Follow Up Care Plan

Developmental wellness and follow-up care visits by a licensed pediatric therapist for screening, assessment, intervention, and support for infants and children who may be at risk for or showing early signs of developmental delays. Care is individualized, family-centered, and focused on optimizing functional development, parent confidence, and long-term outcomes.

Core components of follow-up care

1. Comprehensive assessment

   • Developmental history with parent interview (pregnancy, birth, medical history, family concerns)

   • Standardized screening and outcome measures appropriate to age and domain

   • Observational assessment of functional skills in natural contexts (feeding, play, routine)

   • Sensory and motor examinations as indicated

2. Individualized care planning

   • Clear, measurable goals developed with family input

   • Prioritization of functional tasks important to the child and family

   • Coordination of therapy intensity and modality (clinic-based, home program, teletherapy)

3. Family coaching and education

   • Hands-on training for caregivers to implement strategies in daily routines

   • Guidance on positioning, handling, feeding, play activities, and environmental modifications

   • Goal-setting and progress tracking to empower caregivers

4. Targeted intervention

   • Evidence-based approaches tailored to the child’s needs (e.g., play-based therapy, motor learning, sensory strategies, feeding therapy, and language stimulation techniques)

   • Use of repetition, meaningful contexts, and caregiver coaching to promote generalization

   • Regular reassessment to modify interventions as the child develops

5. Care coordination and referrals

   • Communication with pediatricians, early intervention programs, NICU follow-up clinics, schools, and specialists

   • Assistance with referrals for diagnostics, adaptive equipment, durable medical equipment (DME), or community resources

   • Support navigating insurance, early intervention eligibility, and school-based services

Frequency and duration

• Frequency is individualized: from periodic monitoring (every few months) to weekly sessions for higher-intensity needs.

• Duration depends on goals, progress, and developmental stage; many children benefit from ongoing periodic reassessment through critical early years.

Outcomes to expect

• Improved functional skills in targeted domains (motor, feeding, communication, sensory regulation)

• Increased caregiver confidence and ability to support development through daily routines

• Early detection of evolving needs and timely referral to additional services

• Better preparedness for transitions (to preschool, school-based services, or community programs)

When to seek follow-up care

• Missed developmental milestones or parental concern about movement, feeding, speech, or behavior

• After NICU discharge, complicated neonatal course, or diagnosis associated with developmental risk

• Following a failed screening or when recommended by a pediatrician or early intervention team