Pediatric Physiotherapy

Infant or paediatrics physical therapy is a treatment used to help children learn to move their bodies in healthier ways. Under the term “paediatrics’,” physical therapy is for children under age 18, from new-borns to teenagers, and it is used to treat kids for a variety of reasons, from sports injuries to genetic disorders. Physical therapy for infants typically focuses on helping babies regularize tone, in cooperate neonatal reflexes, facilitate normal development, gain muscle control, learn to balance, and either reach or catch up to important developmental milestones. This is especially helpful for preterm infants and with conditions like cerebral palsy, spina bifida, Down syndrome, torticollis, neuromuscular disorders, Erb’s palsy, spina bifida, and prematurity.

It is ideal to consult a paediatric physiotherapist when you notice some of these red flags but are not limited to:

• Poor latching, and feeding in babies
• Infantile Excessive crying and irritability
• Child shows, no eye contact or social smile
• Shows unusual tightness / rigidness of neck and body
• Unusually floppy child
• Uncontrolled or involuntary jerky movements
• Poor head control at 3-4 months
• Does not roll over in 7 months
• Cannot come to sit by 9 months
• Cannot come to stand by 11-12 months
• Does not walk by 15 months
• Keeps head tilted / turned to one side only
• Moving only by scooting on their bottom
• Aversion to tummy time
• Aversion to one side of the body
• Clicking or popping in their hips
• Asymmetrical movements, including head movements
• Development of flat spots on their head (back / side)
• Toe walking
• Poor balance and frequent falls
• Shows progressive weakness in extremities
• Asymmetric posture – shoulder levels
• Abnormal gait pattern (walking / limping)
• Complaints of pain / headache
• Post fracture, stiffness of joints
• Frequent aversion / avoidance of activities / sports
• Sports injuries

Although there is no set time period for each child to develop milestones as each child might take their own course of time, however, general guidelines that highlight the approximate age your child should reach certain milestones.

• By 3-5 months, the child should attain head control.
• By 5 to 6 months, your child should begin to roll.
• By 7 to 9 months, your child should begin to sit up.
• By 9 to 11 months, your child should begin to crawl.
• By 11 to 13 months, your child should begin to walk.
• By 24 months, your child should jump with two feet and catch and throw a ball.
• By 3 years old, your child should walk up and downstairs independently.
• By 4 years old, your child should be able to hop on one foot, gallop, and skip.
• By 5 years old, your child should be able to jump rope, hopscotch, and ride a bike.

Early Intervention services are offered from birth to 3 years. At this age, the brain is highly adaptable, meaning at this time children have the ability to learn and develop new skills quickly. 71% – 76% of children receiving Early Intervention services demonstrated improvement across performance areas, including social relationships, reasoning, problem solving, feeding, dressing, and other self-care.

The pelvic floor muscles require continuous care. It is important to evaluate and train these muscles preventively before pregnancy, during pregnancy, and postpartum. Dysfunction prevention with specific exercises is crucial throughout life stages, including menopause and aging.

Activities the therapist will choose will be dependent on your child’s condition. Typically, exercises will include:

• Tone management
• Neonatal reflex integration
• Sensory integration
• Deformity corrections
• Balance training
• Gross motor skill development like head control exercises, rolling, crawling, kneeling, standing balance, and walking training
• Gentle stretching, flexibility exercises, and range of motion exercises, core strengthening exercises are usually included
• Muscle kneading and massaging is also an integral part of infantile therapy

Primitive reflexes are necessary for new-born survival, and abnormal reflexes can be a sign of central nervous system dysfunction, early identification and interventions are very important for normal developmental stimulations and prevent disabilities.

Listed below are some of the most important neonatal reflexes and their significance:

• Rooting: Feeding
• Sucking: Latching and feeding
• Moro reflex: Tone and body symmetry
• Asymmetric neck reflex (ATNR): Neck tone and rolling
• Symmetrical tonic neck reflex (STNR): Neck tone and body balance and movements
• Palmar grasp: Tone and symmetry
• Gallant’s reflex: Early indicator for crawling
• Parachute reflex: Body positioning and vestibular integrity
• Stepping: Early indicator for weight bearing
• Plantar grasp: Hyper sensitivity and sensory
• Babinski reflex: Abnormal sign indicates CNS affection

Cerebral palsy is a permanent, non-progressive, neurological disorder affecting movement disfunction caused by an insult to the developing brain, during prenatal, natal, postnatal or in early childhood period.

The cause of cerebral palsy and its effect on function vary from person to person. Some people with cerebral palsy can walk while others need assistance. Some people might have intellectual disabilities while other could be spared.

The distribution of symptoms vary as well, persons with cerebral palsy might affect the whole body and in others, symptoms might only affect one or two limbs or one side of the body.

Symptoms might include but is not limited to: Stiff muscles and exaggerated reflexes, known as spasticity. Variations in muscle tone, such as being either too stiff or too floppy. Stiff muscles with regular reflexes, known as rigidity. Lack of balance and muscle coordination, known as ataxia. Jerky movements that can’t be controlled, known as tremors. Slow, writhing movements. Favouring one side of the body, such as only reaching with one hand or dragging a leg while crawling, or only lower limbs being affected. Trouble walking. People with cerebral palsy may walk on their toes or crouch down when they walk. They also may have a scissors-like walk with their knees crossing. Or they may have a wide gait or a walk that’s not steady.

Trouble with fine motor skills, such as reach, grasp and release of an object. They might also have issues with activities of daily living (ADL).

Persons with CP might have associated complications like delay in speech, hearing, vision, swallowing, osteoporosis and fractures, dental issues, bladder and bowel issues, acquired contracture and deformities, intellectual disability, global delay, seizures, chronic pain and skin breakdown on pressure points. cardio pulmonary and gastrointestinal complications are also seen very frequently.

Cerebral palsy Is not curable disorder, but all treatments are directed to attain maximum functional independence and a state of near normalcy.

There are different proven approaches in treating cerebral palsy like, Early intervention, Bobath, Neuro developmental therapy (NDT), Proprioceptive Neuro Muscular Facilitation(PNF), Roods, Kabath etc.

It is advisable to follow a Multi-disciplinary Team approach focusing on PT, OT and Speech Therapies going hand in hand focusing on functional independence with a family cantered care plan.

Amplified musculoskeletal pain syndrome (AMPS) is a condition that can cause intense persistent or intermittent pain anywhere in the body. When a child has AMPS, he or she often experiences a degree of pain more intense than normally expected. Children may develop AMPS after an injury, illness, or psychological stress. In the case of illness, it is more commonly seen in children with inflammatory conditions like arthritis or tendonitis.

When we typically feel pain, it’s because our bodies are trying to alert us to an injury by sending a signal to our brains. With AMPS, pain perception is increased due to abnormal firing of nerves that sense pain. AMPS also sends a signal to the nerves in the body that control blood flow. This causes less oxygen to reach the muscles and bones and causes a build-up of waste products in the body like lactic acid, which contributes to the amplified pain we see with AMPS.

It is important to understand that your child’s pain is real and can get better.

Different forms of AMPS include :

• Diffuse amplified pain, also called widespread body pain or juvenile fibromyalgia
• Intermittent amplified pain
• Complex regional pain syndrome (CRPS) with autonomic changes (autonomic changes include color and temperature changes – for example, cold and blue – as well as swelling and sweating) (CRPS) with autonomic changes.

Signs and symptoms include:

• Patients with AMPS have chronic musculoskeletal pain and may experience changes in colour or temperature changes, swelling, or sweating in certain areas of the body (either in one spot or all over). AMPS is most often seen in pre-adolescent or adolescent girls.
• Headache, abdominal pain, dizziness, joint pain or fast heart rate
• Increased sensitivity, with normal contact of the skin feeling especially painful
• Decreased mobility or use of the affected area of the body
• Fatigue or trouble sleeping
• Anxiety, depression or related concerns.

Treatment of AMPS: Treatment of AMPS can be challenging and requires focusing on physical functioning and pushing through discomfort to retrain the over-firing nerves and blood vessels. The physical therapist will assist in creating a plan for regular aerobic exercise to improve blood flow, circulatory symptoms, and physical function (including strength, endurance, conditioning, balance and flexibility).

• Specialised Neonatal / infantile Assessment and reflex testing
• Infantile stimulations
• Developmental therapy
• Range of motion and stretching exercises
• Spasticity and tone management
• Strength and endurance training
• Orthotic and equipment prescription and fitting
• Paediatric pain management
• Postural management and ergonomics management
• Deformity correction
• Gait re-education
• Balance retraining
• Chest physiotherapy and pulmonary rehabilitation
• Sports injuries