Prematurity and Babies with Complex Needs
Multi-disciplinary teams - who's who?
Physiotherapist
Your first appointment
Where will it be?
Your child’s first appointment may take place at one of the following places, but will be decided with you:
- your local health centre
- your local Children's Centre or Family Hub
- your child’s pre-school or school
- your home
What will happen?
Your first appointment will usually last between 30 and 60 minutes.
The therapist will discuss and write down your concerns and find out more about your child and the difficulties they are having.
The therapist will ask for some background information including birth details, health issues, and talk about your child's general progress and family history.
There will be opportunities for your child to play while you chat to the therapist. Older children may be involved in discussions.
After discussions, the therapist may need to assess your child in more detail to find out their specific needs and to see if further support is needed.
How will they assess my child?
The therapist may use one or more of the following ways to assess your child:
- watching your child playing and looking / listening to what they can do
- playing with your child to informally check their skills
- undertake formal assessments or tests which will give more information about their skills.
The therapist may also need talk to your child's nursery/playgroup or school teacher to get more information about their strengths and difficulties.
What happens after the assessment?
- The therapist will talk to you about their findings and decide if further support is needed.
- All recommendations and findings will be clearly explained to you.
- You will have the opportunity to ask any other questions you may have.
- The therapist may need to talk to other professionals, for example pre-school or school staff, and explain the assessments and what they need to do to support your child. This might include what targets or activities are needed and who will carry them out.
- At the end of the appointment your therapist will talk to you about what happens next and what the arrangements for this will be.
- A report will be written, and with your consent, shared with other professionals eg GP and school staff so everyone is aware of what the plan is. The report will include advice and recommendations for supporting your child's development.
- You will be actively involved in managing your child's care alongside your child’s therapist and other professionals.
For more information click here.
Occupational Therapist
What do we do?
The occupational therapy team supports children with specific difficulties which affect their ability to plan and carry out the movements required for everyday tasks. These difficulties may affect their awareness of their surroundings and self-care skills, which may impact on the child performing independently. We provide support to children across the whole of Hampshire, Southampton and Portsmouth.
Who do we help?
Occupational therapists provide support and advice for children to from birth to 19 years. No types of difficulty or disability are excluded as we give support based on need, not diagnosis.
We support children with one or more of the following difficulties:
- sitting and positioning
- handwriting and using a pen / scissors
- co-ordination affecting self-care skills (dressing, eating, toileting)
- co-ordination affecting independence (riding a bike, social games, physical education (PE)).
How can we help?
Occupational therapists assess children to build up a picture of their skills and find out their exact abilities, difficulties and needs. This may include one or more of the following:
- formal assessments or tests
- informal play-based assessment
- watching the child at nursery, school or home to see how they move
- talking with those who know them best and speaking to other professionals involved in their care.
After your first appointment, if further support is needed, we may suggest one or more of the following.
- advice and coaching to parents, carers and other professionals to help them apply practical ideas to support your child
- training and advice for parents and other professionals involved in your child’s care
- direct therapy, either individually or in groups
- activities and programmes for home and pre-school or school
- advice on specialist equipment that may be needed to help with seating
- advice on specialist activities to help handwriting
- discussion and liaison with other agencies to allow us to work together to meet your child’s needs
- onward referral to other agencies or professionals who may be able to help
- advice from another member of the Children’s Therapy team.
You will be involved in the decision-making process about your child's care at all stages. We will always review your child's progress with you.
Links
- For more information on disabilities - https://www.scope.org.uk/
- For more information on babies born premature- http://www.bliss.org.uk/
- For more information on Dyspraxia - http://dyspraxiafoundation.org.uk
- For more information on hemiplegia - http://www.hemihelp.org.uk/
- For more information on Autism - http://www.autism.org.uk/
For more information click here.
Speech and language therapist
What do we do?
The speech and language therapy team supports children with speech, language and communication needs and those with feeding and swallowing difficulties. Speaking and eating uses the same muscles and speech and language therapists are specially trained to help with specific difficulties with feeding and swallowing. Some children we see may have a medical condition or diagnosis or learning difficulty, but many do not. We provide support to children across the whole of Hampshire, Southampton and Portsmouth.
Who do we help?
Speech and language therapists provide support and advice for children from birth to 19 years old. No types of difficulty or disability are excluded as we provide support based on need, not diagnosis.
We support children with one or more of the following difficulties:
- unclear speech (speech sounds)
- not understanding what is being said (understanding of spoken language)
- vocabulary and putting words together into sentences (spoken language)
- mixing with other children and adults (social communication skills)
- only speaking in certain situations (selectively mute)
- stammering or stuttering
- hoarse or husky sounding voice
- hearing impairment / deafness.
How do we help?
Speech and language therapists assess children to build up a picture of their skills and find out their exact abilities, difficulties and needs. This may include one or more of the following:
- formal assessments or tests
- informal based play assessments
- watching the child at nursery, school or home to see how they communicate or eat / drink
- talking with those who know them best and speaking to other professionals involved in their care.
After your first appointment, if further support is needed, we may suggest one or more of the following.
- advice and coaching to parents, carers and other professionals to help them apply practical ideas to support your child
- training and advice for parents and other professionals involved in your child’s care
- direct therapy, either individually or in groups
- activities and programmes for home and pre-school or school
- discussion and liaison with other agencies to allow us to work together to meet your child’s needs
- onward referral to other agencies or professionals who may be able to help
- advice from another member of the Children’s Therapy team.
You will be involved in the decision-making process about your child's care at all stages. We will always review your child's progress with you.
Links
- For more information about communication - http://www.communicationmatters.org.uk/
- For more information about Afasic - A voice for life - http://www.afasic.org.uk/
- For more information about Makaton (signing) - https://www.makaton.org/shop/
- For more information about Autism - http://www.autism.org.uk/
- For more information about Stammering - https://www.stammering.org/
- For more information about deafness - http://www.ndcs.org.uk/
- For more information about Cleft Lip or Palate - https://www.clapa.com/
- For more information on Children's Communication - http://www.talkingpoint.org.uk/
For more information click here.
Psychiatrist
A doctor who works in psychiatry is called a psychiatrist . Psychiatry is a medical field concerned with the diagnosis, treatment and prevention of mental health conditions.
Unlike other mental health professionals, such as psychologists and counsellors, psychiatrists must be medically qualified doctors who have chosen to specialise in psychiatry. This means they can prescribe medication as well as recommend other forms of treatment.
Mental health conditions that may be diagnosed and treated by a psychiatrist include:
- anxiety
- phobias
- obsessive compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- personality disorders
- schizophrenia and paranoia
- depression and bipolar disorder
- eating disorders, such as anorexia and bulimia
- sleep disorders, such as insomnia
- addictions, such as drug or alcohol misuse
Psychiatrists may also provide psychological support for people with long-term, painful or terminal physical health conditions.
Dietitian
Dietitians are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public-health level. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
Dietitians work with healthy and sick people in a variety of settings. They often work as integral members of multi-disciplinary teams to treat complex clinical conditions such as diabetes, food allergy and intolerance, eating disorders, malnutrition, kidney failure and bowel disorders. A key role of a dietitian is to train and educate other health and social care workers. They cannot offer advice where there would personal financial benefit.
Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. Only those registered with statutory regulator, the Health & Care Professions Council (HCPC) can use the title of 'dietitian'. The minimum requirement is a BSc Hons in Dietetics, or a related science degree with a postgraduate diploma or higher degree in Dietetics.
The term 'nutritionist' is not currently protected by the Health Professionals Council and so its use is less precise than 'dietitian'. Indeed, currently, anyone regardless of qualifications, experience and skills can call herself or himself a 'nutritionist'. Some nutritionists are also registered dietitians. Association for Nutrition (AfN) is the professional body for qualified nutritionists. The AfN maintains the UK Voluntary Register of Nutritionists (UKVRN), a competency-based register of individuals who are qualified and competent in nutritional science and practice.
Therapy / self-referrals
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
Self care and Prevention
Video Showcase
