As a pediatric occupational therapist, it breaks my heart when I hear parents say something like, “I took my child to the pediatrician and I tried to tell them about all my sensory concerns, but they just brushed me off and told me my kid is just ‘being a kid’ and will grow out of it.” While that may certainly be true for some kids, it’s not true for all.
Today I want to take a few minutes to share some tips about how to talk to your child’s doctor about your sensory concerns.
Occupational therapists often work with children who have challenges accurately processing sensory information they take in from their environment (sense of touch, hearing, vision, smell, and taste) as well as from within their body (sense of balance/motion and body awareness). You can learn more about the seven sensory systems in my post here.
When kids significantly struggle with processing this sensory information, it can impact their ability to participate in the things they often want or need to do throughout their day — things like eating, sleeping, bathing, grooming, taking care of their hygiene, getting dressed (or even wearing any clothes at all), playing, socializing/interacting with other children, or participating in family, school, and community environments. All of these things are examples of childhood “occupations,” which is why occupational therapists care about them so much.
Occupational therapy practitioners don’t address sensory concerns simply for the sake of “sensory”. We address them so kids can more fully participate in their daily occupations (the activities that are necessary or meaningful for their daily function).
In order for a medically-based occupational therapist to be able to evaluate a child for sensory challenges in the U.S., we must first receive an order from the child’s doctor (unless you would like to pay out-of-pocket for services not covered by your insurance). This means the physician kind of serves as the gatekeeper to OT services, sensory or otherwise. So if you want to try and get a referral for an occupational therapy assessment, you’re going to have to be able to communicate to your child’s doctor why exactly you are concerned and why you would like him or her to consider referring for an OT evaluation.
Here’s the biggest tip I often share with parents to help them effectively talk to their child’s doctor about their sensory concerns: Focus on function, and be specific.
I know whenever I go to my children’s pediatrician, I end up having a hard time finding the right words to specifically describe my concerns. I end up sounding ridiculous and making no sense at all. I can never find the right examples while in the doctor’s office, and then I end up talking myself in circles. It’s so annoying. I promise I’m not a blabbering fool! Even when I feel prepared, it usually just comes out all wrong. And that’s just to talk about an ear infection or some other relatively minor medical issue. Talking to a pediatrician about significant sensory concerns as a parent can be so much harder than simply talking about a runny nose or rash.
When talking with your child’s doctor about your sensory concerns, be prepared to note specific examples of how your child’s sensory challenges impact or interfere with his or her ability to function and complete daily activities (aka – “occupations”). Write those examples down and bring them with you to the appointment. If you have a relevant picture or video that would be appropriate to share and would demonstrate your point, bring those too. The more specific the evidence, the better.
Be prepared to also share how long you have noticed these concerns, what you have tried so far (if anything), and whether you have noticed if anything helps or makes it worse.
In order for your child’s doctor to refer for an occupational therapy evaluation, he or she needs to determine that the evaluation and subsequent treatment would be “medically necessary.” They don’t just hand out evaluation referrals in order to be nice (well, at least most of them don’t).
Occupational therapy professionals have a document that specifically outlines what types of occupations we can address in our profession.
Take a look at this checklist of the types of occupations that OT professionals are allowed to address as it relates to sensory processing challenges:
- Activities of Daily Living (ADLs): Bathing, showering, toileting and toilet hygiene, dressing, feeding/self-feeding (everything that happens to the food before it gets to the mouth), eating (what happens when the food is in the mouth), swallowing (moving food from mouth to stomach, therapists typically need a special swallowing certification to specifically address swallowing difficulties), personal hygiene and grooming
- Instrumental Activities of Daily Living (IADLs): Meal preparation and cleanup
- Rest and Sleep
- Social Participation: Engaging in activities and roles on a community, family, or peer/friend level
Did you see anything on that checklist that related to your child’s struggles?
Does your child cry or scream when it’s time to take a bath or shower, to the point that it impedes their ability to bathe on a regular basis? Does he refuse to wear socks, underwear, or other specific types of clothing because he simply cannot stand the way it feels? Does it take two grown-ups to pin him down in order to clip his fingernails? Does she frequently gag or choke when eating because she cannot “feel” where the food is in her mouth, or because she is hypersensitive to the taste or texture of the food? Does she have an extremely limited diet due to significant challenges with accepting different textures, colors, or types of foods? Does it take him forever to fall asleep and/or does he struggle to stay asleep at night? Does he freak out when anyone gets too close to him or accidentally touches him during play time? Does she avoid touching or playing with anything “messy”, to the point that it prevents her from being able to participate in play opportunities like her peers? Does she have a meltdown anytime she goes to a noisy place or event in the community, such as going to a birthday party or to grandma’s house for a big family dinner? Does he become overstimulated when there is an increase in activity level in his environment (such as a family gathering or older siblings coming home from school), and either “shut down” or become completely chaotic and disorganized (such as spinning around in circles or running into walls in an out-of-control manner)? Is she constantly touching, grabbing, leaning on, or falling into things, to the point that it annoys others or damages items?
If you answered yes to any of these questions, then you might be on the right track.
Okay, now here’s the million dollar question: Would it be “medically necessary” for occupational therapy to evaluate and treat your child based on the specific sensory concerns you have?
Well, that answer is between you and your child’s doctor.
So it’s up to you to bring your concerns about your child’s sensory challenges to the appointment along with specific examples of how they are currently impacting his or her ability to participate in daily activities, how long you have noticed these concerns, what you have tried so far (if anything), and whether you have noticed if anything helps or makes it worse.
All of this will help your child’s doctor be able to better determine whether an occupational therapy evaluation is warranted in order to address your child’s sensory needs and their impact on your child’s ability to participate in his or her daily occupations.
Learn more about the role of occupational therapy in addressing sensory integration and sensory processing disorders, from the American Occupational Therapy Association.
Once your child participates in the OT evaluation and the therapist writes up the report to describe the findings, he or she can help shed some light on whether your child’s struggles are truly due to sensory processing challenges. If they are, then that means you are still on the right track and hopefully therapy will begin soon! If they aren’t, then that doesn’t mean all is lost. It just means you can cross “sensory” off the list and continue on your quest to help your child, while leaning on your child’s medical and (possibly) educational team for guidance and input.
I hope this was helpful for you as a parent so you can feel a little more confident about communicating your concerns with your child’s doctor.
And I hope this information will help medical and school-based occupational therapy professionals articulate to parents how to be effective advocates for their children.
Best of luck!
American Occupational Therapy Association. (2014). Occupational Therapy Practice Framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
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