PG - PEDIA BASICS

• Roles of Pediatric Physical Therapists:

  • Decrease pain
  • Decrease or prevent deformities/dysfunction/complications
  • Improve/maintain movement and strength
  • Facilitate motor development and function
  • Promote independence
  • Promote health and wellness
  • Attain maximal function
  • Educate children and their families
• Goals of Pediatric Physical Therapy:

  • Treatments focus on attaining maximal function through improvement of motor skills, balance and coordination, strength and endurance, cognitive and sensory processing
• Common conditions treated in Pediatric Physical Therapy:

  • Cerebral Palsy
  • Torticollis
  • Global Developmental Delay
  • Autism
  • Down’s Syndrome
  • Clubfoot
  • Scoliosis
• Collaborative care in Pediatric Physical Therapy involves:

  • Family members
  • Occupational Therapists
  • Pediatricians
  • Orthopedic Surgeons
  • Neurologists
  • Nutritionists
  • Speech Language Pathologists
  • Community members
  • Educational System
  • Social Workers
• Phases of Motor Development:

  • Reflexive (0-4 months)
  • Rudimentary (0-2 years) (locomotion, manipulative, stability)
  • Fundamental (2-7 years)
  • Sports related (7-adulthood)
• 4 Stages of Motor Control:

  1. Mobility

  2. Stability

  3. Controlled mobility

  4. Skill
• Fine Motor Milestones:

  • 4 months: Bidextrous reach
  • 6 months: Unidextrous reach; transfer object
  • 9 months: Immature pincer grasp, probes with forefinger
  • 12 months: Pincer grasp mature
  • 15 months: Imitates scribbling; tower of 2 blocks
  • 18 months: Scribbles; tower of 3 blocks
  • 2 years: Tower of 6 blocks; vertical and circular stroke
  • 3 years: Tower of 9 blocks; copies circle
  • 4 years: Copies cross; bridge with blocks
  • 5 years: Copies triangle
• Signs of Sensory Processing/Integration Issues:

  1. Overly sensitive or under reactive to environmental stimulus

  2. Unusually high or low activity level

  3. Easily distracted; poor attention to tasks

  4. Delays in speech, motor skills, or academic achievement

  5. Appears to be disorganized most of the time

  6. Coordination problems; appears clumsy or awkward

  7. Poor body awareness

  8. Difficulty learning new tasks or figuring out how to play with unfamiliar toys

  9. Difficulty with transitions between activities or environments

  10. Immature social skills

  11. Impulsivity or lack of self-control

  12. Difficulty calming self once “wound up”/ self-regulation
• Communication Skills Development:

  • Use high pitched voice
  • Use eye contact, facial expressions
  • Play with sounds
  • Describe actions
  • Read books with child
  • Encourage 2-way communication
• Social-Emotional Skills Development:

  • Make friends and keep friendships
  • Gain confidence
  • Manage stress and anxiety
  • Feel empathy
  • Resolve conflicts
• Types of Play:

  • Solitary - self-contained
  • Onlooker - observation of others c no participation
  • Parallel - play c one or more child, playing independently
  • Associative - play c one or more child, shared material
  • Cooperative - play of longr duration, c rules and goals
  • Symbolic - makes something stand for something else, "pretend play"
• Piaget’s Periods of Cognitive Development:

  • Sensorimotor - sensory and motor action schemes such as sucking, hitting and grasping . meas to deal with the immediate surroundings in their world
  • Preoperational - one dimensional awareness of the environment. uses symbols and internal representations to think, thinking is illogical and unsystematic
  • Concrete Operational - solve problems and think systematically (only with real objects and activities)
  • Formal Operational - solve abstract problems by using induction and deduction applied on purely abstract level
• Developmental Milestones:

  • Gross motor behavior
  • Fine motor, adaptive behavior
  • Language behavior
  • Personal-social behavior
• Reflexes are involuntary movements or actions
• Some movements are spontaneous and occur as part of the baby's normal activity, while others are responses to certain actions
• Healthcare providers check reflexes to determine if the brain and nervous system are working well
• Some reflexes occur only in specific periods of development
• Primitive reflexes are special reflexes that develop in the brain stem before birth
• Most primitive reflexes go away throughout the first year of life as higher functions of the brain and muscle control develop
• If primitive reflexes remain, they can interfere with the neurological organization of the brain, causing learning, behavioral, social, sensory, and health problems
• Retained primitive reflexes can be addressed through Integrating Primitive Reflexes
• General Body Reflexes:

  • Moro/Startle Reflex
  • Palmar/Grasp Reflex
  • Plantar Grasp Reflex
  • Limb Placement Reflex
  • Babkin Reflex
  • Parachute Reflex
  • Walking/Stepping Reflex
  • ATNR
  • STNR
  • Landau Reflex
  • Babinski Reflex
  • Gallant Reflex
  • TLR
• Facial Reflex:

  • Blink reflex
  • Doll’s eye reflex
  • Auditory orienting reflex
• Oral Reflex:

  • Rooting reflex
  • Sucking reflex/Swallowing reflex
  • Gag reflex
  • Cry reflex
• Retained Primitive Reflex Symptoms can lead to learning, behavioral, social, sensory, and health problems
• Stages of Labor

  1. Uterine Contractions/Cervical Dilation (latent, active, transitional)
  2. Childbirth/Expulsion
  3. Afterbirth/Placenta Stage
• Growth - Weight

  • Birth: 7 lbs and 5 oz (3.33 kg)
  • Normal: 2.5 - 3.5 kg
  • Low Body Weight: 1.5-2.5 kg
  • Very Low BW: <1.5 kg
  • Extreme Low BW: <1 kg
  • Overweight: >4.5 kg
• Growth - Weight

  • 2x = 4-5 mos
  • 3x = end of first year
  • 4x = end of second year
  • 2-9 yrs old = increments of 5 lbs (2.25 kg) per year
• Growth - Height

  • Birth length doubles by approximately age 4 years and triples by age 13 years.• The average child grows approximately• 10 inches (25 cm) in the first year of life,• 5 inches (12.5 cm) in the second,• 3–4 inches (7.5– 10 cm) in the third,• approximately 2–3 inches (5–7.5 cm) per year thereafter until puberty.
• Growth - Head and Skull

  • at birth the head is approximately 2/3 to 3/4 of its total mature size, whereas the rest of the body is only 1/4 of its adult size
  • anterior fontanelle normally closes between 10 and 14 months of age but may close by 3 months or remain open until 18 months
  • posterior fontanelle usually closes by 4 months but in some children may not be palpable at birth
  • cranial sutures do not ossify completely until later childhood
• Gestional Age

  • Pre term = <34 wks
  • Late Preterm = 34-36 wks
  • Term = 37-42 wks
  • Post term = >42 wks
• Locomotion (Rudimentary) 


  creeping, crawling, walking
• Manipulative (Rudimentary)


  reaching, grabbing catch and release
• Stability (Rudimentary)

  neck, head, trunk and hip control
• Sensory Threshold - Poor Registration

  • missing stimuli
  • responding slowly
• Sensory Threshold - Sensory Seeking

  • persuit of stimuli
  • associated with intelligence and creativity
• Sensory Threshold - Sensory sensitivity

  • distractability
  • discomfort with sensory stimuli
• Sensory Threshold - Sensory Avoiding

  • acting to reduce/prevent exposure to stimuli
  • efforts to make exposure more predictable
• 6 Sensorimotor period stages (Piaget)

  Stage 1

  • 1st month of life
  • Reflexive
  • e.g. rooting, sucking
• 6 Sensorimotor period stages (Piaget)

  Stage 2

  • 1-4 months
  • Primary circular reaction
  • e.g. thumb sucking, grasping of body parts or clothing