Working as a nurse case manager at a nonprofit agency serving children with disabilities, you particularly enjoy working with infants, toddlers, and children with Down syndrome. Although this population has a shared base of health issues, each youngster is an individual with unique needs, resources, and demands. Glancing at your appointment schedule for today, you see that you have four appointments for children with Down syndrome and briefly jot some notes for each meeting:

• Anna-Lise, a three-week old with congenital heart disease, has been referred for a nutritional evaluation and feeding consultation. Since you have not yet met with Anna-Lise and her family, you wonder briefly if she is breastfeeding and whether her heart defect will require surgical intervention. Checking Anna-Lise’s thin chart, you spy a consultation note from the pediatric cardiologist along with a referral to the early intervention program in her town.

• Carlos, an exuberant 32 month old, is getting ready to transition from the early intervention system to the school system. His parents are concerned that they’re losing the warm and wonderful therapists who have worked with their son for three years, and want to know what they can do to continue his recent gains in speech and language.
  

• Lanisha, a shy and quiet five-year-old, has recently begun screaming and throwing things around the room when family members don’t comply with her demands. When she called for the appointment, Lanisha’s mother expressed some concerns that Lanisha wasn’t listening very well. Is this a behavioral issue, you wonder, or is Lanisha having health issues or perhaps a hearing loss?
  

• Justin, an eleven-year-old who prefers computer games and DVD’s to outdoor activities, is coming in for a weight check. Although his parents have tried hard to control his eating and encourage exercise, his weight gain is still out of control.