PEDIATRIC PHYSICAL

THERAPY
GOAL: Help children reach their maximum functional level of independence
MODULE 1: ○ Promotes independence

THERAPIST ROLE ○ Increase participation

○ Facilitates motor development and function
IN PEDIATRIC CARE ○ Improves strength
○ Enhances learning opportunities
○ Eases care giving and promotes health and wellness

Increases
Participation
Pediatric Physical Therapists promote
THE CRITICAL
increased participation in daily activities and
ROLE OF THE
routines in the: FAMILY

Parents and families have FAMILY SUPPORT

the primary role in
● The child's family is supported by physical therapists
children's development.
through:
Pediatric Physical Therapists
● Coordination of services
collaborate with the family
to implement individualized ● Advocacy
programs for each child. ● Assistance with enhancing development
 HOW?
● Positioning during daily routines
ENHANCING and activities
● Adapting toys for play
DEVELOPMENT ● Expanding mobility options
Pediatric Physical Therapists assist the family ● Using equipment effectively
with enhancing the child's development.

FAMILY SUPPORT STARTING A INTERVIEW

○ Teach families about safety in the home
and community CHILD IN
○ Provide information on the child’s physical PEDIATRIC
and health care needs
○ Assist the child & family with transitioning PHYSICAL EXAMINATIO
N AND
from early childhood to school, and into THERAPY EVALUATION

adult life

PHYSICAL THERAPY PEDIATRIC PHYSICAL

EVALUATION THERAPY
Mobility
✔ Includes collaboration & coaching
Muscle and joint function ✔ Occurs in natural learning environments,
Strength and endurance such as:
Cardiopulmonary status ✔ Home
Posture and balance ✔ Child care centers
✔ Preschools & schools
Oral motor skills & feeding
✔ Job sites
Sensory & neuromotor development
Use of assistive technology
 HOSPITALS AND
CLINICS
Children also may receive Pediatric Physical
Therapy in hospitals & clinics when the child is LEGAL AND ETHICAL
OBLIGATIONS IN
receiving care for related medical conditions or
during acute care episodes.

PEDIATRIC CARE

CHILD ABUSE CHILD ABUSE IN THE PHILIPPINES

AND IMPLICATIONS IN PHYSICAL THERAPY (CWC & UNICEF, 2018)
● Child abuse and neglect has been recognized as a 60% Physical Violence at
8 out of 10 03
home
significant social problem 14.3% School
children 12.5% Community
● Cultural norms have considered severe physical experienced some 7.1% Workplace
6.2% Dating
punishment necessary to: form of violence
in their lifetime 01 02
○ Maintain discipline that usually Physical Violence
committed at home
○ Transmit educational, cultural, moral and religious beings at hom consitutes various
forms of punishment
ideas
○ Please gods and/or expel evil spirits

Predisposing Factors
Red
Is the color of blood, and because
of this it has historically been
associated with sacrifice, danger
and courage.
Red
Is the color of blood, and because
of this it has historically been
associated with sacrifice, danger
and courage.
CYCLE OF ABUSE
PHYSICAL SIGNS
• Different aged bruises or
cuts
• Bruises infliced by objects
such as belts or cords
• Dislocations or fractures
• Burins in clearly defined
areas (cigarettes, stove,
etc.)
• Multiple unexplained injuries
• Injuries not age appropriate
• Injuries to the genital
region
• “Sock and glove” type
burns
• Repeated serious injuries
• Appears undernourished
• Has a handicapping
condition
• Wetting ang soiling
• Unexplained abdominal
swelling
• Bald spots (hair pulling)

SIGNS AND SYMPTOMS

 BEHAVIORAL SIGNS
• Parental behaviors
(conflicting stories)
concerning the cause of
injuries
• Delay in seeking medical
attention
• History of “hospital
shopping”
• Refusal of parent to allow
child to receive treatment
• Child is given inappropriate
food, drink or drugs
• Neglect of physical needs
of child
• Child behaviors - regression from age
YOUR ROLE
approprite bahvior
• Withdrawal or aggression
• Treat developmental delays and physical effects of abuse
• Developmental delays
• Seek constant affection • Provide a safe and consistent environment
• Role-reversal • Facilitate trust
• Fearful of adult contact
• Learning problems • Recognizing the signs and symptoms of abuse
• Blunted affect or Hyperactivity • Report suspicion of abuse to the appropriate authorities
• Poor self-esteem or fear of failure
• Lack of familial attachment or fear
of going home
• Lack of empathy and self-destructive
behavior

SIGNS AND SYMPTOMS

WHAT IS TOXIC STRESS?

When a young child’s stress response systems are

TOXIC activated within an environment of supportive

relationships with adults, these physiological
effects are buffered and brought back down to

STRESS baseline. The result is the development of healthy

stress response systems. However, if the stress
response is extreme and long-lasting, and
buffering relationships are unavailable to the
child, the result can be damaged, weakened
systems and brain architecture, with lifelong
repercussions.

WHAT IS TOXIC STRESS?

YOUR ROLE
Strong, frequent, or prolonged
• Realize the impact of trauma and toxic stress
activation of the body's stress • Recognize the signs and symptoms
response systems in the absence of • Respond by integrating knowledge of trauma-informed care
the buffering protection of a • Resist retraumatizing patients
supportive, adult relationship
 REALIZING THE IMPACT OF RECOGNIZING SIGNS AND
TRAUMA AND TOXIC STRESS SYMPTOMS OF TRAUMA
● When a child is exposed to prolonged, significant, and/or Infants and Toddlers
cumulative trauma ranging from abuse, neglect, witnessing ○ Increased separation anxiety
violence in their community, or living in poverty—without
ongoing support from a caring adult—a toxic stress response ○ Excessive clinginess
occurs. ○ Crying and/or whining
● Research shows that trauma and toxic stress experienced in ○ Increased fear and anxiety
childhood negatively impacts the physical, mental, social, and
emotional development of children, from developmental delays ○ Regression in global developmental progress
to learning and behavior problems. In the long term, ACEs are ○ Failure to achieve developmental milestones.
linked to risky health and lifestyle behaviors, chronic diseases,
and even premature death.
.

RECOGNIZING SIGNS AND REALIZING THE IMPACT OF

SYMPTOMS OF TRAUMA
Elementary school students ages 6–12 who have experienced trauma
may exhibit a variety of different behavior:
○ Increased anxiety, fear, and distress
○ Withdrawal and avoidance
○ Demonstrate decreased ability to focus, overreaction to auditory
stimuli (a door slamming shut or fire alarm)
○ A change in academic performance, poor impulse control, and
challenges with authority figures or constructive criticism
○ Increased physical complaints (stomachaches and headaches) may
be observed as well.
TRAUMA AND TOXIC STRESS
● Often a family will miss multiple therapy appointments and will be
labeled as a "no-show." By taking a trauma-informed approach, the PT
recognizes the multitude of social, economic, and contextual factors that
may contribute to missed therapy appointments. Instead of discharging
the patient, the PT incorporates trauma-informed principles and meets
with administrators, office staff, other team members, and the family to
identify pertinent issues and create a solution that allows the child to
regularly attend physical therapy.
● As a next step, the office administrator invites families, office staff, and
the therapy team to review policies regarding the clinic's attendance
policy. Through this process, policies are amended in a culturally
sensitive and collaborative manner with all involved stakeholders to
ultimately promote a more inclusive environment for children and their
families.

REALIZING THE IMPACT OF

TRAUMA AND TOXIC STRESS
● PTs working with children and families can take concrete steps
to build a culture of emotional and physical safety in their
clinical, school, or hospital settings. When the health care team
uses trauma-informed principles in partnership with a
family-centered approach, it creates a safe environment with
reduced potential for retraumatizing children and families. Often
individuals who have experienced maltreatment as children are
distrustful of authority figures, including health care
professionals. By ensuring that families and children have a
voice in their plan of care, we can work toward empowering
patients through choice.