Examples of Pediatric OT Services

I strive to provide services that are highly individualized to each client.  However, I know it can be helpful to see some examples of the potential in-home, pediatric occupational therapy (OT) services I can offer.  Below are 4 scenarios that illustrate how I can help.

Martin is a bright and creative 5 year old boy who has a high level of energy.  His favorite things to do are ride his scooter for hours, followed by building with Legos.  His mother calls him “spirited,” but as he gets older, his behavior has become more challenging.  His grandmother has been nagging his parents to “discipline” him more, and now his kindergarten teacher is saying he is struggling in the classroom.

His parents don’t understand why their parenting isn’t working (their older children didn’t have these problems).  They are starting to think there might be something “wrong” with Martin.  He is always on the move and never seems to run out of energy; it is hard to keep him safe, and he is always full of bruises and bumps.  His imagination is wonderful, but he struggles to play with friends his age and to complete his school-work.  At 5 years old, he still has tantrums and is hard to calm when upset; bedtime is still a struggle most nights.

Their friends are saying to “just let boys be boys” and that he’ll grow out of it.  Their doctor recommends an evaluation for ADHD and is hinting at medication.  Martin’s teacher is stressing more parent involvement because Martin is falling behind his peers.  Martin’s parents don’t know who to listen to. They want to let Martin be himself, but they feel it is time to take some action.  

Paige’s OT Recommendations

As children reach school age, differences in personality and learning abilities start to become more apparent.  Challenging (or “spirited”) toddlers and preschoolers, who could function in play-based environments, struggle to adapt to structured classrooms and higher expectations as they get older.  Most parents report they knew something was different about their child since the child was much younger, and they often report that this child was much harder to parent than their other children.  Sometimes the child needs a different parenting approach to address their unique strengths and weaknesses. In addition, each child needs to be assessed to determine which skills are immature.

Rather than focusing on the problem and trying to punish or change your child’s behaviors, I believe that it is most important to develop the skills your child needs to be successful as they get older.  For example, many children need to work on developing skills related to attention, impulse control, self-regulation, adaptive behavior, problem-solving, or social skills.  Each of these skill areas can be taught, similar to how we teach motor or academic skills.  It is important to understand what each skill means and how it impacts your child’s daily life.  Parents can learn how to create an environment, to use parenting strategies, and to utilize play and daily activities in ways that promote their child’s development.

How I Can Help

I have worked with children from infancy through high school that have struggled with similar problems.  I can help assess what factors may be contributing to the issues you are seeing at home and those occurring at school.  There may be underlying issues with attention, sensory processing, adaptive behavior, mental health, developmental delays, and many other possible issues I am trained to evaluate.  I work to reframe “behaviors” as developmental problems.  By doing so, I can help teach children the skills needed to be successful and help parents to understand their child’s unique needs so they can continue to help their child as they grow and experience new challenges.

Potential In-home Services

Services would include an evaluation with an individualized report and recommendations based on your child’s needs.  Some parents would benefit from meeting on a regular basis to learn more ideas about how they can help their child, such as meeting 1-2x/month with specific homework ideas and activities given at each meeting.  Other parents prefer both parent training and hands-on treatment on a weekly basis in their home.  My ultimate goal is to help parents feel confident in understanding the behavior of their child and how to approach parenting on a daily basis.  I want parents to go from “I just don’t know what to do” to “We’ve got a plan and we’re seeing progress.”

Sara is an only child who is about to turn 3.  She loves Elmo and is excited for her upcoming tea-party themed birthday.  At her 2 year checkup her pediatrician noted that she was a little behind her peers and recommended her parents attend an early childhood program at the local school and go to more social activities, like library story time.

Her parents have been diligent about trying these suggestions, but as Sara has gotten older, it is more apparent she isn’t keeping up with her peers.  They watch their friends’ children meet each milestone effortlessly, and are starting to wonder why Sara has to work so hard to keep up.  While her friends are climbing playground equipment, Sara still needs help to manage the large steps and is too scared to try the slides.  When they try to go shopping, the trip ends most times with Sara in tears and inconsolable.  Sara loves other kids, but plays too rough and the other children don’t understand what she is trying to say.

Their friends just reassure them that she “will grow out of it.”  However, her parents feel she is falling further behind and don’t know where to start finding help.  Her parents just want Sara to be happy; they dream of seeing her run off on the playground with her friends with a smile on her face.

Paige’s OT Recommendations

The toddler and preschool years are challenging for any parent.  The range of normal development is huge, but most of the time a parent’s instincts are right when they are concerned with their child’s development.  The “behaviors” that parents often see, such as tantrums, refusal of tasks, poor attention, social withdrawal, and unhappy kids, may really be developmental problems.  We often see increased negative behaviors due to frustration when demands are placed on children that their skills are not developed enough to handle. Parent are not sure if their child will grow out of these behaviors, or if it is sign of further problems to come.  When behaviors are persistent and typical parenting techniques are not effective, then additional help is needed.

How I Can Help

My many years of experience as a pediatric therapist has prepared me to answer the questions “is this normal” and “should I be worried?”  No two children are alike and strange or quirky behaviors are part of childhood.  However, if there is a pattern of behavior that is concerning to parents, it is better to assess it early and intervene if needed.  I strongly believe in early intervention services.  A proactive approach is usually better than a reactive or “wait and see” approach.  By assessing and determining your child’s developmental level, I can teach parents how to encourage their children to learn new skills.  In occupational therapy we use the phrase “just right challenge”- children thrive in environments with the appropriate level of challenge to grow and learn.

Potential In-home Services

Services would include an evaluation with an individualized report and recommendations based on your child’s needs. I can help assess your child’s development and make a plan with parenting strategies specific to your child’s needs.  I know the local resources and services and will help you find what fits your child’s needs best.  Some children would benefit from early intervention services through the local school district, others from private therapy services through a clinic, or from community-based activities.  Some children need further medical or developmental assessment, which I can help identify for families. If desired, I can continue to provide on-going services directly to children in their home to work on skill development or to parents through parent-training programs individualized to each child’s needs.

Katie is a sweet 7 year old who is an enthusiastic artist and has cerebral palsy.  She loves playing dress-up and chasing her big brothers outside.  She has been going to a clinic for years for occupational, physical, and speech therapy, and she gets school services through an IEP.

There are many professionals working to help her maximize her skills, but her parents still feel like something is missing.  Everyone working with Katie seems to have their own agenda, and their family’s priorities seem to have gotten lost in the shuffle.  They spend hours a week driving to appointments and listening to all the professional recommendations, yet they are still not sure how to implement all those ideas at home. They feel like they are just getting through each day, instead of knowing how to create a home environment and daily routine that helps Katie be happy and healthy.

Paige’s OT Recommendations

Parents and families tend to get stuck in the routine of regular therapy appointments and school services, and at times they forget how to focus on being a family (and focus on kids just being kids).  The most effective therapy I’ve seen has been simple things that become part of family routines, done during play and daily tasks.  However, the therapy models at typical clinics or schools are not able to really address how therapy will fit into home life.  Parents are left to try to figure out the day to day applications, but at times it is hard to weed through all the professional recommendations and know how to proceed.  Even parents with the best of intentions can struggle to commit and follow-through on home program recommendations, especially when the recommendations don’t fit within normal family life.

How I Can Help

Most families that have been receiving therapy services know the services are helping their children and love their therapist.  Yet, if most parents are honest they don’t really understand what each therapist is teaching their child and what they are supposed to be doing at home to follow-through.  In a clinic setting, it is difficult for a therapist to really know what will be most helpful to your child at home; despite a therapist’s best efforts, he or she will be missing some critical elements due to the constraints of the clinic setting.  By providing services in your home based on your individualized need, I can help implement effective home programs and bridge this critical gap.  As a parent, I understand the need for realistic and practical recommendations. As a professional, I have specialized experience working with children with neuromuscular disabilities, such as cerebral palsy, Down syndrome, and other conditions that cause abnormal tone.  I have worked with young infants through adults with a variety of conditions.

Potential In-home Services

Services would include an evaluation with an individualized report and recommendations based on your child’s needs. I want to work within the services you already have in place to help fill the gaps and build your confidence and competence as a parent.  I am able to provide direct treatment focused on functional and measurable outcomes, in addition to parent and caregiver training. Some families need short-term intense treatment to help a child learn a new skill (such as learning to crawl, feed self with a spoon, or throw and catch a ball), others prefer weekly or monthly check-ins to train parents (such as how to create an effective home program that fits within a daily routine or consulting on how to adapt your home environment for your child’s physical needs and safety). Each child’s need are unique and my services are specialized to each family’s needs.

Leah is a 3 year old who was adopted from China.  She loves rice noodles, Mickey Mouse, and is terrified of dogs.  She has been home about 2 months and her family is focused on staying at home to work on bonding and attaching with their new daughter.  Leah is just starting to adjust to her new life, while her parents balance meeting her medical and developmental needs with keeping life quiet and routine at home.

Her parents know that Leah has some developmental delays from her medical conditions as well as her time in an orphanage. However, they are not sure of the extent of her delays or how to start addressing her developmental needs.  Her parents are sensitive to her need to stay at home and be close to her parents, so they are limiting appointments to only necessary medical needs and trying to limit Leah’s interaction with other adults.  Leah’s parents are feeling overwhelmed with trying to determine what behaviors are appropriate given her adoption history, attachment needs, and developmental delays.

Paige’s Recommendations and How I Can Help:

As an adoptive parent and a pediatric occupational therapist, I am uniquely able to help adoptive parents meet their adoptive children’s needs.  Through my personal experience, I am aware of the need to put attachment and bonding first for adoptive children.  However, focusing on attachment doesn’t mean that other developmental issues should be ignored.  Identifying developmental concerns and determining how and when to address them is complex.

I am able to consult with parents to help them better meet their children’s needs.  I can provide services sensitive to your child’s need, such as limiting my interaction with children who are focusing on bonding with parents and providing in-home services so children can remain in a safe, familiar environment.  Part of my role is to reassure what is typical, what is atypical but can wait, and what should be addressed now.  Common concerns may be related to motor skill and feeding delays frequently seen in children from institutional settings.  Most children with general motor delays will catch up given time and encouragement, so addressing general motor skills can wait.  However, some children have medical issues that affect their motor skills (such as motor skill delays related to a medical condition such as spina bifida or cerebral palsy) and waiting to address those issues may make their condition worse.  For feeding, it is important to distinguish if there are underlying issues (such as poor oral motor skills or oral aversion issues) that will impact their ability to get adequate nutrition.

Potential Services

Services would include an evaluation, which can be done through parent interview and observation of your child if needed, with an individualized report and recommendations based on your child’s needs.  My goal is to identify critical needs initially and to prepare parents for on-going needs to address in the future.  A consult-based model with a focus on parent education and training is most appropriate for most adoptive children when they are initially adjusting to their new homes.  After a period of time, additional direct treatment may be appropriate in-home based on each child’s needs, or I can help you locate other appropriate community and school services.

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