Sally Brown obtained her degree in occupational therapy in 1984. Since then she has been employed in various roles, first at the Royal Alexandra Hospital for Children at Camperdown, then The Children’s Hospital, Westmead, and later in private practice.
Sally has worked in many areas of children's health, such as paediatric occupational therapy, newborn follow-up clinics, and psychological medicine.
Much of her time – in hospitals, homes, private rooms, schools and pre-schools – has been with children who are traumatised.
Sally has worked with children and families facing autism, spina bifida, severe burns, behavioural issues and developmental delays.
A: One of the main challenges for parents is having the chance to be part of a network.
If you don’t have a close family or group of friends to help – and many people don’t – then trying to raise your own family, hold down a job, have a social life and do all the other things you try to fit into your timetable can be daunting.
Without any sort of extended family it’s very difficult to have a balanced life.
The other thing is that it’s really difficult to ask for help in our culture. Because we don’t necessarily have the extended families who can offer advice and support, there is enormous pressure to be able to do it all yourself.
You can be a confident and competent worker and then come home with a baby and feel no control – that is really hard for people to reconcile.
I can remember having two young kids, a job, and a house to run and feeling like I’ve done a day’s work even before I got there. It’s difficult, frustrating and tiring.
A: Seek resources, develop networks, and do what we can to create extended families.
Amongst all our modern-day busy-ness we have lost the whole concept that it takes a village to raise a child. We need to get back to that idea.
It’s also vital for parents to understand the concept of being “good enough”.
There is a lot of pressure to be perfect. We need to spread the word that providing the basic needs – such as shelter, food, nurture, love, and security – is good enough. Anything on top of that is a bonus.
When you’re trying your guts out and you feel nothing is working, remind yourself that in this parent business, perfection does not exist.
The father of modern child psychiatry Donald Winnicott talked about children forming attachments by being able to get their needs met.
From an anthropological point of view, if your care is meeting the infant’s needs for all the basic things – such as food, shelter, clothing, safety and nurturing – this is enough for them to be able to grow and develop.
We need to consider the concept of the “good enough” parent.
A: I would first want to know more about their specific pressure or concern. Without context it is difficult to understand the concern.
Then I would be able to put their worry into the context of being good enough, and also be able to understand more about their role in the family, on top of being a parent.
Many people don’t appreciate how active and complex their lives have become.
I know that being a parent to two very different children has helped me to be a better therapist. I know what it’s like to be sleep deprived, hassled, and have school teachers imply I might be wanting in my parenting.
You can be very professional at what you do for a living, but feel as though you fall short as a parent – especially first time parents and people who have not had much to do with small children.
It is easy to feel scared. Many people think that becoming a parent is a licence to feel guilty. We do it to ourselves.
A: Early intervention is giving children experiences, exercises, confidence and interactions with their caregivers, extended family or teachers to help them reach their potential.
Having spent most of my working life in a medical setting, to me early intervention was something that was asked for because there was some concern about the child’s development – they had a chronic illness, or they had behavioural or anxiety problems.
So from that point of view I have seen early intervention as a service to develop ways of tapping into a child’s potential and helping families to be able to tap into that potential.
Every child has potential. If there is no expectation there is no room to grow and develop.
We must be able to stand beside the family, understand their perspective, and inform them what is available to have their child meet their potential.
A: From a neurological point of view early intervention works because all young brains are still developing. They have what we call plasticity, and potential to recover and reorganise.
I’ve also spent many years working with traumatised kids and their parents – for example, people who are traumatised from family events, child abuse or being refugees.
We know from the current research that stress influences children’s brain development and their ability to regulate themselves emotionally and behaviourally.
The earlier we can get in before their brains become what we call “hardwired” means a better outcome is possible for the child and the family.
A: It is never too late to try and it should start as early as possible. When I think about the children I used to see in psychological medicine, I believe that having an opportunity to be understood is a great gateway to recovering function.
For example, occupational therapy is interested in peoples’ function and how they can be as independent as possible.
Such intervention is always worth a try.
A: Some changes are always possible, depending on the reasons for the intervention, the parents’ expectations, and the child’s potential.
And any type of improvement is worth pursuing, however small.
My recent training and experiences with Marte Meo has shown me that some kids with really low cognitive ability and physical mobility are actually able to make wonderful changes.
In many respects, the sky is the limit.
A: Look for gaps in any area of development – language, motor skills, social skills – all the usual suspects.
People tend to concentrate on the “not talking” aspects of their child’s development, but I would also include the “not listening” aspects. I don’t mean selective deafness, but not being able to process what’s being said.
The other areas of concern are not walking or walking very late; having difficulty socialising; having difficulty separating; not being able to eat independently; and not pushing for autonomy.
There is a huge range of warning signs, and different personalities and cultures play a part. But we look mostly at speaking, walking, playing and being with other children.
A: See your GP. The GP may do some investigation, such as a hearing test, and is likely to send you to a paediatrcian.
It is important to be able to understand or identify any diseases or medical issues that may require some medical intervention.
You may then be referred on to another health professional, such as speech or occupational therapist, a physiotherapist, or a psychologist.
A: Wait, watch and wonder.
Have a close look at what your child is interested in and follow their lead. Give them opportunities that are at a developmentally appropriate level.
Help them to experience the park, music, the beach, animals, books and see where that takes you both.
There are enormous amounts of resources on the internet that explain what children should be doing at certain ages and the types of activities you can do with them.
Also, take time with your kids because it goes quickly. Listen to them and love them.
A: I’m a musician’s daughter so music was always important in my upbringing. I also remember an event from my early days at The Children’s Hospital.
Dr Tony Lipson was a paediatrcian and a birth defects specialist years ago at Camperdown and then Westmead. I used to go to a meeting of a team of doctors in the Camperdown days.
This one time I was pregnant with my first child and when I sat down next to Tony he asked me how many weeks I was. I said 28 and he said the baby can hear now; they like music, you should play some music. But they don’t like heavy metal.
I always remember that conversation.
At the time, Enya was popular, so I played Enya a lot when I was pregnant. When my daughter was a baby Enya seemed to have some settling effect on her.
A: We have a team of experienced allied health professionals on site who work together with the teachers to provide a comprehensive child and family service.
A: I immediately think of a little boy I worked with years ago in the burns unit at Camperdown. It was a very hard place to work. The children and families there were very traumatised.
This one little guy came from a distant country area. He was a three year-old who had fallen into a pile of hot coals after the fire had gone out. He was extensively burnt and I had a lot to do with his rehabilitation.
About five years later when the hospital had moved to Westmead I saw him and his parents again.
We were chatting about his progress and he said he wanted to give me the old Superman pyjamas he had worn during his stay at Camperdown years ago so I could give them to another child in hospital who might need them now.
I get teary thinking about that boy and that conversation.
I’m also proud – along with my colleagues – of the victories we had in children’s court in child protection cases.
Today, I just love sitting down with young children in the centres at The Infants’ Home. You can have the most amazing conversations.
For example, I was talking to this gorgeous three year-old recently who asked me why I wasn’t at home looking after my daughter when he found out she was sick.
I told him that my daughter is big and that she can look after herself. He then asked me how old my daughter was. I told him she is 19.
He said: “Oh, so you must be 20.”
A: There has been a lot of research in recent years about what works and why it works.
What has changed in this country is more respect for parents and their strengths.
There is a shift towards the idea that what we do in a session or in the clinic for an hour is not the thing that will make a change.
What will really make a change is the family being able to generalise our clinic work into everyday moments.
It’s the relationship parents have with their kids and the activities they do together that will bring about change.
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