delayed myelin development

[Kim-Lewandowski]

  I am an Occupational Therapist working with a 6 month old infant with delayed development of the myelin in the brain stem.  She hase the presenting problems of :  cleft palate, significantly delayed visual skills and gross motor skills.  She is just starting to focus on light and bright toys. The eyes lack muscular control, intermittent nystagmus is present, along with a repeated moving the head up and down in a rhythmical manner.  She has torticollis.  She has just gained a steady head control.  There is an absence of rolling, prone against gravity weight bearing and reaching.  She smiles and reactive to mother and other people.  The family has been told that the myelin develops for the next 2 years and that the child is developmentally delayed.  What caused delayed myelin growth in fetuses and infants?  What is the prognosis for development and recovery?  Any suggested readings?   Thank you, Kim
==========================================================================
Myelination is a deveolpmental process which is far from complete at birth
and as was pointed out to the parents of this child the process continues
for a few years after birth, this is good news insofar as definite improvement can be anticipated.
The insults which can lead to poor myelination before birth are numerous,
thety include exposure to toxins, maternal infections, prematurity with
low birth weight, and a wide range of congenital brain developmental
disorders including Down Syndrome. In many cases the underlying genetic or
metabolic abnormality has not been fully described or characterised, this may
well be the case with the child you describe since a more specific diagnosis was not given.
The degree of improvement which can be anticipated is wery wide and depends as I
said on the underlying cause, from the information available I cannot
speculate what the extent of this will be.