#315 - Pediatric Pelvic Health Occupational Therapy with Quiara Smith, OTR/L

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Pediatric Pelvic Health Occupational Therapy with Quiara Smith, OTR/L

Quiara Smith an Expert Pediatric Pelvic Health Occupational Therapist who is the CEO/Director of Aloha Integrative Therapy, the first boutique private OT practice exclusively created to treat children with toileting difficulties, pediatric pelvic floor dysfunction, and bowel and bladder disorders. Quiara has been a practicing pediatric OT for over 14 years. Quiara is passionate about creating and holding safe and inclusive space, in order to provide holistic and integrative approaches to pediatric clients and their families.

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Pediatric Pelvic Health Occupational Therapy With Quiara Smith, OTR-L

Quiara Smith, a pediatric pelvic health occupational therapist, specializes in treating toileting difficulties, pediatric pelvic floor dysfunction, and bowel and bladder disorders in children from infancy through their teenage years. These issues are more common than many realize and can significantly impact a child's quality of life if not properly addressed.

Understanding OT vs. PT In Pelvic Health

While occupational therapists (OTs) and physical therapists (PTs) work in pelvic health, their approaches can differ. OTs deeply understands the biopsychosocial approach, the mind-body connection, and children's emotional well-being. 

They look beyond the physical symptoms to know how a child’s sensory environment and overall development impact their pelvic health. PTs tend to focus on the biomechanical aspect and look at how muscles work instead of the overall function OTs focus on to support clients.

When To Request A Referral

As a pediatric pelvic health occupational therapist, Quiara educates about signs and symptoms across different age groups that may require a specialist referral. 

Infants

• Constipation: Infrequent or difficult bowel movements.
• Gas and bloating: Excessive gas that causes discomfort and distention.
• Colic: Prolonged periods of crying and discomfort due to digestive issues.

Preschool-aged children (around 2 to 3 years old)

• Potty training and learning: Providing strategies to support successful potty training.
• Sensory difficulties: Addressing issues with sensory stimuli in the bathroom environment, such as aversion to specific sounds or textures.

School-aged children (5 to middle childhood)

• Bedwetting: Persistent nighttime incontinence beyond the age where most children have achieved dryness.
• Constipation: Continued difficulty with bowel movements.
• Urinary and fecal accidents or leaks: Accidental soiling or urination may occur during gymnastics or trampoline playing.
• Stress urinary incontinence: Leaking urine during physical activities like jumping or running.
• Withholding behavior: Intentionally holding back bowel movements, often noticed during transitions from preschool to kindergarten or between elementary and middle school.
• Sensory differences: Sensory processing issues affect the child's ability to manage continence independently.

Modalities And Structure Of Treatment Sessions

Quiara utilizes a one-on-one intervention model in her private practice, ensuring sessions are held in an intentional and calming space. Here’s what a typical session looks like:

Creating a safe environment

• Private and calm setting: The therapy space is designed to be welcoming and safe, with natural lighting and without fluorescent lights. It includes familiar items like therapy balls and sensory gym equipment.
• Personalized space: Each child has a designated area with comforting items, such as a carpet with their favorite toys or books. Parents often bring a blanket or pillow to help the child feel secure.

Focus on education and play

• Educational activities: Sessions often involve reading books, using diagrams to explain bodily functions, and conducting experiments with props like a pretend bladder (balloon) to help the child understand their body.
• Interactive tools: We use Theraputty to make different types of "poop" and discuss the child's bowel movements, making the learning process engaging and developmentally appropriate.

Complementary and alternative medicine approaches

• Aromatherapy and massage: These techniques help assess and improve gut movement, identify tight muscles, and relax the child.
• Biofeedback: This noninvasive tool measures muscle activity in the pelvic floor. To achieve the same goal, Quiara uses creative alternatives, such as mirrors, for children uncomfortable with traditional biofeedback.

Supporting Children With Low Muscle Tone And Poor Postural Control In Potty Training

Quiara frequently encounters children with low muscle tone and poor postural control in her practice. These children benefit significantly from strengthening activities and exercises, particularly proprioceptive and vestibular input. 

Key elements include:

• Inner core strength: Focus on core muscles, back extensors, and pelvic floor muscles. 
• Functional play: Use play-based activities incorporating movement to help children build strength, endurance, and coordination. 
• Breath control: Teach children how to use their breath effectively to aid in defecation and urination. This often involves repetitive exercises to improve diaphragm movement, which is typically limited in low-tone children.
• Self-Awareness: Help children better understand their bodies' signals and positions. This includes interoception, the sense of internal body conditions, which is vital for recognizing the need to use the bathroom.

Using Vestibular Activities To Enhance Bathroom Awareness

Quiara has yet to specifically see a direct correlation with vestibular activities because every child is different. However, observing children performing specific vestibular activities and tracking the results could validate this hypothesis. 

Vestibular input provides quick and substantial sensory feedback, often yielding noticeable behavioral changes more prominently than proprioceptive, tactile, or auditory inputs. Clinically, Quiara always includes vestibular and proprioceptive activities before asking children to try to empty their bladder. 

Strategies For Working With Non-Speaking Children

For non-speaking children, it is crucial to understand their roles, routines, and expectations. Here’s a breakdown of the strategies used to support these children:

Understanding Roles, Routines, And Expectations

• Assessment: Identify where the child is in their journey to continence. Review previous interventions to determine what has been helpful and what hasn’t.
• Key players: Understand the roles of everyone involved in the child's care, from home to school, to know what happens at each interval of the day.
• Patterns: Observe the child’s natural body patterns, such as when they are likely to hold their bladder or bowels, and adjust strategies accordingly.

Tailored Interventions

• Communication: Since non-speaking children may be unable to use biofeedback or ultrasound effectively, adapt the approach to their needs.
• Environmental strategies: Use sensory techniques to help children become more aware of their bodies. These might include full-body vibration plates for low-tone children, swings, or crawling activities to stimulate awareness.
• Routine adjustments: Integrate regular bathroom breaks and ensure environmental accommodations, such as supporting their feet while on the toilet or blowing bubbles to relax.

Sensory Integration

• Sensory input: Incorporate high-intensity vestibular input activities, like swinging or using vibration plates.
• Creative solutions: Use props and sensory tools tailored to the child’s needs and preferences.

Overcoming Challenges

• Complex cases: Continuous trial and error are necessary to find effective strategies for more complex cases.
• Advocacy: Address misconceptions by educating families and other professionals about the importance of individualized approaches. 

Challenges In Pediatric Pelvic Health Practice

The biggest challenge in pediatric pelvic health practice is addressing each child's unique and highly complex needs. A one-size-fits-all approach is often ineffective, particularly for children with long-standing toileting difficulties.

Another significant challenge is navigating family dynamics; differing perspectives on the best approaches can make this difficult. While therapists provide valuable information and strategies, parents are ultimately the experts on their children.

Quiara's Final Thoughts And Best Advice

Quiara's most important advice is to avoid constipation at all costs because unmanaged constipation can lead to serious issues. Additionally, it's crucial not to start potty training if your child is experiencing constipation, as this can cause setbacks for both the child and the caregiver.

If you need more support from your healthcare team, seek another opinion. Educating providers will empower them to refer families sooner, reducing the frustration and heartache that often accompany these long-term issues.

BORING, BUT NECESSARY LEGAL DISCLAIMERS

While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

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This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.