Pediatric physical therapy (PT) is the branch of physio that deals with infants and kids. Physiotherapists, after completing their basic degree, undergo specialized training to become qualified for treating children.
Babies aren’t just smaller versions of adults. They are different in a lot of ways and so the techniques that work for adult physiotherapy patients don’t always work for kids.
In this article, we’ll explain how physio is done on babies and discuss the five most common conditions that we treat in kids to elaborate on the techniques.
Why Do Babies Need Physical Therapy?
Physical therapists are movement experts. If babies have a condition or syndrome that affects their mobility or functional abilities, then they need PT to improve that.
Babies need physical therapy for:
- Musculoskeletal conditions such as clubfoot, post-fracture rehab, muscle shortness
- Neurological conditions such as cerebral palsy, wrist drop, facial palsy
- Gait (walking) issues and delayed milestones
- Toe walking
- Muscular dystrophy
Some babies are born with these issues while others acquire them later in life as a result of injury or genetics.
Our bodies are incredibly adaptable. Even with developmental disabilities, babies manage to achieve their milestones, learn to walk and be mobile as much as their bodies allow.
The role of physical therapy in pediatric rehab is to facilitate kids in their journey and avoid the development of wrong movement patterns which can negatively affect their bones and muscles.
How Is Physiotherapy Done on Babies?
Pediatric physiotherapy is a world of its own. There are hundreds of different developmental deformities that we treat and each patient requires a customized treatment based on how they respond to therapy.
Since babies can’t follow commands or communicate effectively, pediatric physical therapy is done gently and slowly using toys and play.
For infants and toddlers, a lot of the PT is done passively but for older kids who can respond to instructions, we encourage active participation.
Most pediatric physiotherapists prefer working with kids on floor mats rather than couches that we have in adult physical therapy settings. That way, kids have room to explore their surroundings and get comfortable.
Babies’ rehab almost always follows a multi-disciplinary approach with parents and family members having a big role.
Physical therapy for babies begins with a thorough history of their birth and early life and an assessment of their milestones and movement patterns. Then comes a diagnosis and a treatment plan for recovery.
The focus of physical therapy for babies remains on optimizing movements that they can perform and improving function.
Physiotherapists help kids develop movement patterns and skills if they don’t have them (as in delayed gross motor skills). They also improve these patterns if the kid is performing wrong compensatory movements.
Common Conditions Treated in Pediatric Physiotherapy
Physical therapists use an array of techniques to help kids deal with different mobility issues. Here’s how physio is done on five of the most commonly seen conditions in infants and toddlers:
1. Cerebral Palsy
Cerebral palsy (CP) is a set of neurological disorders that results from damage to a part of the brain while in utero or during childbirth. It can result from toxins, genetics, lack of oxygen during birth or trauma.
It results in physical limitations and secondary conditions along with, sometimes, cognitive deficiencies. Physiotherapy aims to reduce these impairments to improve mobility, fitness level and the quality of life of kids.
Some of the ways through which physio is done on kids with CP are:
1. Gait Training
This is done to train proper foot placement and teach kids to bear body weight while maintaining an upright posture. Repetitive training initially with support and then unsupported improves walking speed in kids who are already mobile.
2. Constraint-Induced Movement Therapy (CIMT)
This works on upper limb functional hand use. It involves restricting the dominant hand and encouraging the use of the weaker hand. CIMT improves coordination and functional activity of hands in kids with CP.
3. Functional Goal-Oriented Approaches (Neurodevelopmental Therapy NDT)
We use targeted muscle group training through goal-oriented exercises to teach movement patterns to kids with CP.
Targeted exercises can also help to achieve milestones. For instance, putting the kid on his or her tummy and encouraging them to look up by using toys develops muscle strength in their neck and improves neck control.
4. Slow Prolonged Stretch
When kids are immobile, their muscles can get stiff in a shortened position, this is called a contracture. Stretching helps to reduce muscle tone and maintain soft tissue length.
Some therapists perform strength training exercises for kids with CP. But there’s a lack of high-quality evidence to show its effectiveness. (Reference)
2. Spina Bifida
It’s a neurological condition that results from a deformity in the formation of the spinal cord and neural structures.
Problems that occur as a result are loss of sensation below the point of spina bifida and issues with muscle movements due to an interference in the spinal cord that’s responsible for transmitting signals from the muscles to the brain and vice versa.
Kids also experience problems with bowel & bladder functions and digestion.
Here are some techniques we use in physical therapy for spina bifida:
1. Passive Range of Motion Exercises
This is done to maintain joint mobility and prevent contractures. Active range of motion exercises are preferred because they also work on muscle tone and build muscle strength.
2. Exercises for Strength and Maintenance
We perform active resistance exercises on the lower limb and back through play and activities that encourage movement and challenge muscles. For example, the physiotherapist will put a ball close to your toddler’s foot and encourage them to kick it.
3. Balance and Coordination Drills
Spina bifida in the lower back often results in lower limb weakness and balance issues. To train balance, your physio might hold the baby upright and stimulate them to step forward and bear their weight.
Doing it while partially submerged in water is also helpful. (Reference)
Active standing is better than using a walker because such assistive devices can’t ensure proper foot placement and weight-bearing by the feet only.
3. Delayed Milestones
Developmental milestones include neck holding, rolling, sitting, standing supported and unsupported or more advanced skills such as jumping and kicking.
These activities require complex movements of an area. Kids can have delayed developmental milestones because of multiple reasons and sometimes the cause remains a mystery.
A physiotherapist’s role here is to simply assist the baby in achieving the milestones and if possible, encourage activities that can help them in doing so.
Here are some ways physical therapy helps kids with delayed developmental milestones
1. At-Home Play Exercises
Milestones work in series and kids usually have to complete one to move to the next. If a baby is 9 months old and doesn’t sit by himself, then independent sitting is the milestone we need to focus on instead of the milestone that’s expected at that age, which is supported standing.
Your physio will prescribe play activities such as placing toys on one side to encourage rolling, moving further away while calling the kid to help them crawl or similar exercises.
2. Guided Play for Older Kids
The principle for achieving milestones for older kids remains the same. Group exercises are often helpful to challenge kids to work harder and move better.
Gait training is done on toddlers by having them walk on a path with handrails on both sides, or walking toward an object while the physical therapist provides the slightest bit of support from behind.
3. Environment Modification to Encourage Desired Movements
Your physio might suggest creating a play gym at home with padded floors to help kids learn complex movements in a safe environment.
4. Down’s Syndrome (DS)
Down’s syndrome is a genetic condition that never goes away but physiotherapy helps to manage its physical symptoms.
Kids with DS have delayed milestones, low muscle tone, bone weakness, and multiple other physical symptoms.
Here are some of the areas that physiotherapists work on to improve independence and quality of life:
1. Balance Improvement
Standing on unstable surfaces such as a wobble board or a soft floor activates postural muscles and improves coordination between different areas of the body.
While having the kid stand, physiotherapists adjust their feet and ensure upright posture to train proper balance. (Reference)
2. Increasing Tone, Muscle Strength and Joint Stability
Physios perform active strengthening and stretching exercises through play. These can include kicking a football, playing catch, climbing a ladder, gripping toys and so on.
3. Avoiding Compensatory Movement Patterns Early in Life
Kids with DS learn movements in their own time. But physiotherapists help them do it right the first time around by avoiding the development of wrong patterns such as walking with their back bent forward, feet wide apart, and toes pointed out.
Read in detail: Why Do Kids With Down’s Syndrome Need Physical Therapy?
5. Torticollis
It’s a condition where babies have a twisted neck, because of muscle tightness on one side or a skeletal problem. Torticollis is confirmed via ultrasound, scans and physical tests.
The primary treatment for it is physical therapy which includes: (Reference)
1. Range of Motion Exercises
Actively and passively increasing muscle length on the affected side is necessary for Torticollis rehab.
For that, mothers are advised different feeding positions, and games to play with the kid that makes them look in the opposite direction of the tight side and increase tummy time.
2. Strengthening Exercises on the Opposite Side
Muscles on the opposite side of the neck get elongated because of the excessive shortness on the affected side. Strengthening them balances both sides and brings the neck back to neutral alignment.
3. Passive Myofascial Release
Although there’s a lack of evidence to support the benefits of passive release, it can be soothing for kids and most physiotherapists use this technique.
The Takeaway
Physiotherapy for babies is a different ballgame than adults. Communication is easier with adults which makes therapy a bit easier as well. But with kids, you have to be creative and truly engage them in physiotherapy to get the benefits.
Having toys, games, and other kids with similar conditions around helps engage kids in your therapy and make them excited to participate.
How physio is done and the techniques used are always tailored to your kid’s specific condition with parents and caregivers having a big role in the rehab.
Feel free to contact us if you have questions about pediatric physical therapy.