Overview

Pediatric physical therapy, a branch of physiotherapy, helps treat or correct movement issues in infants and young children and can help a child through their developmental stages.¹

Some of the body systems addressed include the musculoskeletal, nervous and neuropsychiatric systems, and some problems treated include congenital malformations, breathing issues, and preterm complications.

Developmental delay and movement disorders in children of all ages can also be addressed with paediatric physical therapy. The therapist may work with a wide range of specialists to tackle the complicated requirements of the child and the family, including medical professionals, social workers, nurses, psychiatrists, educators, and speech and occupational therapists.¹

What is the need for pediatric physical therapy? 

While each child develops at their own pace, there are some developmental milestones that most children are expected to achieve by a certain age. These developmental milestones cover movement, including sitting, standing, walking and holding things, speech and language, thinking, and social and emotional skills. They allow us to track a child’s development, to ensure that they are on the right path with the appropriate support, and that nothing is being missed. Some children may struggle to accomplish the milestones by the appropriate age due to illness or injury. For example, an injury may affect their level of independence and their ability to perform daily activities like walking. Paediatric physical therapists often treat children who have the following conditions:

• Prematurity 
• Recent trauma, injuries or surgeries 
• Mobility issues 
• Plagiocephaly 
• Cerebral palsy 
• Spinal muscular atrophy
• Cancer 
• Heart, muscle or lung conditions 
• Neurological conditions²

Intervention with physical therapy may be needed if the infant fails to meet developmental goals, especially those relating to movement, like sitting, crawling, and playing. Based on their age, condition, and stage of development, every child receives personalised care in physical therapy. After assessing their needs in the initial appointment, physical therapists create a treatment plan.²

Types of paediatric physical therapy exercises

Stretching

Stretching is an important part of paediatric physical therapy as it promotes general muscular and skeletal health, mobility, and flexibility. Physiotherapists can improve muscular flexibility, joint range of motion, and posture by including ideal stretching exercises into their treatment plan. Stretching also lowers the chance of contractures, stiff joints, and tight muscles, particularly in children who have neurological conditions or who have been bed-bound or unable to make certain movements for an extended period of time.¹

Handling techniques

Paediatric physiotherapy handling skills lay the groundwork for promoting children's healthy motor growth, sensory integration, and overall well-being. Skilled handling, in addition to enhancing muscle strength, mobility of the joints, and postural control, is critical for preventing anomalies, contractures, and other problems. Physiotherapists can promote active movement, neurodevelopmental advancement, and healthy caregiver-child relationships during therapeutic therapies.¹

Vojta approach

Vojta treatment is highly valued in paediatric physical therapy because it offers a comprehensive and targeted approach to enhancing movement patterns, a child’s ability to keep their body upright, and overall motor development, particularly in children with neuromuscular disorders or developmental delays. To cause involuntary motor responses, Vojta treatment applies precise pressure techniques to specific reflex zones. This promotes deep muscle activation and facilitates coordinated movement patterns. The purpose of this therapy is to improve motor function (muscle function) and postural stability (balance) by stimulating and rewiring the central nervous system that coordinates these functions.¹

Microcurrent therapy

Microcurrent therapy provides children with a mild, non-invasive means of reducing pain. It also promotes tissue healing and enhances the overall healing process. Without generating discomfort or unfavourable side effects, microcurrent therapy can efficiently target specific areas of pain and inflammation, boosting cellular regeneration and speeding up the healing process. It works by sending low-level electrical currents through muscles or tissue, which imitate the body's normal bioelectrical signals. This therapy is most beneficial for children with musculoskeletal injuries, neurological diseases, or chronic pain because it reduces pain perception, improves local blood circulation, and promotes signalling and repair processes.¹

Proprioceptive and visual exercises

These are crucial because they enhance a child’s overall functional performance, coordination, and sensory integration. By including specific activities and training that focuses on coordination, physiotherapists can support improved stability and balance, by promoting body awareness, spatial awareness, and postural control.¹

Treadmill training

A body harness is used during treadmill training to provide either full or partial body weight support, allowing a child to do movements, such as walking, unweighted and without having to put effort into balancing as well.³

Horse riding

Horse therapy can be classified into two types: therapeutic riding and hippotherapy. Therapeutic riding is done in small groups by a professionally qualified instructor, who may be accompanied by a physiotherapist. Hippotherapy is a one-on-one physiotherapy session during which a child will do specific exercises on a horse.³

Swimming and hydrotherapy

Hydrotherapy refers to water-based exercises and helps in strengthening, stretching, and passive joint range of motion. Like harnessing, movements in water reduce the need for balance and stability, and reduce the risks that may come with loading the joints with bodyweight. Many children with major movement impairments find water activities more engaging due to the buoyancy, which helps to make exercises easier to carry out.³

Rebound therapy

Rebound therapy is a physiotherapy technique that uses a trampoline to help patients strengthen their muscles, balance and coordination whilst also having fun. Rebound treatment can also enhance social interaction.³

Incorporating play into therapy

Play is the child's natural environment. By introducing play into treatments, children can participate better in the rehabilitation process, prepare for medical procedures, communicate thoughts and worries, and improve muscular movements. Furthermore, simply taking part in an activity and having fun can be beneficial. This therapy improves overall well-being, lowers stress, and uplifts the soul. Since play was identified as a medium for communicating with children, the term 'play therapy' has emerged, referring to a number of play tactics used to interact with children individually or in groups.⁴

Three common types of play used by child life specialists are the following:

Normative play

Activities that children typically engage in in their daily lives, such as reading books, playing board games, and pretend play, are examples of normative play. These activities are enjoyable and spontaneous. Normative play allows the child to engage in routines they are accustomed to, which might enhance their ability to engage and cope with treatment.⁴

Medical play 

Medical play is an effective approach that gives children the chance to play with medical tools and supplies to help them become familiar with hospital equipment, medical procedures, and can reduce emotions like anxiety and anger. Children may feel less nervous when medical equipment is used that they are familiar with. Three forms of medical play exist.⁴

• Role rehearsal: Role rehearsal is when a child acts as a medical professional and is allowed to handle medical equipment on a doll that represents a patient
• Indirect medical play: Indirect medical play is a more planned process in which the child learns about medical tools and processes through songs or games that have a medical theme
• Medical art: Medical art covers artistic activities like medical collages or paintings made with syringes that have a medical theme

Therapeutic play

Therapeutic play sessions require the ability to use play as a means of interaction and are designed in accordance with the understanding of child development and how children respond to hazardous life experiences. Therapeutic play interventions are meant to assist children in reaching their goals and realising their potential.⁴

In-home pediatric physical therapy

With home physical therapy, therapists can personalise treatments that would not be possible in a medical facility. Therapists can observe the home setting and how children engage with it directly during home-based care. With this knowledge, the therapist can design a treatment plan that considers the child's needs as well as the design of the home. Families can use the equipment and surroundings they have at their disposal to practise the therapies with the child and physical therapist.²

Additionally, in households with several family members and carers, the home setting facilitates carer education. There are restrictions on the number of carers who can attend each session in most medical facility settings, but multiple carers can attend home-based physical therapy sessions.²

FAQs

Why is physiotherapy important for children?

There are some developmental milestones that children are expected to reach by certain ages. These developmental milestones allow us to track a child’s development, to ensure that they are on the right path with the appropriate support, and that nothing has been missed. Some children may not be able to accomplish goals at the same time as others of the same age due to illnesses or injuries. 

Does an infant need physical therapy?

There are several significant changes and growth during a child's early years. Intervention with physical therapy may be needed if the infant fails to meet developmental goals, especially those relating to movement, like sitting, crawling, and playing.

Is aquatic therapy helpful?

Movements in water reduce balance issues, as well as joint loading hazards. Many children with major movement impairments find water activities more engaging due to the buoyancy relieving weight and making movements like walking easier.

Summary

Paediatric physical therapy helps to address movement issues in infants and young children and can help a child reach their developmental stages. 

Conditions that can benefit from these exercises include physical trauma, injuries or surgeries, mobility issues, plagiocephaly, cerebral palsy, spinal muscular atrophy, cancer, heart, muscle or lung conditions, and neurological conditions. Different types of physical therapy and approaches can be applied based on the child’s needs, and these include stretching, swimming or hydrotherapy, horse riding, treadmill training, Vojta approach, microcurrent therapy, handling techniques, and rebound therapy. Play therapy can also be introduced into treatments to help children participate more in the rehabilitation process, communicate thoughts and worries, and improve their ability to carry out small and large movements.