So I am a COTA working at a school setting with preschoolers. I mainly work on fine motor and visual motor activities with them. I know the developmental stages of pre-writing/handwriting with ages and stuff. However, if I have a child who has sensory issues it usually is because they need noise cancelling headphones or require joint compressions to soothe or calm them. But the other day I had an IEP meeting where this little girls family is frustrated because they can’t keep her shoes on because she likes the feeling of different textures on her feet. I asked if they’ve tried to give her a choice on the design of the shoe or if they’ve tried other materials. They said they’ve tried everything, so I really didn’t know what else to say besides I will do my research to try and help with that issue and be in contact with them. I felt dumb because I didn’t know an immediate answer to their concern. I’ve now made a plan for them, I know it’s like trial and error. But still; can’t help to overthink and think I’m not competent or smart enough especially when it comes to the sensory topic. I don’t really deal with a lot of sensory issues often :( venting . Anybody else has felt like that? Ps I’ve only been working as a COTA for 2 years at the school.
Smartest doctors feel dumb too. You think they have the answers to all...no.. they use google, they use their books they have on their shelf as resources because there not ONE solution to everything. The human body is complex as fuck. I always though our vestibular (inner) system was the same for all but NO it varies turns and shapes on everyone, thickness and all so NO dont think you are dumb. Never validate that feeling. Say, I will do my best to find the solution (to yourself) and family if it helps but those thoughts are reinforced but i know you wont think you are dumb because YOU are trying to find answers, YOU are deliberately trying to find the "WHY". People who do not welcome challenge do not grow. Think of this is a challenge that you will come out on top later on if and you dont come up with the answer because of your attempt.
A person who never made a mistake never tried anything new.- Albert Einstein
You’re not dumb! Did you suggest finding an outpatient OT/COTA who is good at sensory integration stuff?
So I don’t know if it’s state specific, but when I worked in schools we were under a lot of pressure NOT to recommend outpatient OT if the child wasn’t already receiving it because then the school was responsible to pay for? Or maybe I was just a young and impressionable new grad haha FWIW, I’ve grown such a backbone now for advocating for my clients that I would probably do it anyways if it’s what I truly believed the client needed!
It’s pretty nationwide that schools are afraid of being “on the hook” to pay for outpatient anything, so schools have to be very cautious and make it very clear that MEDICAL necessities (like doctors visits or outpatient services) are not the scope of the school district to cover, find ways to “say it without saying it” to seek outpatient and use health insurance for “medical needs”
I’m at OT but answering as a mom. My kids all hate wearing shoes and I’ve completely given up on getting socks on them. One child (now 5) is particularly anti-shoe. She does understand context and gets that shoes must be worn at school, stores, restaurants and while crossing the street. Otherwise I let her be barefoot at home, at parks, to run over to the neighbors house in nice weather etc. sometimes I just bring her shoes with me to the car and don’t put them on until the last minute when she can see the shoe-requiring place we are about to enter. The shoes that she tolerates best are barefoot shoes. The cheap ones on Amazon are basically Aqua socks- very thin sole so you can feel the ground pretty well. And also these fuzzy ugh boot looking slipper shoes from target. They have a hard sole, but feel like a teddy bear inside. I’m not a germaphobe as a parent, but some people seem uncomfortable letting kids be barefoot at parks? Perhaps using wipes afterwards would be a good compromise? Also I live in California so we do have a lot of barefoot options most of the year so maybe none of this works for you.
11 years in peds. Parents/teachers never stop asking you to solve the most bizarre problems. Sometimes the answer is “I don’t know. Sometimes kids just do stuff like that.” After 11 years and having my own children, if there is one thing I know for sure about kids, it’s that you can’t force them to do anything. It will be their decision. Sometimes all the BIPs, rewards and sensory strategies in the world don’t matter. It’s not you. It’s the kids 😂
You are right about this! Thank you so much for your comment.
It's ok to not have immediate answers even though you may feel you need to in meeting situations. It takes time to problem solve and to work out personalised plans for service users....that's why OT is amazing - we want to make sure our interventions are tailored and suit the person.
In cases like that I always feel it's better to recognise that it's a new goal and something you'll be working on with the service user which can take time if it's an area you feel confident in.
Its also really cool when practicioners acknowledge their scope of practice. If we need external supervision, training or support to help with interventions then being honest about that is your best bet. Doing your research is all part of the role.
You sound like such wonderful, caring practitioner with your service user at the forefront of your mind. That's so important! 🌱
Also please don't forget you're doing the best with the tools you have, you're enough 💚
You’re right, as OT practitioners we are always learning new things which is great!! Thank you so much for your kind comment
If you ever feel like you don’t know the answer, ask more questions. It helps you feel more in control.
Example: have you tried offering choices? Doesn’t work. What have you tried? Everything Can you give me an example? Different shoes, different socks… What does it look like when you have her put them on? Does she throw them? Does she run away? When we ask her to put them on, she just melts into the floor. And I’m sure that feels very out of control for you. Besides the ideal situation where you ask her to put them on and she listens, what would you like it to look like? Maybe if she can just wear any shoe at all. Crocs, boots, fuzzy socks, white socks. I don’t really care. Okay great. I think we can work toward that.
You didn’t give any immediate answers, you just asked more questions.
Hello 👋🏻I am a mommy of 3 and 2of my children are special needs . My oldest is 15 non verbal with autism (uses an AAC) and has massive sensory issues . My youngest is 15 and she has hydrocephalus , hypotonic muscles , developmental delays and sensory processing issues . Both of them have had issues with keeping their shoes on and I thought I would let you know what we have done in the past to keep them on their feet lol . Also, you are not dumb and you clearly have a huge heart for your patients and your career otherwise you wouldn’t be scouring the internet for feedback . We used brushing and different textures to prepare their feet in the early days . My oldest is sensory seeking and my youngest is very sensitive . For my oldest we used high tops and then we’ve used easy peasy slip ons . The high tops are helpful because when they are working to take them off you can usually catch them in time to redirect them . The slip ons are for easy take off , easy put once they get to a point where they are more independent . It’s frustrating but that Repetition along with using the same words over and over seem to help quite a bit . “Shoes on, thank you” maybe even use shoes off as a reward provided she is willing to put them back on ❤️you’re amazing and we parents appreciate and commend you ! Keep truckin!
Thank you so much for your comment !! I appreciate it very much. This was very informative.🫶🏻 it is a whole process and can take years, and definitely something that my students family would have to work on at home because 30 minutes a week of my OT time at school isn’t really gonna do much unfortunately if they aren’t working on it at home. According to her teacher mom tells my student to take off her shoes and socks before entering the classroom so she’s kinda enforcing that behavior I guess.
New grad OT here - there’s so much to learn and we cant know what we dont know. I dont think you should feel bad for not having an immediate answer. It’s great to be open and just say, I can’t answer that question right now but I will look into and get back to you with some more information. Thats what one of my OTs told me on one of my placements
OP don’t be hard on yourself, I think that was a great answer! and i see a lot of sensory kiddos home visits, direct and consult minutes at school. i can’t tell you how many times i tell a teacher “hmm okay let me think on that and get back to you”. and personally as someone who does exposure therapy, when i ask my therapist a question and she’s not sure about something, i greatly appreciate her letting me know and collaborating with colleagues or doing research than giving me some bullshit answer.
also, is she having problems keeping her shoes on at school or is this just happening at home? if it’s just happening at home, it’s really not something you need to address since it’s not impacting her at school or impeding her education.
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And I’ve had training on sensory regulation like 2 times but I am the type to learn by doing!!!
She could have some sort of sensory processing disorder where instead of getting overstimulated she is under stimulated. I used to have this as a kid, but I would get uncomfortable feeling different textures of clothing because it was overstimulating. In this situation she likes to feel different textures because with shoes on she is getting under stimulated. You can try shifting the texture feelings to her hands by using books/fidget toys with different textures. Also this may be a sign of ADHD or autism from an early age.
Smartest doctors feel dumb too. You think they have the answers to all...no.. they use google, they use their books they have on their shelf as resources because there not ONE solution to everything. The human body is complex as fuck. I always though our vestibular (inner) system was the same for all but NO it varies turns and shapes on everyone, thickness and all so NO dont think you are dumb. Never validate that feeling. Say, I will do my best to find the solution (to yourself) and family if it helps but those thoughts are reinforced but i know you wont think you are dumb because YOU are trying to find answers, YOU are deliberately trying to find the "WHY". People who do not welcome challenge do not grow. Think of this is a challenge that you will come out on top later on if and you dont come up with the answer because of your attempt.
A person who never made a mistake never tried anything new.- Albert Einstein
I hear you - sensory challenges can feel overwhelming, especially when they're outside your usual area. But remember, actively listening, acknowledging concerns, and seeking solutions are exactly what a competent COTA does!
You've got 2 years under your belt, and learning is part of the journey. Embrace the opportunity to expand your sensory knowledge with resources like AOTA or SPD Star. Connect with colleagues or OTs who specialize in sensory integration - they're there to support you!
Focus on progress, not perfection. Celebrate small wins and collaborate with the family to find what works for them. Remember, you're not alone! Keep up the amazing work, and don't hesitate to ask for help. We're all rooting for you!
Immediate answers are hard to come by and while you might feel pressured to have one, that’s not always going to be possible. While it’s understandable the family is frustrated, you are ultimately not their keepers, and it’s okay to take your time to work on a good solution. Especially in pediatrics where concerns can be so individual. I look stuff up all the time in outpatient. You’re not dumb.