Bad news

In the last week, I sat in on a combined treatment session with my supervisor, the OT and a OT student. The patient was a 4 month old baby who was brought in by his mum due to poor head control. During the initial treatment session, my supervisor noticed that the poor head control was not the conventional floppy/weak. Instead, he was unable to keep his head in a good position due to an excessive extensor reflex. In addition, he had a strong ATNR. The OT and my supervisor decided to review the child in 2 weeks, so that the child was able to “grow a little more”.

On the next treatment session, the child still presented the same. That session was mainly an objective assessment. The senior physio was called in for a second opinion. But, by then, the child was tired and started crying. The physio had to quickly complete the assessment. The senior physio then tried to explain she found, but was unable to as the child was still crying. The staff then decided to have a discussion so that the mother could calm and feed the child.

My supervisor and the OT had to discuss the findings and discuss treatment options with the mother. It did not look good for the child as he was still holding onto the extensor reflex. This inhibited him from functioning normally as a 4 month old. He was unable to tolerate prone, and could not use his hands in supine, and sometimes seemed not to be able to respond to sounds. However, he responded appropriately if someone talked to him face to face.

This was a difficult situation as the mum was already feeling anxious as her child was crying and there were too many people in the room. Furthermore, the whole group had to leave the room to discuss, which probably added to her anxiety level.

On reflection, I suppose the situation could have been handled better if there were less people in the room during the treatment session (ie no students). It also made me think about how I would approach the subject of breaking bad news to family, esp in the area of paeds. I suppose this would come with experience. I did not sit in with the physio when she had to tell the bad news, as it was not appropriate. So, if I happened to come across a similar situation, I would most likely have to excuse myself after the assessment if the situation permits. This would allow me time to collate my thoughts before speaking to the family. If not, I would probably explain the assessment findings to the mother while doing the assessment so that she is involved in the treatment session.