Beyond Kangaroos: Q&A with Sharon Grady, PT, MS, RCS

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July 2003

By Sarah Schmelling

Sharon Grady, PT, MS, RCS, Fountain Valley, Calif, has been working with infants for more than 30 years. Though she says that kangaroo care can be helpful for premature infants, she believes that there are many other aspects of therapy in this area that need to be considered by practitioners and, more important, by parents. Grady recently shared with Rehab Management her thoughts on the specifics of working with her very young clientele.

Rehab Management: What special considerations need to be taken into account when working with infants? What are the risks?

Sharon Grady: Of course, the most important consideration is their medical status. Second, one of the things we look at is what we call their “central state,” which is the homeostasis of the nervous system. Because, in order for a baby to really function and grow and develop, he must have that balance between his emotions and his sensory motor, so you look at that.

There are different methods of beginning sensory integrative-type therapy that will help that child to balance the nervous system, so he can absorb the sensory stimulation around him. This is because a baby develops in order to function within his environment, so as his nervous system develops, he is then better able to cope, begin to explore and integrate himself, and be able to process that sensory information within his environment. That’s a special consideration that you need to take to lessen the risks of physical therapy for the medically fragile; you have to know exactly where [the patient] is at medically and what their status is.

RM: Is there specialized equipment that can be used with these infants?

SG: The equipment isn’t really different from what is out there in the market for other infants, unless you have a child who has a real motor impairment, then you will have to make some adaptations. Of course, what you always have to look at is safety first—the same for any infant. There isn’t really any adaptive equipment for them until they get older. Sometimes we can get some adaptive equipment within that 8- to 12-month range.

RM: How is equipment for a newborn to 2-year-old different from that of an older child? How much does the child’s growth need to be factored in when looking for equipment?

SG: The biggest thing you are looking for in equipment is that it is adjustable, because that child is going to grow. It must be a cost-effective piece of equipment. And if you have a child who has severe motor impairment, you want to make sure you are looking at something that would prevent deformities. Growth needs to be taken into account very much because most insurance companies now are looking at a 3- to 5-year use for a piece of equipment.

RM: What are the long-term effects of very early physical and occupational therapy intervention?

SG: [When practicing with infants] you want to address the child’s weaknesses, and then you want to facilitate growth and development as much as the child is capable. Of course, our biggest hope is that we will continue to make that child functional within his environment, and also prevent deformities.

RM: How can parents help with facilitating growth and preventing deformities?

SG: Educating the parents on appropriate positioning, activities, and, of course, equipment can play a very important role. There are different people out there using different equipment, but I think you must have a piece of equipment that will adjust and adapt to the child’s growth and development. You have to make sure the equipment is not something the child is just going to be made comfortable in, because sometimes “just comfort” is not what is best for the child.

This can be difficult when dealing with parents, because of their acceptance of a child who has problems. [Parents] want the child to look as normal as possible, so many times if they can get him in a stroller, he may fit in it for size, but it may not be what is best for that child. So the parents need to be educated in terms of saying to them, “This may not be what your child needs forever and ever, but right now, to facilitate his growth and development, this is what is best for him,” and then explain why.

This is why this kind of therapy takes a therapist with a lot of experience, who can give the parents a picture of the needs of their child at this time that they are going to be able to accept.

RM: How important is parent involvement in infant therapy?

SG: Parent involvement is a must. It’s the first thing I say to parents, that they have to be involved. I tell the parents coming in here to therapy, two or three times a week is not going to be the difference. I am just the coach to help the parent understand what to do for the child at home.

I’m finding now—even with children who have no problems—the importance of parent education. There is this [idea out there] to always put children on their backs, never on their stomachs, while they are sleeping. But that does not mean you don’t put them on their stomachs when they’re awake to play with them. So now I’m getting kids coming in with flat heads and torticollis (neck deformities), and they aren’t rolling, they aren’t crawling, because they are never on their stomachs. And the parents say, “Well, they cry,” but that’s because they’re not used to it. Then there are these nice little bouncy seats and saucers that parents put children in. They’re wonderful babysitters, but they don’t help the child develop the way they should develop. But they do keep them in one place.

RM: Is there a need for more practitioners in this area? Is it a specialty more PTs and OTs should consider?

SG: We do need more PTs and OTs in pediatrics, but there also needs to be more training in this area, because none of the schools are providing really extensive training. It’s an important field, because we do have a federal law [in California]1 that mandates that children who are born at risk are entitled to the Early Start Program, early intervention, between 0 and 3 years of age.

RM: If there are not a lot of school programs, how can PTs and OTs get this kind of training?

SG: Through experience, and through working with someone with a lot of experience. They can also work where there is a lot of continuing education provided for them.

RM: Kangaroo care is one form of infant therapy. How beneficial do you think it is, and what other kinds of infant therapy are there?

SG: With preemie babies, I think [kangaroo care] is very good, but I also think there are other interventions that can be used along with it. I’ve been a pediatric therapist for more than 30 years, and there has never been one method that works always and only. You have to really look at each individual child and determine what is best for them.

One of the other areas of therapy that is used a lot with babies is massage—because it is stimulating and helps with sensory awareness. And, of course, any intervention you use is going to be dependent on the child’s medical status.

You just want to facilitate the child for development. Because [for an infant who is not premature], if you only provide kangaroo care, he can’t very well move around and begin to roll and crawl when he is strapped to his mother. Kangaroo care is not new. Parents have been doing this for years. The philosophy behind it is very good, but some people think the child should be carried around all the time. I think the child needs to learn how to pull away from his mother and father to be able to explore his environment.

Sarah Schmelling is senior editor of Rehab Management.

Reference

1. The California Early Start Program provides intervention services for infants and toddlers with disabilities and their families to promote growth and development and support families during ages 0 to 3 years. The program is federally mandated by the Individuals with Disabilities Education Act and in California by the California Early Intervention Services Act. For more information, see the program Web site, at: www.aapca3.org.

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July 2003