Pediatricians often are asked to prescribe physical, occupational and speech therapies for children with disabilities. Therapy prescriptions, like those for medications, must address the child’s diagnosis and functional goals, as well as the type, frequency and duration of treatments.
An updated AAP clinical report from the Council on Children with Disabilities provides guidance to pediatricians in prescribing therapies, with approaches to best characterize the therapeutic needs and goals of children with disabilities by using the International Classification of Functioning, Disability and Health.
The report,Prescribing Physical, Occupational and Speech Therapy Services for Children with Disabilities, offers recommendations for writing therapy prescriptions and case examples to help pediatric health care providers address the needs of children in their practices. The report is available at https://doi.org/10.1542/peds.2019-0285 and will be published in the April issue of Pediatrics.
Childhood disability related to congenital or acquired health conditions is on the rise. Disability may be temporary, permanent or progressive in nature. The World Health Organization’s International Classification of Functioning, Disability and Health provides a biopsychosocial framework to characterize a child’s function and disability as related to health condition(s). It is a useful tool in defining functional goals in the context of a child’s personal and environmental factors to optimize family and community participation.
Type, location, frequency of treatment
Physical therapists focus on a child’s gross motor function, strength and mobility, often using adaptive equipment such as braces, walkers or wheelchairs. Occupational therapists address upper extremity function, fine-motor skills and self-care abilities (activities of daily living). Speech therapists target communication and cognitive skills as well as swallowing function.
There often is overlap between therapists. For example, both occupational and speech therapists may provide feeding therapies. For many children with disabilities, co-treatment can be the best approach. A coordinated process with all stakeholders is a central element of habilitative and rehabilitative programs.
Therapists treat children in hospitals during acute illnesses, in outpatient settings, in patients’ homes and/or in their schools.
The efficacy of therapy services to help children with disabilities gain and/or maintain function and provide adaptations is well-documented. Children maximally benefit when they practice newly acquired skills in their natural environments. Home programs and family participation are key components of therapeutic programs.
Some interventions, such as patterning and hyperbaric oxygen therapy for children with cerebral palsy, lack evidence of benefit, and pediatricians are encouraged to partner with parents in guiding treatment choices.
Children with disabilities have varying needs for physical, occupational and speech therapies. The dose is influenced by acute changes in function, such as postoperative changes after surgery or immobilization after a critical illness. Often, therapies are provided in episodes or bursts, and in between, children and their parents work to master new skills in their home and community settings.
Collaboration, communication key
The care of children with disabilities is centered in the medical home. Pediatricians, pediatric subspecialists, physical therapists, occupational therapists, speech therapists, educators and parents should continuously share updates on the child’s functional status, the achievement of therapy goals, the identification of new goals, and family functioning and concerns. This is especially important when children receive services in multiple settings simultaneously from multiple providers.
Quick and timely communications regarding changes in a child’s medical or functional status, both anticipated and unanticipated, are recommended. Carefully and continuously coordinated care that is organized around patient- and family-centered goals with clear communication among the health care team members is the best way to optimize the health, function and well-being of children with disabilities.
Drs. Murphy and Houtrow are lead authors of the clinical report and former members of the AAP Council on Children with Disabilities Executive Committee. Dr. Murphy is a former chair of the executive committee.
