Deborah Howell (Host): Occupational therapy has been helping children for many decades, but it's not always very well understood. In this episode, Shawna Townsend, an Occupational Therapist at Miller Children's and Women's Hospital, will tell us why your child might need occupational therapy and why that's a good thing.

Welcome, Shawna.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Hi. Thank you for having me.

Host: Of course. What is pediatric occupational therapy and how would you describe it to someone who's never heard of it before?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Yeah, so occupational therapy focuses on the things you want and need to do in your daily life. We work with clients across the lifespan, so from birth all the way throughout the geriatric period. For younger children, we facilitate activities that really like occupy their day. So thinking of things like even getting dressed for school, brushing their teeth to get ready for school, getting to school and staying focused and learning and participating in their school activities, because that's such a big part of what children do to occupy their day and even engaging in afterschool sports or family time. So we strive to provide like individualized care that's meaningful for each unique person.

Host: Got it. Now for babies in the neonatal intensive care unit or NICU, what does occupational therapy look like?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: So similarly, we look at each infant and their family as a whole. We have to consider the needs and the priorities of the family, their family unit, and work with that family to achieve success with the infant's future milestones. So in the NICU, we might help a family with understanding their infant's unique cues or even adapting the environment to be more sensory friendly for a premature infant.

Or we might assist with the infant learning to eat by mouth or other skills that enhance the infant and caregiver bonding.

Host: It sounds like a wonderful, wonderful job.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: I love it.

Host: It's shining through, I can tell. How do these therapies used on NICU babies differ from the therapies used on older children or even adults?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: So with pediatrics, we always want to consider the whole family, and what is meaningful for them. You can't really treat a child without including their family unit, which may be a parent, might be an aunt, an uncle, siblings, whoever is taking care of that child. Young infants in our NICU, they can't use verbal communication like you and I can.

So they use other ways to communicate, like facial expressions, different movement patterns, stress cues to let us know kind of what help they might need. As occupational therapists, we can help that caregiver interpret their infant's cues so that they can have a successful bond and understand how to facilitate the milestones and help their infant succeed.

Host: Wonderful. Now, can you explain the specific goals and interventions of pediatric occupational therapy within the NICU?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Yeah, so occupational therapists work with these babies on developing motor skills, increasing cognitive function, helping with self-regulation so they can succeed in their future milestones. We want to minimize stress in the NICU environment and create positive experiences for optimal development.

So ways that we might address those goals are through maybe modifying the environment, supporting optimal positioning for the preterm infant, facilitating developmentally appropriate activities or even altering feeding strategies and providing that caregiver education and support so they can be successful taking care of their baby.

Host: You mentioned self-regulation. What's that?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Yeah, so self-regulation is your ability to process all the input that you're receiving from the environment. When there's noises, if you take, for example, the NICU environment, there's a lot of extraneous sounds from machines, that lighting. The discussion of the staff taking care of the baby, things like that might be challenging for the baby to interpret and turn into a meaningful output.

So for self-regulation, we want to help take the outside stimulation and help interpret that and have a good output. And that's for babies. For children, we all have self-regulation as well. For some kids, they have a hard time with maybe sitting still in class and learning, paying attention, because of all the extraneous sounds, noises, textures from their clothes. So we want to help find strategies and soothing ways that the child and the family can incorporate so that they're successful in doing all those meaningful things every day.

Host: Thank you so much for explaining that. What developmental challenges are most commonly addressed by occupational therapists working with premature or medically fragile infants?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Every infant in our NICU is unique and faces different challenges. Not all infants in the NICU are born premature. A lot of people think that they're all preemies, but we also work with infants that have genetic conditions, cardiac diagnoses, neurological deficits, and various other diagnoses. So the OT needs to consider the unique characteristics of each of those diagnoses and collaborate with the physician and the nursing staff, other staff members, respiratory, dietician, to create an individualized plan that is safe and functional for that infant and that family.

Host: Now, why might an older child need occupational therapy?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: So as we were mentioning kind of an example, a child of school age because from the age of three to four up until 18, that really is what occupies most of a, a child's day is being a student. An older child might need occupational therapy to help with activities they want and need to participate in their everyday life.

So things like fine motor skills, gross motor skills, cognitive skills, sensory processing, and self-care. They might need to participate in school both academically and socially or even tolerating food textures so they can participate in the family outings, uh, social gatherings and dinners. And even support for that self sensory processing, that self-regulation so they can regulate their bodies for participation in their everyday activities.

Host: Got it. How do occupational therapists collaborate with physical therapists and speech language pathologists in pediatric rehabilitation teams?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: We really work together. We work side by side to create a care plan for each individual that is holistic. A lot of what we do may seem like it overlaps and we do overlap in a lot of ways, but we each have our unique lens of how we assess and provide intervention for each child. For example, maybe a child with a traumatic brain injury, they might be receiving services from all three disciplines, so a physical therapist, speech therapist, and occupational therapist.

Perhaps the physical therapist is working on balance, movement, transfers. The speech therapist might be working on cognition, speaking and eating, and OTs are also working with that same client, but to return to independent functioning. So a lot of what we do might also be some of the other skills. We might be working on balance to stand at the sink. But the outcome is to work on their self-care and standing and be able to brush their teeth and getting ready for their daily activities. So we have a lot of overlap and we work closely together, but we all have a unique endpoint that we're trying to achieve, and we all want to work together for the best interest and needs of the family.

Host: Absolutely. And how can occupational therapy support not only physical development, but also cognitive and emotional development in children?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: One of the biggest ways that we help meet the goals of our pediatric clients is actually through the use of play. I think it's always fun when I am working with a child that's a little bit older, a lot of times people think that we are just playing and having fun times and playing games, which we are.

But children are born with a natural urge to play. So we actually use games and activities to facilitate and to address social skills, to work on problem solving, to engage in visual motor skills, attention, memory, and emotional regulation.

Host: I think we're all born with a little urge to play.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Absolutely.

Host: Even through adulthood and even in geriatric treatment programs, they're using play a lot.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Oh yes, for sure. It's a great way and there's so many things. Uh, you know, one of the skills occupational therapists can do, what we call is a task analysis. So really you can take any kind of game and turn it into a multifaceted intervention tool. You know, think of something as simple as the game of Go Fish.

Right. You're picking up a pack of cards and you have to think of all the components that are going into holding that stack of cards, right? Your fine motor skills, the visual scanning, using the cues to ask for what card you need next. Laying the card down, you can also upgrade that activity or downgrade it.

We can make it more challenging or easier based on that individual. And how are they responding to intervention, which is like kind of the unique characteristic of occupational therapists and their ability to adapt their intervention.

Host: Kids might have some fun playing Go Fish.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Absolutely.

Host: So what impact does early occupational therapy intervention have on long developmental outcomes for children?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: So a lot of studies have shown that providing services early on for children that are at risk for developmental delays, like some of our babies that are born premature or with medical complexities; these early intervention services can help with reducing long-term negative outcomes and help the children reach their full potential.

So it's important to intervene early, to assess, ask questions, and get the treatment as soon as possible.

Host: Got a final question for you, Shawna. If a parent is concerned about their child's development, what should they do first and how do they advocate for their child?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Parents can start by asking their pediatrician for a referral to an occupational therapist if they wanted to have an assessment completed. Really depending on the how old their child is, they may be able to ask for a school-based assessment if the child is three or older. But if the child is still under three, they may qualify for some early intervention services that are state funded.

But the biggest thing a parent can do is really know the milestones and recognize when something may not be as it should be. Ask for help to identify the services that their child may need and qualify for.

Host: Where can parents learn more about the therapies offered at Miller Childrens?

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: They can visit millerchildrens.org to learn more about our services.

Host: That's Millerchildrens.org. Thanks so much, Shawna, for your time and expertise today. We really enjoyed having you on the show.

Shawna Townsend, OTD, OTR/L, CNT, IBCLC, NTMTC, SWC: Thank you so much.

Host: That's all for this time, I'm Deborah Howell. Have yourself a terrific day.