Brittany Norton

Northland Community and Technical College

Occupational Therapy Assistant Program
Pediatric Case Study
Child Age and Identifying Information:

Charles, 4months

Description of Diagnosis:
Pertinent information in treatment of Diagnosis:
Type of Setting:
Frequency/Duration of OT
Clients assets:
Problem/areas that need to be addressed:

-Pre mature and has respiratory distress

-Problems transitioning from tube feeding to oral feeding
-Outpatient
-2x a week for 30 minutes for 3 months
-Taking bottle without screaming throughout the process,
mother only works for 3 days but 12 hours a week, dad helps
out as much as possible
- father is nervous about taking care of Charles for it is the first
born and he is having these problems, Charles is only sleeping 2
hours at a time, sensitive around the mouth, difficulty
transitioning from tube feedings to oral feedings.
Charles will sleep 4 hours at a time within 1 month
.- pressured blankets/ swaddle
-1. Heavier blankets and put into a tight swaddle when putting
them to sleep
2. If using a pressured blanket- blankets must be ten percent of
the childs weight plus one pound.
3. OT will teach parents how to swaddle the infant:
- Lay blanket in a diamond shape. Fold top corner down. Place
baby on top
- Pull one side of blanket across baby's chest. Tuck under
opposite arm
- Fold bottom of blanket over feet and tuck behind baby's
shoulder.
- Pull remaining side of blanket across the baby's chest. Tuck
underneath.
- teach both parents how to swaddle the infant using a fake
baby and then the real child.
- use swaddling technique when feeding and doing
desensitization techniques as well as when putting to sleep
-skills: positioning of the body, discerning of touch and
pressure, anticipating different technique,
-establish/ restore, modify, create and promote
-purposeful/ occupation based

STG #1:
Treatment Intervention:
Step of Treatment Intervention:
Skills/Areas Addressed:
Intervention Approach:
Type of Intervention:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
Type of Intervention:

Soft peaceful music/ darkness and lights- both parent will look up and create list of different sleeping
techniques to help a child sleep: this will include other
swaddling techniques if need be, darkness of the room- if
needing heavy duty blinds, if a nightlight is appropriate for
their child- this will be demonstrated through trial and error.
-1. Soft music will be played while the child is sleeping during
nap times, and throughout the night, the parents will then
incorporate other strategies found during these times.
Skills: hearing the musics, timing appropriateness of falling
asleep, responding the music with becoming tired
-create/ promote, modify
-purposeful
STG #2:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
Type of Intervention:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
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-1. Charles will take a bottle without screaming throughout

process within 1 month.
- Oral desensitization- 1.Using firm touch and at least 2 fingers, start at the forehead
and draw a heart shape around the eyes, down along the
cheeks, and to the chin.
2. Using the same firm touch, drag fingers from outside areas of
the mouth towards the mouth opening. Move all the way
around the mouth in this fashion.
3. Using firm touch, take your fingers and rub along the gums:
both sides, top and bottom.
4. Using firm touch, stroke the tongue with finger tip. Start with

finger at the midpoint of the tongue (if tolerates) and pull

forward to the tip.
- Some babies or children do not tolerate touch well initially, so
if he or she is unable to tolerate a certain step, respect that, and
slowly progress them over time.
- while completing the desensitization techniques, the child
should be swaddled in blanket and held in one of the caregivers
arms as the other performs the technique.
- the parents will take turns holding and performing the
technique so the father can get more involved in the process and
feel comfortable.
-skills: positioning the body, discerning touch and pressure,
persisting through task, controlling emotions, initiating when
wanting to be fed
- create/ promote, prevent
- preparatory
-

LTG #1:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
Type of Intervention:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
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LTG #2:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:
Intervention Approach:
Type of Intervention:
Treatment Intervention:
Step of Treatment Intervention:
Skills Addressed:

Oral desensitization
1. Taking rings from a play toy and putting them in
his mouth.
2. Starting out with smaller rings and bringing them
up to his mouth with hands/ feet, and play with them
dangling in his face.
Child may lay supine or prone whatever their
preference is
-skills: Positioning the body, pacing tempo of
movements, discerning pressure and touch, persisting
through task, sequencing tasks,
Create/ promote, prevent
preparatory

Charles will take in 30-45 oz of food 4-6 times a day in 3 months

without screaming throughout process.
Tongue strokes- Suckling
1. Complete rhythmic rolling of your forefinger onto
the tongue at the midpoint stroking towards the front
2. Do only as much as the baby tolerates, stop if
needed
Skills: positioning of the body, discerning with
pressure and touch, persisting through task, utilizing
desensitization techniques,
Create/ promote, prevent
Preparatory
Sucking
1. Continue with tongue strokes.
2. Pacifier tugs or bottle tugs
3. Complete short, gentle pulls away from the child
while the pacifier is in the mouth to assist with
strengthening the latch.
4. If doing during bottling, do it during the middle 1/3
of the bottle.
Skills: positioning of the body, attends to task,
accommodates to task, discerning between touch and
pressure
Create/ promote, prevent
Preparatory
Charles will sleep for 6 hours at a time within 3 months.
Playing with child hour before nap/ bed time
-1. Play with multiple toys while utilizing tummy time an hour
before bed/ nap time
-2. Activities include during playing time: the rings for
desensitization and having him reach for them while prone:
having little ducks in front of him and promoting him to reach
for them and bring them to his mouth; playing with sensory
boards with different materials on them and when he pulls

Intervention Approach:
Type of Intervention:

them off it would make a different sound due to the texture;

playing with a toy that when you press the buttons the button
pressed would make a certain sound; playing with different
rattles and stuffed animals out in front: playing with measuring
cups and teaspoons on a baking pan and promote banging and
bringing the items to his mouth
-skills: positioning of body and head control, coordinating body
movements to reach out in front, hearing and locating the
sound, visually determining where to press, discerning of touch
and pressure when brining/ promoting to bring to mouth,
persisting through task
- create/ promote, prevention
- preparatory, purposeful
Have set nap times throughout the day
Make a schedule that includes the desensitization
techniques, hour of play before bed time of 3
scheduled sleep times throughout the day.
1. Parents will keep track of all activities in a planner
and note when things were performed, and for how
long (napping). They will bring this planner to the OT
session one a week to see improvements and
consistency as well as if there needs to be other
recommendations made.
2. Use the desensitization techniques, incorporate the
hours of play and then put in bed to sleep using the
swaddling technique and playing soft music.
3. If child wakes before six hours is up, wait a few
minutes hour before approaching him and entering
room to get him up so he understands that nap time is
crucial. If crying is persistent for 15 minutes you may
enter the room to get him.
Skills: hearing the music, timing of when to wake up,
discerning between touch/ pressure, responding to
child when he awakes and timing appropriate moment
of when to get him, as well as when to put him to
sleep, persisting through task despite frustrations,
organizing a schedule including all necessary items
and steps to take to put him to sleep, and prioritizing
those steps, acknowledging hes awake at an
appropriate time.
Create/ promote, remediation, maintain
Purposeful/ occupation based