02 – Child’s age: 18 months

Report of hearing: The appellant was accompanied by an assistant to her local political representative. She submitted a portfolio which contained an account of her daughter’s daily routine, an outline of developmental milestones for a child of 18 months, a letter from the Consultant Neurologist, a letter from the relevant HSE Speech and Language Therapy Department, a letter from the Paediatric Department at the hospital where [B] attends, a letter from the Consultant Neurologist at that hospital, a report from the HSE Community Paediatric Physiotherapy Service, and a letter from the family GP.

The appellant said her daughter was now aged 18 months but was functioning at the level of an 8 month old. She said that [B] had to have a very strict regime of physiotherapy every day to develop her muscles. As a result of this regime, her upper body strength had shown some improvement but she still had no power in her legs. She said that [B] had also had psychological assessments done and that she may also have an intellectual disability. She went on to say that she is unable to talk except for the word ‘nana’ and, while she babbles a lot, this only commenced following an ear operation when she had grommets inserted.

The appellant said that [B] has to be monitored day and night, far more than a child of a similar age, and that she has to be monitored during nap time as she suffers from Apnoea and regularly stops breathing. She advised that [B] is unable to eat solid foods and that all of her food has to be puréed. It can take up to 40 minutes to spoon feed her. She described how she has to be lying on her tummy during mealtimes, on a wedge, and that feeding her involves a great deal of care as she does not have gag reflexes and chokes very easily. She provided a photograph. She said that [B] has to have some sensory distraction to enable her to be fed. This could include showing her a favourite toy or having the family dog sit in front of her.

The appellant advised that [B] is overweight as she is unable to run around and, as a result, she is prone to sores on her neck and groin. She also gets sores on her elbows as these joints get to bear most of her weight during the day. She said that the child is unable to crawl and drags herself forward using her elbows. She is unable to sit properly, and is unable to use a walker or activity centre that children of a similar age enjoy.

Comments/Conclusions: Having considered all of the evidence in this case, including that adduced at oral hearing, the Appeals Officer concluded that [B] requires substantially more care and attention than a child of a similar age who does not have a disability. She noted, in particular, that the child is developmentally at the level of an 8 month old, is unable to walk, is unable to sit unaided, is unable to speak, is subject to sores due to her condition, and must follow a strict physiotherapy regime to try and develop her muscles. She noted also that her prognosis was unsure.

Decision of the Appeals Officer: The appeal is allowed.

Note on decision reason(s): Domiciliary Care Allowance may be paid where a person is providing care at home for a child who has a severe disability, and requires continuous care which is substantially in excess of that normally required by a child of the same age. The qualifying conditions are outlined in social welfare legislation.

Having examined the evidence available in this case, including that presented at oral hearing, I have concluded that with regard to [B] who has a diagnosis of Developmental Delay, it has been established that she needs substantial additional care on a continuous basis, as provided for in the legislation.