Paediatric physiotherapy involves the assessment, diagnosis, and treatment of disorders of movement and physiological issues

in children up to the age of 19. Paediatric physiotherapists work in various settings, including hospitals, rehabilitation centres,
outpatient clinics, and homes. The treatment approach is tailored to meet the child's needs, with play-based therapy frequently
incorporated to improve functionality. Paediatric physiotherapy techniques include arm exercises, ball works, action songs,
standing encouragement, fetching and carrying games, and obstacle courses.

The physiotherapist must create a child-friendly environment with appropriate toys and games for rewards, distractions, and
facilitating treatment. Congenital and acquired conditions can lead to childhood disabilities, requiring careful treatments that
incorporate play activities to help regain lost skills.

Paediatric Physiotherapy –

Working with children is exciting, challenging and enriching. Physiotherapists entering this field of paediatrics will need to be
prepared to adapt to the techniques that they have learned in relationship to adults to the everchanging needs of the growing
child. The physiotherapist will inevitably work within the context of the child and his family and have opportunity to work with the
child in a range of situations extending into home, preschool groups, education and leisure activities. Because of the complex
needs of the child and the family, the physiotherapist may work with many other disciplines including medical, nursing, social
work, educational and care staff, psychological and psychiatric teams as well as speech occupational therapist. The
physiotherapist working in such teams must be able to communicate his/her observations, assessments and treatment plans to
the child, his parents and other members of the team.

To work effectively and efficiently the paediatric physiotherapist must in addition to his physiotherapy skills, have a clear
understanding of the development process of the childhood, primitive reflex patterns and paediatric illness and disability.

It is important that patients feel comfortable and reassured by their surroundings during treatment. For children this is of enormous
importance. The treatment environment starts as the child enters the waiting area; where children are seen in the same area as
adults it is important that provision is made for their specific needs. For the pre-school child the size and furnishing of rooms
should be as home like as possible. Children become anxious about large pieces of mysterious equipment which they don't
understand. The natural play environment of the young children is on the floor and the treatment environment should have suitable
floor coverings of washable carpet, mats or safe rugs. Toys and games for children of varying ages should be available both for
reward and distraction as well as to facilitate pediatric physiotherapy treatment.

Pediatric physiotherapy could take place in a number of areas, e.g. hospital ward, department or home, and for children there is
an increased possibility of venues. They may include health centre, nursery group, school or recreational group.

Childhood Disability

When considering childhood disability, it is important to remember that one is dealing with a child and family with a disability.
Disability is defined as state of body or mind which jeopardizes full functioning throughout a significant development stage or the
remainder of that person's life.

Defect: a structural or physiological abnormality.

Disability: a lack or impairment of a particular capability or skill.

Handicap: a condition or set of conditions that hinder or prevent the pursuit or achievement of desired goals.

Congenital Conditions: These are conditions that are present at birth. It would however be misleading to imply that all congenital
conditions present themselves at birth. Some are clearly apparent, e.g Down syndrome talipes, and major cardiac defects Others
do not reveal themselves immediately but only become apparent as the infant or child matures, e.g muscular dystrophy,
neurofibromatosis, most cerebral palsy and many hearing and sight defects. This group includes intra uterine infections the
outcome of which may or may not be apparent at birth, e.g cytomegalovirus, rubella and toxoplasma. Some conditions are
genetically linked, e.g muscular dystrophy, and may occur in several children within the family.

Acquired conditions: These are conditions that are acquired as a result of for example: Illness- encephalitis, meningitis, juvenile
chronic arthritis, dermato-myositis, neoplasm, malnutrition, etc. trauma- head injury, child abuse, road traffic or playground
accidents.

Pediatric Physiotherapy Techniques for infant and young child

The importance of play activities cannot be overstated. It is a vessel through which child regains skill lost as result of illness or
injury. In pediatric physiotherapy arm exercises may be combined with ball works or drawing pictures on a large sheet of paper
on the wall. Leg exercises may be combined with touching well placed objects with the toes. Any exercise may be reinforced by
using an action song. Standing may be encouraged by placing an attractive activity on suitable height surface. Movement may
be encouraged by fetching and carrying games, e.g shopping. Obstacle course provide endless possibilities for the therapist and
fun for the child. The child should not be allowed to become bored. The therapist should try to keep activities simple and have a
selection to choose from and if the first one fails or fades out quickly.

Pediatric Physiotherapy Techniques for Older child -

From about the age of seven children's awareness of their own bodies has matured enough to enable them to co-operate more
actively in their pediatric physiotherapy treatment. They have sufficient body and spatial awareness to be able to carry out simply
explained exercises and activities. The therapist should plan a number of short activities lasting 5 to 10 minutes. She could allow
time for play as a reward between or after therapeutic activities. She should always explain to the child what is expected of him.
Parents who are not present during pediatric physiotherapy treatment need to be kept informed about their child's treatment, his
progress and any treatment that should be continued at home.

The use of Equipment and Appliances:-

All children use some form of equipment as a part of daily life, e.g. pushchair, feeding chair or baby walker. All children have toys
of some description. There is a very thin line between ordinary baby gear and therapeutic equipment.

During the early months many babies will use a fully supporting chair or bouncing cradle seat. Some of these are designed for
use as a car seat and indoor chair and are recommended from birth. They give total support at a reclined angle in order to protect
the infant's spine from damage. These seats are particularly important for the floppy infant and can in many instances contain
the young baby with strong extensor spasms. A baby placed in one of these seats for planned period each day will have an
increased opportunity to watch his surroundings and they may assist the development of a mid-line awareness and early reaching
and grasping.

A little later a less supporting seat may be introduced at a more upright angle. If plastic baby chairs do not offer enough support
consider using a car seat with added foam cushions. It is sometimes easier to provide support from the upholstered surface of a
car seat than using vinyl or plastic which tends to be slippery.