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Month: January 2023

feet forward

Put Your Best Foot Forward!

When to see a pediatric physical therapist for your child’s feet?

How do you know if your child’s little feet are functioning at their very best? Here are 10 clear signs that you should have a pediatric physical therapist screen your child’s feet so they can put their best foot forward!

Pain 

If walking causes pain in your child’s feet this is a concern that should be addressed immediately. There are a number of reasons for pain in the feet and a pediatric PT can assess and address painful walking.  

Asymmetry

Any difference in one foot compared to the other foot should be seen by a pediatric PT. Feet should look and move the same at the other foot. Seek advice if you notice a difference in foot size, a heel lifted on one side, turning in or out of one foot or any other noticeable differences. 

Toe Walking

Toe walking is an abnormal gait or walk at any age at any time! We often see children raise up on their toes when they are very excited, nervous or cold but only for a few steps and then come down to their heels to walk or run. The earlier a child is seen for toe walking, the faster the treatment and the better the outcome. Don’t Wait!

In or Out Toeing (Pigeon or Duck footed)

Toe inning or outing is a common foot alignment deficit. When the feet are not aligned, the knees are not aligned which can lead to pain and inflammation. Often it can be a sign of leg, hip or trunk weakness or all three! It could also be a misalignment of bones within the joints. Seeing a pediatric PTl will determine the root cause and help get those duck feet in a row!

Flat Feet / Pronation

Flat feet is when almost the whole foot makes contact with the floor while standing. Pronation is when the ankle collapses inward when standing. Both flat feet and pronation can cause similar problems. Postural deficits are usually present as well as over use and under used muscle groups. This imbalance causes poor body mechanics which can lead to premature breakdown of joints. Flat feet and pronation cause the body to move inefficiently. It will take more energy to walk, run and jump!  

Tripping

Children are still developing their sensory systems and body awareness which can look a bit messy. It’s common to miss a crack in the sidewalk or move too fast for their feet causing them to trip and fall. Tripping becomes a problem when they are doing it so much they are hurting themselves. Tripping on the same thing over and over, on stairs or ramps, carpets or even nothing at all can be concerning.  A pediatric PT will be able to assess why they are tripping so often and help keep them on their feet!

Fatigues Quickly with Walking

Carry me! Is a phrase often used by a child who fatigues quickly when walking. A child who has good endurance, body mechanics, postural control and strength will want to walk vs being pushed in a stroller or carried. A child who struggles with one or more of these deficits will fatigue quickly when walking and ask to be carried more often. Ask a professional if your child seems to fatigue quickly when walking vs other children their age. 

Aversion to changing shoes

New shoes or any new clothing item can be stressful to a developing sensory system. Our children who are more sensitive to change will often break down their favorite pair of shoes to a thin sole, or wear shoes that lack proper support such as slip-on type shoes. A professional can help get children into good quality shoes that support the foot properly, helping them to move with better posture and efficiency. Let’s make shopping for new shoes fun! 

Sprained or twisted ankles

This painful injury literally stops you in your tracks. It’s common once in a while but abnormal if it happens over and over again, especially when doing everyday activities. Ankle weakness, misalignment or even vision could be the cause of ankle sprains. A PT can assess and address the reason for this very painful problem. 

Abnormal gait / walk

Any abnormality of a child’s gait should be addressed as soon as possible. Sometimes it’s hard to put your finger on it because the smallest thing could be affecting their gait or it comes and goes. Listen for your child’s steps on a hard surface. It should be an even beat most of the time. Rubbing the top of their foot while walking can be a sensory movement that is affecting their gait. Running instead of walking. Gait abnormalities can easily be addressed in PT. 

High Arches

High arches do not always need to be addressed but if your child has any other deficits such as any problems above, then high arches may need extra support. A PT can assess their gait and determine if treatment is necessary. 

Pediatric Physical Therapists assess the cause of these symptoms and use conservative interventions to improve their everyday function on their feet! They will also refer you to the appropriate healthcare professionals when extra attention is required for the best care of those little feet! 

Set up a free screening with a pediatric PT to ensure your child is putting their best foot forward!

Written By: Dana Bukala, PTA

 

Tummy Time

COVID Babies – Impacts of Quarantine on Development

The Global Pandemic of 2020 has left its mark on our lives in a variety of ways. It has changed the way we shop, the way we work, and even the way we learn. The lives of our kiddos have also been changed, especially for our “COVID Babies.” Babies born just before, during, or shortly after the global pandemic do not know anything different than the lives we live now. 

So how has this new “normal” affected the way they learn and grow? Has it even affected them at all? Here’s what the latest research shows: “COVID Babies” were less likely to “wave” to greet others, point/use gestures, and say their first words prior to their first birthdays. 

So, how can we support these “COVID Babies” and make sure they are on the right track? Meaningful play and reading together can be great ways to work on development. Exposing your child to as many different experiences as possible can create new environments for them to learn. It doesn’t have to be big and expensive. Something as simple as packing a snack and heading to the park can create new and unique learning opportunities for your little one. Click HERE  for a list of more ideas. 

If you have concerns about your kiddos development, click HERE for a link to our milestones page resources or schedule a free screening with one of our skilled therapists at BDI Playhouse. It’s never too early to make sure your little one has the skills needed to grow!

REFERENCES

Byrne, S., Sledge, H., Franklin, R., Boland, F., Murray, D. M., & Hourihane, J. (2022). Social communication skill attainment in babies born during the COVID-19 pandemic: A birth cohort study. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2021-323441 

Emily Francis, M.S. CCC-SLP

 

Understanding Visit Limits in Pediatric Therapy

 

  • What does understanding visit limit mean in Pediatric Therapy mean?
  • What is the difference between hard and soft visit limit?
  • If my visit limit says 60 visits, why does my insurance not let me use all those visits?
  • What does “Medically Necessity” mean? If I have 60 visits why is insurance saying it’s not medically necessary?

Visit Limit

is a set number of visits your plan will consider for services for the year. For Pediatric Therapy, this may be a combined visit limit for any/all services. It could also be a separate limit for Physical, Occupational, and Speech Therapies. 

Hard Limit

is when your insurance company determines a set number of visits per year, such as 30. They will not pay for any therapy services once you have reached that number. As a result, if you choose to continue to treat after your hard max, those services would be your full responsibility, and will not be applied to your insurance deductible, co-insurance, or out-of-pocket expense. 

Soft Limit

is when your insurance company says they are allotting a set number of visits, such as 30, BUT they will consider additional visits beyond that number based on their determination of medical necessity. They would review medical records, and determine if therapy services are warranted, and could choose to allow or deny additional visits based on their review. And note, extra visits are not a guarantee.

My plan says I have 60 visits, and I was cut-off at 40. Why? 

Some insurance plans will say your plan has a set number of visits, but that does not necessarily mean you can “use” all of them. Many times, insurance companies request medical records from your Pediatric Therapy provider, and perform their own independent medical review. They can determine at any time, services are no longer needed. If that occurs, you would be financially responsible for those services.

What does Medical Necessity mean?

Many insurance companies have outside review companies they partner with to review records. They determine if they “feel” services are warranted, or a patient can be discharged from care. In short, f the reviewer determines that visits are not medically necessary based on their criteria, they will no longer cover services. 

Written by Ann Marie Johnson

Visual Schedules

Importance of Schedules and Routines

Just like adults, children feel more confident and secure when their daily activities are predictable and familiar. Consistent daily schedules and step-by-step routines give children a predictable, safe day. Schedules and routines help children:

  • Feel in control of their environment
  • Feel safe, secure, and comfortable
  • Know what is happening now and what comes next
  • Know how to do an activity or task

However, what happens when you have a change in schedule or routine?  Does your toddler or child melt down or show big behaviors?  An unexpected schedule change or a change in their routine can be upsetting and stressful. If your child is struggling when transitioning between tasks or with changes in schedule or routine, BDI Playhouse recommends you use simple visual schedules to make those transitions and changes smoother.

What is a visual schedule?

A visual schedule is an image-based tool that helps support children of all ages. It presents a sequence of events for what is going to happen during a specific task, during an activity, or throughout the day.  Visual schedules help individuals complete a sequence of tasks or activities, attend to tasks, transition from one task to another, or maintain emotional regulation in various settings.

A visual schedule may use a sequence of photographs, videos, illustrations, or other visual elements that help your child understand what they are expected to do.  The visual schedule can be virtual on your phone or printed on paper.

Benefits of Using Visuals

  • Provides clarity and predictability in routine which allows a feeling of control (reducing anxiety or confusion)
  • Provides concrete visual information for (can make something abstract feel concrete, such as the length of time before an activity will be over).
  • Reduces behaviors caused by frustration, confusion, anxiety.
  • Provides a critical avenue for visual learners to understand and retain information.
  • Serves as a virtual “contract” for completing expectations and delivering rewards.
  • Assists in building independent routines with better success (such as packing a backpack, washing hands, or cleaning up after snack).
  • Helps children know what to expect and/or what the expectation is so that they don’t have to fear what will happen or become impatient and frustrated.

How to create your own visual schedule

  1. Identify your Target/Routine for the schedule
  2. Choose the type of visual that will be most meaningful to the child: 
    • Photographs of the child/child’s environment
    • Real life images
    • Line drawings 
    • Clipart
    • Text writing only
  3. Keep language simple and direct
  4. Involve the child in preparation
  5. Involve other caregivers

Easy Resources for Visual Schedules

If you find that your child is still having difficulty when you have a change in schedule or routine or need help learning how to use a visual schedule, contact BDI Playhouse to set up a free screening with one of our pediatric occupational therapists or speech language pathologists.  We can help you help your child!