypical stutter more like stuck on what he wants to say so he repeats the same thing over and over till he remembers)
- He is not able to count to twenty consistently and does not recognize some of his numbers to twelve, recognizes his alphabet and is beginning to associate sounds to the letters, but does not yet read or spell; - Gross motor delays
- Fine motor delays (just recently began writing, but needs hand over hand assistance often and can be difficult to decipher his letters and numbers)
- Clumsy-poor with coordination

Feeding: - Poor suck/swallow as a baby, poor appetite
- Poor weight gain even now he is below the 3rd percentile but kept a steady growth curve
- Low muscle tone orally
- Severe gag reflex
- Very picky eater
- Tactile defensiveness

Behavior / Social: - Overly friendly, has limited safety awareness
- Loving child
- Hyperactive
- Short attention span
- Overly sensitive
- Obsessive behaviors and gets "stuck" on issues that he needs to know about (like what our plans are for the day or the next day, who is visiting etc.)
- Attention Seeking behaviors

Misc: - Drools a lot
- Bruises easily
- Decreased sensitivity to pain
- Potty trained after laminectomy, but still experiencing soiling, doctors not sure if this is due to a lack of sensation or his chronic constipation
- TIPTOE walking (wears smo ankle support orthotics for weak arch muscle in feet)
- Constipation almost all the time
- when concentrating on something his tongue protrudes and he drools

Laboratory Test and Findings: - Normal 46 XY karotype
- Tested for metabolic disorders and all findings were normal
- Downs syndromre -- normal
- Williams Syndrome -- FISH -- normal
- Pradar willi - normal
- Pompeii disease - normal
- Glycogen storage disorders - normal
- Smith Magenis -- normal
- Angelman Syndrome -- normal
- Noonan Syndrome -- (done twice) normal
- G/bbb syndrome - normal
- Cardio facio cutenous syndrome (CFC) - normal
- Subtelelomere FISH -- normal
- Abnormality in the vein of galen on MRI but not significant according to neurosurgeon
- Abdominal ultrasound -- fused kidneys that are anterior and to the right
- Muscle biopsy - normal (but intercostal muscle biopsy showed elevated glycogen but genetics dismissed as no data on intercostal muscle to compare to)
- Skin biopsy sent for FISH micro array - normal
- Liver biopsy - normal but he had hepatomegaly for the first two years of life with no underlying issues
His geneticist wants to check for connective tissue disorders next