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:

  1. Medical/biological neonatal risk criteria, including:
    1. birth weight less than 1501 grams
    2. gestational age less than 33 weeks
    3. central nervous system insult or abnormality (including neonatal seizures, intracranial hemorrhage, need for ventilator support for more than 48 hours, birth trauma)
    4. congenital malformations
    5. asphyxia (Apgar score of three or less at five minutes)
    6. abnormalities in muscle tone, such as hyper- or hypotonicity
    7. hyperbilirubinemia (> 20mg/dl)
    8. hypoglycemia (serum glucose under 20 mg/dl)
    9. growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem)
    10. presence of Inborn Metabolic Disorder (IMD)
    11. perinatally- or congenitally-transmitted infection (e.g., HIV, hepatitis B, syphilis)
    12. 10 or more days hospitalization in a Neonatal Intensive Care Unit (NICU)
    13. maternal prenatal alcohol abuse
    14. maternal prenatal abuse of illicit substances
    15. prenatal exposure to therapeutic drugs with known potential developmental implications (e.g., psychotropic medications, anticonvulsant, antineoplastic)
    16. maternal PKU
    17. suspected hearing impairment (e.g., familial history of hearing impairment or loss; suspicion based on gross screening measures)
    18. suspected vision impairment (suspicion based on gross screening measures)
  2. Medical/biological post-neonatal and early childhood risk criteria, including:
    1. parental or caregiver concern about developmental status
    2. 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
    3. elevated venous blood lead levels (above 19 mcg/dl)
    4. growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia)
    5. 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:

  1. no prenatal care
  2. parental developmental disability or diagnosed serious and persistent mental illness
  3. parental substance abuse, including alcohol or illicit drug abuse
  4. no well child care by 6 months of age or significant delay in immunizations; and/or
  5. 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

Back to Index