My knowledge and understanding of Pediatric Occupational Therapists (OTs) and therapy began during my son’s time in the NICU. 

During my first interaction with our OT in the hospital, we sat together while she assessed my son to see how far and how comfortably he could turn his head to the left and right.

The second time she sat with me, she spent time bottle-feeding my son and watching how he swallowed.

My son was periodically evaluated after his discharge from the NICU to see if he would benefit from additional occupational therapy for his development.

Before he formally began first grade, I sought out and chose to work with an occupational therapist for help with his handwriting.

It is through my personal experiences I’ve come to deeply value the work of pediatric occupational therapists. I see how much value and education they offer to parents, and I know how hard they work to help children meet their developmental milestones.

Dairian the OT

Dairian is an occupational therapist licensed through the California Board of Occupational Therapy. She resides in Los Angeles with her husband, 3.5-year-old son, and 6-month-old daughter. Here she gives us a mini crash course about the work of pediatric occupational therapy.

Occupational Therapy

What is occupational therapy? 

Occupational therapy (OT) is a profession in which we support individuals across the lifespan (newborn to elderly) participate in their daily activities. It sounds very general because it is. OTs are traditionally trained as generalists, then we specialize once we start working. The concepts are the same, but the techniques and activities change based on the population.

How does OT benefit infants and toddlers in their development? 

OTs are trained in a holistic way. We look at the baby, the environment, and the demands of the task in order to make recommendations to help them in their development. We can work in a preventative model for “typically” developing babies, babies “at-risk” of delay, or those that are already displaying a delay in their development. 

What are the common development delays you treat in infants? 

The “occupation” or daily activities for infants that I normally treat are play and feeding. Feeding difficulties can start immediately through insufficient weight gain. Play difficulties are usually seen in the older baby (3+ months) when they are unable to hold toys, not tolerate tummy time, not meeting milestones such as rolling/sitting/crawling, not engaging in social play, etc.

How long do you usually work with families? 

The length of treatment usually depends on why the infant is being referred to therapy. Some issues, like torticollis, can be resolved faster than some feeding issues. 

How can parents determine if their baby needs to be evaluated by an occupational therapist? 

The first step is knowing what your baby or toddler should be doing. My usual recommendation is a website called pathways.org. They provide a simple way to see what milestones should be occurring and “red flags”. If there is a concern, it should be brought to the pediatrician in order to receive a referral for therapy. If your concerns are dismissed, (in the state of CA) you can self refer to the regional center for early intervention services. This is a state-funded program to receive Occupational Therapy, Physical Therapy, and Speech Therapy for ages 0-3. Each state has an early intervention system, but referral procedures can vary from state to state.

Preemies

When my son was an infant, he had significant delays in certain areas due to his prematurity. Do you have any advice specifically for families with preemies, who are unable to have in-person support during this pandemic? 

Prematurity is a common risk factor for developmental delay. My best advice is to take a preventative approach and not wait until it’s “significant”. The earlier you intervene, the better. This is what the research tells us. Research also tells us that more frequent intervention is better than intensive treatment. So focus on being consistent in your intervention. During the pandemic especially, many therapies are offering virtual services. Last, be gentle with yourself as a parent. We all want to do our best.

Breastfeeding

I noticed you’re going to become an International Board Certified Lactation Consultant (IBCLC) this year, how did that interest develop? 

I became interested in lactation after the birth of my first son. We had many breastfeeding problems and as a woman of color, I felt I received culturally incompetent care. I knew that this was a space that needed more inclusive professionals. Breastfeeding is the first feeding and as a therapist, if we are not taking the extra education to become informed about lactation, we are truly missing a piece of the puzzle. I found a mentor, gained all the necessary requirements, and have been working with families for the past two years with breastfeeding issues.

Baby Gear

My go-to things for babies are a playmat, swaddle blanket, infant carrier, and the baby Bjorn soft infant seat. What are your thoughts on jumpers, infant seats that prop baby upright, swaddling, and walkers? 

In general, I think baby gear is overrated and overused. Good marketing by companies make it seem like parents need all the things for their baby, but it’s honestly not necessary. Usually, if used within reason, there is no negative effect on development. However, many of the infants I do see tend to overuse baby gear. This is how infants can develop torticollis (“twisted” neck) or plagiocephaly (flat spots on the head). 

Jumpers are especially not good for babies that aren’t ready to place full weight on through their legs. 

Playmats are fine. 

Bumbo chair is a “no”. The Bjorn soft seat is a good choice if looking for a seat. We all need 15 minutes to shower! 

Swaddling has its place, especially for preemies, but again, it is overused. Swaddling inhibits the integration of the Moro reflex. Not getting into too much neurodevelopment, retaining a strong Moro reflex can inhibit efficient brain pathways and you can see difficulties with learning in school-aged children. If using a swaddle, it’s better to stop around 8-10 weeks. Again, this may look different for a preemie.

Tummy Time

I saw your online Tummy Time program in your Instagram stories. The way you talked about it reminded me of RIE, you mentioned just giving babies independent free time. Can you share more about your Tummy Time program, and what kind of results parents can expect if they follow it? 

I do like some principles of RIE in that the baby is more involved, but RIE specifically is not something I associate myself with. Babies do need time outside of containers (car seats, jumpers, bouncers, etc.) so that they can feel the forces of gravity for muscle development. The tummy time program I teach is called Tummy Time! Method which was created by another Occupational Therapist, that gives parents a simple, easy to follow routine for tummy time. This makes sure it is a positive (no cry) experience for the baby. We know the brain thrives for consistent, positive experiences for proper development. Parents will see on track, consistent progress towards milestones as well as an increased sense of connection with their baby.

In addition to your Tummy Time program, are there any other tips you can share to help parents support their babies’ development on their own?

1. Be consistent with tummy time focusing on creating positive experiences and connection.

2. Bookmark pathways.org to know the progression of development, focus less on the age, more on the order of skill development.

3. Every baby is different and walking their own development journey, avoid comparing your baby with others.

4. As the parent, the best thing you can do is set up their environment for success.

5. Practice makes progress, not perfection. Let baby practice, fall, and learn. It’s a learning process.

Dairian the OT

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