Occupational Therapy: An Essential Component of Support for Young Children With Cancer.

We established a multidisciplinary early childhood clinic to support infants and toddlers receiving cancer treatment. The access to occupational therapy (OT) in this population is unknown. To describe the access to OT for infants and toddlers with cancer. We retrospectively reviewed medical records to determine the frequency and characteristics of children with cancer who were referred to OT. Demographic data, medical information, and frequency of referrals were extracted from September 2015 to September 2018. Of the 134 patients, 112 (83.6%) received an OT evaluation: 88.4% were referred for hospital-based OT services; 42.0% were recommended for services upon returning home. Between-group comparisons revealed significant differences in referrals for home- or community-based OT services based on age and disease. OT is crucial to treatment plans that address the developmental needs of young pediatric oncology patients during hospitalization and thereafter. Recommendations for monitoring this vulnerable population are provided.

Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit.

INTRODUCTION: Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. METHODS: We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. RESULTS: Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. CONCLUSIONS: Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.