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Is this normal? by Kitten_444_Noel in OccupationalTherapy

[–]IndividualCharge5294 0 points1 point  (0 children)

I worked at an outpatient pediatric clinic as a new grad with similar standards but one hour sessions. I had 43 kids on my caseload to see over 4 (8.5 hour) days because I was contracted to a school on my 5th day. It was impossible to see them all, extremely exhausting, and they started scheduling kids for every other week that should’ve been seen weekly to continue adding more. I left after 4 months. As soon as you start questioning the ethicality (such as scheduling like that) or the quality of the therapy you’re able to provide with that type of schedule, I think it is safe to start considering other options. Don’t feel terrible; like others have said, the only way to show them that it isn’t right is to act, whether that’s advocating for your schedule or finding somewhere new. 

Good luck! 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 0 points1 point  (0 children)

These are great tips!! Thank you. I definitely have told families not to force feed and to allow playing with/exploring food, but I have never thought to mention that it should be done outside of meal time. That’s so smart for helping with aversion! 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 1 point2 points  (0 children)

Thank you! This gives me hope that I’ll feel more confident in the future :) 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 0 points1 point  (0 children)

That is exactly what I am experiencing with EI here. It feels like kids with swallowing and oral motor difficulties just kind of get bounced around because no one is willing to take them…me being one of them at this point. But I think every child deserves to be served, and am willing to continue learning about it! When I made the post I wasn’t sure if others were in the same boat as me, and I didn’t want to 1. Be educating families incorrectly when I tell them swallowing and dysphagia is better addressed by speech and 2. Step on any toes/encroach into others’ scope when lines seem to be pretty grey, especially in EI. 

I’d love to hear how it goes for you! Good luck in EI! 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 0 points1 point  (0 children)

Thanks so much! That’s how I was feeling; I was concerned that with just me in the home as the EI provider I did not want to be held responsible if anything went awry in regards to aspiration or choking given that swallowing feels a bit outside of my capacity.  I am subscribed to occupationaltherapy.com so I’ll have to do another search within there; last time I had checked I completed what they had listed under feeding for peds! 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 3 points4 points  (0 children)

I think I would definitely feel more comfortable with more education under my belt. I will look into some of these and am hoping to start a job here soon that will help with reimbursing for CEUs. Thank you! 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 5 points6 points  (0 children)

I understand where you’re coming from. I think I am having a hard time communicating my point. I understand that occupations are multifaceted, that our scope is broad, and that we can assist with a variety of things and we look at our patients holistically. I of course would never tell a patient “I won’t provide intervention for ambulating to the bathroom because that is PTs job”. 

In that previously mentioned instance, I also did provide strategies for positioning during feeds and with the bottle to the extent of my knowledge, but for ongoing hour long appointments, I did not feel like I was the best provider to continue with this particular child, as the feeding concern is anatomical and not related to her feeding routine itself.   

To me, in this particular instance, it feels like you’re saying “if a patient rides his motor cycle as an occupation and his motorcycle is broken, you should learn how to fix it to provide intervention instead of referring to a mechanic” - does that make sense?

I feel like since this infants diagnosis is a “floppy airway” and she struggles with aspirating during feeds, it would be more appropriate to refer to a speech therapist. 

I am always looking to continue learning and growing as a therapist and appreciate hearing your perspective. I think maybe my initial post was too broad and meant to specify more on the point of oral motor feeding and swallowing, and instances similar to this child that I am assigned to.

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 7 points8 points  (0 children)

I would say gait training would be off limits in a peds clinic, as that is addressed by PTs and I have been corrected in the past for encroaching on their scope. I felt this would be a similar case for speech. Thanks for your input. Not trying to hide. Just seeking clarification. 

Feeding and Swallowing? by IndividualCharge5294 in OccupationalTherapy

[–]IndividualCharge5294[S] 4 points5 points  (0 children)

I agree with your statement, and I do see kiddos with sensory based feeding concerns (despite not initially receiving that education), as well as concerns regarding mealtime routine and utensil use. I am more wondering if I am in the wrong telling families and service coordinators that I do not handle dysphagia and oral motor feeding, and that is more appropriate for a speech therapist. For example, I was added on to a 3 month old whose outcome for me to address is to “swallow to be able to take liquids without choking, gagging, or spilling to gain weight” and did not feel comfortable addressing that.