The triumphs and challenges of pediatric therapy

Working with children requires a combination of skills and patience

When they’re doing it correctly, pediatric therapists make their job look like play. But in reality, it’s hard work.

Knowing how to help children who are medically fragile, developmentally delayed or who suffer from cerebral palsy, autism or other conditions  takes extensive training and dedication.

“It’s a very strenuous job. You’re lifting, climbing, stretching all the time, while dealing with behavioral issues and thinking outside the box most of the time. You try getting a 3-year-old to do something he doesn’t want to do,” said Megan Carroll, lead therapist at Children’s Healthcare of Atlanta’s North Druid Hills rehabilitation facility.

Or try holding a five-day-old infant with a gastrostomy tube and other wires attached, knowing that your job is to help him get stronger.

“For this job, you need a keen eye to detect physical defects and developmental abnormalities, a creative mind to keep therapy interesting and fun, and a load of patience,” said Sara Jones, a physical therapist at the same facility.

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Then there are the parents. Because the outcomes are better when parents are active participants, therapists want to integrate them into the process as much as possible. That way, parents spend more time with their children and can practice the lessons learned.

“In this role, we’re constantly educating, encouraging or calming anxious parents,” said Jones, PT-MPT, who got a better idea of what parents are up against when her 19-month-old son was born. “Being a new mommy is hard enough. Adding therapy when you’re already tube-feeding and watching an apnea monitor is overwhelming. Our parents have a lot of emotional stress.”

Still, neither Jones nor Carroll can imagine doing any other job. The rewards far outweigh the challenges.

“I’ve worked with kids my whole life. I love their personalities and helping them become successful,” said Carroll, OTR/L, CPAM. “There’s nothing like seeing a parent’s face when a child hits a milestone like tying his shoe, feeding himself or picking up a block for the first time. These parents can’t take anything for granted about their child’s development, and they get so excited.”

Jones loves when a child exceeds her expectations and she can say, “ 'Look at THAT. I didn’t think he’d be able to do that so soon.’ It’s super-exciting,” she said.

Being the catalyst for positive outcomes requires special training in school, learning on the job and taking continuing education courses. It also takes someone who can respond compassionately to difficult, critically damaged or abused children.

“It requires a certain personality. We can teach skills, but not the attitude. You have to want to build a rapport with children and parents, and you need to be upbeat and engaging most of the time because children feed off your mood,” Carroll said.

On any given day, Children’s Healthcare of Atlanta’s pediatric therapists see newborns, toddlers and older children. Jones may work with a 2-year-old who is not yet walking  or help a baby who has torticollis, a tightness in the neck that makes it hard to turn the head to one side.

Carroll often treats babies with brachial plexus injuries (damage to nerves in childbirth which causes diminished movement in the arm) or helps children who have developmental delays learn to crawl, sit or dress themselves . When the issues are complex, therapists often work collaboratively to meet goals.

“Every day is different and we see such a huge gamut of things that you really have to stay on your toes,” Jones said. “A child could have had an accident or a stroke or some rare genetic condition.”

Carroll’s office is lined with reference books and papers, which she consults often.

“We get surprised a lot. Every couple of months there will be a diagnosis you never heard of, so you look it up and talk to your co-workers,” Carroll said. “We need to keep learning because our parents rely on us to answer questions on almost anything.”

The body of pediatric research is growing exponentially in areas such as brain injuries and autism, and so is the patient population. Children’s is adding more rehab facilities to meet the demands.

“Pediatricians have a growing knowledge base and are referring children earlier because research has shown that earlier intervention is better,” Jones said.

“Trying to get coverage for necessary therapy, especially with recent changes to Medicaid, is one of the most frustrating parts of the job,” Carroll said. “But overall, I work in a fascinating and very rewarding field.”

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