My “first steps” in building pediatric clinical competency

I was fortunate enough to find a beginners-level pediatric continuing education course allowing me a month to finish the video series, of which there were more than 100. This is originally a two-day course recorded in video that was taught by two esteemed pediatric therapists, one of whom is Julia Harper, an occupational therapist practicing in Florida (per my understanding) and who founded this company, Therapeeds. It offers a variety of different AOTA-approved CEUs in pediatrics ranging from general courses to more specific ones, such as in sensory integration. The course I took was called The Pediatric Primer, and it is specifically designed for new practitioners or practitioners transitioning to peds from other settings. Both of these qualities applied to me as I still consider myself a new practitioner, even though it is now almost two years. Regardless of my being a new practitioner, I know I will always be learning because therapy is such a dynamic field in that there is always some new research to keep up with, or always some skill to refine.

The Pediatric Primer’s main focus is on assessment and evaluation, as that is the first step in starting any pediatric plan of care. I had learned many of the assessment tools discussed in graduate school which is not too far in the past for me, but I also learned how to form an outlook which allows me to see the BIGGER PICTURE. Julia’s examples, stories, sample cases and videos talked me through how to form that outlook, certain key tenets which should structure how I analyze each eval. In that, this course was even better than my pediatric classes in school- I didn’t have to wait to stumble through real-life situations to form a clinical outlook, although I’m sure it will become more refined once I actually start to practice in peds.

Here is a summary of the techniques Julia recommends to “live by” in order to create such a holistic outlook:

1. ASK, ASK, ASK. Ask many questions during evaluation and treatment- I shouldn’t feel like I already know the answers. I also should ask questions about if the child was premature, did the pregnancy have any complications, and was the baby delivered via a C-section?- among others. The answers to these questions may provide essential information with clinical implications, such as if the child was breached and had to be delivered via C-section, I should be wary of vestibular system deficits due to diminished gravitational experiences in the mother’s womb. I shouldn’t jump to conclusions, but like in any detective case concrete facts point to possible suspects.

2. Which brings me to my next take-away from this course: don’t ever guess or make assumptions, but NOTICE everything which may indicate the need for further testing. For example, if I see a child constantly grinding her teeth together I shouldn’t automatically assume she has sensory processing disorder, but note that it is a symptom which may indicate the need to perform the SIPT.

3. One thing that hit me hard is the notion that even in pediatrics, we have to convince people to get on board. In adult practice, there are many days I feel like I’m pulling teeth just to get people to agree they need therapy, much less participate. However, even the most well-meaning parents need to feel hopeful about their child’s functional capabilities to pursue treatment. It always helps to put a positive spin on things: “Sure, your 3 year-old’s fine motor skills may be at a 6 month level, but at least the gross motor skills are better coming in at 12 months of age.”

-I’m sure many parents feel like this mommy. Even terms like “developmentally delayed” should be communicated gently.

-NEVER mention a diagnoses based on functional deficits and symptoms seen, regardless of how accurate it seems. Always ask if the child has been given a  diagnosis by the doctor.

-Motivation gives people hope and highlights the agency of the family. “Normal movement” as referenced in pediatrics refers to the ability to apply skillful movement in a variety of different settings, and to build those translatable skills outside of the carefully structured therapy gym requires parental compliance with home programs. Parents must believe in the effectiveness of the therapy to invest time into home programs from their busy schedules and other important responsibilities of caring for their child.

4. Be realistic, but get the child to where he needs to be.

-address the root of the problem- don’t just practice movements over and over again, because it will not be skillfully applied across a variety of different settings.

-don’t short-change the child because of a diagnosis. Julia’s poignant example of a mother calling for services for her son with autism who cannot communicate needs, socialize or maintain relationships but saying he wouldn’t benefit from OT because “he is autistic, you know” will always stick with me. I know there is only so much therapy can do, but we can definitely maximize the functionality in a child’s life- whether through improvement in the child’s skills or by assisting the family in catering to the child’s special needs to ensure quality of life.

In the end, it’s all about quality of life, right? Our beautiful, playful children grow up to be adults expected to contribute to society and self-sustain to a certain extent. That’s a lot, but that’s why we need to make sure to do the best therapy possible because in most pediatric cases we are creating new neural networks rather than using motor learning to re-connect old ones as we are in adult practice.

Taking this course is my first step in ensuring I be the best pediatric therapist I can be.

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