Physical Therapy

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Specializes in School LVN, Peds HH.

So, my little patient was referred for in-home PT about a month ago. He's very stiff, and they figured the therapist could help with that. The PT has come out a few times and I'm not there when she visits. But foster mom fills me in on the sessions. I'm very concerned that my patient isn't getting proper therapeutic care, and that the therapist is over stepping her bounds. These are some of the things I've been told:

- the baby can roll over now, so when he rolls over during a diaper change, he's doing it to get away from foster mom because he doesn't like her

- he throws fits & cries because he doesn't feel secure with foster mom & for no other reason (mom was really upset after this visit...)

- PT doesn't do any exercises with the baby. Just tells foster mom what to do

- PT focuses on things like: oral play, getting baby to understand "up" and reach to be picked up, tracking objects with eyes, keeping baby from rolling in sleep...

Am I right to be concerned about this? I don't think I have any power to change anything, but none of that seems related to therapy to me...

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Totally inappropriate in my opinion.

Babies roll because rolling has opened up a whole new world to them and they wish to explore their newly found "freedom" by using this new skill. It's always a tad annoying when they roll away with poopy butts but it happens....

Babies cry because they are in pain or have an unmet need. He probably doesn't feel secure because he is in FOSTER CARE which means that he had some sort of serious emotional trauma when he was removed from his home or that was the cause of him being removed from his home. Totally judegemental and inappropriate.

How is the PT assessing this child if she doesn't have her hands on the baby? We have had in-home PT/OT/ST for years for different children and this is not how it's been done in my experiences.

Oral play/feeding/oral therapy is usually the domain of OTs with a specialty in feeding therapy or STs. Why are they trying to prevent rolling in the sleep? Tracking objects maybe...does the baby have vision problems? We had a vision therapist for a year for a child but that was not through PT, it was arranged through the state department of the blind.

I think the most important thing is that the foster MOTHER has concerns and she brought them up to you. I would support her by saying that you think her concerns are valid and encourage to request a different PT or speak to the PT's supervisor. Somewhere there should have been some sort of plan that listed the goals for PT. She should request a copy. She should have been a part of the evaluation in the first place.

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Specializes in LTC, Memory loss, PDN.

i don't know if any barriers to communication exist so

im inclined to say be very careful with second hand info

focus on the goals and expected outcomes

ventmommy is absolutely right

request a copy of the goals as well as written

instructions on exercises/plan how to achieve goals

since the pt. has pdn, it is very reasonable to request

pt to schedule sessions while nursing is present

to ensure continuity of care (unless pdn is nocs only)

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Is mom experienced in foster care? If she's newer perhaps she felt alarmed and defensive. Is English a second language for mom (or the pt?) I could see how "the baby's rolling away from you to the other side of the bed" could be confused. Same with "the baby may be feeling insecure" and mom hears "because of you, and no other reason". So by the time p.t. tried to teach/demo the exercises all hope was lost and mom was completely upset and not able to process anything. Maybe while talking to mom you could fill in a few of the blanks such as "gum massage may look strange but it's useful for desensitization" etc. Or maybe it was a crazy p.t....

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Specializes in Pediatrics, Emergency, Trauma.

I would reach out to the therapist and see what is going on; have the therapist come on a day where you and the mom can be there so you are ALL on same page. :yes:

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Specializes in Pediatric Private Duty; Camp Nursing.

I think mom doesn't realize she's being taught the PT care, when she says she's being made to do the work. She may think PT comes in and does it all. It does sound like a communication problem, or else Mom's expectations are quite different of what's really supposed to happen. She might also be projecting her own fears and insecurities on what the PT is saying, and the meaning is getting confused, as someone had suggested.

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