Should I continue my toddler's hated physical therapy?

November 18, 2010 10:24 AM

Should I continue my toddler's physical therapy for lagging gross motor skills?

My 18 month old son has been getting physical therapy through our state's early intervention program for three months now.  He was flagged at 12 months old for the therapy because he was crawling incorrectly and was having trouble pulling up to standing.

It took awhile to arrange his evaluation and he ended up starting to walk before they even came over to assess him.  Nevertheless, he qualified to receive the services based on where his milestones had been at 12 months.

Now it's been three months and I wonder if we're seeing any benefits.  He hates his physical therapist, won't let her touch him, and says "No no no!" when she arrives.  She is not playful and has a no-nonsense persona, so I don't see her growing on him anytime soon.  Sometimes she is able to coach me through the interventions from a distance, but some sessions he hides in another room while she tells me what to work on, and then I email her videos of him to show how his skills are coming.  Looking through the videos, I seems to me that his improvements over these three months are modest.  He crawls properly now; he walks steadily but still with a bit of a babyish gait; and he hesitates at thresholds and low curbs before stepping over them. (His communication and fine motor skills are good.)

I work on his skills every day, taking him to indoor gyms and outdoor playgrounds, playing games to encourage climbing and muscle building.  I've spent hundreds of dollars on walker toys and ride toys and indoor climbing toys.  He walks for blocks and blocks.  The therapist agrees that he hasn't made any great strides towards catching up with his peers, but when I asked her what else we could do, she said, "If he would let me touch him, we could then increase services to weekly." (Currently, she comes every two weeks.)

His pediatrician, who had been the one to initially recommend we look into services, saw him yesterday and thought his walking was appropriate for having started at 15 months.  When I said we have been working on stairs in PT, the pediatrician implied that we needn't be worried about his stair skills yet.

I don't want to negatively impact his development in any way, but I really wonder if the therapy is having any benefit.  A part of me thinks it may be a racket -- just like back when I mentioned to my mental-health therapist that I felt finished, she wanted me to start coming twice a week.

One last detail is that my son is a chubby boy.  He has been 100th percentile for weight (50th for height) since he was three months old.  (There was a big weight gain in infancy, due, I think, to breastmilk oversupply, but since then his growth follows the curve, just across the top of the chart.). He weighs 32 lbs now, so certain gross motor skills are harder for him than they'd be for a lighter baby.  The pediatrician has not told me to put him on a diet, but tends to recommend low-calorie foods like oatmeal and vegetable soup.


So, dear readers, I can:
1.  Quit the therapy and continue working with my son on my own, but do I need the expertise of a therapist to notice things I'm not trained to see?
2.  Request another therapist, in hopes that liking him/her would enable my son to get more out of the experience?
3.  Restrict his diet (stricter portion control, cut out carbs), assuming that the key to his catching up is weight loss.
4.  Chalk it up to natural differences in ability and just leave him be.

posted by misoramen to health & fitness (14 answers total)

If this were me, I would request another therapist. I think a warm, kind therapist could make all the difference here. If by chance you are near Portland, OR and you are interested, you can memail me for a recommendation.
posted by peep at 10:31 AM on November 18, 2010 [1 favorite]

I would recommend find a new therapist, one who will be more playful and fun with your son. This should be like playing for him.

As far as his diet, responsible medical professionals do not recommend dieting for toddlers. They need fat and calories for brain development. You may want to look into the Ellyn Satter method for family feeding. Essentially, Satter says that the best way to teach children to respond to their own hunger cues and eat well without developing food-related issues is to practice a division of responsibilities. You, the parent, are responsible for deciding what foods will be available to your child and when feeding will take place. You should prepare healthy meals containing a variety of foods and serve meals and snacks on a regular schedule. Your child, regardless of age, is responsible for determining whether to eat, which foods to eat out of the ones you've prepared, and how much of each food to eat. That means that if your kid wants to eat his macaroni and not his broccoli, or vice versa, that's ok, but if he wants peanut butter instead of the meal you've served, you say no. There's no fighting over how many bites to take of which foods, no denying second helpings, and no using sweets as rewards for good behavior. It's nerve-wracking for parents sometimes when kids don't eat what the parents think they "should," but it means much less stress at mealtimes for kids, and it teaches kids to listen to their own bodies and trust themselves in a way that many of us have trouble with as adults.

I wish you all the best!
posted by decathecting at 10:35 AM on November 18, 2010 [9 favorites]

My four and a half year son has gross motor delays. I'd strongly encourage you to find a new physical therapist and continue with physical therapy. Physical therapy definitely made a difference to our son, and the therapists he's worked with have been great kid people: friendly, warm, fun, and playful. He doesn't generally love physical activity, but he almost always enjoys playing with the physical therapist.
posted by alms at 10:40 AM on November 18, 2010 [1 favorite]

I'd go a step beyond what others are saying and go out of my way to complain about the therapist to her employer. As mentioned, this should be like playing for the kids, and somebody who can't put on a good "I'm playing with toddlers" face has no business working with small children.
posted by colin_l at 10:49 AM on November 18, 2010

Could you maybe sit down and have a conversation with the therapist, or with your pediatrician, about best-case/worst-case scenarios if you continue the treatment, or if you stop it?

For instance, stopping language therapy with a child who's language-delayed could lead to a vocab deficit, which could lead to problems with reading, which could lead to academic problems, which could affect grades, which could affect career prospects, so I'd tend to err on the side of over-intervention where language issues are concerned.

On the other hand, I'm at a loss to identify what the long-term risks might be if your child stays slightly delayed in gross motor skills. Nobody's saying he might not be able to walk and make love and drive a car as an adult, so what exactly is at risk? His chances of ultimately having a major-league football career? (Disclaimer: IANAD, but I'd think yours should certainly be able to address this question.) If the physician can explain how stopping the therapy might have deleterious consequences ultimately (as opposed to consequences now), then consider continuing, possibly with a new therapist. Otherwise, I'd probably write the therapy off as one of the many expensive and tiresome instantiations of the modern impulse to optimize our children.

Anecdata: my daughter was also a bit behind on gross motor skills-- crept late, crawled late, pulled up late, etc. The pediatrician did recommend that we contact early intervention when she still wasn't walking at 15 months, but since fine motor skills, language, socialization, and so forth were on track, we never did. She finally started walking at 17.5 months, still hesitates at thresholds, but seems on the whole to be a smart, happy little girl. Time will tell, but I haven't noticed that the delay has really impacted her in any major way.
posted by Bardolph at 10:56 AM on November 18, 2010

I would call your program and request a new service provider. A good pediatric therapist should make the session feel like play for the child. If she can’t even touch your son, you and your son are not getting what you need from this person. Ask for a new therapist.

Whoever evaluated your child saw something to be concerned about and that qualified your son for services. Please do not take this lightly, what looks like a minor delay now could become something more involved in the future. Or it may not and your child may be fine and it sounds like you’re doing all the right things with him. Just in case, I would try to stay with the program. I’ve watched a number of parents leave the Early Start program and then they come back 6 months to a year later when the child’s delays have only progressed or new delays show up.

As a side note in the interest of disclosure, I am a manager of an Early Start program in my state. We usually keep kids in the program until 24 months, even if they seem to be doing well. The 24 month cut off is because at that point we can get a better picture of the child’s language development and we can make sure that the kiddo is caught up in all areas of development. We do have several kids who do catch up and graduate. Also 1x a week is pretty standard for treatment, you should be asking for at least that level of frequency. Most of our therapists agree that 1x a week is a minimum for the intensity required to help a child make developmental gains.

I’m also the mom of a kid with motor delays. We have an OT who is fantastic, my son actually asks to go to her clinic every week. If he didn’t work with her, he wouldn’t be making progress. After every therapy session she has new ideas for things we could be doing at home to help him. She had made a huge difference in our lives, and yes her trained eye catches things I didn’t.

Ask for a new therapist and ask for your services to be increased to 1x a week. While you’re asking for stuff, also ask to have a Sensory Profile done with your child. He may actually benefit more from an occupational therapist (OT) who specialized in sensory-motor needs if he has some balance issues that are related to his ability to process where his body is in space (which from what you’ve written here sounds like a strong possibility).

Good luck to you and your little one! It sounds like you’re doing great work with him.
posted by Palmcorder Yajna at 11:05 AM on November 18, 2010 [6 favorites]

I'm confused about what delay you're experiencing? Our daughter didn't walk until almost 17 months, is still wobbly, definetly hesitated at curbs, etc.. She was evaluated at 17 months to make sure she didn't have hip/leg issues that were keeping her from walking (she was fine). No one has suggested, since she started walking, that she's delayed. So I personally vote for number 4 based on what you said, unless I'm missing something?

If you do want to keep it up, because you think he is delayed, then by all means, request a new therapist. And if you do it on your own, can you request periodic review from your doctor in case your missing something?
posted by dpx.mfx at 11:15 AM on November 18, 2010

"(There was a big weight gain in infancy, due, I think, to breastmilk oversupply, but since then his growth follows the curve, just across the top of the chart.)"

And 32 lbs?

My kid was nearly that at 18 months and he wasn't chubby. Granted he's taller.

But I don't think that breastmilk oversupply "caused" his weight, FWIW.
posted by k8t at 11:31 AM on November 18, 2010

With the info you've provided I'm inclined to option 4, feel pretty sure the issue in option 3 is not causal and the suggested course is not conducive to good development, I could probably be persuaded on 1 or 2 i, but we option 4ed on our sons immature gate with no ill result at 8 years old.
posted by putzface_dickman at 11:53 AM on November 18, 2010

I'm a speech therapist, and in the world of speech therapy, three months is not a big amount of time to see more than modest gains, especially if sessions are every other week, and with rapport/difficulty transitioning to a new person, due in part to your son's young age. You should both be commended for working with what you have--using video resources and having the therapist describe exercises for you to do is great! As his mom, you know best and should trust your gut. I know with some early intervention programs, changing therapists is not an option, but nothing strikes me as deal-breaking on the therapist's part yet from your description.

As for your pediatrician's guidance, it should be a comfort to you that your son is not far off target motor-wise. However, I have had many pediatricians refer preschoolers to me for articulation issues that are inappropriate, such as saying "wabbit" for "rabbit" at age 3. PTs are like specialists for developmental norms for motor skills, whereas pediatricians have to know the whole broad medical realm of kidness. I would be reassured by the pediatrician, but trust that the PT is using more specialized developmental guidelines specific to motor development.

You get definite mom props for doing everything you can to help your son!
posted by shortyJBot at 12:30 PM on November 18, 2010 [1 favorite]

she said, "If he would let me touch him, we could then increase services to weekly."

That makes it sound like it's his fault. If she were any good, she would suggest you find someone else.
posted by Obscure Reference at 1:08 PM on November 18, 2010 [3 favorites]

If the therapist hasn't been able to build rapport with your son in three months, that's a problem with her and not with him. Definitely request a different therapist.
posted by epj at 2:12 PM on November 18, 2010 [1 favorite]

I haven't read all the comments, but seriously, I'd like to hit that therapist. After a few meetings, something should be going on. She is obviously grossly lagging in her therapist skills.
Your son sounds fine to me. My son was large for his age, and still is (at 11, he is 5'9). I think when he was young, holding up his skeletal weight before having the muscle control may have delayed some of his motor skills. It's hard not to worry as a parent, but I'd kick that therapist to the curb.
posted by littleflowers at 5:22 PM on November 18, 2010

I'm inclined to think #4 and am violently opposed to #3. Children absolutely require higher levels of fat to develop properly - not getting that amount of fat leads to developmental delay.

I'd be concerned that the paediatrician is okay with his walking (and it sounds like it's totally and completely normal) but the therapist is making a big deal out of it. Combined with her lack of empathy, I would AT LEAST change therapists.

But in all seriousness, why is barrelling into stairs and over obstacles a milestone? Almost every kid I know does it to a certain extent.
posted by geek anachronism at 6:18 PM on November 18, 2010