Getting kids on the right track … early

GPs play an important role in referring children with neuromuscular disorders for early help, explains paediatric physiotherapist Nicole Pates

Paediatric physiotherapists work with babies, children and adolescents experiencing a wide range of conditions, injuries, or developmental concerns. However, your regular private practice physio might not necessarily have paediatric experience or skills, as the entry level degrees in Australia have no standard for a paediatric curriculum.

Just like in medicine, physiotherapists undergo extensive post graduate paediatric training to become a paediatric physiotherapist. The Australian College of Physiotherapists recognises these physiotherapists with expertise through titling and specialisation, and it is possible to find these professionals in local areas.

However, it gets a bit trickier still. Paediatrics is a broad age range, covering 0-18 years. We can work in the city and the country, in hospitals and in the community, in private practice, in not-for-profit organisations and in the disability sectors. Just like in medicine, there are generalist paeds physios who see a little bit of everything and paediatric physiotherapists with expertise in particular areas.

So, what are these areas?

Paediatric physiotherapists work across a range of areas including neuromuscular disorders such as muscular dystrophy, neurological conditions such as cerebral palsy, injuries to the spinal cord, respiratory conditions such as cystic fibrosis, congenital issues such as spina bifida and developmental delay, rheumatological issues such as chronic pain, CRPS and Ehlers Danlos Syndrome and of course orthopaedics/musculoskeletal practice.

One thing that all paediatric physios have in common is we work in a family-centred practice model of care. We are working with the child in the context of their family and their community to build their physical skills and participation, to help them do the things they love doing.

So how can a paediatric physiotherapist help you and the families you see?

Across all ages we work with children with disabilities in the NDIS, more often than not in multidisciplinary teams.

Paediatric physiotherapists can make a big difference in the first few years of a baby’s life, providing assessment and management for:

• Gross motor delay

• Asymmetrical movement patterns

• Plagiocephaly/brachycephaly –referral prior to 12 weeks is ideal

• Developmental dysplasia of the hip

• Foot shape concerns such as talipes and metatarsus adductus.

As children grow, we can help in the assessment and management of gross motor skill development, walk, run, jump, hop, skip and ball skills, as well as playground confidence; balance and coordination, including developmental coordination disorder assessments; in-toeing, out-toeing, toe walking, knock knees and bow legs; and growing pains.

Towards and into the adolescent years we can help with musculoskeletal concerns such as apophysitis – the wait and see approach is no longer evidencebased and early intervention is key to prevent ongoing pain and maximise participation; rehab after injury or surgery, sports participation, sports performance and post-fracture rehabilitation.

Working with GPs

We are so grateful to GPs for their use of Medicare-funded MRI scans for children under 15 to rule out significant ligamentous or bony trauma.

For rheumatological and pain conditions such as hypermobility, connective tissue disorders such as Ehlers Danlos Syndrome, juvenile idiopathic arthritis, CRPS, chronic fatigue and chronic pain – usually these paediatric physios will work in a multidisciplinary team with psychologists and occupational therapists.

One of the most common reasons a child is seen in private practice for physiotherapy is pain.

Experienced paediatric physiotherapists are adept at understanding and assessing the possible red flags in this cohort and work with you as the child’s GP to minimise the risk of missing pertinent diagnoses, which if not caught early can lead to both unfavourable outcomes and missed opportunities for intervention.

The earlier we can see kids in pain, the more efficient and effective care we can provide.

The moral of the story is to refer early and refer to a paediatric physiotherapist with expertise in the area you need.

ED: Nicole Pates is a paediatric physiotherapist and managing director of Western Kids Health.