1. Dr Teresa Carter
Developmental Paediatrician
McMaster Children’s Hospital
PReschool Pathways and services, need for communication, collaboration, coordination

2. Objectives What can be done in Primary care
Use case examples to illustrate collaboration with community services

3. Complexity ‘Many parts in an intricate arrangement’ influenced by:
Genetics
Prenatal environment
Specific health needs
Physical environment
Social environment/cultural environment
Learning environment
Emotional environment

4. First approach in primary CARE
Promote play
Refer to Universal Services

5. Case 1 18 month old boy 2-3 words, not imitating gestures
3-4 temper tantrums per day
Fussy when they visit the mall
Likes to watch the same DVDs and listen to the same books
Mum is very stressed and cannot cope
They feel as if their son rules the

6. Case 2 18 month old boy Walking since 14 month
Unable to get up from sitting
Did not mobilise prior to walking
Picky eater since 15 months, losing weight
Severe distress in grocery store
very distressed visiting others homes

7. Case 3 18 month old girl No words, points and babbles
Knows several body parts
Easily follows a one step command
Crawls, not taking weight on her feet
Has a fine pincer grasp and holds a spoon

8. Case 4 Team Assessment Girl, 18 months Severe delays Hypotonic
FTT & major feeding challenges
Concerns about vision
ESL

9. Care Pathways Down Syndrome – Health supervision guidelines AAP 2001
Williams Syndrome AAP 2001 – growth charts
Angelman – become overweight at adolescence
There is no care pathway for ASD, yet!

10. Conclusion
Children with Complex needs should be linked to community based services as soon as possible
We need to improve communication and collaboration between community services and primary care
Dr R will be talking about Family centred care and it is true particularly for children with rare conditions that their parents do become the expert in the condition as well as the expert in their own child. We should use that expertise to provide their support