My child's OT recommends a physiatrist

[Anonymous]

Hi, my DS is 4 and has gross motor delays and motor planning problems in addition to general weakness on one side versus the other. His OT recommends that he get evaluated by a physiatrist. (Not psychiatrist--he has no mental health problems. A physiatrist does muscles and nerves, I think). Any ideas on what to expect? Any experience on what they will do or what they are looking for?

[Anonymous]

Does he have a developmental pediatrician? Probably a good idea to see what if anything is causing his motor delays.

[Anonymous]

I would start with a developmental pediatrician too. I thought physiatrists were for rehabilitation, e.g., after an injury or illness.

My 4 year old sounds like your four year old plus mine has a speech delay.

[Anonymous]

I think you got an excellent suggestion. I too would start with a physiatrist first or a neurologist since there is a weakness on 1 side and motor planning issue. Pediatric physiatrist are not just for rehab. They also are the best people to prescribe equipment, IMO.

Any speech issues?

[Anonymous]

Does he have a developmental pediatrician? Probably a good idea to see what if anything is causing his motor delays.

[Anonymous]

My son sees Dr. Nichols at Mt. Washington Pediatric Hospital -- in PG County Hospital. It is a very difficult to get an appointment, so decide to get one and get it. It takes 6 months or more for first appt. We see him once a year and it is useful. My son also sees a neurologist, gets OT etc.

[Anonymous]

Anonymous wrote:My son sees Dr. Nichols at Mt. Washington Pediatric Hospital -- in PG County Hospital. It is a very difficult to get an appointment, so decide to get one and get it. It takes 6 months or more for first appt. We see him once a year and it is useful. My son also sees a neurologist, gets OT etc.

If this is OP and you already have seen a developmental pediatrician then maybe taking a different approach might be helpful.

Also, if you DC has a speech issue too and your in PG county, you should check out LEAP at UMD:
http://hesp.umd.edu/content/about-leap

[Anonymous]

They are specialists who treat muscles, bones and nerves and how you move. They manage long term movement disorders like paralysis. They do a lot to improve function and manage pain. Your OT is suggesting that there are medical interventions which will help you child in addition to OT and PT. Go for it!

I had a client in a wheelchair who treatment from a physiatrist. It was enormously helpful for her.

[Anonymous]

Hi everyone, this is OP and I thank you for your responses. (The pp 16:02 was not me).

My son was not identified as having any issues until he was 12 months old, when his pattern of motor development had shown an odd course (i.e. He could cruise around a coffee table, but he couldn't roll over or transition from one position to another, such as from laying to sitting or pulling to a stand). We did PT with Infants and Toddlers and he "graduated" before age 3.
But as his mother, I knew he still wasn't right, and I could see his peers doing so much more than he could do. So I finally fired my under-reactive pediatrician and found a new pediatrician (not a developmental one, because at the time, he didn't seem to have severe issues). The new ped recommended that if I was concerned, we should have him seen by an OT. We now have been doing OT for a year. They work a lot on motor planning, building tone and stability, and more gross motor stuff. He has "lower" tone, especially in his core. He has no speech or cognitive delays at all. He also has no major sensory issues. But his motor skills are largely in the 5th percentile.

The physiatrist rec came when the OT stated, and I quote, " The left-sided weakness is beginning to interfere with his gross motor development" (above and beyond the the delay caused by motor planning problems).

Does this help in your feedback for me? I am truly at a loss. should we see a developmental pediatrician? Is there something else i should look into?

[Anonymous]

Anonymous wrote:I would start with a developmental pediatrician too. I thought physiatrists were for rehabilitation, e.g., after an injury or illness.

My 4 year old sounds like your four year old plus mine has a speech delay.

I'd go with the suggestion of the medical professional, in this case the OT, rather than the suggestion of the person on the internet who doesn't know what a physiatrist does. I'm sure your OT has a good reason for suggesting this route. Good luck, OP!

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would start with a developmental pediatrician too. I thought physiatrists were for rehabilitation, e.g., after an injury or illness.

My 4 year old sounds like your four year old plus mine has a speech delay.

I'd go with the suggestion of the medical professional, in this case the OT, rather than the suggestion of the person on the internet who doesn't know what a physiatrist does. I'm sure your OT has a good reason for suggesting this route. Good luck, OP!

Yes. The OT is recommending a physiatrist for a reason. Make an appointment. See what they say.

[Anonymous]

Melissa Trovato at Kennedy Krieger is excellent.

[Anonymous]

Hi OP. I remember when my child was your child's age and had similar issues, how overwhelming it was to be constantly recommended to different specialists. We have ended up seeing PT, physiatrist, orthopedist, neurologist. Each has their place. The physiatrist follows the degree of impairment and makes recommendations as to devices such as DAFOs, gait trainers, walkers, and also a long term plan for rehabilitation. She (we go to Melissa Trovato) was the one who discovered my child's hips were out of alignment.

People on this board often think that dev. pediatricians are essential for everyone, but for a child with orthopedic delays you really need different kind of specialists. This is not a behavioral issue, it is muscles, bones, and nerves. I take for granted that my child is behind in physical milestones and the feedback of a DP is not that important to me.

Kennedy Krieger also has a team approach which I really like with all the different doctors participating in a plan.

[Anonymous]

We worked with Dr. Katharine Alter, who is excellent, but don't think she takes new patients often. She is out of Mt. Washington though, so I think they have a pretty strong team there.

[Anonymous]

Anonymous wrote:Hi everyone, this is OP and I thank you for your responses. (The pp 16:02 was not me).

My son was not identified as having any issues until he was 12 months old, when his pattern of motor development had shown an odd course (i.e. He could cruise around a coffee table, but he couldn't roll over or transition from one position to another, such as from laying to sitting or pulling to a stand). We did PT with Infants and Toddlers and he "graduated" before age 3.
But as his mother, I knew he still wasn't right, and I could see his peers doing so much more than he could do. So I finally fired my under-reactive pediatrician and found a new pediatrician (not a developmental one, because at the time, he didn't seem to have severe issues). The new ped recommended that if I was concerned, we should have him seen by an OT. We now have been doing OT for a year. They work a lot on motor planning, building tone and stability, and more gross motor stuff. He has "lower" tone, especially in his core. He has no speech or cognitive delays at all. He also has no major sensory issues. But his motor skills are largely in the 5th percentile.

The physiatrist rec came when the OT stated, and I quote, " The left-sided weakness is beginning to interfere with his gross motor development" (above and beyond the the delay caused by motor planning problems).

Does this help in your feedback for me? I am truly at a loss. should we see a developmental pediatrician? Is there something else i should look into?

I am the PP who has seen Dr. Nichols. I would make an appointment with Both a developmental pediatrician and a physiatrist. It can take 6 months to see either one. You see the physiatrist to see if there are other things that need to be addressed, (i.e. Dr. Nichols just recommended an x-ray to see if my child's hips were doing OK or there was more of an issue than just joint looseness). You see the Dev. Pediatrician who sort of has an overview of things your child may need. He may ask for tests to be performed. My child (at 12 months) was asked to take many many tests, of which I didn't think any of them would reveal anything, but lo and behold, one of the tests gave a diagnosis which led us to see other specialists to rule out other issues we never would have known to look for.)

My child see's Dr. Gersh at CNMC - Laurel, and I recommend him. I like him more every time I see him. He is not a cuddly type of personality, but he is very knowledgeable and really keeps up and makes very good recommendations.

Good Luck, and don't delay because it can take awhile to get an appointment.