Checking small survivors

 Had they been born a quarter-century ago, the 200 children would have been lucky to survive.

These days, the issues they face at Children's Hospital of Philadelphia seem mundane by comparison.

Can the children babble a few words? Put wooden pegs in holes? Kick a ball?

The 200 infants and toddlers are veterans of major heart surgery, and to the untrained eye they seem no different from any other kid, but for a faint scar on the chest. Yet increasingly, researchers at Children's Hospital and elsewhere are finding that such patients are more likely to experience subtle developmental delays.

A similar pattern holds true for cancer and other childhood scourges that have started to yield to the advances of modern medicine. After the big hurdle is cleared, there are smaller ones that no one ever used to think about. Mere survival is no longer good enough.

So every Monday, a few of the kids come back to Children's Hospital for evaluation by experts, one after the other:

Speech language pathologist.
Physical therapist.
Occupational therapist.
Developmental pediatrician.
Cardiologist.
Neurologist.

Part of the broader NeuroCardiac Care Program, the clinic allows specialists to share vital information on the spot - say, if the physical therapist wants to ask the cardiologist whether a child's heart is ready for vigorous activity.

"We were realizing that we couldn't work in silos," said cardiologist Gil Wernovsky, the program director. "It allows communication amongst multiple disciplines."

It is a long morning, especially if older siblings are along for the visit. But it is a welcome one for parents on a journey that typically begins during pregnancy, when an ultrasound reveals the need for surgery as early as a few days after birth.

Fun and games with a purpose

Rowan Erb raced up and down the colorful hallway. He kicked a ball, played with puzzles and chattered happily with a series of visitors.

Yet one thing worried his mother, Rebecca. The 3-year-old, from Warrington, still couldn't climb stairs on his own.

"He looks just exhausted," the boy's mother said.

At 2 months old, Rowan had surgery to correct a combination of four heart defects. So that the wound could heal, his parents did not place him on his tummy for eight weeks after surgery - ordinarily an important period for developing core body strength.

Physical therapist Heather Hanson agreed with Erb that this might be part of the reason for the boy's stair-climbing difficulties.