PEDIATRIC REFLECTIONS

One of the documented ways to become a good practitioner is to engage in the practice of
regular reflection about what you are doing and why you are doing it.  This assignment is to help
you reflect about your personal skills and the emotional component of therapy. Please answer
each of the 6 questions with at least one paragraph. Worth 2% of your final grade (but
invaluable for your professional growth!)
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Student’s Name:

1. Think about what you know about the practice of pediatric patient physical therapy. What
draws you or pushes you away from this from this type of practice? What personal attributes do
you have that would be helpful or not helpful in the pediatric setting? 
I am drawn to pediatric physical therapy because I love children. Also, I fell in love with
physical therapy when I was observing pediatric physical therapy. I am drawn to the playful
nature that mixes with science and medicine. However, I am also pushed away by the playful
nature because I am not a very playful person and I worry I will be burnt out from the constant
“play” and creativity that is required. I am also pushed away by the issue of the parents. I can
see myself becoming very frustrated and angered by parents that do not take the necessary
steps to help their children. I think that would become very mentally draining for me and more
difficult to “leave at work.” I am a creative person which is helpful but I feel my creativity is
limited. I am also patient and persistent which would be helpful when working with children. I am
also an empath and I think that will be very difficult when working in pediatrics because of the
vast emotions that both the child and family brings to the therapeutic relationship.

2. There are many different styles of parenting. This varies across and within cultural groups. 
How much have you been exposed to different ways of raising children? Have you encountered
people taking care of children in ways that are different from your upbringing? Please discuss
some of the good and bad things that you have seen, and your emotional response to these
encounters.
I have been exposed to many different ways of parenting through my years of coaching
gymnastics and babysitting. Additionally, my cousins were parented very differently from me
and I have realized that as I’ve gotten older. Some of the good (in my opinion) parenting that I
have observed is with parents that really limit time on electronics and instead encourage
creative play. Their parenting style was never to just tell the child what they could not do (TV
time) but to instead shower the child in tons of different toys, puzzles, and books to play with
instead. On that same note, some of the worst behaved children that I have worked with were
parented by people who were extremely busy and often resorted to electronics as a way to
appease their children when they needed to get work done. I found that those children were
more likely to throw fits and have difficulty communicating. Lastly, my cousins were raised in a
household that would often scream and yell when upset. I was parented in a household that
never yelled and still to this day I feel very uneasy when people resort to screaming at one
another.

3. Please think about and write down your thoughts about how to maintain unconditional
positive regard for families who respond to behavioral issues of their children with more or less
strictness than you would prefer. Remember that, especially with younger children, the parent
may be present throughout the physical therapy session.
I have thought about this a lot because it is something I have witnessed when
babysitting and coaching. I try to remember that there is so much more going on in peoples’
lives than I will ever fully know or understand and it is not my place to judge, especially on
limited information. Judgement is more harmful in most cases and does not serve a purpose for
myself or my patients. However, I know that is easier said than done. In the moment, if I am
getting upset with how a parent responds to behavioral issues, I remind myself that I only have
control over how I respond and then I do so according to what I think is best. I can also hope
that the parent might learn something from how I respond to the child or even catch on to how I
would correct and redirect bad behavior. Unconditional positive regard is definitely tricky but I
understand why it is essential for a positive therapeutic relationship. There truly is not anything
positive that comes from feeling judgmental and the parents will likely pick up on the judgement
and be even less inclined to trust me and work with me for the benefit of the child.

4. Describe what you think would be your initial response to a 4 year old patient or client who
screams back at you, “No! Go away!” and then tries to punch you. After you describe your initial
response, please write some ideas about how you could pull yourself together emotionally to
continue to provide calm and compassionate care.
I was raised to be very polite, calm, and to speak my emotions so I am always taken by
surprise when people of any age use yelling or physical measures to respond to conflict. My
initial response would likely be stress and annoyance. However, I have learned in my classes to
first take a big, deep breath and then respond with something that identifies the wrong behavior
and offers a positive behavior instead. I might tell the child, “We don’t hit people at physical
therapy. Hitting hurts, ouch! When we are upset, we tell someone with our words what we are
feeling. What are you feeling?” We have also discussed in other classes that is really important
to reflect on why that behavior might be happening, especially if the patient is unable to tell you
why they are feeling so upset. For example, they might be overstimulated which can be fixed by
turning down the lights, eliminating extra noise or giving more or less physical touch. Also, the
patient might be challenged too much or be working outside of that zone of proximity which
might be causing them to lose control emotionally.

5. Some pediatric PT is done in the community, in schools, centers for developmental

disabilities, or in patient’s homes. Schools and developmental centers usually do not have the
same amount of funding as hospitals, but they are readily accessible to patients.  Please
honestly reflect on how you might feel about working in a facility that is not as bright, shiny or
equipped as a hospital.
 I know without a doubt that I will honestly get very, very frustrated that money plays such
a role in the level of support that some children receive. I have become acutely aware of the
true influence of wealth on society in the past few years and I am still learning about the impact.
I grew up in a very privileged household but I also often had less than those around me and I
felt the psychological impact of that. Children are very observant and they will sometimes pick
up on those things to. I will be prepared with responses as to why things might me “missing” or
not as shiny as other schools or places. On a bad day, I will likely let the disparity upset me and
blame lack of PT progress on the lack of resources. However, on my good days I think that it will
motivate me to give the highest level of care possible, since that is what is in my control. I will try
to harness my creativity and my compassion to fill in the gaps left from lack of funding.

6. Please reflect on what you can do to make yourself a better practitioner of physical therapy
for children or adults with limited verbal communication skills.
I actually believe that this is one of my strengths because I have a few people in my life
that do not communicate in a traditional sense. My brother did not talk until he was four so my
family learned about communication when I was very young (6 years old). I have practiced
using the augmentative charts with photos when he used them and also when I was a volunteer
at CCHMC. My cousin has cerebral palsy and she communicates verbally but it is difficult for
her to form more than a few words at a time so I have learned to interpret her body signals. For
example, when she sticks her tongue out she is saying “no” and for saying “yes” she will either
verbalize or smile. Lastly, my fiancé’s uncle has a traumatic brain injury and is unable to
communicate verbally but he does mouth words so we have learned to read his lips. Our neuro
teacher is also teaching us a few common ASL signs. I know that sign language is often helpful
with children especially. Overall, my past experiences have taught me that everyone is different
in how they choose to communicate but most people are trying to communicate if you watch
closely.