Hi all,
I'm on my paeds prac at the moment, and I'm seeing lots of babies with torticollis, plagiocephaly and preferential head turn (so that assignment we did last year has come in really handy). From seeing quite a few of these infants, it really does highlight the importance of knowing what "normal" is, but also keeping in mind that "normal" has a huge range. There are so many different factors that might be affecting the infant, that we don't really consider. For example, playing in the prone position (or tummy time) is encouraged ++++++. However, I saw one baby that was incredibly chubby, and reportedly didn't like "tummy time", which wasn't that surprising because it wasn't a really easy position for him to be in because of his chubbiness. So, to encourage tummy time, we suggested that the baby could be held in the prone position by the mother when standing, with one leg up on a chair and the baby resting on the leg (because he was heavy). It really highlights that we need to look at the overall picture when we are assessing, because something that we might not have learnt about or expect may be affecting the patient, and we need to be able to give treatment that will actually help fix the problem, and consider that there are random things that will hinder the treatment, and we need to work around it, and not just give a prescribed treatment for every patient that we see who has the same problem.
2 comments:
I think you are definately right, but its funny I think that is something we would all automatically do for an adult. I think we have had it drilled into us to tailor the Rx session for the patient- don't automatically mob the Lx spine, only mob if its restricted, dont treat every MS pt the same, consider the stage of recovery when treating a GB pt etc. But when it comes to paeds it's funny that you say that because I too found paeds needs a little more thought when tailoring the Rx- maybe we arent used to handeling bodies that small? or maybe its because we do our OSPEs and prac time on dolls, which are obviously all the same. I suppose with experience it will come as naturally as it does with adults.
Did you know that in some circumstances when the baby doesn't like to be in a prone position could also be that they have a congenital heart defect. And the moment they lie prone, their work of breathing increases becuase they have to work their ribs against a surface, inadequate venous return, increased work on the heart etc. obviously they will cry if you put them in prone, but their are many other factors.
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