Is your child struggling with bed wetting, constipation, or toilet training?

PEDIATRIC PELVIC HEALTH OCCUPATIONAL THERAPY CAN HELP

YOUR CHILD IS NOT ALONE

  • 20% of pediatrician visits are for incontinence problems

  • 15% of visits to gastrointestinal doctors are for lower bowel dysfunction

  • 3% of visits to pediatricians are for constipation

  • 5 million children complain of nocturnal enuresis (bedwetting)

SENSORY PROCESSING AND TOILETING

Toilet training, or achieving and maintaining continence, requires a very complex set of skills which is highly reliant on our sensory processing system. Recognizing internal body sensations of urinary vs bowel"urge"and correctly interpreting the urge signal (including discriminating it from other body signals such as hunger or thirst) requires development of the interoceptive system.

 

Development of the vestibular and proprioceptive systems are required in toileting for proper balance, coordination, positioning and optimal force generation for elimination. Integration of other sensory systems such as touch, smell and vision with the vestibular and proprioceptive systems is also integral to successfully toilet and maintain continence.

HOW CAN I TELL IF SENSORY PROCESSING MAY BE CONTRIBUTING TO MY CHILD'S ISSUE?

Every child (just like every adult!) has unique sensory likes and dislikes.  And not every child with sensory sensitivities will be identified as having Sensory Processing Disorder.  But here are some ways sensory processing issues can manifest with toileting behaviors:

  • Child may be unaware that their bowel is full resulting in constipation, fecal smearing in underwear/diaper, intermittent diarrhea and/or bedwetting.

  • May be unaware their bladder is full resulting in very few voids per day, recurrent UTIs, frequent leaks, and/or intermittent complete emptying of bladder.

  • May feel they need to go, but are unable to discriminate whether they need to urinate OR have a bowel movement (can result in bathroom messes for boys who stand to urinate).

  • Unable to "go" within 5 minutes of sitting on toilet; don't understand how to make those muscles relax to allow for emptying.

  • Unaware they have had an accident and clothes are soiled.

  • Dislike the feeling of peeing or pooping and withhold OR become upset, crying, fearful, report that "it hurts".

  • Demonstrate fear of falling into a regular sized toilet or dislike hard toilet seat.

  • Dislike the feeling of wiping or being wiped.

  • Do not like to wash their hands OR wash hands for en extended period of time, play in sink.

  • Take off all their clothes to use a toilet.

  • Avoid flushing the toilet OR flush toilet repeatedly.

  • Extreme reaction to the sound of the flush or the air dryer.

  • Gag, or choke at the smell of poop, hold nose in the bathroom.

  • Play with feces.

  • Frequently has accidents in clothing/diaper seems to enjoys the sensation OR requests an immediate change, seems to greatly dislike the sensation.

  • Avoids wearing big girl or big boy underwear, prefers a diaper.

  • Difficulty tolerating in new or public bathrooms OR constantly asks to use public bathrooms.

  • Avoids going into the bathroom, “sneaks off” to poop in diaper behind a couch, etc.

HOW DO WE TREAT?

You can expect your child's initial evaluation to last about 90 minutes.  Prior to the initial evaluation you will be asked to complete a thorough medical history and history of the current issue for which you are seeking treatment. We meet with each child and their parent/s or guardian to review this information and get a thorough understanding of your child.  We then do a physical examination looking at the muscles of the abdomen, legs, back and any others we feel may be relevant to your child's issue.  The exam is with an adult present and over clothing.  Based on the initial findings of the physical exam, the therapist may conduct further assessments including large motor, coordination, reflex and/or sensory processing assessments.  Finally, we consult with the child's pediatrician to develop an individualized treatment plan.

Treatment is one-on-one with a licensed and registered Occupational Therapist who has advanced training in pelvic floor dysfunction.  Treatment directly addressing pelvic floor muscle strength and coordination (with or without the use of biofeedback) is performed in a private treatment room, over clothing and a parent is required to be present.  Treatment addressing sensory integration, core muscle strengthening and/or gross motor coordination is performed in our sensory gym and parental presence is not required. 

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TREATMENT SERVICES

Treatment may include the following:

  • Family support and education

  • Education in bowel, bladder and pelvic floor muscle anatomy and function appropriate to child's level

  • Muscle strengthening, relaxation and/or coordination training for core and postural systems

  • Sensory Integration treatment

  • Surface EMG biofeedback 

  • Electrical stimulation 

  • Behavioral and dietary modifications

  • Bladder retraining

  • Autonomic quieting techniques

  • Skin care management

  • Individualized Home Program 

CONDITIONS TREATED

  • Constipation

  • Toilet training difficulties

  • Urinary incontinence (enuresis)

  • Fecal incontinence (encopresis)

  • Urgency and frequency

  • Recurrent UTIs

  • Core and postural muscle weakness

  • Sensory Integration Disorder/Dysfunction

  • Diastasis recti (abdominal muscle separation resulting in bulging)

FAQS

Pediatric Occupational Therapy

DO YOU TAKE MY INSURANCE?

Core Functional Wellness is a Medicare provider. Other than Medicare we are a fee for service provider and do not contract directly with any other insurance providers. Many of our clients use their HSA/FSA cards for qualifying therapy services. You will also be provided with a superbill for your occupational therapy which you can then submit to your medical insurance company for reimbursement for out of network benefits. Why are we out of network with most insurance companies? In a nutshell, because it results in better outcomes and faster resolution of symptoms for YOU. It allows you to self-refer to therapy without having to see a physician first and receive a medical diagnosis.  It allows your therapist to spend 100% of your treatment time directly with YOU rather than having your treatment cut short or having an assistant or aide complete your treatment session while your OT does your insurance mandated paperwork.  The result is concierge style service with longer treatment times and faster resolution of symptoms for you.  

HOW DO I FIND OUT IF MY INSURANCE COMPANY WILL REIMBURSE ME FOR MY CHILD'S TREATMENT?


Recommended Questions to Ask Your Insurance Provider:

  • What is my out-of-network deductible? How much has been met this year?

  • What portion of my child's services will be reimbursed?

  • Does my plan allow reimbursement for each of the following therapy codes?

    • Evaluations: 97165, 97166, 97167

    • Treatment: 97530, 97112, 97110, 97535, 97140

  • Do I need a referral from a physician to obtain reimbursement?

  • Do I need pre-authorization to obtain reimbursement?

Many of my clients are now using an app called Better which takes care of your out-of-network health insurance claims for you for a zero to 10% fee.  You can find out more at getbetter.co

DO YOU DO INTERNAL PELVIC FLOOR MUSCLE ASSESSMENT?

Internal assessment is never performed on children. Depending on your child's age and the preference of both child and parent, an external visual assessment may be performed to assess muscle strength and coordination.  Pelvic floor muscle strength and coordination can also be screened through external SEMG biofeedback at parent request and child consent.  Parents will be required to be present for any biofeedback assessment or treatment. 

Please note that pelvic floor muscle assessment is not required to receive treatment at Core Functional Wellness. We recognize that a child's toileting issues are never caused solely by pelvic floor muscle issues.  We treat your child holistically looking at diet, sleep patterns, sensory issues and any behavioral issues that could be contributing factors.

LOCATION

Core Functional Wellness is located at 543 Encinitas Blvd #114

Encinitas, CA. 

In-home appointments available to Medicare clients in some areas of San Diego.

 

Consultations and appointments are available to out of area clients through our online Telehealth services.

ASK OUR BOARD CERTIFIED SPECIALIST A QUESTION ABOUT YOUR CHILD'S ISSUES:

Tel: 858 231 2800

Fax: 858 210 6363

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