Physical therapy treatment planning approach for a medically fragile child: A case report involving a child with complicated gastroschisis

Abstract

Medically fragile children often present with complexities beyond the scope of typical pediatric physical therapy practice. The purpose of this case report is to describe the challenges of treatment planning for a medically fragile child throughout the continuum of care until the child's death as a result of medical complications at 22 months of age. The patient was a young girl with complicated congenital gastroschisis, requiring a multivisceral transplant at the age of 7½ months. As a result of her complex medical condition, gross motor skill development was delayed, and adaptations were required to compensate for absence of functioning abdominal musculature. The fluctuating needs of this child and her family as a result of her unpredictable medical issues, frequent hospitalizations, and illnesses required a varied treatment approach. Through flexibility, goal setting, and treatment planning, intervention challenges were appropriately met. She demonstrated steady gains in overall gross motor skill development. Knowledge of the complexities with medically fragile children can assist the pediatric physical therapist develop an appropriate treatment-planning approach.