Florida – Pediatrics – Newborn With Occipitofrontal Circumference In The 97th Percentile

A child was born on 3/5/2010.

From 3/15/2010 to 5/10/2013, the mother of the minor child, presented the child to a pediatrician at least ten times for check-ups and/or sick visits.

On 3/22/2010, the child presented to the pediatrician for a 2-week check-up.  The pediatrician documented the child’s occipitofrontal circumference (OFC) to be in the 75th percentile.

On 5/5/2010, the child presented to the pediatrician for a 2-month check-up.  The pediatrician documented the child’s OFC to be in the 90th percentile.

On 7/12/2010, the child presented to the pediatrician for a 4-month check-up.  The pediatrician documented the child’s OFC to be in the 97th percentile.

ON 9/13/2010, the child presented to the pediatrician for a 6-month check-up.  The pediatrician documented the child’s OFC to be in the 97th percentile.

On 12/6/2010, the patient presented to the pediatrician for a 9-month check-up.  The pediatrician documented the child’s OFC to be in the 97th percentile.

The pediatrician documented that the child had developmental delays in crawling on all fours, pincer grasping, and language development.

On 3/6/2011, the patient presented to the pediatrician for a 12-month check-up.  The pediatrician documented that the child had developmental delays in waving and pointing.  The pediatrician documented that the development was discussed with the parent.

On 6/15/2011, the child presented to the pediatrician for a 15-month check-up.  The pediatrician documented the child’s OFC to be in the 97th percentile.  The pediatrician documented that the child had developmental delays in walking alone, stooping, and recovering.

On 9/14/2011, the child presented to the pediatrician for an 18-month check-up.  The pediatrician documented that the child’s OFC was in the 90th percentile.  The pediatrician documented that the child had developmental delays in walking backward and kicking a ball.

On 3/7/2012, the child presented to the pediatrician for a two-year check-up.  The pediatrician documented that the child’s OFC was in the 97th percentile.  The pediatrician documented that the child had developmental delays in language development, specifically, the child had “very limited vocabulary.”

On 5/31/2012, the pediatrician referred the child to an ear, nose, throat doctor (ENT) to consider frenulectomy for a tied tongue.

On 6/4/2012, the pediatrician referred the child to pediatric orthopedics for falling, stumbling, and inability to jump.

On 6/12/2012, the pediatrician referred the child to a speech therapist prior to the frenulectomy.

The speech therapist suggested that the child have his hearing checked.

On 7/12/2012, the pediatrician referred the child to audiology prior to the frenulectomy.

On 12/5/2012, the pediatrician referred the child to an occupational therapist for low motor skills.

The pediatrician did not refer the child for a workup, to include an MRI of the head and neck or a pediatric neurology evaluation, to diagnose OFC enlargement and developmental delays at any of these previous appointments.

On 3/11/2013, the child presented to the pediatrician for a three-year check-up.  The pediatrician documented that the child had developmental delays in language development.  The pediatrician documented concerns with the child’s motor skills and speech.

On 3/13/2013, the pediatrician referred the child for a pediatric neurology evaluation with an MRI.

On 5/10/2013, the child was diagnosed with hydrocephalus and arachnoid cysts.

The Medical Board of Florida judged the pediatrician’s conduct to be below the minimal standard of competence given that she failed to have the child evaluated for excessive OFC and developmental delays at least when the child was nine months old.  She also failed to perform a complete workup on the child, including an MRI of the head and neck or a pediatric neurology evaluation, at least when the child was nine months old since the OFC was in the 97th percentile and developmental delays were evident.  The pediatrician also failed to refer the child to a pediatric neurologist or developmental pediatrician to diagnose the reason for the child’s OFC enlargement and developmental delays at least nine months old.  She also failed to refer the child for a complete workup at either the 12-month, 15-month, 18-month, or 2-year check-up due to the child’s OFC enlargement.

It was requested that the Medical Board of Florida order one or more of the following penalties for the pediatrician: permanent revocation or suspension of her license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, probation, corrective action, payment of fees, remedial education, and/or any other relief that the Medical Board of Florida deemed appropriate.

State: Florida


Date: December 2016


Specialty: Pediatrics


Symptom: N/A


Diagnosis: Neurological Disease


Medical Error: Delay in proper treatment, Failure to examine or evaluate patient properly, Failure to order appropriate diagnostic test, Referral failure to hospital or specialist


Significant Outcome: N/A


Case Rating: 3


Link to Original Case File: Download PDF



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