California Children Services: CCS

High Risk Infant Follow Up: HRIF
Eligibility Criteria

How were the HRIF Eligibility criteria developed?
After monitoring thousands of newborns for their physical development, research pediatricians confirmed that certain events in a newborn's perinatal (meaning around the time of birth) experience could affect the child's later development. These events are called "Risk Factors". If present, they do not mean that a child definitely will have a physical developmental problem. They do mean there is a higher than average chance that the child will have a problem. The HRIF Eligibility Criteria include the most serious risk factors giving CCS reason to monitor those children in the HRIF Program.

What is the chance that a risk factor will become a problem?
There is no easy answer because each child's story is different; but, in general, the risk is low.

If a child does not have any risk factors, is she/he free of any risk for physical developmental problems?
Unfortunately, there is still a chance for a developmental problem. Children with risk factors have a higher risk for problems; but, all children have a very low, yet real risk for a problem. Therefore, parents and health care providers should always review a child's development during regular well child check-ups

Why monitor children with risk factors?
Most pediatric specialists believe that if a child with a developmental problem is identified early and receives service early, the developmental outcome will be improved. Special developmental monitoring is one way to avoid a delay in the recognition of a developmental problem.

So, what are the CCS HRIF Eligibility Criteria?

1. Birth weight less than 1500 grams, (3 pounds 4 ounces)
2. Assisted ventilation (breathing) for more than 48 hours during the first 28 days of life
3. Prolonged hypoxemia (low oxygen level), acidemia (a metabolic disturbance), hypoglycemia (low blood sugar) or repetitive apnea (stop breathing)
4. Cardiorespiratory depression at birth (breathing and circulation problems) including children who have an APGAR score of 3 or less at 5 minutes, fail to breathe spontaneously by ten minutes or have hypotonia (weak muscle responsiveness) for more than 2 hours
5. Neonatal seizures (convulsions)
6. Documented intracranial (brain) pathologic abnormality, such as intracranial hemorrhage or thrombosis, but, not associated with established neurological functional abnormalities (Children with functional problems are referred to other CCS programs.)
7. Infants who required ECMO Treatment
8. Infants who experienced other problems that might affect the function and development of the brain such as meningitis, exchange transfusion, sepsis

How do I refer an infant to HRIF?
You can click on HRIF to review the process or click on CCS Referral Form and CCS Family Application to obtain the documents that the referring person and family must complete.