@kylon I think we are largely in agreement, and again, I'm really sorry if I came off like I was crapping on your profession. That was not at all my intention and I'd like to make sure I don't communicate like that in the future. And yea, I do agree that this would work in a perfect world. It's just sad that we live so far from, well not only a perfect world, but a remotely functional legislature and politics that was actually based around finding solutions instead of stirring up hatred of the other side for votes.
Doctor said my 6mo needs PT
- Thread starter springwillow
- Start date
-
- Tags
- advice needed new parents
@brianball Thanks for elaborating! I agree with alot of these points.
I will say, as an occupational therapist that works in an early intervention program (which is a state run program that exists in all states of the US for birth to 3 years old therapy including PT, OT, and speech), that some of the points above to don't apply to this situation with the OP.
Every single county in the country has an early intervention program (some combine together). While some agencies do have waitlists, many don't. Like the one I work for or the other local one near me. Early intervention evaluations are free, with insurance or not, so it does not waste the parents money. Time sure, but it's not more than 2 hours and can be done at their home or over telehealth. It can be done with grandma or even at the daycare so mom doesnt have to take off of work. In many states, if they child qualifies services are also free.
It doesn't waste the PTs time, because 9/10 times with these early intervention agencies, the therapists are paid either hourly or by client. So they are getting paid for this eval, but wouldn't if there wasn't another one to fill the time slot with. It doesn't "take the slot from someone that needs it" in most cases, because many early intervention programs struggle to meet their state determined quotas for headcount as it is. We are almost never able to evaluate enough babies or have enough in the program to meet our state headcount for the year, and therefore we don't qualify to get full funding each year. So we constantly are trying to educate doctors and NPs on the benefits of referring when it is needed or there is a concern. There are still many referrals that we don't get till the child is almost 3, and they are extremely delayed and unable to catch up. If the doctor or NP would have caught it early when they were under 1, we could have had a chance to make a difference but it's SO much harder to undo the damage that was put off for years.
So while NP may not be the most qualified person to say this child needs PT or not, these other points are likely not the issue in this scenario if they are in the US.
I will say, as an occupational therapist that works in an early intervention program (which is a state run program that exists in all states of the US for birth to 3 years old therapy including PT, OT, and speech), that some of the points above to don't apply to this situation with the OP.
Every single county in the country has an early intervention program (some combine together). While some agencies do have waitlists, many don't. Like the one I work for or the other local one near me. Early intervention evaluations are free, with insurance or not, so it does not waste the parents money. Time sure, but it's not more than 2 hours and can be done at their home or over telehealth. It can be done with grandma or even at the daycare so mom doesnt have to take off of work. In many states, if they child qualifies services are also free.
It doesn't waste the PTs time, because 9/10 times with these early intervention agencies, the therapists are paid either hourly or by client. So they are getting paid for this eval, but wouldn't if there wasn't another one to fill the time slot with. It doesn't "take the slot from someone that needs it" in most cases, because many early intervention programs struggle to meet their state determined quotas for headcount as it is. We are almost never able to evaluate enough babies or have enough in the program to meet our state headcount for the year, and therefore we don't qualify to get full funding each year. So we constantly are trying to educate doctors and NPs on the benefits of referring when it is needed or there is a concern. There are still many referrals that we don't get till the child is almost 3, and they are extremely delayed and unable to catch up. If the doctor or NP would have caught it early when they were under 1, we could have had a chance to make a difference but it's SO much harder to undo the damage that was put off for years.
So while NP may not be the most qualified person to say this child needs PT or not, these other points are likely not the issue in this scenario if they are in the US.
brewster1118
New member
@springwillow I’m a peds PT and I would be surprised if I got a referral for a kiddo who couldn’t sit at 7 months. Did she say anything else? It sounds like your LO is meeting their milestones based on your other comments. Any diagnoses like torticollis?
springwillow
New member
@brewster1118 She said nothing else, no diagnoses like that, the only problems he has are like mild gastrointestinal issues, which he takes baby pepcid for. He doesn't have a flat head, lots of tummy time, rolling around, all that good stuff. In fact he tries to sit up a lot, he just can't sit up fully yet, and when I get him into the sitting position he'll hold it for all of like 1 or 2 seconds before he loses balance. I definitely feel like I should talk to her again.
@springwillow Was she worried about his strength otherwise? I’m wondering if she mentioned the sitting specifically but she’s overall noticing that he’s slightly slower in physical tasks than average. It might be that he’s really only very minorly slower than average but she’s just trying to give him every advantage to catch up which isn’t a bad thing!
brewster1118
New member
@springwillow Yeah based on what your saying, I’m sure he’ll get it soon. You could get the referral process started and not schedule if he starts sitting by himself. If not, it can take awhile to get things going and it wouldn’t be the worst thing to have the process started if he ends up needing it.
johnnyelectro
New member
@springwillow I had a preemie and even tho she was on track age adjusted we still did some sessions of PT to make sure all was going well. At out 9mo regular pediatrician appt (just over 7mo age adjusted) she still wasn’t sitting super well so Dr recommended if not doing well by 8mo age adjusted to check out PT again. I really focused on the sitting and feel all good now! Sometimes it’s just paying a bit more effort to make sure meeting those milestones. And PT is a great resource if you ever need it!
Just my two cents.
Just my two cents.
petros2015
New member
@springwillow It does seem a bit soon, especially if not sitting independently is the only reason. Idk if I’d change doctors over it, but you could just decline PT at this point and re-evaluate later, or ask for a second opinion.
My pediatrician told us around 6mo that PT in the future was a possibility, but that we would wait and see. She was not sitting independently at 6mo, but she did get it around 7-8. At our 9mo visit they still said the same thing, she was a little behind but we would wait a little longer, and that if she was still behind at her 1yr visit than they would give us a referral. By 1yr she was not crawling great and was not pulling up to stand yet, so we got the referral to PT. She ended up doing PT once a week for 6 months, and we also got SMOs (like foot braces) during this time. She didn’t take her first steps until 15mo and didn’t walk consistently until 17mo.
It was scary for me. Even though I knew it was coming before her 1yr visit, I cried after we left with the PT referral. And many other times throughout the process. I was worried, felt like we had messed up somehow, and just wanted my baby to be okay. And she is! She was a little behind and we got her the help that she needed. It’s scary but every kid is different and it’s actually fairly common for kids to need OT/PT at some point. Happy to chat more about our experience if you want.
My pediatrician told us around 6mo that PT in the future was a possibility, but that we would wait and see. She was not sitting independently at 6mo, but she did get it around 7-8. At our 9mo visit they still said the same thing, she was a little behind but we would wait a little longer, and that if she was still behind at her 1yr visit than they would give us a referral. By 1yr she was not crawling great and was not pulling up to stand yet, so we got the referral to PT. She ended up doing PT once a week for 6 months, and we also got SMOs (like foot braces) during this time. She didn’t take her first steps until 15mo and didn’t walk consistently until 17mo.
It was scary for me. Even though I knew it was coming before her 1yr visit, I cried after we left with the PT referral. And many other times throughout the process. I was worried, felt like we had messed up somehow, and just wanted my baby to be okay. And she is! She was a little behind and we got her the help that she needed. It’s scary but every kid is different and it’s actually fairly common for kids to need OT/PT at some point. Happy to chat more about our experience if you want.
@springwillow My son began sitting unassisted at 8ish months. I expressed concerns to our ped around 7 months and they were not worried at all. Keep practicing with your LO and they will get there when they’re ready.
@springwillow I wouldn’t turn it down. There’s no harm that can come from a little extra help!
katrina2017
New member
@springwillow PT is not a bad thing. Early intervention is amazing. If I were you, yeah, I’d look into PT for a 7 month old that could not sit up. Both of my kids were on the later side for milestones, FWIW.
somerandomperson
New member
@springwillow Mine was around 7 months when she started to really be able to sit unassisted. I’ve also found that NPs tend to be more “strict” about being at or above whatever the expectation is. I actually switched practices to one where we only see a doctor because of this. Our issue was about weight (my girl is small and always has been), and the NPs at our prior ped were always raising the alarm, but the doctors at the same practice were much less concerned. Drove me nuts to have people within the same practice giving me very different guidance, and exacerbated my new mom anxiety. For this milestone, I’d give it some time personally.
@somerandomperson I think it’s not about the practice but training differences. NPs and MDs training varies greatly
@timothy59 Yup. I’m not here to start a midlevel discussion lol, but MD/DOs go through significantly more schooling and training than their NP counterparts. My thing is that training of NPs is drastically different depending on the school, whereas medical schools are all run by an overarching governing body.
So it makes sense that an NP might be a little more prone to playing it on the safe side whereas a physician might have seen this scenario many more times and has a better idea of what’s going down in the patients body. I’m that scenario I’d rather my provider be over cautious!
So it makes sense that an NP might be a little more prone to playing it on the safe side whereas a physician might have seen this scenario many more times and has a better idea of what’s going down in the patients body. I’m that scenario I’d rather my provider be over cautious!
@annie9824 For sure. And I’m never gonna bat an eye at someone going to PT, physical therapists are amazing
@somerandomperson Yes, I wish more people would point this out in the comments. NP's should in no way be doing pediatric diagnostics, that is outside of their scope of practice.
somerandomperson
New member
@brianball And yet it’s more and more common, and not just in peds.
@somerandomperson Yea, it's a growing issue across the country. A great way for health care MBAs to generate more profit by cutting labor costs while charging patients and insurance the same. This isn't even exclusive to medicine, but de-professionalization in the name of cost-cutting is an ongoing epidemic in the US across industries. So far, us attorneys seem spared, which just makes me sad that government entities are more afraid of messing up with things like money management and corporate liability than they are with people's lives. Imagine if we had paralegals writing briefs and representing clients, yet that's what's happening in medicine, NPs doing what up until a decade ago only doctors had been doing, where the consequences for mistakes are far higher than hurting a corporation or bank.
It's unfortunately common across medicine and continuing to grow. There have been a few books published on the issue recently, growing bodies of data pointing out the dangers - especially since what qualifies as an NP today is vastly different than NPs of even a decade ago. You used to need to have been an RN for a decade or so before becoming an NP, and the classes all required live clinical rotations. Now, there are numerous online diploma mills where people with next to no nursing experience can become NP's and not even have in-person instruction. It's pretty frightening that midlevels are being entrusted with our care in emergency settings, for primary care, and now for pediatrics. Thank God our own pediatrics practice where we take our daughter only has MDs seeing children, I did not realize that scope creep had infiltrated pediatrics. That is so incredibly dangerous.
If anyone disagrees with this, please read the stories over on r/noctor, or just check out any of the evidence-based studies on worse patient outcomes and wasted resources when care is being directed by midlevels instead of doctors.
From the AMA- "Three Year Study of NPs in the ED: Worse Outcomes, Higher Costs"
It's unfortunately common across medicine and continuing to grow. There have been a few books published on the issue recently, growing bodies of data pointing out the dangers - especially since what qualifies as an NP today is vastly different than NPs of even a decade ago. You used to need to have been an RN for a decade or so before becoming an NP, and the classes all required live clinical rotations. Now, there are numerous online diploma mills where people with next to no nursing experience can become NP's and not even have in-person instruction. It's pretty frightening that midlevels are being entrusted with our care in emergency settings, for primary care, and now for pediatrics. Thank God our own pediatrics practice where we take our daughter only has MDs seeing children, I did not realize that scope creep had infiltrated pediatrics. That is so incredibly dangerous.
If anyone disagrees with this, please read the stories over on r/noctor, or just check out any of the evidence-based studies on worse patient outcomes and wasted resources when care is being directed by midlevels instead of doctors.
From the AMA- "Three Year Study of NPs in the ED: Worse Outcomes, Higher Costs"
steveepperson
New member
@springwillow Sitting up unassisted - started maybe 6.5 months but still wobbly, now at 7 months she can sit up a bit better, falls over if she reaches for something.
I would ask for more info - were there other things she noticed during the exam? You could always get a second opinion.
I would ask for more info - were there other things she noticed during the exam? You could always get a second opinion.