This page explains how various health care professionals can offer assistance with movement, speech, developmental and other day-to-day skills to children with heart conditions.
Physiotherapist
What is a physiotherapist?
Physiotherapists (also called "PTs" or physical therapists) are health care professionals who prevent, identify, and correct movement problems. These problems can result from illness, injury, or birth defects. The goal of physiotherapists is to promote optimum physical health and mobility for children. They work closely with other members of the health care team, including nurses, doctors, respiratory therapists, and occupational therapists.
Physiotherapists assess, treat, and provide consultation to children who have cardiorespiratory (affecting the heart and lungs), neurological (affecting the brain/spinal cord/nervous system), and musculoskeletal (affecting muscles and bones) problems.
On the cardiology unit at some hospitals, PTs see all children over the age of 3 before they have surgery to help prevent respiratory problems after surgery. They also provide treatment to children who do go on to develop respiratory problems after heart surgery, or children who have developmental needs or other types of movement difficulties.
Why might your child need a physiotherapist?
If your child is 3 or older, it is important that they see a physiotherapist before surgery to learn and practise preventive exercises. The right activities can help prevent problems like pneumonia, lung infections (e.g. pneumothorax), and weakness due to immobility. The physiotherapist will explain what to expect in terms of activity after the surgery. If your child develops respiratory problems following surgery, a physiotherapist may be involved to assist in improving your child’s lung function.
The need for a physiotherapist is not usually tied to a certain type of heart condition, but more to the length of time a child is in bed immobilized and not active.
How would your child see a physiotherapist?
At some hospitals, if your child is 3 or older, you and your child will automatically have a pre-operative visit with a PT. If, after surgery, your child is having breathing problems, the doctor will refer you to a PT. If your child has developmental needs or is showing other signs of neurological or musculoskeletal problems, a PT can help to address these types of movement problems as well. If your child is having a heart transplant, a PT will be very involved with your child both before and after surgery.
Occupational therapist (OT)
What is an occupational therapist?
Paediatric occupational therapists (also called "OTs") are health care professionals who work with children to help them overcome physical problems caused by conditions and diseases in order for them to grow and develop properly. Their goal is to help decrease the impact of disability on children, enhance their quality of life, and enable functional independence.
For example, the OT works with your child and family to help with:
- your child’s ability to do things for themselves (self-care), such as eating, bathing, standing to pull up pants, buttoning a shirt, or tying shoelaces
- play skills, such as playing with toys or playing a game, moving to get a toy, or playing with friends
- school skills, such as attention and memory skills, being able to organize tasks, printing, or writing
The term "occupational therapy" may be a bit confusing as it applies to children, since "occupational" generally means "job related." When it comes to children, however, it refers to the functional skills and behaviours that are essential to common activities of daily living, like self-care, playing, and school skills. Think of it this way: a child's job is to grow and develop. This is critical to how a child copes with a heart condition or recovers from surgery to correct a heart defect, for example.
Occupational therapists do some work that is similar to the work of physiotherapists, although PTs focus more on range of motion, orthopaedics, musculoskeletal concerns, and chest physiotherapy.
What is the OT's role on the cardiology unit?
On the cardiology program, the OT provides developmental and feeding assessments and intervention for children during their hospital stay, or when they visit a clinic. A feeding problem may be the result of a congenital heart defector a heart-related syndrome like Down syndrome. It could also be the result of a complication that occurred during surgery, for example. The same may be true for developmental problems, which may also be tied to long periods of time in bed.
OTs tend to work mostly with babies, but do see children of all ages. OTs work in collaboration with other members of the health care team, including nurses, doctors, social workers, dietitians, and physiotherapists.
What feeding problems need addressing?
Sometimes an infant with a heart condition experiences difficulty with oral feeding. The OT will assess and provide treatment recommendations to improve oral feeding and swallowing function so that the child can eat safely and efficiently.
There are a number of possible reasons why a child with a congenital heart defect (CHD) may experience difficulty with oral feeding. Sometimes a condition can make it hard for your child's heart and lungs to work properly. This can affect your child's ability to breathe and take in enough oxygen, both of which are needed to feed effectively. Your child may experience fatigue and decreased endurance as a result. Also, heart conditions and their treatments can sometimes affect the body in other ways, making it difficult for your child to do the sucking and swallowing necessary for feeding.
Some children might need help moving from tube feeding to oral feeding, or progressing through different textured foods. Other children may be struggling with gastrointestinal problems or a sensitive throat after being intubated, while some simply need to be prepared to manage a feeding tube and oral feeding after an operation.
Depending upon the specific feeding issue, the OT will recommend feeding strategies such as changing the feeding equipment or method, altering the feeding position, or providing techniques to change the flow rate of liquid. All interventions are specific to the individual needs of each child.
How would your child see an OT?
A doctor or nurse may refer your child to an OT if they, or you, have concerns about your child's development or feeding ability.
What does the OT look for?
When evaluating children at risk, OTs look for possible signs of developmental delay. They do in-depth developmental, functional, and feeding assessments. They look at things like movement patterns, muscle tone, head control, and reflexes. The assessment may also involve the use of diagnostic tools, like X-ray. Once the source of the problem has been identified, the OT will develop and put in motion a care plan for the child that will be carried out by the family and the health care team.
How will the OT help your child?
If there is concern that your child is not reaching developmental milestones, the OT will assess, provide therapy, and make recommendations to help. The OT assesses your child’s developmental function in a number of different areas, including:
- motor skills: movement, fine motor, and gross motor skills
- personal-social skills: play skills and making friends
- cognitive skills: attention, memory, and problem-solving skills
For example, if an infant appears to be behind in achieving early movement skills such as rolling, sitting, or crawling, the OT will assess and provide specific therapeutic play activities or exercises to help. They may use direct intervention, bedside programs, home programs, or caregiver education, or a combination. The OT can also connect families with therapy services within the community if needed.
Speech-language pathologist
What is a speech-language pathologist?
A speech-language pathologist is someone with expertise in human communication and swallowing disorders. They are part of the health care team. These health care professionals provide services to infants, toddlers, preschoolers, school-aged children, teens, and adults.
Why would your child need to see a speech-language pathologist?
Your child might be referred to a speech-language pathologist if they have:
- speech difficulties: problems babbling or pronouncing words, or problems speaking fluently (e.g. stuttering)
- language difficulties: trouble understanding verbal and non-verbal language, trouble with expression (finding the right word, putting ideas and sentences together), trouble with memory or problem solving, trouble understanding written language (reading, writing), and communicating in social situations
- voice difficulties: voice too breathy, nasally, loud/soft, etc.
- feeding and swallowing difficulties: trouble swallowing liquids or foods, coughing, choking, slow eating associated with weight loss
