Physio and your child!
There is nothing worse than seeing your child in pain. And physical therapy can change that. Physio is designed not only for adults but for children too. Through a range of different treatment techniques and programmes physiotherapy can help your child to jump back on the playground and get back to living the life they should.
There are many, many reasons a child may see a physio. Physio can help you beyond your regular strains and pains and help tackle some more specific paediatric conditions. Conditions may include;
- Gait abnormality
- Coordination problems
- Changes in neck movement or head shape in your baby
- Chronic, widespread pain
- Juvenile arthritis
- Developmental Hip Dysplasia
- Neurological Conditions
- Fractures/sprains/general injuries
Developmental milestones are a guide for what is considered normal development. All babies develop in unique ways; the one who sits up weeks after her peers may be the first to walk. It is important to remember that variation is just as normal as the guide itself. But to give you a rough idea; if you don’t see your child sitting independently by 9 months, standing by 12 months or walking by 18 months then they may be showing some delays. If so it’d be a good idea book your child in for an assessment by one of our physios who can see what’s causing a potential delay and prescribe an appropriate management plan.
Please continue reading to find out what is considered ‘normal’ development in a child, and more about specific paediatric conditions and what we can do to help.
The term hypermobility is used when a child has several joints that are more flexible than usual. This happens when the connective tissue that holds your joints together (capsule and ligament) is more easily stretched than usual. Your child may experience increased joint extensibility, ligamentous laxity, poor scarring, tendency for easy bruising and muscle weakness. Generalised hypermobility is quite common, and is in fact normal. You can be hypermobile and fit and healthy too, for example the best gymnasts and dancers often have a degree of joint hypermobility. Hypermobility is only a concern if it’s causing unfavourable symptoms, such as pain, coordination issues, frequent sprains/subluxations or dislocations, and affecting your child’s quality of life.
There is a range of different hypermobility syndromes and so these symptoms may appear in isolation or in conjunction with others. The most common form of hypermobility is ‘Benign Joint Hypermobility Disorder’ which involves joint hypermobility along with pain and loss of function. Other symptoms may also be present such as low blood pressure and fatigue. Another common condition is Ehlers Danlos Syndrome. Ehlers Danlos syndrome is a genetic disorder, which affects the structure of the connective tissue that contains the joint. This condition can also affect the skin and so you may notice your child’s skin is more easily stretched than others.
Please note that it is very difficult to differentiate between the two and it is important to consult a trained professional for a confirmed diagnosis – if a diagnosis at all.
Physiotherapy management includes; strengthening and body awareness exercises, and learning to control joints through movement. We will also provide education for the parent/carer to enable them to manage symptoms effectively at home.
A gait abnormality simply means abnormalities with the walking pattern. These most commonly include knocked knees, pigeon toes, tip toe talking, duck feet walking, bow legs, flat feet as well as changes in gait to pain with the child offloading and reducing the time they spend weight bearing through the affected side, and compensations observed from the hip (eg with the hip dropping of the opposite side of the standing leg) or the entire leg being lifted at the hip to help the foot clear the floor).
Variations in gait from one child to another are very common. It is important to remember that some of these variations may be normal, however they are a concern if your child is in pain or if it’s affecting their quality of life.
If you notice any differences in your child’s walking pattern, it would be ideal to be assessed and screened by a physiotherapist as early as possible to determine the cause. From the assessment, your physiotherapist will explain the reasons for your child’s gait variations, and develop a collaborative plan with you with the appropriate management including specific exercises, treatment and/or orthotic prescription if indicated.
Coordination issues can be particularly frustrating for your child as it makes it difficult for them to keep up with their peers in the playground, and can often lead to children avoiding sport and adopting a more sedentary lifestyle.
Coordination problems can result from neurodevelopmental delays as well as musculoskeletal issues. Often coordination problems appear much scarier than they are, and can be managed quite simply. In some cases there may be no neurodevelopmental issues but rather more musculoskeletal impairments. These cases often include increased muscular weakness and poor core stability assosciated with excessive flexibility (please see hypermobility disorders). In these cases there are plenty of available treatments a physiotherapist can provide to your child. Simple treatments may include;
- Developing core, postural and pelvic stability
- Increasing joint stability
- Specific drills to improve gait, running, hand-eye coordination
- Endurance activities
Early intervention is always the best but it’s never too late to begin improving your childs coordination. If you have any concerns about your child’s coordination, an assessment by a skilled physiotherapist is helpful to determining just where that problem is coming from.
Baby Head Shape & Infant Torticollis
Infant torticollis is shortening in the muscles at the front of the neck, causing the baby to turn their head more to one side. This can cause asymmetries in the shape of the baby’s head. You may notice your baby is struggling to turn the head to one side, struggling with breast feeding to a particular side and/or a flattened area on the back of the skull.
Infant torticollis can occur as a result of:
- Packed position whilst inside the womb
- A difficult birth or delivery
- Favouring one side to sleep or feed
- Or insidious onset
It is important to get this checked out, as left untreated can result in permanent restriction in neck movement and asymmetries of the face and jaw. Physiotherapy management is key and has very positive, long lasting effects. Treatment options may include; stretches and exercises for you to do with your baby, sustained positioning for feed, play and sleep and education regarding what is best for your baby. Physiotherapy will not be painful for your baby.
This is more common than you think, and is seen quite often in clinic. Please don’t hesitate to contact if you have any concerns about your baby’s head and neck position.
Complex Regional Pain Syndrome (CRPS)
CRPS is a painful condition usually involving the limbs. CRPS often occurs after injury such as fracture or sprain. Symptoms vary; they often last weeks to months however if left untreated can stick around for years. Early physiotherapy intervention is essential for a quicker recovery.
CRPS presents differently in everybody, common symptoms include
- Constant (often burning) pain in the affected limb. Pain starts close to the original injury site but spreads further up the limb if untreated
- Pain ongoing beyond normal time after original injury
- Pins and needles, numbness, abnormal sensation or weakness around the area injured and surrounding areas on the limb
- Pins and needles often in a sock or glove-like distribution
- Child will often keep the affected limb very still (like it is "frozen")
- Muscle wasting from disuse
- Tremors or spasms in the affected limb
- Stiffness of joints in the affected limb
- Changes to the integrity of skin, hair and nails on the affected limb
- Temperature changes in comparison to the other limb (very warm and sweaty or cold/clammy)
- Colour changes during day in the affected limb compared to the opposite limb including red blotchiness, to while and purple/patchiness.
- Often appears more swollen and/or bruised
- Difficulty weight bearing due to severe pain in the injured limb
The best form of management is often a combination of medical (Dr) and physical (physiotherapy). Physical therapies involve desensitization of the affected area, restoration of movement, strengthening that area, weight transference to the injured limb, gait retraining if necessary and restoration of function in that limb. Physical therapy can also provide a range of techniques for pain relief and more comfortable functional movement.
Juvenile arthritis not a disease in itself, but rather an umbrella term to describe the different types of arthritis that may occur in your child between the age of 0 and 16. Around 1 in every 1000 children develop some form of juvenile arthritis. While there are many types of juvenile arthritis, they share common symptoms including;
- Joint swelling
- Redness/warmth around joints
- Joint stiffness
- Fever and general feeling of being unwell
- Skin rashes
- Vision problems
- Eye inflammation
- Increased tiredness
We do not yet know the cause of juvenile arthritis but we do know what to do to help. Appropriate medication along with physical therapy and a catered home exercise program will give your child the best quality of life with this condition. Physiotherapy can offer an extensive range of treatment options, some may include;
- Hydrotherapy to maintain joint mobility and relieve pain
- Strengthening exercises and programs to maintain muscle and joint strength
- Flexibility exercises to maintain joint movement
- Hands on therapy to reduce pain and maintain joint flexibility
- Advice on pacing of activity
- Core stability to take pressure away from painful joints
- Postural exercises as a prevention method to maintain good spinal alignment
- And overall education on ways to maintain strength and keep moving!
Physio can help not only you but your child too. If you have any concerns about your child’s physical wellbeing please don’t hesitate to book an appointment with your physio. We can provide many different treatment opportunities to your child and will always cater our program to your child’s needs.
Developmental Hip Dysplasia
Developmental dysplasia of the hip (or DDH) is the general term for instability, or looseness of the hip joint. It can develop after birth and can be genetic or as a result of positioning in the womb. Because a babies hip is softer, more pliable and loose it is easier for the joint to become unstable. There are different degrees of hip dysplasia varying in severity.
Some signs and symptoms to look out for in your child include; asymmetries in the buttocks area (around the bottom creases), clicking of the hip joint, limited range of motion at the hip, pan especially with weight bearing, and a sway back posture (see picture – note the strong curve in the lower back).
If you’re concerned about the stability of your child’s hips, book an appointment with your physiotherapist who will run a full assessment and build a rehab program or refer on if necessary.
A neurological condition is any form of disorder or disability in which the brain or nerves have some role. These range from diagnoses such as Cerebral Palsy, to developmental delays resulting in physical or cognitive impairments. Concerns you may have might include; lower muscle tone (feeling floppy), poor coordination, poor balance, challenges with communication and sensory challenges. Neurological conditions can present in many ways, please see the developmental milestones table and if you have any concerns for your child’s development please book an appointment with your physio to see what we can do.
Children are always out and about playing on the playground or joining in their favourite sports, and so often will fall over and suffer injury! When they do, physiotherapy can help build them back up to being on the playground again. If it’s a broken leg or a rolled ankle; it is important to develop a catered rehab program to best prepare your child to return to sport and prevent the reoccurrence of injury. Physio plays a role in injury rehabilitation and injury prevention through strengthening, re learning of movements after injury, endurance, flexibility and many other treatment modalities. Depending on your child’s injury, a physiotherapist can development a treatment program to best suit their recovery.
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- Din, I, Rahman, F & Rahman , I.(2003). The Role Of Physiotherapy In The Management Of Sternocleidomastoid Torticollis. Pediatric Surgery International, 11(7), .
- L Johnson, D Eastwood & B Jacobs .(2014 ). Variations in normal gait development. In W caroll (Ed), Paediatrics and Child Health.
- Sandstedt et al..(2013). Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial. Paediatric Rheumatology , 11(7), .
- Tofts et al..(2009). The differential diagnosis of children with joint hypermobility: a review of the literature. Paediatric Rheumatology
- Jacobsen et al..(2013). Changes in walking and running in patients with hip dysplasia. Acta Orthopaedica, 84(3), .
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