Reducing hospital visits to improve inclusion in early child and family support

Is some paediatric therapy a hangover from an out-dated medical approach?

It is obvious that early child and family support services and systems must be adapted to local culture, family structures, traditions and resources. It is equally obvious that when we design or modify an early child and family support service, we must avoid any elements that disadvantage children and families. I have seen some serious disadvantages coming from health agencies, hence my view that an unthinking adherence to some medical traditions is holding back development of early child and family support.

All children growing up make some progress in communication, dexterity, movement, self-esteem, socialising, cognition, self-care (washing, feeding, drinking, etc.), action planning, making choices and so on. This typically starts at home with the family and continues in mother/baby groups, infant/parent groups, playgroups, kindergartens, nurseries and first schools. In my understanding, even in children who have significant challenges to development and learning, these are all education/learning/development issues rather than health issues.  

The people who have knowledge and expertise to help the child with this learning are parents, other family members, staffers in nurseries, first schools, etc. and professionals allied to medicine including paediatric therapists. In these people there are different types and levels of valued knowledge.

Team around the child philosophy suggests these people should collaborate in each child’s TAC team  to produce a shared view and an integrated action plan with parents invited to have full membership of the TAC. The work/play to support the child’s education/learning/development should then happen where the child naturally is.

I have argued elsewhere that paediatric therapists have a dual role depending on each child’s needs. Firstly they have an essential medical role with muscles, joints, hearts, lungs, breathing, swallowing, etc. Secondly, they have an educational role to help as TAC members with communication, dexterity, movement, self-esteem, socialising, cognition, self-care, action planning, making choices and so on. While the medical role might be well-placed in hospitals and clinics, the educational role should go to where the child is. Therapists’ support might sometimes have to be as advisors to parents and staffers because of time constraints. 

An out-dated medical approach can take children and parents on regular visits to hospital and clinics for ‘therapy’ some or all of which is really education and would better happen at home or in community education settings. These visits cost the family money, time and energy and disrupt family/community life. They are barriers to inclusion and quality of life and turn learning children into patients who have some sort of illness to be treated. The TAC action-planning should determine which visits to hospital are essential for health reasons and which can be better done in the home and community.

So, in my view, the automatic assumption in some parts of some countries that babies and pre-school children must have regular visits to hospital imposed on them is an historical anomaly and should be re-thought at the systems level and at the child and family level.


Peter Limbrick, February 2024

See also: Contrasting a therapy approach with an educational approach to the early skill of moving on the floor

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