Appendix A - Risk Factors Pertaining to Referrals of At-Risk Children
10 NYCRR 69-4.3(f) provides that referrals of children at risk of having a disability shall be made based on the following medical/biological risk factors:
- Medical/biological neonatal risk criteria, including:
- birth weight less than 1501 grams
- gestational age less than 33 weeks
- central nervous system insult or abnormality (including neonatal seizures, intracranial hemorrhage, need for ventilator support for more than 48 hours, birth trauma)
- congenital malformations
- asphyxia (Apgar score of three or less at five minutes)
- abnormalities in muscle tone, such as hyper- or hypotonicity
- hyperbilirubinemia (> 20mg/dl)
- hypoglycemia (serum glucose under 20 mg/dl)
- growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem)
- presence of Inborn Metabolic Disorder (IMD)
- perinatally- or congenitally-transmitted infection (e.g., HIV, hepatitis B, syphilis)
- 10 or more days hospitalization in a Neonatal Intensive Care Unit (NICU)
- maternal prenatal alcohol abuse
- maternal prenatal abuse of illicit substances
- prenatal exposure to therapeutic drugs with known potential developmental implications (e.g., psychotropic medications, anticonvulsant, antineoplastic)
- maternal PKU
- suspected hearing impairment (e.g., familial history of hearing impairment or loss; suspicion based on gross screening measures)
- suspected vision impairment (suspicion based on gross screening measures)
- Medical/biological post-neonatal and early childhood risk criteria, including:
- parental or caregiver concern about developmental status
- serious illness or traumatic injury with implications for central nervous system development and requiring hospitalization in a pediatric intensive care unit for ten or more days
- elevated venous blood lead levels (above 19 mcg/dl)
- growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia)
- chronicity of serous otitis media (continuous for a minimum of three months) HIV infection
10 NYCRR 69-4.3(g) provides that the following risk criteria may be considered by the primary referral source in the decision to make a referral:
- no prenatal care
- parental developmental disability or diagnosed serious and persistent mental illness
- parental substance abuse, including alcohol or illicit drug abuse
- no well child care by 6 months of age or significant delay in immunizations; and/or
- other risk criteria as identified by the primary referral source
Diagnosed Physical and Mental Conditions with a High Probability of Resulting in Developmental Delay79
Diagnosed physical and mental conditions with a high probability of resulting in developmental delay found at 10 NYCRR §69-4.1(3)(e) of the New York State Department of Health EIP regulations:
- Chromosomal abnormalities associated with developmental delay (e.g., Down syndrome);
- Syndromes and conditions associated with delays in development (e.g., fetal alcohol syndrome);
- Neuromuscular disorder (e.g., any disorder known to affect the central nervous system, including cerebral palsy, spina bifida, microcephaly or macrocephaly);
- Clinical evidence of central nervous system (CNS) abnormality following bacterial/viral infection of the brain or head/spinal trauma;
- Hearing impairment (a diagnosed hearing loss that cannot be corrected with treatment or surgery);
- Visual impairment (a diagnosed visual impairment that cannot be corrected with treatment (including glasses or contact lenses) or surgery);
- Diagnosed psychiatric conditions, such as reactive attachment disorder of infancy and early childhood (symptoms include persistent failure to initiate or respond to primary caregivers; fearfulness and hypervigilance that does not respond to comforting by caregivers; absence of visual tracking); and
- Emotional/behavioral disorder (the infant or toddler exhibits atypical emotional or behavioral conditions, such as delay or abnormality in achieving expected emotional milestones such as pleasurable interest in adults and peers; ability to communicate emotional needs; self-injurious/persistent stereotypical behaviors).
79 For additional information, consult Early Intervention Guidance Memorandum 1999-2 on Reporting of Children's Eligibility Status Based on Diagnosed Conditions with a High Probability of Developmental Delay