introduction to paediatrics and young people

• the role of paediatric physiotherapists

  • Physiotherapists support children with their physical development
  • Physiotherapists help a child develop their physical skills through play, specific exercises and functional activities
• definitons of child abuse

  • Physical - hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child.
  • Emotional - persistent emotional maltreatment of a child to cause severe and persistent adverse effects on the child’s emotional development
  • Sexual - involves forcing or enticing a child or young person to take part in sexual activities
  • Neglect - persistent failure to meet a child’s basic physical and/or psychological needs
• motor control

  • Ability to regulate or direct mechanisms essential to movement.
  • Includes how the CNS can organize different muscles and joints and how sensory information is used from the environment and the body to select and control movement
  • It is about perception of ourselves and the environment in which we live, move and influence motor behavior’
  • No one model for understanding motor control
• musculoskeletal

  • Initial flexed posture becomes more extended (gravity)
  • Bone growth dependent on muscle activity
  • Allows for development of ‘skills’, e.g., gross motor, fine motor, communication, and social
• movement

  • Movement enables self exploration and body awareness
  • Movement gives comfort, security and safety
  • Independence increases with ability to move and explore
  • Contributes to child’s social and emotional development
  • Necessary for dynamic elements of postural stability which underlines skill performance
• elements of normal/typical development

  • Gross motor - large group of muscles to sit, stand, walk, run, keep balance and change positions
  • Fine motor - using hands to be able to eat, draw, dress, play and write
  • Language - speaking, using body language and gestures, communicating and understanding 
  • Cognitive - thinking skills e.g. learning and understanding, problem solving, remembering
  • Social - interacting with others, having relationships, co-operating and responding to feelings
• Case study - ATNR

  • 0-2 months onset
  • 4-6 months integration
  • Stimulus – rotation of the head to one side
  • Response: arms and leg on jaw side extends; arm and leg on the skull side flex
  • Importance: early eye-hand regard; vestibular stimulation, changes distribution of muscle tone
• case study - STNR

  • 4-6 months onset
  • 8-12 months integration
  • Stimulus – flex/ext of head and neck
  • Response:
  • Neck flex = UL flex + LL ext.
  • Neck ext = UL ext + LL flex
  • Importance: bilat patterns of movements; assume quadruped; allows to move against gravity
• common paediatric conditions - respiratiory

  • Asthma
  • Bronchiectasis
  • Bronchiolitis
  • Chronic lung disease (preterm infants)
  • Cystic fibrosis
  • Emphysema
  • Pneumonia - community or hospital acquired
• growth

  • Feet – bones not present till age of 3
  • Gait pattern – not fully established until age 7-8
  • Feet grow first – age 8-10
  • Limbs – age 11-13/14
  • Spine last – age 14-16
  • Puberty and hormone influences
  • Peak height velocity (approx. age 12.8 years girls, 13.4-year boys)
• common paediatric joint (MSK) conditions

  • Flat feet
  • Toe walkers
  • In-toeing gait
  • Genu varum / bowlegs
  • Genu valgum / knock knees
  •  developmental hip dysplasia
  • Perthes disease
  • Fractures
  • Slipped upper femoral epiphysis
  • Congenital talipes equinovarus (clubfoot)
  • Osteogenesis imperfecta
  • Osgood Schlatter’s
  • Osteochondritis dissecans
  • Juvenile idiopathic arthritis (JIA)
• What does JIA stand for?


  Juvenile Idiopathic Arthritis
• What type of condition is JIA?


  It is a chronic inflammatory condition.
• What is the primary age group affected by JIA?


  Children
• How many cases of JIA occur per 10,000 children?


  1 case per 10,000 children
• What is the prevalence of JIA?


  10 per 10,000 children
• What are the clinical reflexes associated with JIA?


  • Joint inflammation, pain, stiffness, and swelling
  • Acute anterior uveitis (pain and redness of eyes; chronic eye problems can cause blindness)
  • Fatigue and malaise
  • Growth retardation
• What diagnostic tool is abbreviated as P-GALS?


  Paeds Gait Arm Leg Spine
• What is the purpose of X-rays in diagnosing JIA?


  To visualize joint damage and inflammation
• What types of blood tests are used in the diagnosis of JIA?


  Full blood count, ESR, C-reactive protein, Serum Rh Factor, and positive anti-nuclear bodies
• What are the management strategies for JIA?


  • Physiotherapy
  • Drugs: NSAIDs, corticosteroid joint injections, disease-modifying drugs (e.g., methotrexate, corticosteroids)
  • Eye screening
• Common Paediatric Conditions - Neurological / Neuromuscular

  neurological

  • Cerebral palsy
  • Brain tumors
  • Pediatric stroke
  • Encephalitis
  • Epilepsy

  Neuromuscular

  • Spinal muscular atrophy
  • Duchenne muscular
  • dystrophy
  • Charcot-Marie tooth
  • Congenital myopathy
• What is Cerebral Palsy (CP)?


  CP is a permanent non-progressive condition.
• How is Cerebral Palsy caused?


  It is caused by damage to the brain of a baby, either in-utero, during birth, or during the first few months of their life.
• What are the predominant problems caused by Cerebral Palsy?


  It predominantly causes problems with posture and movement, including weakness and abnormal muscle tone.
• What is the prevalence of Cerebral Palsy in children in the UK?


  Cerebral Palsy is the most common cause of childhood disability and affects 1 in every 400 children in the UK.
• How might Cerebral Palsy affect a child?


  • Increased muscle tone (spasticity / hypertonia / stiffness)
  • Low muscle tone (hypotonia / floppy muscles)
  • Muscle weakness
  • Delayed or impaired development of fine and gross skills
  • “Abnormal” movement patterns
  • Sensory processing difficulties
  • Visual impairment
  • Communication problems
  • Challenging behavior
  • Learning difficulties
• How can Cerebral Palsy affect a child's oral muscles?


  In some types of CP, the child’s oral muscles might be affected, impairing speech and swallowing.
• What are some characteristic joint deformities associated with Cerebral Palsy?


  • Flexion at elbows and wrists with clasped fingers
  • Adductor spasticity of the hips, resulting in a ‘scissor’ stance and gait
  • Flexion at the hips and knees
  • Equinus deformity of the feet
• What are the postural effects of Cerebral Palsy?


  • Risk of hip subluxation and dislocation
  • Abnormal biomechanical forces placed upon the joint
  • Spasticity causing adduction and flexion of the hip
  • Development of contractures limiting movement
• Why is effective hip surveillance important for children with Cerebral Palsy?


  Effective hip surveillance prevents hip dislocation, improves quality of life, and saves money through cost-effective early intervention.
• What role do contractures play in the postural effects of Cerebral Palsy?


  Contractures develop as muscles do not grow normally, limiting movement and causing abnormal postures and deformities.
• Quality of life

  • It is important to remember that disability does not necessarily link with QoL
  • Children with parents who are accepting of disability limitations and foster autonomy and have been shown to have higher QoL scores
• What is the first step in the methodical approach to respiratory assessment?


  Observe – charts / obs / patient / feeds / O2
• Why is it important to know what is normal for a child during respiratory assessment?


  To identify any signs of respiratory distress effectively
• What are signs of respiratory distress?


  Signs include increased respiratory rate, use of accessory muscles, and nasal flaring
• What equipment and position should be considered during a respiratory assessment?


  Chest assessment tools and a comfortable position for the patient
• What should be assessed during a chest assessment?

  Auscultation and cough
• Why is it important to have family present during a respiratory assessment?


  To provide support and reduce anxiety for the patient
• What is required in the birth history of a baby during assessment?


  General observations, color, and whether the baby is settled or unhappy