How to Advocate for OT with Your Pediatrician
In honor of Occupational Therapy month, I’m interviewing Dr. Krupa Playforth to help us understand the challenges parents and doctors face when it comes to referring kids with sensory needs to OT. Dr. Playforth and I will unpack from a parent perspective, therapist and pediatrician perspective and give tips on specific questions to ask/what to say in order to best advocate for OT services with your pediatrician.
Dr. Krupa Playforth
Dr. Playforth is a board-certified pediatrician (and a mother of three) who believes every parent deserves clear, evidence-based, nuanced answers to their child health questions. Although social media and the internet are powerful tools, they can also be a mine of misinformation. Using a combination of sincerity, dry humor, and practical tips from her own experience as a mother, she created The Pediatrician Mom: a safe space and resource full of free information for parents on everything from milestones and constipation to ADHD and COVID. Dr Playforth can be reached at www.thepediatricianmom.com or on social media (@thepediatricianmom).
In this episode you’ll learn:
- What makes someone a “good pediatrician?”
- How you can rephrase certain questions to get more support from your pediatrician
- Some common roadblocks parents run into when trying to advocate for OT services with their pediatrician
- Questions to ask the pediatrician if they don’t give you a referral to OT right away
- Strategies, scripts and tips for getting a referral to OT
- How you can self-refer to OT if you need to
- Episode transcript: https://www.theotbutterfly.com/70
- The OT Butterfly Instagram: https://www.instagram.com/theotbutterfly
- Work with Laura: https://www.theotbutterfly.com/parentconsult
- Find more from Dr. Playforth www.thepediatricianmom.com and www.instagram.com/thepediatricianmom
Dr. Playforth (00:00): And so trying to have a productive conversation. Some of the tips are exactly what you described. So doing, being as prepared as you can in talking about specific examples where you’ve noticed certain challenges and the impact that those challenges have had on your day-to-day life or on your family’s life. On things like sleep on things like motor skills, on things like social interactions or playtime or so like social participation. If you can talk about the impact of those things on developmental sort of features and milestones that we as pediatricians talk about all the time that makes that more evocative and makes more of an impression. Speaker 2 (00:43): Welcome to the Sensory Wise Solutions podcast for parents where parents can get real actionable strategies to support kids with sensory processing disorder. I’m Laura OT and mom to Liliana, a sensory sensitive kid who inherited my anxiety and my love for all things Disney. Consider me your new OT mom, bestie. I know my stuff, but I also know what it’s really like in the trenches of parenting a child with sensory processing disorder. Speaker 3 (01:13): Okay, mom, enough about me. Let’s start the podcast. Laura (01:20): Hello. Welcome back to the podcast. We are celebrating occupational therapy month this month in the United States, but even if you’re not in the United States, you get to celebrate along with us. Celebrating the field of OT means making sure everybody knows all of the wonderful things that OT can do for you, for your child, really for anybody in the lifespan. But of course, myself on this podcast and as a mom and as a clinician, I focus on supporting neuro divergent kids and whether we like it or not in the United States, this system is failing us in terms of how we can get this access and these services for our kids. And it’s something that I hear all the time that parents are having a hard time getting through to their pediatrician or their MD to get the referral to ot. And so I wanted to start this conversation with Krupa or Dr. (02:18)Play forth of the pediatrician mom on Instagram. And her and I have this wonderful conversation about where we see advocacy going and how you can best advocate for your child with their pediatrician if you are noticing some signs of sensory needs and other neurodiversity qualities. So a little bit about her before we jump into the conversation. Dr. Play Forth is a board certified pediatrician and a mother of three who believes every parent deserves clear evidence-based nuanced answers to their child health questions. Although social media and the internet are powerful tools, they can also be a mine of misinformation using a combination of sincerity, dry humor, and practical tips from her own experience as a mother. She created the pediatrician mom a safe space and resource full of free information for parents on everything from milestones and constipation to A D H D and C O V D Dr play. Fourth can be reached at www.thepediatricianmom.com or on social media at the pediatrician mom, and you can find all of the links to her resources and to learn more from her down below in the show notes. Let’s start the episode. (03:34)Hello, Dr. Play Forth. It’s so good to have you here on the podcast. I have so many questions to ask you, but thank you for being here. This is a podcast episode. I think that’s going to be very popular, especially for OT Month, which is all about how we can better advocate for our kids, especially in the context of trying to get them into OT services. So I’ll share more of my inspiration behind this episode and what it means to me personally and clinically, but I would love for you to introduce yourself to the audience and let us know everything about you, who you are, and also your platform on Instagram. Yeah, please share. Dr. Playforth (04:15): Yeah, so thank you so much for having me. I think this is going to be a really good conversation. So my name is Dr. Play fourth. I’m a board certified pediatrician and a mom of three. My kids are eight, five and 20 months. So I’m kind of in the trenches with a lot of parents. And once you’ve had multiple kids, I think you begin to realize that there’s very little that is standard. Kids are so different and your interactions with them are different. What they need from you is different. And part of why I created the pediatrician mom is because I really want to promote this idea that parenting is not black and white. So sometimes you’ve got to kind of adapt and pivot and adjust what you’re doing to what your child needs. And there’s no right single right answer for a lot of questions. So I started writing on the pediatrician mom, that’s my handle. And my website is the pediatrician mom.com. And I try to address that and answer a lot of the common child health questions parents have. Laura (05:12): I love your page. I love that you do offer guilt free. I call them permission slips. Sometimes we need permission slips from the trusted experts, permission slips to use screen time. Yes, permission slips to get angry, sometimes permission slips to cry, permission slips to vent. Inherently, we know we’re doing it, but we have so much of that guilt and hearing from experts like yourself that you do it too or that you’re like, this is not going to ruin your kid. Here’s a permission slip to do that. It feels so good. So thank you for that and I hope everyone listening if you’re not already following her, to check her out. And we’ll also talk more about your resources and everything where people can continue learning from you at the end of the episode. Sure, yeah. I wanted to start out by clearing sort of setting the tone. (05:57)I’ll say setting the tone for this episode. My reasoning for asking Dr. Play forth on here and my personal and clinical experience with this, I guess this challenge, this dilemma that keeps coming up in ot. So it’s occupational therapy month. We want to celebrate the field of occupational therapy. We want to spread awareness about all of the wonderful things that this field can do. And if you didn’t know, OTs can work with kids from infancy like day one all the way up to the end of life in so many different settings, so many different areas. Obviously here I am a pediatric occupational therapist, and so for occupational therapy month, I would love parents who are either thinking about OT or maybe have never heard of OT to look into it more. If any of the things that I’ve ever talked about are resonating with you, then this is your sign. (06:50)And I have Dr. Play forth here to help us better advocate confidently with some of the pediatricians that you might have that are less informed on sensory things and some other common ways that OT might help your child. So I am a pediatric OT and my daughter is neurodivergent. She doesn’t check a lot of the boxes, so to speak, to get a lot of those diagnoses that hold more weight in a pediatrician’s office. And so I have had a constant uphill battle trying to fight for the services that I believe my daughter deserves. And I share my story not to discourage parents, but to tell parents to help them kind of learn how I’ve tried to advocate, but also to show that sometimes the system is broken. And I want this episode not to be one where we are trashing pediatricians or the medical field in general, but to really understand how big the, and more, how it’s more of a system-wide issue and can, since that feels harder to change, if we can put the tools in more of the parent’s hands and give them more tools to advocate for their kids, that would make me feel better. (08:11)But I have had many pediatricians sort of push back on some of the behaviors and challenges that I experienced with my daughter that now I know I’m very confident is related to anxiety and sensory processing challenges for my daughter. So I want all of the tips that Dr. Play Forth shares with us today to give you those tools rather than let you feel discouraged or feel like we’re talking bad about pediatricians because you do have a really, really hard job. And I think one of the biggest questions that I have for you, and one of the biggest things that I start out with for parents is pediatricians are expected to know so much from infancy to eight till they’re 18. So much of development happens there. And on top of that, every illness, every virus, every vaccination, every milestone, every new, what is it new protocol for handling childhood obesity and the nutritional guidelines, what do you even keep up with all of that as a pediatrician? Dr. Playforth (09:22): So it can be challenging. So I think that when you start to think of what makes a good pediatrician, we have to change and adjust our definition a little bit because you’re right, there’s a lot to know if you’re thinking about pathology, physiology, development, there’s a lot to know and there’s a lot that changes. You think about what is, okay, take abdominal pain. Abdominal pain in an infant has a different differential diagnosis than abdominal pain in a toddler or abdominal pain in a teenager and in an adult. Now, obviously I don’t see adults, but understanding that the pathology and the physiology is different in those different stages, that takes a lot of time and learning. And yes, it’s important to keep up with all of it. So I think what defines to me as a mother of three, one child that does have some sensory processing challenges, I think what to me defines a good pediatrician is one that is willing to say that they don’t know everything. A lot of people think a good pediatrician is one that just knows everything, but that is basically impossible. A good pediatrician is one that has humility and that understands that we cannot know everything and there are areas where other people may know more than us, and it is our job to learn and to think critically about what we’re being told, but also to be open to the possibility that we are not the be all and end all of childhood health knowledge. Laura (10:53): I love that answer. I think that’s so true that sometimes you would classify a good pediatrician as one that always has the right answer, but even what you said at the beginning that there is no right way or no one answer for everything in parenting, and I think I would feel much more comfortable with the pediatrician who answered me. I’m not so sure about that, but let me look up some resources for you. Yes. And get back to you or let me, I have a colleague who has a child like that. Let me get back to you. Rather than either brushing it off or coming up with some very textbook basic answer that it’s Dr. Playforth (11:30): Really, it’s something I tell new pediatricians as they’re graduating that you know, feel like you ought to know all the answers and you feel like maybe I’m a failure or if I don’t. But parents aren’t judging you for that. Parents are judging you if they, I, and parents are smart, they understand and they can tell if you’re making stuff up. So it just makes far more sense to just say, you know what? I’m not sure. Let me look it up. Let’s learn together. Sometimes parents will come in with information about diagnoses if their kid has a rare condition where they know more than I do, and it is my responsibility to listen and to hear what they’re saying because I can learn something. And I also think that there’s also the pathology and the physiology, but also the home day-to-day life experience of having a child with a specific condition that nobody can tell you until you’ve lived it. So if you’re willing to listen to somebody that is living it, you can then take that information and share it with somebody else who is going to live it or who can anticipate living that life. Laura (12:28): I’m sure you get this question a lot, and I get this too as an ot, and I always pause for a second and reflect it back to the parent when they say, my child is X, Y, Z. Should I be concerned five? And I always say, should I be concerned? Is such a different question of going, this is after so much years of therapy for myself and learning how to reparent and learning about validating emotions, I’m like, well, should you be concerned as a different question than why is this behavior happening? If you are concerned, let’s talk about it. Do you want to be validated in that concern? Are you wondering if this happens a lot? Are you wondering, should you be concerned? Does that mean do you need a referral to something? What are you really asking? Yeah. When you say, should I be concerned? (13:12)And I, I’m sure that that is where a lot of the pushback gets maybe misinterpreted from some pediatricians when parents, my kid is biting, but it’s very specific. My kid is biting, my kid is hitting, my kid is a picky eater. Should I be concerned? And then some pediatricians might hear that and say, oh, it’s really common for two year olds to be really picky, and then that gets misinterpreted by the parent. I was like, okay, we don’t have to do anything about it. And I feel like that question, should I be concerned, is really the doorway to explore more of what the parent’s looking for. Dr. Playforth (13:44): And this is where we get back to what you were saying about it being a system issue. If you are seeing 25 or 30 patients a day and you have only have 15 minutes to cover everything in a well visit, I mean that’s what I was doing in my old practice. So you’re covering everything from development to vaccines to doing a physical exam to talking about sleep and eating and pooping and all those things. How do you have the space to have that conversation? Laura (14:14): And it’s such a big one. And then towards end of it, the 15 minutes, I never even real 15 minutes, I never even realized that that was the booking time. I always remember booking a wellness visit and that was my time slot, but I did not know that you were expected to only stay in there for 15 minutes. Dr. Playforth (14:29): And so if you were five minutes late or it takes five minutes to, I mean, let anyone who has an 18 month old, you’re the time it takes to dress them and undress them and weigh them and measure them, that’s five minutes of your 15 minute slot that’s gone, especially if you come late. And I don’t think people vilify healthcare providers, pediatricians for this system, but I don’t know any pediatricians that are happy with the system either. It is just the way that the insurance companies have set things up. Now, one workaround for that is to try to make sure that if you have a specific concern, you make a separate appointment to talk about it, but not everybody has a job that’s flexible enough to do that or Laura (15:15): No, you can get an appointment. Dr. Playforth (15:16): Exactly. Exactly. Laura (15:17): Yeah. So Dr. Playforth (15:18): There is a systemic issue that I think is going to at some point come to a head and needs, I mean, I don’t know if this will change, but for myself as a mother, I am looking outside of the box when I have concerns about my kid to try to find answers from somebody that is not so burnt out and depleted and time constrained. Laura (15:39): Yeah. Oh gosh, that’s such a good tip. I always would try to make a separate appointment or go in saying, I need, while you’re checking her this routine stuff, can we please talk about this? Don’t really, you can write down what her weight is. I don’t really care. Talk about her growth chart. I know. So I’ve been able to work around it that way, but if you can make a separate appointment, Dr. Playforth (16:01): The other thing is that parents don’t always understand is that the insurance company does not let you talk about an issue during a well visit, which literally does not make sense. So if you talk about, say a child, a child’s been constipated and you talk about the constipation or their eczema during their well visit, you cannot, well most of the time it is challenging to get paid for both the sick diagnosis and the well visit. And I mean a lot of pediatricians just sort of swallow that because we get it too. I mean, if you’re coming to talk to me about your kid, obviously we are going to talk about the eczema because that’s a big part of what’s going on with your kid. But I think it makes it much more challenging. So especially if there’s something that is truly of concern to you, even trying to do a telemedicine appointment to talk about it separately just gets you the space and also feel, makes the pediatrician feel like they have the space and they can give the attention to the issue that it deserves. Laura (16:55): Yeah, I always encourage parents because they’ll say like, oh, well his three-year-old visit is coming up in a couple months, so I’ll bring it up then. And I’m like, you could, but I would maybe start the conversation now maybe if you have a way to email them, if you have an option for a phone call if it’s within your access. Yeah, I would do it. Dedicate some time to ask the questions. Absolutely. This brings up the topic of, so a lot of times when parents are either getting pushback from their pediatrician or maybe not getting enough answers that they’re looking for, I will say, look into a developmental pediatrician. Yeah. Can you talk about the difference maybe in schooling, the niche training that they might have and whether or not a parent should just go straight that route or should they still be first check with your pediatrician and see if they could help. What’s your process and thinking about it? Dr. Playforth (17:50): It’s a really good question. So a standard pediatrician will get some development training in within residency. Truthfully, I look back and I can remember I did one month of developmental pediatrics in my entire three months of training, I mean in my entire three years of training. So that’s not a lot. You learn more as you go along. And I personally learned more as a parent exactly, but somebody who does a developmental pediatrics fellowship is someone that did a pediatric residency, decided they were interested in specifically development, and then went and did several additional years of training at a dedicated facility where that’s all they did for several years. A lot of them will do research. There aren’t that many spots available and there aren’t that many developmental pediatricians in this country, which is part of why jumping straight to a developmental pediatrician is not an option for a lot of people in my area, which is comparatively a well served area. So I live in right outside of dc, so we have access to Hopkins, we’ve got access to DC based, we’ve got access to Northern Virginia, and even in this area, the waits time to get in to see a developmental pediatrician can be anywhere from nine months to two years, (19:05)Obviously if you’re concerned about an issue. Yeah. Wait, that Laura (19:10): Makes no sense. Oh, why is there such a lack of them? Is there just not many interested in that area? Dr. Playforth (19:17): There aren’t that many training spots because the training is so intense and so specialized, and I think a lot of people after they’re done with the residency don’t necessarily want to go and do an additional several years at a low salary. I mean, they want to start their lives, which is understandable. But what I tell my patients, if they, we together have come up with a mutual concern for something that might need a developmental pediatrician’s expertise, I tell them, make the appointment, get on the wait list. A lot of times there’s a lot of paperwork and things like that. Yeah. Oh yeah. But don’t let that delay you on starting some of the interventions that we know can be effective, which that speech therapy, that’s occupational therapy, that’s pt. It depends on the specific reason for something going on or what the issues and the concerns are. But in the meantime, if you get some of that stuff going, even if you see a developmental pediatrician, odds are that’s what they’re going to refer and recommend anyway. They may might want additional testing, but while you’re waiting for that, it is not wrong to start to work on some of the concerns, especially if they’re interfering with your day-to-day life. Laura (20:29): Yeah. How do you handle it? Obviously it’s case by case, but I’m sure you also get the very quick question, do you think my kid is autistic? Do you think they have h d, do you think, and obviously no one can truly say unless you do an in-depth assessment, if you have a parent who brings up those specific diagnoses, is there in your practice kind of like, oh, they’ve brought this up the past few times, maybe it is time to refer? Or do you just give them resources right away and just follow their line of questioning whether knowing there’s a spectrum of super concerned parents that might be a little bit too much on Google and some very realistic, this could be potentially something there. How do you navigate that? Dr. Playforth (21:14): Like you said, it depends a little bit on context. I sometimes we’ll get parents that will come in for a newborn visit and say, I’m worried that they’re not making enough eye contact and I’m worried that they might be autistic and I do my best not to dismiss that because that’s a real concern. That’s probably keeping that person up at night. And that’s such an emotionally charged time. We talk about it and we say, really, we can’t really tell, okay, let’s keep a close eye on it. Let’s keep talking about it. But I try to really listen to it. I know that not everybody has that philosophy, but at that point, if somebody’s expressing that concern that early, there’s not a whole lot you can do at that point. But it is something that I take note of. It is something that I try to bring up again as we start to see the family and as I start to get to know the child, the benefit of getting to know your pediatrician and them getting to know your child and your family is that if you are in a system where you’re not seeing somebody different every time they get to know you and so then they start to recognize what is normal for your kid? (22:17)What is your level of concern? I mean, sometimes parents are bringing their own anxieties in and it’s less about the kid and it’s more about what’s going on with them. And that doesn’t make that irrelevant. I mean that’s obviously so relevant and it shouldn’t be dismissed, but it might mean that maybe that parent needs resources for themselves and more than for their kid. Just depends so much on the situation. I try to always take concerns like this. Seriously, if you haven’t someone who has an 18 month old and they’re coming in with that concern, that’s a totally different conversation. And my understanding and my experience has been that if it is keeping a parent up at night, it is probably worth getting the assessment and getting the peace of mind that potentially, I mean go, if you go and see an OT and they access your child and they’re like, you know what? Everything looks great. That is a best case scenario. That is not a, oh, I wasted my pediatrician’s time. In the OTs time. That is the dream. That’s what you want to happen. Laura (23:18): Oh, thank you for saying that. I sometimes talk about it how I feel like it makes me feel like certain pediatricians have a quota. You can only give out five OT referrals in a month without I’m how I feel like sometimes they withhold it in certain instances, but it, you’re right, the best case scenario, it doesn’t mean you wasted anybody’s time. It means you ruled something out and now you can focus on other aspects. And it’s funny how you talk about getting to know your pediatrician, which we have an insurance that’s in one of those big medical systems. We have no continuation of care with any one provider. So when I see I follow you several other pediatricians on Instagram and then they’re always check with your pediatrician. I’m like, my pediatrician doesn’t know my child more than they do because I’ve been talking to you in the dms about my kid. That’s my course more than them. And so I’m like, I don’t trust, I mean I trust her medical knowledge, but she does not know my child and I cannot keep going through the story in 10 minutes and then where we are and then ask for your opinion. So it is very discouraging for parents who are in that kind of system. Oh gosh, Dr. Playforth (24:28): I hear that. I’m trying to create a practice, I’m starting my own practice. I’m trying to create a practice where you have those smaller, it’s just going to be very intimate. It’s going to be like me and a only a cap number of patients so that we can do developmental assessments that are thorough and have these long conversations. But not everyone has that option. And that’s tragic. And I think it puts a lot of pressure on parents to feel like they have to be the one to figure things out. And that’s a really tough place to be. Laura (24:57): It is really tough. You’re right. I’m glad to hear that you’re, you’re trying to start that practice and excited to hear about it. Okay, so I want to ask a question about the elephant in the room, why we’re here, and the biggest thing I feel like that comes up and so I talk a lot about sensory processing disorder and what I tell everybody, the confusing part about it, it is not technically a diagnosis, meaning it is not in the dsm, which is the right big book of diagnoses that medical professionals and mental health specialists use to diagnose a certain mental or cognitive disorder. Sensory processing disorder is not its own code, but it’s listed under some of these umbrella diagnoses. I would love to hear and where this comes from, obviously because I hear from PA clients, but also I remember vividly when I took my daughter at that time, she was two to a developmental pediatrician and I was like, I’m seeing so much stuff about S P D in her, we need to get assessed. And then the first thing he said was, because he knew I was an ot, the first thing he said was, well, our fields don’t really agree on sensory processing disorder. That’s how he started it out. And I was like, okay, so you’re saying you don’t believe Dr. Playforth (26:09): It’s missing you from the get-go, Laura (26:11): From get-go. And I was like, okay, that kind of set the tone. And so if you can unpack a little bit about why sensory processing disorder is not getting enough of, I don’t know, the credibility, the support from the medical community. There are research, there are like M R I studies and things that are showing out, showing more proof behind the n neurological basis behind a lot of the sensory stuff. What gives, Dr. Playforth (26:46): So for, and you should correct me if I’m wrong because, or if there’s more I should add to this because you have much more expertise on this than I do, but my understanding of sensory processing disorders is essentially that there are family of disorders where sensory information is processed differently in the brain. So most people are going to assume that that means that these individuals are more sensitive to stimuli, but it can also mean that they’re less sensitive. And the sensory input could be things like how loud sounds are. I see that a lot textures of certain foods are fabric, but how bright an environment is, and then we were talking about this right before we started the podcast, but even the sensory experience of certain bodily functions, right? And I think that what is challenging and what maybe is difficult is what you said about the D S M, which is that this idea of a sensory processing disorder was not included in this most recent edition of the D S M. (27:40)And that’s because I think the difficulty here is that it is hard to define sensory struggles because there are so many different ways that this can present. And I don’t think we have as many evidence-based randomized control trials that help us understand not only what they are, but also how to intervene to help. Now, that’s not an excuse. And I do think the way that a lot of clinicians think about sensory processing difficulties is that they may be more of a symptom cluster than a single diagnosis because they, that symptom cluster can be indicative of other underlying pathologies that are important to identify. So it’s not so much like, oh, it’s not important to know that there are sensory processing difficulties, but more if there are, then what else might be going on? And is that something that we can intervene on? I, I think that if it were included in the dsm, it would make things like getting insurance companies to pay for some of these therapies easier. And so it’s unfortunate that this is the way it is and I don’t know enough about how those criteria come together to be able to say why it wasn’t included. But I do think that ensuring that you’re getting to the bottom of why a symptom cluster exists is effective and important and shouldn’t be dismissed by just focusing on that symptom cluster. Does that make sense? Laura (29:04): Yeah, no, I agree. And the way that you described it was exactly it. There’s so many different ways to respond to sensory and I think everybody has a sensory profile whether or not you’re divergent right or neurotypical. Everyone has a certain pattern of way that they respond to different sensory stimuli. And that’s just then how the nervous system responds. That’s what we all have. But I think do think that having S P D in the DSM would just really open more doors to access. I also agree. I think we do know more about the symptomatology of it, the behavior part of it, and the OT profession and sensory integration I think could use a lot more research on that. But even so, if we don’t know the proper, if we’re arguing which intervention is best, I think we can all agree that OTs are really the sensory experts. And so if we could still at least help parents identify where we, where I feel like in the equation where we get stuck is that parents don’t come to OT until years later because I didn’t even know OT existed because no one mentioned that whether or not your child has a diagnosis, the things that you’re describing are things that and OT can help Dr. Playforth (30:20): With. Right? Laura (30:21): And some parents I didn’t know. So I either get parents saying, I didn’t know OT existed for sensory stuff or I’ve been trying to for years, but it wasn’t until they were in first grade that the doctor was fine. Okay, I see it’s daily. But parents, like, I’ve been saying this since they were three and we kept getting wait and see, wait and see, wait and see. And then now with the wait list and this, now they’re seven and just getting OT for things like that. Dr. Playforth (30:48): And it may be partly on the clinicians and how much experience they have with ot. Now my mom is an ot, so I’m probably a little bit bias. I’m a little more open to it, but Laura (31:00): Is she a pediatric ot? Dr. Playforth (31:02): She is a pediatric ot. Oh my gosh. I mean, I grew up in Malawi in Central Africa, and she worked with polio with kids who had had polio. So a very niche sort of experience, but I’ve been hearing my OT my entire life, so my openness to it maybe different from other pediatricians. Laura (31:20): Okay, okay. It’s good to put that out there. There’s a little bias to it, but I love it. I love it. That’s so cool. But Dr. Playforth (31:26): I think going back to the dsm, what is also interesting about the DSM is that many of the diagnoses that actually make it into there rely on one common factor, which is the degree to which any symptom or any pathology is interfering with quality of life or daily function. And what is important to remember about sensory processing difficulties is sensory. Sensory input is how we engage with the world around us. So if you are having difficulty with that, by definition, it is going to eventually be interfering with your quality of your life and your daily function. And maybe not even just for yourself, but for your whole family if it’s a toddler, right? And so paying attention to that and if there are deficits or challenges on the front, helping teach the skills and develop protocols to help, that’s so important. And I mean, do wish I’ve even seen this happen where with behavior issues, there’s a lot, there’s hard to find, for example, plate therapists in our area that are taking patients, and especially in that three to five age range where I think it can be a little bit challenging. Some of those children benefit so much from seeing an OT to help them figure out how to manage their and manage their feelings. And people don’t think about OT in that context, right? Because it’s that, yeah, you don’t always think about that as being a sensory processing challenge, but it can be Laura (32:49): When it’s linked to interception. And I think a lot of people don’t realize that OTs got our start in the field with mental health. It’s rooted in mental health. So when that, yeah, and it was I believe 1917 and their initial field of work with was with a mental health population. So that’s where it got started. So it’s so good to hear you talk about that for parents to hear that that sensory is stuff that it is part of our every day, but it’s something that I emphasize for parents when they’re like, how can I get my OT pediatrician to believe? And I said, take what you’re experiencing daily and make it as objective as you can to show them how impactful it is not. So not just my two year old is having tantrums. Oh, well then you’re going to get, oh yeah, that’s welcome to the two year old. (33:43)That’s normal. They’re figuring this out. But for me it was like my two-year-old is biting her hand, she’s leaving bruises, she’s banging her head, she’s having meltdowns that last 45 to 90 minutes a day, three times a day. I’ve had two cancel work four times this week. The babysitter quit. All of these things where you’re like, no, this is very impactful for our daily life. So sometimes you have to really, really paint the picture or the pediatrician. And I will also say, I don’t know if this falls in line with your line of thinking is I’ve helped parents switch the question of should I be concerned to, I am really concerned this is impacting our daily life because X, Y, Z, can you please refer us to an occupational therapist? Can you help us get seen by an ot? Can you help us rule out any diagnoses? Can you help us X, Y, Z? Dr. Playforth (34:38): Yeah, I think I’m so glad you talked about focusing on this criteria of interfering with daily life. If your child is refusing to put on their shoes here or there, and you describe that to the pediatrician, I mean, yes, that could be part of normal neurotypical sort of, sure, technically neurotypical toddler behavior. But if you find that your child refuses to wear shoes at all ever, and you’ve found you’ve gone to buying multiple different types of shoes, endless pairs of shoes because they, there’s literally none that they will keep on. That’s a wholly different experience. And sometimes it is about describing that, and you don’t always have the space to do that, but it is worth keeping in mind that you’re the only one at home with that child. Your observations, your experiences, your gut instinct on that, those are important in terms of the conversations to have with the pediatrician. (35:26)It is important to remember that the pediatrician, the parent, the child, you’re all together on the same team. You all have the same goal. Your goal is to optimize the and the wellbeing of that child. And I think sometimes when parents come in and they’re nervous or they get a reaction, a lot like the one you described when you brought up that if you come at the conversation with aggression, rather than assuming positive intent, assuming, okay, my pediatrician went into this field because they want to help my child, it makes that conversation potentially less productive because it’s more combative. None of us D does as well. If we are approached by somebody who’s being combative. And so trying to have a productive conversation, some of the tips are exactly what you described. So doing, being as prepared as you can in talking about specific examples where you’ve noticed certain challenges and the impact that those challenges have had on your day-to-day life or on your family’s life, on things like sleep, on things like motor skills, on things like social interactions or playtime or so social participation. (36:33)If you can talk about the impact of those things on developmental sort of features and milestones that we as pediatricians talk about all the time, that makes that more evocative and makes more of an impression. And then you also want to talk about not just your observations, but how long you’ve noticed them potentially, what progress or changes you have seen or have not seen. You know, talk about concretely about the things you’ve tried that have and have not helped. And then if you are told watch and wait, then what do you do with that? So ask what you can try in the meantime, ask at what point you should circle back. So a lot of people will say, oh, okay, it’s normal. But what you want to ask is at what point does it not normal? At what point do I get a timeline, get something that is concrete that you can hold onto, and if you really feel like you’re going to be laying awake at night and worrying, I mean, our system here is that means that you can self refer in a lot of places in most places. So you don’t necessarily have to wait for them to keep that referral. But you could just tell them, look, I would really like to have the OT referral. And I think sometimes the barrier to that for parents is that they don’t want to offend their pediatrician. They don’t want to make it seem like they’re undermining what their pediatrician knows. But yeah, all right, pediatrician isn’t going to care about that. And even if they do, what does that matter? Right? Your job is to take care of your kid and so who cares? Laura (37:59): Is there any harm or, so I hear that and I am such a people pleaser. They’re like, Ooh, I really trust you. I really like you, but also I’ve got this nagging thought in my brain. And then I would just feel much more at peace if I were able to rule out any developmental or sensory processing issues. Can you please just make the referral? This Dr. Playforth (38:18): Literally, that sentence is just perfect. You could just say that, Laura (38:22): Yes, it would just put me at ease. I’m not saying I think my daughter has X, Y, Z diagnosis, but I would like to just rule it out. Is there any harm in going there? I would phrase that, is there any harm? And then maybe the pediatrician at that point be like, you know what? No, I could see this is important to you. Hopefully, yeah, here’s the referral. But then again, it comes back to what I was saying is that assumes that the parent knows to ask for OT rather because a lot of the sensory processing challenges look like typical behavior and then get hand, and then parents get handed a parenting tip sheet or a parenting style, Dr. Playforth (39:02): And nobody has time to sit down and talk Laura (39:05): Or take a better parenting class. And so that’s where, again, if pediatricians were offered the resources. Do you see any education outside of your, after your training, are there professional development for pediatricians or any way or avenue of learning other than social media about sensory processing or neurodiversity issues? Dr. Playforth (39:37): The programs exist. A lot of different continuing medical education like courses exist, but it all comes down to we all have a certain number of hours you do that we have to fulfill to maintain certification, but you can pick what you’re learning about. So during a time of a pandemic, I would say a lot of people were leaning towards learning about infectious diseases and covid and things like that. I personally have an interest in lactation, and so I’ve done a lot of C M E and lactation, which is again, yet another thing that is remarkably missing in pediatric training, a whole different conversation or nutrition. We’ve worked on this baby-led feeding guide and I have an interest in this, so that’s what I go and seek out. But if a pediatrician would have to choose to seek that education out, it’s not that it’s not out there, it is, it’s just a matter of, unless you go to one of these big conferences that has a series of talks on multiple different topics, but even then a lot of times you have simultaneous talks and you just pick the one that you’re most Laura (40:41): Interested. I know. Yeah. It’s so hard. So I would imagine it varies if you are a pediatrician who has a practice, you’re like, you know what? I’ve been getting asked a lot of questions about this recently. It seems to be more prominent. And on that topic, I’m curious, this will probably our last question, but how much more of these concerns are you seeing post pandemic in terms of not just overall development, but a lot related to sensory and a lot of the stuff that we see in the preschool years, kids who are growing up in the middle of a pandemic, how much are you seeing? Dr. Playforth (41:13): It’s interesting. I’ve seen a lot more developmental concerns, but on the topic of some sensory processing difficulties, I’ve seen it go two ways. In some cases, preschools, daycares, having other caregivers around to observe a child and to bring those observations, a parent, that can be really helpful. That’s true because true, you have multiple different eyes of, and a lot of those providers are seeing multiple kids in the same age, so they have a better sense of what is neurotypical and what maybe is not what we more typically see in this age group. And so they will bring that information to parents and then those parents bring it to us. So when kids have been staying at home, I feel like we haven’t seen as much of that. I think that maybe comes up. I think I’m seen that more in school-aged kids where, especially around mental health issues, because sometimes if your kids have coaches or multiple teachers in their classroom, those teachers will get to know the kids. Sometimes you could pick up more brewing anxiety and mood disorders and things like that because those people will bring those observations to parents. But developmentally, I think parents are more anxious and we have seen that that means that they’re more likely to bring things up, but also pediatricians are more burnt out and have less access. So I think there’s so many different factors at play. I would say overall I’m seeing more concern and more, I’m seeing more demand for some of these services that isn’t always available. Laura (42:55): Yeah, there’s definitely, and I think post pandemic, a lot of therapists, even myself, have left the clinic and found virtual work to be fulfilling and reaching more people at different stages of their need for support. So because you Dr. Playforth (43:09): Also are parents that have to take care of your kids more like virtual, it’s learning and stuff, it’s a Laura (43:14): Big cycle that impacts all of it and something, so the one thing that I’ll leave here that I share in regards to whether some in regards to the pandemic, because I’m getting a lot of referrals for parents, especially around social anxiety or having a hard time transitioning to school for the first time, or they’re very sensitive, but I wonder if it’s because I didn’t give them access to the playground. So now they don’t know how to do the slide. And so parents are saying, is this just it’s, it’s probably just because of the pandemic. And I say whether or not the leading cause or the trigger was a pandemic, if you’re noticing it, you can still get support for it. It’s not going to self-correct. Most of the time. The whole idea of something growing out of it is always something that’s a factor. But if you are noticing it to the point that it’s impacting your daily function, now whether or not it was for the pandemic, it doesn’t matter. Reason part, it doesn’t matter, you still need support. So that’s what I think is, and Dr. Playforth (44:11): The quicker you get that support, the less overall intervention you may need. Yeah, depends on the situation. Just Laura (44:17): Get that access when they need it. Dr. Playforth (44:20): It’s like people should remember that you can self-refer. And yes, there are wait lists, but sometimes getting on those wait lists and getting all of that paperwork taken care of, and then suddenly, if you’re doing the wait and see and your child starts to show the skills or overall improves, then you know, give that spot to somebody else that needs it. But there’s no harm in doing that. Laura (44:44): And so for self referring, for anyone who’s listening, I mean, this is just cold calling clinics and see, you know, could go backwards. You don’t have to go from pediatrician to referral. You can go straight to the OT clinic, whether it’s a Google search or a lo, I love local mom’s groups. My kid has this early Dr. Playforth (44:59): Intervention, Laura (45:00): Early intervention. Call ’em and say what their intake process is and then they could tell you what steps you need. The clinic I used to work at, we would get calls directly from parents and they would say, I want to go through insurance or have my insurance reimbursed. And we would say, okay, have your doctor fill out this form with a certain diagnosis code or C P T code referral. And then it was a simpler process that way. So parents, you can still self refer ’em. And do you have any other tips for a self-referral that you can think of? Dr. Playforth (45:29): I think what you said about mom’s groups is helpful because people in your community will know who is easy to get in with or who is experienced with certain issues. Yeah, I mean leaning on your village in that way can be worthwhile. And also, I mean, the other piece I just like to say is that if your child is struggling with some of these things, it doesn’t mean that your child is step up for long-term struggle. Many developmental challenges are transient and will improve with the right interventions. It’s a key is getting those right interventions. But children are capable of often of developing skills that can help them manage those challenges. And then the last mean, what I want to leave with is if your child is struggling, it’s not a reflection on you. It doesn’t mean you’re doing a bad job. I mean, similarly, if your child achieves milestones early, it doesn’t mean you’re doing a fabulous job either, right? Some of this is just not about you. Laura (46:28): I love that. It’s so true. It’s so true. That’s so good. Thank you so much for leaving us with that. Can you please tell people who want to learn more from you, your website, any resources you may have, please share with us? Dr. Playforth (46:41): Yeah. So I have a ton of resources on my website. I try to keep everything free, so I have a lot of stuff on what do you, if your infant is constipated, what do you do if your child is diagnosed with C O V D, step-by-step instructions, practical instructions for how to hydrate your kid if they’re sick, how do you think about a fever? When do you call the doctor? Stuff like that. I try to keep everything very practical and down to earth and accessible because there’s already too much gatekeeping to information. And I want to make sure that people know that they can get quality information from somebody that has qualifications. So it’s www.thepediatricianmom.com or at the pediatrician. Mom. I try to maintain a good sense of humor on Instagram because my toddlers are hilarious and sometimes you just have laugh to help get through some of the challenges of having a toddler. And so that’s at the pediatrician, mom. Laura (47:35): Yay. Awesome. Everyone, definitely check that out. I’ll put the links to that below in the show notes. Thank you again for being with us here today, Dr. Play Forth. Dr. Playforth (47:43): Oh, it’s my pleasure. Speaker 2 (47:46): If you enjoyed this podcast, please consider rating it and leaving a review, which helps other parents find me as well. Want to learn more from me. I share tons more over on Instagram at the OT Butterfly. See you next time.