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So my 11 month old has seen a private physio who is referring her for NHS physio - anyone else been in this situation?

(10 Posts)
currymaid Tue 07-Jul-09 22:22:28

I've posted before about DD who is basically immobile.

Saw a private physio 2 weeks ago and DD made some good progress. Saw her again today and she was happy with her progress and has also written a letter asking the GP to refer her for NHS physio.

I just want to get a handle of what my expectations should be. Physio's letter to GP says this:

"I would be grateful if you would consider referring this little girl for NHS physiotherapy.

XX's mother contacted me with concerns regarding XX’s motor development and excessive ranges of movement. At 10.5 months, she could sit independently when placed but not roll or tolerate prone.

At her initial assessment on 25/06/09, I found her muscle tone to be a little low, but within normal limits. The ranges of movement in her upper limbs, feet and knees was fine; but her hip abduction excessive, with 90º bilaterally.

Functionally, I found that XX was reluctant to move; she was able to sit but only move out of her base of support forwards. Until the end of the session she would not tolerate prone at all, but then surprised us by rolling over onto her tummy when placed on the floor and encouraged to reach for a toy. She was unable to roll onto her back and seemed fearful of the movement when assisted to do this. She would not put her hands on a supporting surface to hold herself in standing.

I provided XX's parents with activity and handling advice and reviewed her earlier today. She has made very good progress. She will now roll on to her tummy easily and push up well on her arms. She still needs help to roll on to her back and still seems a little fearful of this at times. She stood by herself, with support from a low table. In sitting, she reached well out of her base of support to the left and sat back up independently, but was reluctant to reach to the right and pivoted so she could reach forwards.

Whilst XX has made excellent progress, I think she may need more physiotherapy and would be grateful if you would consider referring her to the Child Development Centre."

I asked the physio if she thought DD would ever crawl as I know some babies don't and it's not necessarily a milestone and she said she thought she may. I guess I just wondered if anyone has been in the same boat as I need someone to manage my expectations -e.g. 'don't expect this child to be moving before 18 months'

Sorry for the essay sad

FairLadyRantALot Tue 07-Jul-09 22:25:19

tbh, not really know what you can expect, but by the sound of it, the physio has/is doing all the right things...and with further help your lo should be able to progess well...
wishing you all the best !

currymaid Tue 07-Jul-09 22:31:54

Thanks FLRAL.

idontbelieveit Tue 07-Jul-09 22:36:20

Hi can't help with expectations but my daughter has been seeing an NHS physiotherapist for about 3 months (she is now 5 months) and I've been really pleased with the improvement (she has problems with her left arm and hand). Just wanted to say that my experience with the NHS has been great so hopefully yours will also be good, definitely good to have another physio take a look at her and get another opinionsmile

currymaid Tue 07-Jul-09 22:41:36

Thanks idontbelieveit smile

MollieO Tue 07-Jul-09 22:45:51

Think you've had a similar thread recently, or someone else has! Ds didn't sit up until 10 months and didn't walk until 22 months (9 months after the latest of his playmates). He has hypermobility and no treatment until he was walking as his paed wasn't concerned - seen every 6 weeks for other health (lung) concerns. Ds had NHS physio which was fab and we had lots of exercises to do at home. He will always be hypermobile but muscle tone is excellent and consultant confident that he will be able to participate in most activities.

I suppose because ds was seeing a consultant so regularly it didn't occur to me to seek another - private - opinion. The only time we went private was to see a consultant paed orthapedic surgeon as there was no NHS one locally but fortunately he decided that ds's hips didn't require a plaster cast!

Although I have private health insurance I have always chosen to use the NHS for ds's treatment. The care he has received has been faultless.

Milco Tue 07-Jul-09 23:06:42

Hello Currymaid

Not sure how helpful my experience will be, but thought I'd share in case it is. My son at 11 months was similar to how you describe your DD - could sit well but showed now interest in crawling or pulling up. He had rolled a few times from tummy to back (first at about 4 months corrected age (he was 10 weeks prem, so at that point all his motor milestones happened closer to his corrected age (ie age from due date) rather than real age)) but really didn't like being on his tummy. Even though he could roll in theory he always seemed to "forget" and would whinge and wail on his tummy so much before thinking about rolling that we hardly ever put him on his tummy. I don't think he had ever rolled back to tummy. He was therefore basically immobile, as you describe your DD.

On his first birthday he was for the first time encouraged to take "steps" with someone holding both his hands. But still no crawling or pulling up, and only a very slight attempt at bum-shuffling if very keen to get something. Generally his approach was to get someone's attention and get them to help him get it instead!

Anyway, he is now just over 17 months, and has been walking properly for almost 2 months. From his birthday onwards he has basically learned to be mobile through people holding his hands, and gradually he has required less support from them. He still would much rather you helped him up than he pulled himself up! Due to his prem-ness we see a consultant every 6 months. The last check was a month ago. Despite the fact he still can't (or doesn't) get to his feet fully alone, the doctors are happy with his progress.

So when he was just a year, I was wondering how on earth he was going to get mobile. An now he's done it. An unconventional route - which has caused me considerable (though probably unneccessary with hindsight) worry - but who cares really?

I know some aspects of your DD's case differ a bit (we didn't have a formal assessment of my DS at that stage so don't know how he would compare anyway), but hopefully this might offer some reassurance that it might not take as long as you think. The frustrating thing is, one can never know how long in ones own case until its all over. Good luck to you and your DD.

currymaid Wed 08-Jul-09 08:19:13

Thanks both.

Mollie it's not really the private/NHS treatment side of things that I have queries about. I'd just like to get an idea of what I can expect from DD in the next year or so, so that I am not expecting too much or pushing her too hard but I'm glad to hear your NHS experiences were positive.

Milco, that's interesting to hear, thank you. The main issue with DD is that she seees frightened or cross to try anything new. She was red-faced and tearful when we attempted to get her to roll on to her back form her front but then stopped crying and started grinning as soon as I picked her up - so not anywhere as incosolable as she appeared.

I'm really struggling with how far I should 'push' her or whether I should let her get on with it herself (which she won't, so I guess that is my answer).

Milco Wed 08-Jul-09 20:26:20

I had exactly that dilemma with my DS too. Especially as when I went to see the HV (when DS was cruising but still could pull up or get himself back down safely from something he was holding on to)she told be I needed to say "no" to him more and refuse to pick him up/put him on his feet until he learnt to do it himself. Though she said I hadn't done anything "wrong", she implied that if I didn't come to help him all the time he would be more developed than he was.

I did then try her approach - putting him in front of things he could pull up on with his drink/snacks/toys etc on top as an incentive and such like. A few times he did manage to pull himself up, but with a lot of crying before hand. Trouble is, it made me unhappy - particularly as sometimes I would leave him (me in the room or nearby) for several minutes (even maybe 10 on occasion) and he would just wail and still not make efforts to pull up (or whatever). I got quite down about it, and I felt it was making us both miserable.

In the end (with quite a bit of wavering in between) I have generally abandoned that approach. Instead I have tried more subtly to help him do/learn new things - for example deliberately putting less effort myself into getting him to his feet, so he does more - giving him my hand to help him get from lying to sitting (which at 17 months he still can't or doesn't do on his own).

Certainly in my DS's case, I think part of the issue is inclination rather than ability. I'm pretty certain he has the building block skills now to get from lying down to standing up, but he just doesn't put them all together to achieve that end goal. The consultant said as soon as he has done it once or twice he will remember and do it all the time. I guess he will- but I just think its not too high on his priority list at the moment! He is quite a sociable, affectionate chap and he seems quite happy to be reliant on his mum for rather longer than most. I have found this very frustrating at times, but in the end have decided to go with the flow and accept it. It is, though, much much easier now that he is walking, so he can do quite a lot independently now.

You mention your DS seems upset at trying new movements. Could it be frustration at not being able to do things herself? Or being made to do something she doesn't want to? I assume no one has suggested she is in pain?

Anyway, this is another long post. But my basic point is, I would try to encourage your DS gently, but in my experience, pushing too hard doesn't achieve a great deal and might well cause psychological harm to one or other of you or both! I'm sure your DS will do things when she wants to and is able - you can help a bit with the latter, but not the former, I guess.

currymaid Wed 08-Jul-09 21:08:54

Thanks Milco, that's really good to hear and basically reinforces what I have been thinking.

I've had quite a few well-meaning comments about how DD obviously doesn't do things for herself because she just cries and I do them for her. At the moment it still feels more wrong for me to ignore her crying than it does to just help her with what she wants.

I agree in that just leaving her to her own devices makes both of us upset, and that doesn't help at all.

Interestingly the private physio (who was great) has now asked us to concentrate on helping her to learn to sit from lying down, and also rolling the other way. She is getting there with sitting up with just a bit of support from us. I guess I'm just a bit worried that once she can sit from lying she will never bother to learn to move!

Hand on heart I do think she is fine, and seems to be following my development process as a child. The only point at which is becomes hard is when I see her with similar aged babies, or even quite a big younger and it seems quite stark that she is not doing as much. That, however, is my problem, and not DD's so I really need to sort that one out myself!

THanks again smile

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