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Occupational Therapy Considerations for !Child Development!Newborns Ages 0-1

Patti Sharp, OTD, MS, OTR/L

Disclosures §  Presenter Disclosure: Financial: Patti Sharp has received an

honorarium for presenting this course. Non-financial: Patti Sharp has no relevant non-financial relationships to disclose.

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Pediatric Primer Series § Child Development, Birth – 5 years

1.  In Utero 2.  Premature Infant 3.  Newborns 0-1 year 4.  Babies 1-3 years 5.  Toddlers 3-5 years

Pediatric Primer Series § School-Aged Children, 5-18 years

6.  Early Childhood 7.  Mid-Late Childhood 8.  Preadolescence 9.  Adolescence 10.  Transitions to Adulthood

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Learning Outcomes After this course, participants will be able to: §  List occupations of newborns, ages 0-1. §  Describe typical and atypical presentation of newborns,

ages 0-1. §  List common conditions presenting in infancy. §  Describe OT’s role with newborns, ages 0-1.

Occupation in Infancy §  For children and youth, occupations are activities

that enable them to learn and develop life skills (e.g., preschool and school activities), be creative and/or derive enjoyment (e.g., play), and thrive (e.g., selfcare and relationships with others) as both a means and an end (Clark & Kingsley, 2020).

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Occupation in Infancy § Occupation refers to activities that support the

health, well-being, and development of an individual (AJOT, 2017).

§ An infant’s needs can be looked at on a continuum, where basic needs must be met first before more complex needs can be addressed.

Infant Hierarchy of Needs § All babies have three

basic levels of need

3) Cognitive

2) Emotional

1) Physical

Q5

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Physical Needs § Nutrition – feeding form, type, quantity § Sleep – position, duration, frequency § Comfort – temperature, health, cleanliness

Emotional Needs § Security – routines, trusting responsiveness § Bonding – affection, closeness § Attachment – “Secure attachments lay the

foundations for physical, motor, and cognitive development that prepare children for success in school and their adult lives” (Clinton et al., 2016).

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Cognitive Needs § Communication – expression, talking § Enriched Environments – sensory stimuli §  Learning – exposure to new places, things, ideas

Occupations in Infancy § Occupations are created as babies seek to have

their needs met.

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Physical Occupations §  Form the basis for Activities of Daily Living (ADLs)

§  Nutrition – eating, self-feeding §  Sleep – rest, recuperation §  Comfort – dressing, bathing, toileting

Emotional Occupations § Establishment of performance patterns builds trust

(AJOT, 2017). § Habits, routines, roles, rituals § Routines are crucial to facilitating emotional

security (Kingsley, Sagester, & Weaver, 2020).

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Cognitive Occupations § Meeting basic cognitive needs sets the foundation

for more complex occupations §  Social participation – communication §  Play & leisure – exploration, enjoyment of stimuli §  Education & work – learning, confidence

Participation in Routines § When basic needs are met with the right resources,

contexts, and supports, infants can start the process of participating in routines.

§ Routines create confidence and encourage independence, which result in occupational participation.

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OT’s Role § Occupational therapists partner with the infant and

their caregivers to improve occupational performance and competence in their natural environments.

Participation is the goal

OccupationalParticipation

OT

CaregiverInfant

Environment&Context

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Typical Development § Knowledge of neurological, physiological,

biological, and emotional growth can serve as guidelines for occupational performance.

Developmental Milestones § Children develop on fairly predictable timelines. § Progressions vary by many contextual factors

(Smet & Lucas, 2019). § These can help identify any performance problems.

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Postnatal – possible diagnoses § Brachial Plexus Birth Injury – asymmetric UEs § Spina Bifida – Impaired LEs § Down Syndrome or other genetic conditions § Congenital anomalies

Importance of Reflexes § Reflexes – predictable motor responses § Primitive reflexes – automatic survival responses

necessary for health and survival §  Onset 3rd trimester of pregnancy §  Integration typically within 1st year

§  Failure to integrate can inhibit function (Smet et al., 2019).

Q6

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Infantile Primitive Reflexes § Neonatal Positive Support

§  Onset: Birth §  Integration: 1-2 months

§ Rooting, Swallowing, Sucking §  Onset: Birth §  Integration: 2-5 months

Infantile Primitive Reflexes § Moro § ATNR - Asymmetric Tonic Neck Reflex § STNR - Symmetric Tonic Neck Reflex § TLR - Tonic Labyrinthine Reflex

§  Onset: Birth §  Integration: 4-6 months

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2 months - Physical § Movement

§  Jerky arm movements §  Head movement in prone §  Hands fisted, hands to mouth

§  Feeding §  Brings hands to breast/bottle

2 months - Emotional §  Increasing eye gaze § Beginning to self-calm § May begin to smile

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2 months - Cognitive §  Increasing attention § Turns head toward sounds – visual exploration § May begin to make noises

2 months – Detectable Risks § Asymmetry in posture/movement of the extremities

or hand preference § No response to sound § Not bringing hands to mouth

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2 months – possible diagnoses § Cerebral Palsy (CP) – asymmetric movements,

abnormal muscle tone §  Feeding problems, Failure to Thrive

4 months - Physical § No head lag, increased neck stability § May begin to roll § Grasps & shakes toys § Pushes up to elbows in prone § Pushes down through feet on a hard surface 

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4 months - Reflexes §  Landau

§  Onset: 3-4 months §  Integration: 12-24 months

§  Integration of §  Rooting §  Sucking & Swallowing §  Neonatal Positive Support

4 months - Emotional § Smiling § Signs of happiness and sadness § Responds to affection

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4 months - Cognitive § Babbling § Differentiated crying §  Imitating sounds

4 months - Cognitive § Reaches for toys §  Increasing attention – exploratory reaching § Recognizes people

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4 months – Detectable Risks § Head lag, no head control § Does not watch people § Does not make sounds § No hand to mouth

6 months - Physical § Rolling over § Sitting unsupported § Supports weight through legs, bounces § Moving into quadruped

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6 months - Feeding § Holds bottle with both hands § Drinks from cup with assistance § Gasps finger foods, brings to mouth

6 months – Reflexes § Protective Extension/Parachute Reflex

§  Onset: 6-9 months §  Integration: None – continues

§ Reflex Integration §  Moro §  Palmar grasp §  ATNR, STNR, TLR

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6 months - Emotional § Knows familiar faces § Responds to others’ emotions §  Likes looking at self in mirror

6 months - Cognitive § Responds to sounds by making sounds § Responds to name § Makes sounds to show pleasure and displeasure

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6 months - Cognitive §  Increasing curiosity § Bringing toys to mouth § Transferring objects between hands

6 months – Detectable Risks § Physical

§  Asymmetry of posture, movement, hand preference §  Head lag §  Leg Stiffness or overall floppiness §  Unable to bear weight through feet when held

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6 months – Detectable Risks § Emotional & Cognitive

§  Does not try to get objects within reach §  No display of affection §  Does not bring objects to mouth §  Not making sounds

12 months - Physical §  Intentional, smooth movement § Crawling, cruising, transitioning § May begin walking § Object manipulation

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12 months - Feeding § Holds own bottle or sippy cup § Plays with utensils, may dip in food §  Finger feeds self § Messy, inaccurate

12 months – Reflex integration § All infantile reflexes should disappear

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12 months - Emotional §  Increased shyness, separation anxiety § Plays games (peek-a-boo) § Brings desired items to parent

12 months - Cognitive § Responds to simple requests § Communicates yes & no § Using simple gestures § Tries to imitate words

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12 months – Detectable Risks § Physical

§  Asymmetry of posture, movement, hand preference §  Unable to sit without support §  No attempts to communicate verbally or nonverbally

12 months – Detectable Risks § Emotional & Cognitive

§  Does not search for objects hidden by parent §  No gesturing §  Does not point to things

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4-12 mo. – possible diagnoses §  Increased chance of identifying developmental

deficits as the child ages § Caregivers have increasing opportunity to compare

their baby to others which might highlight delays § Common diagnoses throughout this age group

remain the same – primarily neurological or physical

Infant Screening Tools § General –

§  Ages & Stages Questionnaire 3 (Valleley & Roane, 2010) §  Assesses important social-emotional components (Little et al.,

2016) as well as developmental stages §  Developmental Milestones – (Lipkin & Macias, 2020)

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Infant Assessments § Physical

§  HINE §  GMA §  PDMS

§ General Development §  Bayley Scales of Infant & Toddler Development III

(Michalec, 2011)

HINE (Haataja et al., 1999) § The HINE is a simple, scoreable, standardized

clinical neurological examination for infants between 2 and 24 months of age.

§ Specific cut-off scores for predicting cerebral palsy both in pre-term and full-term infants have been published.

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GMA (Ferrari et al., 2004) § The General Movements Assessment is used to

identify absent or abnormal general movements and, depending on the type of general movements abnormality, can be highly predictive of cerebral palsy by about 3 months of post term age. 

§ Scoring requires training.

PDMS-2 (Folio & Fewell, 2000) § Peabody Developmental Motor Scales – 2

§  0-5 years §  Assesses reflexes, fine & gross motor skills

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Alternative Trajectories § Development of skills can vary greatly by culture. §  Family and cultural values play a big factor. § These components must be considered as

important factors in context and environment.

Adverse Childhood Experiences Early Death

Disease, Disability

Health Risk Behaviors

Social, Emotional, Cognitive Impairment

Disrupted Development

Adverse Childhood Experience

InterveneEarly

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OT’s Role § Occupational therapy practitioners work with

children, youth, and their families, caregivers, and teachers to promote active participation in activities or occupations that are meaningful to them.

OT’s Role § OT practitioners offer services that are proven to be

effective for promoting a child’s ability to participate and engage in daily life activities (Case-Smith, 2013; Case-Smith, Frolek Clark, & Schlabach, 2013; Frolek Clark & Schlabach, 2013; Howe & Wang, 2013).

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OT Intervention § Recommended interventions are based on a

thorough understanding of typical development, the environments in which children engage (e.g., home, school, playground) and the impact of disability, illness, and impairment on the individual child’s development, play, learning, and overall occupational performance (Clark & Kingsley, 2020).

OT’s Role § Monitor Development

§  “Developmental monitoring combined with developmental screening is the best way to identify children with a developmental delay” (Barger et al., 2018).

§  It is encouraged to learn the signs of developmental delay/disruption and get intervention early.

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Collaboration § Positive outcomes in childhood occupations are

observed when the caregiver is involved (Chiarello, Palisano, Bartlett, & McCoy, 2011; Danhauer, Coster, Tickle-Degnen, & Cermak, 2007; Priest, 2006).

Collaboration § Collaborate with all caregivers to identify and meet

the needs of children experiencing delays or challenges in development (Clark & Kingsley, 2020) §  identifying & overcoming barriers §  teaching and modeling skills and strategies §  adapting activities, tools, & environment

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Early Intervention § Acting early, for infants at risk for deficit, or as soon

as deficits/delays are noted, results in positive outcomes for babies in multiple areas §  Motor skills (Tanner, et al., 2020) §  ADL performance (Gronski & Doherty, 2020)

Facilitating Development § Caregiver coaching (Chödrön et al., 2019) § Encouraging routines (Doll, 2014) § Home environmental modifications (Albrecht &

Khetani, 2017)

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Thank you! § Patti Sharp, OTD, MS, OTR/L