Hi Robynne -- I've been a member of IRD for ages, but I don't think I've asked you a question before. Thanks in advance for your answer and your support of this site.

At my son's preschool conference last week, his OT said he hasn't yet shown a preference for being right or left handed and in fact she's noticed that he has trouble crossing the midline of his body. When he writes his name (which he does very poorly, although he's been able to spell it and recognize his letter and even letter sounds for ages) he writes the DAN on the left side of the paper with his left hand, then switches to his right for IEL.

During the conference, I just assumed crossing the midline, and practicing his writing in general because it's not something he enjoys, is just something he'll need to work on. No big deal. But later I remembered that we had midline concerns when I was 20 weeks preganant and his cleft lip and palate were discovered via ultrasound. I went on to have several more ultrasounds and an amnio with a perinatalogist to rule out other midline disorders, and everything came back fine. But now I'm feeling a bit haunted.

Could this current midline issue be at all related? Or is it something common that we just need to work through? I appreciate any information and thoughts you have about this.

Oh yeah, guess I should add a little background. Daniel was a 2-pound 28-weeker with a cleft lip and palate and severe reflux. He was speech delayed (now they're just working on articulation), had sensory issues, and didn't swallow food or liquid willingly til he was about three. He's in his second year of a two-year developmental preschool program but won't go to kindergarten next year simply because he won't be old enough. So we are enrolling him in a mainstream preK and I expect him to do just fine.

Thanks again, Robynne!

Hi Becky!

I am so sorry, but I did not get a notice for your post and I feel horrible that I have just found it over a month later :oops:. Your little guy is just precious, and he is also a miracle baby :) Since you know the cleft lip/palate are midline "issues," you also know that the reflux is as well. Reflux is also a preemie "issue" and is observed in over 80% of our premature population. Heck, now 1 in 5 term babies is diagnosed with GER.

Crossing midline, left/right orientation, and proprioception (where your body is in space) can be a challenge for anyone. I have treated numerous patients with craniofacial anomalies and midline issues do not necessarily accompany these patients. I do have some preemies, however, who present with some of these deficits (which are all treatable). Again, I have treated 25-28 weekers who also have no residual effects of being premature. Think back to how Daniel was positioned in the NICU. Did he have developmental equipment such as Bendy Bumpers or Snuggle-Ups keeping his shoulders flexed and protracted, or did the unit he was in lack nesting supplies to keep his hands in midline for the the duration he was in the NICU? Good positioning in the NICU believe it or not can prevent some midline issues.Does Daniel need to have his vision assessed by a neuro optometrist? This made the world of difference for my son, who has midline issues. He was placed in prism glasses and has made such wonderful progress with his fine motor skills.

Instead of focusing on "why," think about putting your energy into how you can help Daniel overcome some of his issues. I don't want you to be haunted by the past. You must look at that half full glass and find out how you can best help Daniel. He may have some visual-motor deficits that may be require special corrective lenses. Hand dominance is typically established around 5 year of age. It is your OT's job to figure out what resources she will need to help Daniel. Daniel will do well with the right kind of intervention. Please feel free to write back with more questions.

Robynne