A Parent’s Guide to Cerebral Palsy

Cerebral palsy is loosely defined by impaired motor function (body movements) due to an injury to the brain before, during, or immediately after birth.  People diagnosed with cerebral palsy can have impairments that span a wide range from very mild to very severe. There are several different types and a plethora of information on cerebral palsy that can be difficult to navigate through. Here we will take a look at an easy guide to cerebral palsy.

What is Cerebral Palsy, and How Does it Happen?

Cerebral palsy is considered a neuromuscular disorder, meaning that it disrupts how the brain and muscles of the body work together to produce body movements. Damage to the brain occurs while in utero either through abnormal brain development or injury during the birthing process. As a result, a child can be left with impairments such as paralysis, spasticity, and contracture that inhibit functional mobility. Cerebral palsy can be classified in a few different ways.

Nonspastic Cerebral Palsy

Also known as extrapyramidal CP, is broken down into two categories: dyskinetic and ataxic. Dyskinetic CP is characterized by uncontrolled body movements and muscle tone that can be hypotonic or hypertonic. The involuntary muscle movements can make it increasing difficult for a child to perform functional tasks.

Ataxic cerebral palsy involves lack of coordination and control throughout the entire body. Lack of coordination can negatively affect gross motor patterns and poor fine motor control can impact tasks such as dressing and writing.

Spastic Cerebral Palsy

Spastic, or pyramidal, cerebral palsy involves contracted or tight muscles that are incapable of relaxing. This spasticity can make many tasks difficult to complete due to difficulty moving stiff body parts, controlling movements, and coordination deficits. Spastic cerebral palsy is broken into four subgroups:

  1. Monoplegia: in which only one limb is affected.
  2. Hemiplegia or diplegia: either one side of the body—one arm and one leg—or both arms or both legs are affected.
  3. Triplegia: three limbs are affected; both arms and one leg or both legs and one arm.
  4. Quadriplegia: both arms and legs are affected.

How Can I Help My Child with CP?

Fortunately, with the techniques, knowledge, and adaptive equipment available, many children with cerebral palsy can live an independent life. Physical and occupational therapists can work with your child to increase mobility and independence. Strengthening, stretching, neuromuscular re-education, and manual techniques can aide your child in adapting activities to perform them independently. Therapists will work with you and your child on appropriate adaptive equipment and braces that will increase independence. Additionally, carrying over the home exercise program designed by your therapist will help your child achieve their goals.

While a diagnose of cerebral palsy can be scary and overwhelming, therapy staff are happy to help answer any questions and work with you to develop the best treatment plan to set your child up for success.

Prenatal Substance Abuse: The Functional Consequences and How Occupational Therapy Can Help

According to the National Center of Substance Abuse and Child Welfare (NCSACW, 2016), approximately 15% of infants in the United States are prenatally exposed to alcohol or illicit drugs. Common types of substances may include the following: cocaine, heroin, inhalants, marijuana, MDMA, methamphetamine, nicotine, and prescriptive (i.e., opioids) or over-the-counter drugs (National Institute on Drug Abuse, 2018). Expecting mothers who allow any dangerous chemical into their body will cause harm to the baby, whether it be short-term or long-term damage. The following consequences should be expected with substance use while pregnant:

  • Prematurity and low birth weight
  • Neonatal abstinence syndrome - the baby is born addicted to the drug they were exposed to in the womb.
  • Fetal Alcohol Syndrome - a disorder that develops in the womb when the fetus is exposed to alcohol.
  • Cardiovascular issues
  • Behavioral challenges - impulsivity, attention deficits, poor judgment, decreased reasoning skills.
  • Lung or respiratory damage - such damage can be short-term or permanent
  • Muscle cramping and weakness
  • Movement abnormalities
  • Stunted growth - substances literally make the bones stop growing.
  • Kidney and liver damage
  • Mental health problems - depression, anxiety, hallucinations, and paranoia (National Institute on Drug Abuse, 2018)

From a functional standpoint, prenatal drug exposure can severely disrupt a developing child's life and their ability to participate in meaningful tasks as they age. Example tasks may include:

  • Playing with Toys: Physical, cognitive, and emotional disruptions from prenatal substance exposure can drastically warp how an infant interacts with objects in their environment. This may refer to an inability to grasp toys in one or both hands, to initiate grabbing a toy, to understand cause-and-effect with buttons, transitioning from one play task to another, etc. Poor play skills in infancy can lead to delay in reaching pivotal milestones (i.e., rolling, crawling, walking, speaking, coloring, etc.).
  • Social Participation: Children with prenatal substance exposure may struggle with creating friendships and appropriately interacting with family members and friends. Causes can include displaying unacceptable behavior (i.e., tantrums, dominating conversations, inattentiveness, etc.), mental illness (i.e., depression, anxiety), and speech or communication delays.
  • School Attendance and Assignments: If the child sustained brain damage due to substance exposure in the womb, he/she will most likely experience some escalated challenges in school. Due to inattention, impulsive behavior, poor judgment, and reduced emotional regulation (to name a few), sitting in a desk to listen to a teacher or to complete an assignment becomes more difficult than usual.
  • Daily Living Tasks: Behavioral problems, cognitive delays, and developmental milestone deficits can reduce a child's ability to accomplish necessary living tasks at home. Examples include toileting, self-feeding, dressing, and hygiene tasks.

Pediatric occupational therapy can offer so much for infants and children with prenatal substance exposure.  Of course, such OTs are present from day 1 if the newborn goes through the neonatal intensive care unit (NICU). For time's sake, let's focus specifically on home health pediatric OT services. Home health OT can occur within the home or in a community setting. Depending on what the child's goals for therapy are and what their functional deficits look like, OT can offer any of the following: therapeutic exercises, motor learning techniques, gross motor/fine motor activities, daily activity interventions, daily schedules or systems, and caregiver education.

So, how does a child with prenatal substance exposure get started in home health OT? The child is already home from the hospital. Two scenarios will usually play out: the child goes home with the biological parents or the legal and welfare systems place the child into foster care. No matter where the child is placed, intervention services need to begin immediately. It is essential for parents or legal guardians to conduct the following once the newborn comes home:

  • Note Observations of the Newborn: For brand-new parents (and even experienced ones), it can be very difficult to visualize what "typical" development looks like. For a newborn with prenatal substance exposure, side effects can be obvious (inconsolable crying, low levels of arousal, breathing problems, movement issues, etc.) or not so blatant in the slightest. If the newborn was exposed to illicit substances or alcohol in the womb, then it is essential to consult with early intervention services so that clinicians may or may not identify problems that you don't notice.
  • Contact Your Local Early Intervention Services: Give early intervention services a call and set up an appointment as soon as possible. Your pediatrician may have some referral information or resources for early intervention care.
  • Participate in Free Consultation and Evaluation: Since early intervention services are typically government-funded, the first visit and initial evaluation of your newborn is free. Occupational therapy along with physical therapy, speech therapy, psychiatry, and social work will want to assess your child in order to determine the deficits (if any) and appropriate services for your child.
  • Actively Participate in Home Health Services: If your child qualifies for early intervention services, proactively schedule and attend appointments that will usually occur in your home.

Fine Motor Developmental Milestones

Fine motor activities require skilled use of the hands as well as coordination to perform a task. Early fine motor skills set the stage for many tasks in life that require well developed fine motor skills and coordination such as handwriting, computer skills, and feeding. Fine motor development can often be overlooked as parents watch for gross motor milestones such as sitting, crawling, and walking. Using this guide can help you to monitor your child's fine motor progress and ensure that he/she stays on the right track.

Birth to 3 Months

One would think that there is nothing in the way of fine motor skill development happening for a tiny newborn. However, there are a few tricks that your little one will be developing over this time. Around 1 month old, babies should be tightly grasping objects placed in their hand, such as your finger.  At two months, babies can hold small toys for short periods of time and may begin to swing at objects such as dangling toys from a mobile. It is around this time that babies will start to notice their own hands.

4-6 Months

Between four and five months, infants are able to reach and grab a small toy with both hands as well as bang objects on a table, such as the spoon as they sit on your lap at a restaurant. At around six months, the raking grasp emerges. The raking grasp is when a child uses their entire hand and all fingers to "rake" or pick-up small objects.

7-9 Months

The critical fine motor skill that emerges during this time frame is the development of the pincer grasp. The pincer grasp entails using the thumb and index finger to pick up small objects. This is a critical fine motor skill to develop for self feeding. To help your child with the pincer grasp, allow opportunities to pick up small but appropriate foods such as Cheerios or dissolvable puffs or yogurt bites.

10-12 Months

During this time, an infant will begin to place smaller items into a larger container such as blocks. At around 12 months is when a child really develops the skill to pick up an object and throw it. So, all of those pacifier and sippy cup chases are not in vain—it just shows that your baby is developing those fine motor skills. Around 12 months is an excellent time to introduce large peg puzzle boards to your baby.

While it may not seem that babies are doing a whole lot in regards to fine motor development, the first year is a critical stage to lay the foundation for higher level fine motor skills as a child gets older. If you have concerns about your child's fine motor development, consult with their pediatrician or an occupational therapist. An occupational therapist can work with you on ways to facilitate fine motor development and ensure your child is hitting all of their milestones.

Pediatric OT: Home Health for Children with Cerebral Palsy

Cynthia is a 4 year old female with spastic cerebral palsy. Ever since she was born, Cynthia has been having profound trouble getting around because both of her legs are affected. Her mother, Jana, started Julia off in early intervention services once it became clear to her that Cynthia was falling behind in her developmental milestones. At age 2, she could hardly stand on her own without the assist of her mom or a piece of furniture. Her hands are mildly affected by her cerebral palsy, making it very difficult for her to hold a crayon or a pencil, zip her own pants up, tie her shoes, and play with her toys. Cynthia is going to be turning 5 soon and will be enrolled in kindergarten in about 6 months from now.

For some parents, defining cerebral palsy is like preaching to the choir. However, and short overview may be helpful for parents who are experiencing it for the first time and don't know what to expect for their child over the next few years. Cerebral palsy describes a group of disorders that impact typical movements and posture. Because of damage to or dysfunction of the brain, the body shows abnormalities in muscle tone, muscle control, muscle coordination, reflexes, and overall posture. Some forms of cerebral palsy come with speech and language impairments, epilepsy, visual deficits, and intellectual disabilities https://research.cerebralpalsy.org.au/what-is-cerebral-palsy/.

There are three main subtypes: quadriplegia (all four limbs affected), diplegia (usually the two lower limbs), and hemiplegia (same side arm and a leg are affected). Motor control abnormalities include spastic (tight), dyskinetic (involuntary movements), and ataxic (shaky or tremor-like movements). Review Cerebral Palsy Alliance Research Foundation's chart for further details about subtypes at https://research.cerebralpalsy.org.au/what-is-cerebral-palsy/types-of-cerebral-palsy/.

Cerebral palsy for a young child means that their participation in daily activities at school, at home, and in the community will change drastically because it is a life-long condition. Like Cynthia's situation, the following examples strongly reflect what those changes look like (worst-case scenario):

  • Inability to run around the playground and climb gym equipment and recess
  • Inability to dress, shower, and toilet themselves
  • Inability to self-feed at home or in the cafeteria
  • Inability to sit up in a desk to complete school work
  • Inability to communicate and make friendships at school
  • Inability to walk from classroom to classroom
  • Muscle pain and tightness negatively distracting them from other tasks
  • Increased number of falls and injuries

Each child with cerebral palsy as a unique set of limitations, but it is still possible for them to live a fulfilling life with the right help. Occupational therapy (OT) is only one of the many professions that can offer relevant services for children with cerebral palsy. More importantly, OT takes a specific approach in which they address the child's goals, carefully assess the activities they want to or must complete, and then helps the child revamp their lifestyle so they can complete tasks as independently as possible. Home health OT is especially effective because the therapist is allowed to work with the child in their home and community environments in which they are familiar and comfortable with. Here are some examples of interventions OT has used with children with cerebral palsy:

  • ADL interventions: Eventually, young children in many families are expected take care of their own personal needs including dressing, toileting, showering, and self-feeding. All of these tasks require refined fine motor strength and coordination as well as the ability to stand, sit up, and change positions without support from others. OT can specifically work with children in breaking down each task, discover the barriers, and then eliminate the barriers with restorative (improvements to the child's physical movement) and compensatory (introducing adaptive equipment) interventions.
  • Neuro-developmental Treatment: Some OTs are highly knowledgeable or certified in Neuro-developmental Treatment (NDT) in which past theories were based off of working with individuals with cerebral palsy http://www.ndta.org/whatisndt.php. It's a fairly complex treatment that is useful for addressing muscle strength, range, and coordination.
  • Splinting/bracing: Given that the majority of children with cerebral palsy are of the spastic type, this means that many clients are dealing with heightened muscle tone. In other words, children experience limited abilities in voluntarily moving their arms and legs in full range and strength in order to walk, sit up straight, stand, change positions in bed, crawl, climb the stairs, and the list goes on. Over-time, muscle tissue is some cases can atrophy and break down. Some OT's may recommend a rigorous splinting or bracing program in order to prevent breakdown and loss of movement.
  • Range-of-Motion and Therapeutic Exercise: Often times, an exercise program is paired with a splinting program in order for the child to maintain as much joint range and strength as possible. For home health programs, OTs will usually train family members on how to assist the child in carrying out daily splinting and exercise programs.
  • Adaptive Equipment and Durable Medical Equipment: Some children may benefit from having some external supports which include: walkers, adaptive feeding equipment (plate-guards, weighted spoons, etc.), wheelchairs, and communication boards just to name a few. Such adaptive equipment should be useful across several environments including the home, school, and the community.

How to get OT services for my child at Home: Tips for Parents

How to get OT services for my child at Home: Tips for Parents
Kimberly became a brand new mother to a baby girl a little over a year ago. Labor and delivery was typical, and there wasn't anything to indicate that there something developmentally wrong with her child, Camille. Recently, Kimberly has realized that Camille seems to be behind in her ability to get around and to feed. Camille is about 16 months old and has trouble sitting up without support, which makes it very difficult for her to learn how to walk. She has trouble with spoon-feeding Camille with simple, pureed foods because her mouth won't conform around the spoon to keep food in. Kimberly has never had any experience with early intervention services, has never heard of occupational therapy (or had any first-hand experience with other therapies), and is at a loss for where to start.

Parents have one thing in common: we are all raising children through new stages of life for the very first time. Unless we've read several volumes on parenthood and pediatrics, most of us are flying by the seat of our pants as we guide our children's growth. Some of us are fortunate enough to raise one or more children who have no developmental dysfunction. For other parents, it is a shocking reality to learn that through their own observation their children are struggling with the basics: rolling, crawling, walking, talking, and eating. Some of us won't catch anything off at birth, but might discover some problems a few months or years down the road.

Fast forward past your regular pediatrician visits. You and the doctor have already confirmed that your child is not meeting the typical developmental milestones. So, what can a parent or guardian do to seek appropriate services for their child?

  1. Look up your local Early Intervention Programs: Early Intervention are services provided by law via Part C of IDEA (Individuals with Disabilities Education Act). Clinicians in early intervention programs provide education and treatment to children ages 0 to 2 years old. The child is evaluated, and if found to have an established condition (physical or mental) that could potentially cause developmental delay, they receive services for a set period of time http://www.wrightslaw.com/info/ei.index.htm. Depending on what program you enroll in, services could include physical therapy, speech therapy, occupational therapy, social work, nutrition, and psychology to name a few.

    Furthermore, early intervention programs are to conduct treatment in the child's natural environment including the home or the community: "to the maximum extent appropriate to the needs of the child, early intervention services must be provided in natural environments, including the home and community settings in which children without disabilities participate." (34 CFR §303.12(b), Part C IDEA). Since early intervention addresses a small part of the lifespan (ages 0-2), it is essential for parents to get on the ball, talk to a doctor, and contact services immediately.

  2. Set up a consult and an Evaluation: Initial evaluation helps clinicians determine whether or not your child has developmental delays that need to be addressed. It also gives providers a chance to determine which clinician will best be able to help with your child's needs. If you look back at Kimberley's case, if Camille is found to have developmental delays according to standardized testing, then Camille could potentially receive physical, speech, and or occupational therapy to address her movement and feeding needs.

    The initial consult and evaluation are free. This gives parents a chance to figure out whether or not their child is in need of help, or if it's all in their head. Parents who have no previous education in health and pediatrics are not expected to know everything. Thus, it never hurts to check before the opportunity passes you and your child by.

  3. Develop a game plan for therapy: Once your child qualifies for early intervention services, clinicians will walk you through the next steps. This includes financial questions, scheduling appointments in the community or in your own home, and determining which specific services will best suit your child's needs.
  4. Look ahead for when your child ages out: Remember, your child will age out of early intervention once they turn 3 years old. For some, maybe early intervention is all that is needed and your child will be fine without any additional services. For others, developmental delays could still carry on and impact home and school activities. While your child attends early intervention services, thoroughly research what programs would be included in the next step including pediatric home health services, pediatric outpatient clinics, and school programs.

Intervention Carryover: What Parents/Guardians Can Do to Help their Child reach their Therapy Goals

Occupational therapy, due to its very nature, is a flexible discipline that can work in just about any setting. Examples include outpatient clinics, skilled nursing facilities, inpatient hospital units, transitional care units, school districts, community clinics, and home health companies to name a few. Treatment is tailored to fit the needs for anyone across the age span, from neonatal care to hospice. Out of all of the possible clinical combinations, pediatric home health OT has a unique format filled with a variety of approaches for children:

  1. Therapy occurs at home: The OT physically shows up to conduct treatment in the child’s own home. This allows for the child to comfortably participate in an environment that is familiar, which eliminates the stressors that come with working in a sterile and intimidating clinic. The OT has an advantage because he or she can create treatment based off of the child’s interests, which is incredibly easy to observe in a safe, home environment.
  2. The child is the focal point of treatment: Although adults including parents, caregivers, or additional family members will be heavily communicating with the therapist, it is the child who steals the stage for therapy. Working with a young client is rewarding, but it can be tricky for children to communicate their needs and goals to a stranger. Therapy looks a lot more like a play group rather than treatment. Additionally, children may not see the barriers (physical, cognitive, behavioral) keeping them from succeeding in meaningful tasks.
  3. Scheduled appointments are different: There are some settings in which an OT will see a patient 7 times a week, and for other settings maybe just twice a week. In the case of home health care for children, there are some organizations (i.e., early intervention) that will only allow for two or three appointments per month. This means that OT has time to cram in tons of clients per month, but at the expense of not getting to know the child very well.
  4. Caregiver input is essential for success: In order for children to meet their goals in therapy, parents, guardians, foster parents, or other relevant caregivers need to take the reins. Being proactively involved in your child’s therapy sessions is essential, especially if home health therapists only show up a couple of times a month.

The following are some tips that parents/caregivers should consider if they need assistance in participating in their child’s OT treatment (or really any other rehabilitation treatment for that matter):

  1. Be present: Be awake and at the house at the time of each appointment. Make sure your child is ready for treatment. This doesn’t necessary mean that your kiddo needs to be spit-shined and properly dressed; however, it does mean that the child is away from other distractions in order to focus on therapy (i.e., meal-time, naps, bath-time, etc.).

    Remember that the therapist is not hired to be a babysitter. In fact, most therapists will expect parents to stay in the room where the child’s sessions will take place. Put your phone away so that you can actively engage in the sessions as well.

  2. Create a productive working environment: Being a parent of young children usually equates to a messy household, so please don’t think that therapists expect to arrive at the home while it is in pristine condition. Instead, concentrate on eliminating distractions that you know your child will try to go after during therapy. Examples include electronics, toys (other than ones used in therapy), blaring music or televisions, snacks, etc.
  3. Involve siblings if necessary: Consult with the therapist about whether or not it is a good idea to have siblings present during sessions because you may be surprised by their answer. Depending on the goals, therapists might want siblings around as playmates for the child in order to carry out treatment (i.e., sharing toys in order to get the child to crawl, stand, or walk).
  4. Communicate treatment ideas to others: Realize that although treatment occurs at home, what the child learns from therapy will translate to other environments including school, community centers, friends’ houses, etc. If the child’s treatment creates changes that could impact other settings (i.e., coping skills, transition techniques, schedule changes, etc.), it is important for parents to communicate those changes with teachers, aides, and other parents or adults in which the child has frequent contact with.
  5. Actively carry out treatment outside of therapy sessions: When you sign on for home health, be ready to take on some changes to your own day-to-day schedule. If the child only completes therapy requirements during the few days per month in which he or she is seen by the OT, no long-lasting changes will occur. Parents or caregivers will be expected to carry out intervention as instructed by therapy in order for the child to positively benefit from services.

Motor Learning: What OT can do to get your Child Moving

Motor learning theory isn’t new by any means to the occupational therapy profession; however, therapists continuously come up with innovative treatments based off of motor learning in order to teach or re-teach people how to move in a functional manner. Jarus (1994) quotes this common definition, which has been recited numerous times in OT literature:

“Motor learning refers to a set of internal processes that are associated with practice or experience and that lead to relatively permanent (i.e., long-lasting) changes in motor behavior (Schmidt, 1988). Because permanent changes are the desired outcome, the ability to retain the learned task is of great importance”. (p. 810).

So, what does all of this information mean for people who aren’t therapists or who are not willing to digest this type of peer-reviewed information? The term “motor”, in its most simplistic light, means “movement”. OTs work persons of all ages evaluating and treating barriers to movement necessary to perform functional activities.

Let’s take a look at what this means for children working with OTs in their own home. Functional activities vary per child depending on their age and where they are developmentally. For example, a typical 6-month-old may already be trying to put the motor pieces together to sit up unsupported in order to play with some blocks. A 6-year-old may be starting to take the first few fine motor steps in order to participate in handwriting their ABCs. A 16-year-old may be focusing more on participating in school sports with their friends. Yes, some of these examples do take place outside of the home, but much can and will be learned at home with the help of parents or guardians.

Read through the following scenario depicting what OT can provide a child within the context of their own home, while keeping in mind that the skills the child learns can be generalized across multiple environments:

Jill is a 10-year old female with Down syndrome. Cognitively and academically, she is about 2 years behind her classmates. For the past 6 months, her mother has arranged for an OT to come visit Jill in her home twice a week. Her mother is very concerned because Jill is struggling in all of her classes because she has trouble with handwriting. The OT ran a detailed evaluation and concluded the following: Jill can read at about the level of an 8 year old, so comprehending what she is writing doesn’t seem to be a problem. However, while observing Jill color a few pictures, the notices that the crayons are very loosely held and that Jill doesn’t hold the utensils with a typical grasp like others her age. Jill also has a preference for slouching forward and laying on the table while drawing.

In this case study, when it comes to making motor learning a primary focus for intervention, the OT purposefully identifies barriers in movement required for Jill to write. Now, it is about taking apart the poor compensation habits Jill has developed (i.e., irregular grasp, slouched position), adding in some new habits, strengthening her grasp and fine motor skills, and then watching as her new handwriting skills help her succeed in school. Aside from handwriting skills, OTs can do so much more for kids to encourage movement:

Early intervention: OTs work with children ages 0-3 to attain motor milestones of development. Examples include learning how to crawl, roll, sit-up, furniture-walk, and then eventually walk. Other are more precision-based including how to grasp for toys, picking up objects one or two-handed, holding a spoon for self-feeding, developing grip strength to draw with a crayon, etc.

Elementary-aged children: OTs can work with children on more complex tasks (including handwriting) in order to accomplish tasks at home, at school, and on playdates with friends. Examples include learning how to ride a bike, running all over a playground, self-propelling a swing, and conducting small chores at home (sweeping the floor, folding laundry, setting the table, making a sandwich, etc.).

Middle and High school children: OTs can work with children of this age on teaching and refining movement patterns to better participate in school supports, to dance at school formals, to drive a car, to take on even more complex chores at home (i.e., repair work, sewing, etc.), and to perform part-time work responsibilities.

The possibilities are endless when it comes to motor learning in occupational therapy for children!

References

Jarus, T. (1994). Motor Learning and Occupational Therapy: The Organization of Practice. American Journal of Occupational Therapy, 48(9): 810-816.

Self-feeding for Picky Children: What Pediatric OT can do for you in your home

The time has come for your little one, who has surpassed the baby phase, to transition from milk/formula to actual foods. The steps can be meticulous and slow, as it should be for a child who is experimenting with foods for the very first time. After the parents spend months on introducing the purees and dissolvables, comforting the child when teeth start cutting through the gums, toying with a variety of spoons and sippy cups, and discovering the child's allergies and preferences, the light at the end of the tunnel appears and parents can pat themselves on the back for a job well done. Their young toddler is now feeding themselves!

If only it were so easy for all parents of young children. Some kiddos are not given the luxury of such smooth transitions through the self-feeding process. Conditions or disorders create unexpected obstacles, which include: sensory processing difficulties, dysphagia, nervous system deficits (i.e., cerebral palsy), muscle weakness, respiratory complications, and cognitive/behavioral difficulties to name a few. As a result, the child does not develop a typical feeding pattern which can result in malnutrition and dehydration.

That's where occupational therapy (OT) comes in, as well as clinical input from speech and language pathology (SLP). Take a look at the following scenario which provides context from a home health stand point:

Clarissa is the mother of 3 children, 2 of which attend elementary school during the day. Her youngest, Emma, is 2 years old and has Down's syndrome. Clarissa pursued therapy services soon after Emma was born, thus she has been seeing early intervention therapists in her home. Due to Emma's overall, low muscle tone, she has trouble manipulating and chewing solid foods in her mouth. OTs and SLPs from the early intervention program have been tag-teaming it, OT addressing oral muscle strengthening for self-feeding while SLP has been mainly focusing on Emma's language development. Clarissa would like to see Emma attend preschool in a couple of years, so her goal is to have Emma catch up on eating and talking well enough so that she is comfortable around her classmates.

Let's extract OT's role and describe what this particular therapy can offer for self-feeding tasks with children. The following list is not all-inclusive, but it does provide some of the common issues that OT is equipped to remedy:

  1. Therapeutic exercise: If it is a matter of muscle, tongue, or joint control, OT can offer exercises for the child to complete in order to improve movement required to chew, manipulate, sip, and swallow food. Of course, no child is going to voluntarily sit for several minutes of the day completing a rote exercise schedule. OT would introduce activities in the form of play so that the child will have joy and motivation while not realizing what exercise benefits they are automatically receiving (i.e., chewy candies, bubble-blowing, making faces, etc.).
  2. Sensory Challenges: Some children are beyond "picky" to the point where their food aversions make every mealtime a dramatic feat. OTs can evaluate children for specific sensory processing deficits and then set up the child on a detailed feeding schedule combined with relevant interventions. The process is slow and complex, but it can be easily carried out by parents/guardians at home if the OT provides proper training and resources. OTs who are well-versed or even certified to address sensory processing disorders are the most suitable to consult with regarding this area of self-feeding deficits.
  3. Behavioral difficulties: Childhood diagnoses or conditions often come with misunderstood cognitive or behavioral elements. Examples include atypical aggressive behavior, meltdowns, reduced attention span, and language impairments, all of which have a devastating impact on meal time participation. OTs can offer interventions or programs that reduce maladaptive behaviors in order to allow for productive feeding. Examples include developing consistent feeding schedules, locating and implementing effective environmental cues, introducing coping techniques, eliminating distractions, etc.
  4. Parent/caregiver education: Any type of home health therapy is going to heavily emphasize the need for parent/caregiver/guardian education. Although the therapists provide the intervention, it is the at-home parents who will be responsible for carrying it out when therapy is not around. This includes therapy providing sufficient and comprehendible resources for the parents, parents implementing schedules, routines, or habits consistently at home with the child, and parents educating other caregivers who may interact with the child (i.e., babysitters, respite care providers, teachers, other family members, daycare workers, etc.).