Emma Guthrie is an Occupational Therapist who, in light of the recent Occupational Therapy Month, prepared for us this short piece that explains occupational therapy when working with children.
Occupational Therapy in the field of Paediatrics by Emma Guthrie, Occupational Therapist
Working with children as an Occupational Therapist is like opening a bag of Liquorice Allsorts: each child is so uniquely different, in appearance, character, temperament and abilities, that the approach ‘one size fits all’ will never work. The most humbling lesson I have learned from working with children, is that as adults, we often think we have the solutions to address or remediate a problem, however it’s the children who end up teaching us more ; about resilience, adaptability, flexibility and learning to accept our mistakes and shortcomings.
In this regard, I think particularly of Lebo, a 10 year old girl who was brutally attacked by an enraged step- brother, sustaining serious injuries to the left side of her head and brain. This resulted in a right-sided hemiplegia (paralysis of the right arm and leg muscles) affecting the dominant side of her body. Lebo underwent various surgeries to save her life and received trauma counselling and therapy, to deal with the emotional and physical effects of her attack. She had to re-learn many physical skills and almost effortlessly taught herself to become left-side dominant and carried on with her daily activities as a ‘lefty’ instead of a ‘righty.’ She never complained, she simply persevered and got on with living her life and thereby mastered her own destiny.
“She never complained, she simply persevered and got on with living her life and thereby mastered her own destiny. Occupational Therapists like to think that enabling a person or group to master their own destiny is their main purpose. Occupational Therapists use scientifically chosen, meaningful, dignifying and health promoting activities or occupations to assist diverse patients with a range of problems to optimise their potential and maximise their functioning.”
Occupational Therapists like to think that enabling a person or group to master their own destiny is their main purpose. Occupational Therapists use scientifically chosen, meaningful, dignifying and health promoting activities or occupations to assist diverse patients with a range of problems to optimise their potential and maximise their functioning through participation in activity/occupation. This empowers the patient to be as independent as possible and to experience dignity and quality of life at work, at home and at play.
Play is a child’s main occupation until he or she enters formal education . From then onwards, learning to read, write, spell and do maths, as well as participate in sport, become the child’s primary occupations. The foundation years are essential for developing the child’s sensory systems, self-care skills, gross and fine motor skills, and visual perceptual and memory skills. All of these skills are non-verbal and successful integration is the focus of occupational therapists working in the paediatric field.
A Paediatric O.T. can work in a variety of settings: hospitals, schools, clinics, community settings and private practise. An O.T. should always form part of a multi-disciplinary team , working alongside other professionals for e.g. Doctors, Nurses, Social workers, Psychologists, Speech Therapists, Dieticians, Teachers. The most important members of the team are the child and their parents.
Hospital work can involve working with children who have sustained various injuries or suffered illnesses. For example, in a Burns Unit – the O.T. will assist in helping the child to maintain the range of movement of affected joints with range of motion exercises and playful activities, make a thermoplastic splint to be worn when the child is not exercising in order to keep an affected limb in a functional position to prevent contractures, as well as sew a pressure garment to be worn when the wounds have healed and scar management is the priority. All the time, the O.T. will be aware of the child’s emotional and mental status, whilst stimulating the child’s gross and fine motor skills to achieve independence in mobility, activities of daily living (washing, dressing, eating, toileting) , play and learning.
The O.T. may arrange a home visit, once a child has been discharged to determine how the child is coping both at home and at school, whilst assessing access to the house and the physical layout of the home, and providing any assistive devices that may assist a child to be more independent. Clinic visits will include follow-up of the child’s progress and assessment of the splints and pressure garments.
Occupational therapists can also work with children in educational settings, for e.g. in a mainstream school or a school for children with Special Educational Needs. Some children may have no history of injury or illness, however they experience certain barriers to learning . Some reasons for this may a hereditary component, vision or language difficulties, delayed development, lack of stimulation or opportunity, the influence of an attention deficit or other neurological disorder, and too much passive activity, such as playing computer games and watching television.
“Today’s technology-driven lifestyle isn’t doing our children any favours. Children who spent a lot of time in front of screens lose their ability to concentrate actively. Their concentration becomes passive, as the screen game is visually stimulating, entertaining and provides instant gratification.”
A short comment on technology: today’s technology-driven lifestyle isn’t doing our children any favours. Children who spent a lot of time in front of screens lose their ability to concentrate actively. Their concentration becomes passive, as the screen game is visually stimulating, entertaining and provides instant gratification. However, the real world is different; In school, a child needs to listen to an instruction and follow through with an activity, through self-motivation and maintaining interest. Children who spend hours on devices and in front of television tend to become bored quickly as they lack the ability to self-motivate. Screens decrease our children’s exposure to activities that require movement and planning. Active, physical play helps a child’s gross and fine motor development and gives them body awareness. If these skills do not develop efficiently, a child can’t plan their body movements, will have difficulty maintaining a good posture, have weak shoulder stability, poor eye movements and will struggle to manipulate tools (pencil, ruler, pair of scissors) and to plan things on paper.
Through specific assessment tools, an O.T. will be able to identify the non-verbal skills that are requiring development and provide a context in which learning takes place through therapeutic play. Children with diagnoses such as Down Syndrome, Cerebral Palsy and Autism Spectrum Disorder may need a different educational approach to assist them in reaching their potential at school. Children develop at different rates and have their own inherent strengths and weaknesses. It is when their functioning in the classroom or on the sports field shows significant difficulty that a referral to an O.T. should be made. Often, these children have exhibited avoidance behaviours, reduced motivation and confidence, slow completion of written tasks, fatigue and poor posture, difficulty with activities such as cutting, colouring and pencil control, as well as academic difficulties.
“Early intervention for a child exhibiting delays or difficulties is always better than later. The longer it takes for a child to receive Occupational therapy after referral, the more the difficulties become compounded and the therapy process is lengthened.”
Early intervention for a child exhibiting delays or difficulties is always better than later. The longer it takes for a child to receive Occupational therapy after referral, the more the difficulties become compounded and the therapy process is lengthened.
To end with, I once asked a child to draw a picture of a man, as part of the O.T. assessment. He quickly replied, “I can’t”. I asked why. He looked very seriously at me and replied, “because I am still a kid”.!
This article was written by Windhoek based Occupational Therapist, Emma Guthrie. You can reach Emma on 061223380