Occupational Therapy for Pediatric Heart Patients
Explanantion | Problems Identified | Signs and Symptoms | Evaluation Areas | Treatments
What does an occupational therapist do?
The occupational therapist evaluates and treats feeding-related problems in infants and young children with complex cardiac issues.
An occupational therapist additionallyevaluate s an infant's or child’s development and functional skills, and provide treatment to optimize positioning, promote advances in developmental fine motor, visual motor, visual perceptual, sensory processing,cognitive and self help skillsand provide family education to prepare for discharge to home.
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Feeding problems seen in children with heart problems
Feeding problems in the cardiac population may be related to poor endurance, decreased interest to feed, poor suck, swallow and breathe coordination, and muscle weakness.
A syndrome, chromosomal defect or association with congenital heart disease can also have a direct effect on an infant or child's feeding abilities.
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Signs and symptoms commonly seen with feeding problems
- Poor interest in feeding
- Rapid fatigue during feeding
- Increased work of breath during or after feeding
- Tachypnea
- Poor coordination of suck, swallow and breathe synchrony
- Wet or noisy breathing during or after feeding
- Hyper or hypo sensitive response to oral stimulation
- Increased irritability during feeding
- Coughing, choking or gagging with feeding
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Evaluations used in assessing feeding problems
A bedside oral-motor evaluation can be performed by an Occupational Therapist. Areas evaluated include:
- Quality and coordination of oral-motor movements (includes the tongue, lips, jaw and cheeks)
- Response and tolerance to oral stimulation (peri-oral and intra-oral)
- Oral - facial tone
- Quality of respiration and the impact of feeding on respiration
- Oral structures
- Level of arousal
- Positioning
- Muscle tone and postural control
An occupational therapist may also recommend a Video Swallow Study (VSS) or Fiber Optic Endoscopic Evaluation (FEES) be performed if the patient displays signs of compromised airway protection. These evaluations can identify anatomical and physiological aspects of swallow dysfunction. A developmental evaluation may also be used to evaluate the following skills:
Activities of daily living
Fine motor skills
Perceptual skills
Wheelchair and adaptive equipment needs
Cognitive skills
Sensory integration
Positioning
Level of arousal/sensory responsiveness
Range of motion/muscle flexibility
Muscle strength
Endurance
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Treatments commonly used for feeding problems
Following a bedside evaluation, an occupational therapist will develop a treatment plan to be implemented during the patient's hospitalization. Treatment for feeding related problems may include:
- Identifying proper nipple or feeding equipment
- Pacing strategies
- Activities and strategies to optimize behavioral state for feeding and play activities
- Positioning
- Use of external feeding supports
- Peri-oral and intra-oral stimulation techniques
- Implementation of a feeding schedule to optimize interest to feed
- Parent education
- Bedside feeding programs
Treatment for problems related to muscle weakness, positioning, and motor skills may include:
- Splinting
- Range of motion programs
- Age-appropriate play and strengthening programs
- Parent education
- Bedside positioning programs
- Motor activities to promote increases in muscle strength and postural control
At the time of discharge, an occupational therapist will make recommendations for outpatient or home-based occupational therapy as necessary to continue to promote advances in feeding and development.
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Rev. 9/09
