Jun 24, 2019

The participant was delivered by C-section because she was in breech presentation. After birth she spent one day in the Neonatal Intensive Care Unit (NICU) because of jaundice and trouble feeding. In the first few weeks of her life, her parents noticed that she had low muscle tone (hypotonia). She was also found to have some differences in her facial features, such as drooping eyelids (ptosis), eye folds (epicanthus), and a smooth area between nose and upper lip (smooth philtrum).

At 4 months old, the participant was noted to have some developmental delays, poor suck, and gastroesophageal reflux (acid reflux). At 10 months, she was found to have breathing issues (apneic episodes), which were determined to not be seizures. Over the next two years she continued to have motor and speech delays. She first crawled at 24 months and was able to hold a bottle at 35 months. The participant is currently nonverbal; however, she has been making some sounds.

• Global developmental delay
• Absent speech
• Failure to thrive
• Feeding difficulties
• Low muscle tone (hypotonia)
• Small head size (microcephaly)
• Flat spot on head (posterior plagiocephaly)
• Astigmatism
• Farsightedness (hyperopia)
• Lazy eye (amblyopia)
• Drooping eyelids (ptosis)
• Eye fold (epicanthus)
• Smooth and long area between nose and upper lip (smooth philtrum, long philtrum)
• Thin upper lip (thin vermilion)
• Short neck
• Sunken chest (pectus excavatum)
• Difficulty swallowing (dysphagia)
• Gastroesophageal reflux (acid reflux)
• Excess curvature of the spine (kyphosis)
• Elevated serum aspartate aminotransferase

• Nasogastric tube – feeding difficulties