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Welcome to Otika template!
Yesterday
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Patient Details
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OPD :
08-Aug-2026 11:48AM
Demographic Details
Child's Name
:
Kanishk Yadav
Age
:
4 Year 6 Month 23 Days
Gender
:
Male
DOB
:
2022-01-16
Contact
:
6266584746
Interaction history:
Eye contact
:
Fleeting
Quality of Interaction
:
limited
Behavioral history:
Repetitive behaviors (RRBs):
Patterned behavior or activities:
Hyperactivity
Inattention
Temper tantrums
Stubbornness
Others Emotional History Details
:
Irrelevant laughing
Sensory Concerns:
Tactile
:
Hypersensitive
Auditory
:
Hyposensitive
Proprioception
:
Seeks pressure
Birth & Perinatal History:
Antenatal History
Natal and Postnatal History:
Past history:
Investigations done-
Family history:
Developmental History:
Gross Motor
Fine Motor
Language
Expressive:-
Communication & Language Assessment
Non-Verbal Communication Grading:-
Need-based communication
:
Inconsistent
Drag for needs
:
Inconsistent
Joint attention
:
Emerging
Pointing
:
Attempts
Understanding gestures
:
Emerging
Following commands (gesture + verbal)
:
1-step
Answering Questions:-
Echolalia
:
Present
Patterned speech
:
Present
Social
Response to Name Call
Sitting tolerance- (in minutes)
For interaction
:
1-2 minutes
For tasks
:
5 minute
ADL Skills (Age-appropriate)-
Eating
:
3. Needs significant assistance
Bathing
:
2. Started attempting
Toilet training
:
2. Started attempting
Dressing
:
2. Started attempting
Undressing
:
2. Started attempting
Type of Play : 2. Isolated
Academic History:
Is child enrolled in school
:
No
Diet History:
Food preferences
:
Mixed
Food allergies
:
No
Junk food intake
:
Nil
Sleep History
Total sleep duration (night)
:
7-8 hours
Afternoon nap
:
No
Sleep disturbances
:
Daily Screen Time
Duration
:
Zero
Examination
a. Vitals:
b. Anthropometry:
Weight
:
13.3Kg
Height
:
93 cm
Head circumference
:
50 cm
c. General Examination
Dysmorphology
:
Ab
Neurocutaneous markers
:
Ab
d. CNS:
Higher Mental Functions
Sensory Examination
Cranial Nerves (1–12)
Neuromuscular Concerns
Oromotor Examination
Impression
:
Improvement in interaction, eye contact, understanding.
Advice
Intervention plan
:
IDP 2/week + PMT 1/week
Medications
:
Syp Sizodon (1mg/ml) 0.1 ml at evening for 7 days then increase to 0.2 ml (at 7:30 PM), Syp Autinorm 5 ml BD
Follow up plan
:
every month
General recommendation-
Zero Screen Time
Physical interactive play
No Junk food
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