by Anna Wall, MA, CCC-SLP, Little Tesoros Therapy Services
It is not uncommon for babies leaving the NICU to be discharged with orders for therapy, or for the need for therapy to arise in the first two to three years of life. Navigating this world may seem confusing and overwhelming, so we’ve tried to make it as simple as possible. Remember that it never hurts to seek an evaluation if you have concerns. At best, the therapist can reassure you that your child is developing within typical ranges. If they do recommend services, be encouraged that you sought help quickly because the benefits of early intervention are numerous and can have an important impact on your child’s later growth and development.
Choosing A Therapy Setting
Benefits of Therapy
Your child may leave the NICU with doctor’s orders for therapy, or the need for therapy may not become apparent until they are older, at which point the parent or caregiver refer their child for therapy, or consult with their pediatrician. If you suspect that your child may have a need for therapy, trust your gut and schedule the evaluation. Because the brain is the most adaptable to change during the first three years of life, benefits of early intervention are tremendous. Therapy is less costly and more effective at a young age and high quality services can change a child’s long term outcomes.
In-home therapy: In this situation, the service provider (physical, occupational, or speech therapist) comes to your home or your child’s daycare. Consider this: for babies who are immunocompromised, staying at home is usually the safest place to be because it means decreased exposure to germs. It’s also extremely convenient for the caregivers—no loading your child up in a car seat, fighting traffic, etc. Traveling therapists can only bring a limited amount of therapy equipment with them. Depending on individual needs, your child may receive greater therapeutic benefit from swings, large balls, and climbing structures, etc.; and these items are generally available in clinics.
Practice-based therapy: Practice based therapy can include freestanding clinics, who may offer one or more disciplines, as well as outpatient clinics connected to a hospital. Consider this: If your child needs more than one therapy discipline, you may be able to stack appointments back-to-back for efficiency. Clinics typically offer a variety of equipment and toys and your child may enjoy the fun, new environment. Visiting a clinic, also means coming in contact with lots of kids. While clinics should follow strict procedures for cleaning mats, balls, toys and equipment, your child is still at risk of contracting an illness from being around other people.
ECI: Also known as Early Childhood Intervention, ECI is state and federally funded through the IDEA (Individuals with Disabilities Act) and offers services for families with children age birth to three with disabilities and developmental delays. Consider this: ECI offers free evaluations and you are assigned a service coordinator who can not only help you navigate therapy, but help you plug in to other community and family resources. By law, ECI has 45 days to write the service plan from the date of referral, so you may not be able to see a professional right away and because they operate from the Family-Centered Service Model, visits tend to be less frequent than with the Medical-Based Service Model (as listed above).
Building Relationships with Your Therapy Providers
You’ve selected a therapy provider, now what? You are investing precious time, and most likely money into the therapy process so it’s to your advantage to get as much out of it as you can! Here are some tips:
5 Things You Should Know About Therapy
Physical Therapy. Physical therapists assess and treat problems with gross motor skills (gross motor relates to the large muscles in the body). They can help develop strength and range of motion and often target developmental milestones such as neck strength, sitting, crawling, standing, and walking. PTs also assess the need for orthotics (braces and splints), adaptive equipment, and helmets.
Occupational Therapy. Occupational therapists assess and treat problems with fine motor skills (fine motor relates to small muscles in the body), as well as sensory disorders and feeding issues. They often work on activities of daily living, strength, coordination and motor milestones.
Speech Therapy. Speech therapists assess and treat disorders of speech (sounds children make), language (what children can say and what they can understand) and feeding. They also address social language which includes eye contact, turn-taking and appropriate play skills.
Orders. Doctor orders, also called a prescription, are required for treatment. Your doctor may give the prescription to you or your therapy provider can request them directly from your child’s doctor.
Expert. Your therapist is the expert in their field, but YOU are the expert on your child. Think of therapy as a team effort and don’t be afraid to make your voice heard.
- Be on time! Chances are, your therapist has a patient scheduled immediately after yours, so they aren’t able to run late just because you are. Maximize your time by getting the full session.
- Attend as many sessions as possible. You should always cancel when your child is ill, but you’ll see the most progress when your child gets regular therapy appointments without large gaps in services. Be diligent about attendance and make an effort to reschedule any missed appointments.
- Be present during the therapy session. It’s not uncommon that parents of young children (especially under 2) will be in attendance for the entire session. Resist the urge to update your Facebook and instead, engage with the therapist and your child; observe what the therapist is doing closely, so that you can try and replicate it when s/he is gone.
- Ask lots of questions. If you don’t understand, ask. If you’re uncomfortable or confused, ask. Don’t leave the session with unanswered questions. Also, ask for a home program. Your therapist should be able to suggest activities and exercises that you can do with your child that will further their progress in therapy.
- Advocate for your child. Chances are you’re an expert at this by now! If you have concerns, don’t feel like your therapist is a good fit for your child or just feel uncertain, trust your gut. Don’t be afraid to speak up, ask for changes, or share your apprehension with your therapist or case manager. You have 100% control over the choice of therapist for your child.
Creating A Balance Between Play and Therapy
If your child isn’t meeting their developmental milestones or has more significant impairment this can be very stressful and it’s natural to want to do everything you can to help them. When parents carry over therapy into a home program, we often see great progress. However, for the sake of you and your child, avoid becoming consumed by therapy at home.
Choose 15-30 minutes (total) per day that you can build therapy techniques into your natural routine as a family. By integrating therapy into the natural routine of your day, you won’t feel the burden to set aside extra time for therapy and your child will have many opportunities to practice their skills.
Here are some ideas:
- Mealtime. This is a great time to practice speech and language techniques, such as signing ‘eat’, address feeding issues and work on fine motor skills, such as pincer grasp to pick up a piece of food.
- Diaper changes. At each diaper change, you can perform necessary stretching, and address gross motor skills such as rolling, head control, and building strength in the arms and legs. Language can be encouraged through eye contact, smiling, and singing songs.
- Bath time. The bath is another great place to practice language skills and gross and fine motor skills such as clapping, grasping, and sitting.
- Play time. This is a great opportunity to replicate things your therapist does with your child. You can build in stretches as part of a game, play games that challenge your child’s physical development, and involve siblings, friends or even the family pet in encouraging your child’s progress.
Because of your NICU experience, you’ve learned the value of taking action and advocating for your child. If your child needs therapy, these skills will serve you well in the process of choosing a provider, attending therapy, and carrying out the home exercise plan in a way that benefits your child and works for your family.
- CDC Developmental Milestones. If you have questions about your child’s development, the Centers for Disease Control offer this checklist broken down by age. Consult with your child’s pediatrician about whether you should be using their adjusted or chronological age.
- Developmentally Appropriate Toys. Walking in to Target to pick out toys can be totally overwhelming. Use this or similar guides to help you choose toys that will stimulate and challenge your child and help further their developmental progress.
- What to Expect at your First Therapy Appointment. It is totally normal to feel apprehensive about your child’s first appointment. Knowing what to expect can help calm your nerves and help you feel prepared. The more relaxed you are, the happier your baby or child will be!
3 People Who Can Help:
- Little Tesoros Therapy Services or a therapy practice near you. Little Tesoros Therapy Services provides physical, occupational, and speech therapy within the fun, playful atmosphere of our clinic as well as in homes, schools, and other community sites.
- Your pediatrician or family doctor. Your doctor can help you determine if your child is developing within typical ranges and offer guidance about what behaviors are and are not warranted for concern.
- Your insurance representative. Your insurance representative can help you find in-network providers, advise you of potential costs and any limitations to your plan (such as a visit limit per year or any diagnoses that aren’t covered).