Pediatric Occupational Therapy
When you are pregnant, the initial medical professional is typically your OB-GYN. During the pregnancy, you become very familiar with their role and even prepare yourself for the next medical professional who will be your baby’s pediatrician. However, there are additional professionals who are developmental specialists that can contribute to your baby’s development: occupational, physical and speech therapists. Physical therapists address gross motor skills and the speech therapists address oral motor and language, but what does an occupational therapist do? The occupational therapist (OT) can be a comprehensive evaluator and even portal of entry for developmental therapy for a child who is premature, has cerebral palsy, Down Syndrome or other special needs.
The occupational therapist can also contribute to the development of a typical as well as the atypical child referring to the child’s physical development, cognitive development, and development of language skills, social and emotional skills. Occupational therapists are specialists in evaluating developmental milestones related to fine and gross motor skills, motor coordination, sensory integration (processing of touch, movement and noises), self-regulation (the sleep-wake cycle, specific to rolling, crawling and sitting up), as well as developmental milestones (bringing hands together or hands to mouth). The occupational therapists can also evaluate when there are issues with breastfeeding and make the appropriate recommendations specific to the child to improve these skills.
Occupational therapists can be found in hospital settings, clinic settings, school systems or as early intervention specialists. The goal for the OT is to improve the quality of life and engagement of the infant/child and family in desired activities of daily living with all ages of children. Occupational therapists use frame of references ranging from handling techniques, massage, feeding, sensory integration and principles of neuroscience, adaptive equipment, splinting/taping, positioning and strengthening to facilitate development.
Growth and development is a journey. There are children whose neurodevelopment progresses naturally and there are children that will need assistance to meet the developmental milestones. Gross motor milestones are contingent upon primitive reflexes that develop in gestation such as the Moro reflex and the ATNR (asymmetric tonic neck reflex). As the central nervous system matures in the first three months of life, these reflexes become integrated so that the baby can make purposeful and volitional movements. Postural reactions such as righting reactions come after the integration of primitive reflexes. This is when the child learns to extend his or her arm to keep him or herself from falling. Meanwhile the sensory system is also maturing so that the baby can learn about where he or she is in space and in relation to others. At this time, the equilibrium responses begin as well so that the child can start to gain foundation for balance, coordination and ultimately bilateral coordination. After a base of support with trunk and head stability is established, fine motor skills will emerge which require the use of the upper extremities to perform play and self-care activities. A child will demonstrate his or her cognition and visual perceptual skills through his/her hands. The American Academy of Pediatrics is an excellent resource for specific developmental milestone per month relating to gross motor, fine motor, self-help, problem solving, social/emotional, receptive and expressive language. There are red flags that indicate possible delays within a child and may require the use of an OT to facilitate neurodevelopment for your child.
If you are referred to an occupational therapist and your infant is pre-mature or delayed, you want to make sure that the OT is board certified, licensed, has continuing education training in Neuro Development Treatment or handling, Sensory Integration, feeding/swallowing, infant massage and that the OT specializes in pediatrics. The treatment sessions may take place in your home or in a clinic setting. The session will be hands on by the OT with the therapist facilitating typical movement patterns and reactions to sensory stimuli from the baby. There should be a lot of parent interview and training so that the parent can carry over the goals and techniques with the baby at home. There may be specific positions that will be recommended to facilitate the postural reactions from the baby. The occupational therapists can make recommendations regarding toys and specific play activities for the parent and the child to perform in order to reach developmental milestones. There is a lot of strengthening that can be done from prone on elbows or time on the stomach. This may require some adjustments to the make it possible for the child such as a wedge or a rolling a dowel shape out of a towel or blanket. The OT may also use a dynamic surface such as a swing, ball or the therapeutic use of self to create a dynamic surface to facilitate postural reactions and integration of reflexes for typical movement patterns by the child. Infants will typically be seen up to 50 minutes, before they fatigue.
If you have a concern regarding your child’s overall development whether it is fine motor, gross motor, self care, motor planning, self regulation/sensory integration or feeding or language, please ask your doctor to consider a pediatric OT referral for your child. Occupational therapy is typically covered by your health insurance plan; however each individual’s plan coverage varies.