What is paediatric physiotherapy

Physiotherapy is the treatment of body using the body’s self healing abilities. The healing is enhanced through specific treatment after detailed assessment by the physiotherapist to diagnose the root of problem.

Physiotherapy, like medicine, have different areas of sub-specialization. The commonly known ones are:

  • musculoskeletal
  • cardiopulmonary
  • neurology

Other areas of specialization are:

  • paediatric
  • women’s health
  • geriatric
  • research

In the field of paediatric physiotherapy, physiotherapists are trained to understand in-depth and treat a wide range of childhood conditions ranging from musculoskeletal to neurological problems. Paediatric Physiotherapist understands that children learn through play, thus, will design activities to make therapy fun. Not everyone can work with kids hence paediatric physiotherapist have that ‘special touch’ on children!

What are the conditions seen by paediatric physiotherapist?

These are the common conditions seen by paediatric physiotherapist:

Musculoskeletal:

  • Congenital talipes equinovarus (CTEV)
  • Congenital talipes calcaneovalgus (CTCV)
  • Torticollis
  • Plagiocephaly
  • Arthrogryposis
  • Post fracture rehabilitation
  • Hip dysplasia
  • Poor posture
  • Sports injury
  • Pes planus (flat foot)
  • Abnormal gait

Neurological:

  • Cerebral palsy
  • Brain injury
  • Hypoxic ischemic encephalopathy (HIE)
  • Early intervention for
    • Premature baby
    • Metabolic disorders
    • Heart conditions
    • Any congenital condition resulting in long hospital stay with high risk of delay
    • Hypertonia
    • Hypotonia
    • Gross Motor delay
      • Developmental Coordination Disorder
      • Autism
      • Attention Deficit Hyperactivity Disorder
      • Global development delay

Oncology:

  • Post surgery rehabilitation
  • Neuro-rehabilitation

Cardiopulmonary

  • Chest Physiotherapy
    • ICU- airway secretions clearance
    • Pneumonia
    • Bronchiectasis
    • Chronic lung disease
    • Cystic fibrosis
  • Weight management

Plagiocephaly

What is plagiocephaly?

Plagio- in Greek refers to ‘oblique’; Cephalad- refers to the head. In combination, the term plagiocephaly refers to a musculoskeletal condition in which there is an asymmetry of the baby’s head, or oblique head, when viewed from the top. This is often accompanied by torticollis (head rotated and/or side tilted) and mandibular hypoplasia (smaller jaw bone on one side).

Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional or to be a substitute for medical advice of physicians.

What causes Plagiocephaly

Plagiocephaly can develop while the baby is in the womb (intrauterine) or  after delivery. One intrauterine cause is the lack of space during late stages of pregnancy. The baby’s head may be compressed at one side as a result of limited space, causing a relatively flatter skull on the pressured side. Thus, plagiocephaly is more common during the first pregnancy and multiple pregnancy.

Most plagiocephaly happens after delivery. In 1992, prone lying was identified as a factor that may cause Sudden Infant Death Syndrome (SIDS). As a result of SIDS prevention, parents position their baby on their back for play and sleep. This has successfully reduce SIDS incidence worldwide. However, this also caused many babies to developed pressured spot on their skull while lying on their back, resulting in development of plagiocephaly.

Plagiocephaly is also related to torticollis. Torticollis is a condition where  certain neck muscle is shortened, causing the head to rotate and/or side tilt. This preferential head rotation results in flattening of the skull on the pressured side. Infants with macrocephaly and/or low muscle tone (hypotonia) tend to develop plagiocephaly due to the lack muscle strength to rotate or control head movement. The flattened skull also encourage the child to lie on it even more as it is a position of comfort. As a result, the deformity is maintained.

Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional or to be a substitute for medical advice of physicians.

Tummy Time Video

Also see

Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional or to be a substitute for medical advice of physicians.

Tummy Time

Why Babies Need Tummy Time?

Since 1992 when ‘Back to sleep’ campaign was started to prevent  Sudden Infant Death Syndrome (SIDS), some parents are avoiding putting their babies in the the tummy down position. However, what is known now is the exact causes of SIDS is still unknown.

Avoiding the tummy down position has caused an ‘epidemic’ of plagiocephaly (flattening of the skull, often associated with torticollis). In addition, babies who are not placed on their tummy are found to have delay in their motor milestone, e.g. head control are developed at an older age then what it should have been. This is due to lack of opportunity for babies to strengthen their body in the anti-gravity position while they are on their tummy. Hence tummy time is an important exercise for all babies.

Also see:

Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional or to be a substitute for medical advice of physicians.

Cerebral Palsy

What is cerebral palsy?

Cerebral palsy is a brain disorder that happens in infancy or early childhood. Cerebral palsy is non contagious (does not spread to other people) and non progressive (does not worsen over time).

What are the different types of cerebral palsy?

The traditional classification of cerebral palsy is according to the type of muscle impairment and the number of limbs involved.

Classification according to muscle impairment:

(1) Spastic

  • most common type of cerebral palsy
  • reduced ability to stretch muscle
  • usually due to damaged motor cortex of the brain

(2) Ataxic

  • presented as increase tremors and/or low muscle tone
  • caused by damage to cerebellum, hind brain that controls coordination

(3) Athetoid

  • presented with mixed muscle tone
  • caused by damage to the corpus striatum

Classification according to number of limbs involved:

(1) Monoplegia: only 1 limb involved

(2) Hemiplegia: one entire side of body affected

(3) Triplegia: 3 limbs involved

(4) Diplegia: predominantly lower limbs involved

(5) Quadriplegia: all 4 limbs involved

Hence, for instance, if a child has increase muscle tone in all 4 limbs, he/she will be classified as a spastic quadriplegia.

 

What causes cerebral palsy?

There are numerous risk factors that are related to cerebral palsy. Below is a summary some of the risk factors:

  • Low birth weight
  • Preterm
  • Postterm
  • Asphyxia during delivery (lack of oxygen)
  • congential malformation
  • congential or perinatal infection
  • Intrauterine growth retardation
  • Viral Infection (TORCH – Toxoplasmosis, Rubella, Cytomegalovirus and Herpes simplex virus)
  • Multiple pregnancies
  • Injury to the brain in first year of life
    • cerebral infection
    • acquired brain injury
    • infantile spasm
Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional/physiotherapist or to be a substitute for medical advice of physicians.

When and how to start tummy time

When should I start my baby on tummy time?

You can start tummy time as early as the first week after delivery. You may want to start with very short practice. For instance, every time after you bath your baby, you can put him/her for a while on the tummy. As long as you child can endure without making much fuss, you can play with him/her on her tummy. Attract the baby’s attention with your voice. Go down to your baby’s eye level. Sing to your baby, talk and touch him/her. All these gesture will reassure your baby that the tummy position is harmless. As your baby grows, the endurance for tummy time will improve. NEVER leave your baby unattended while he is on tummy.

My child really hates tummy time. What should I do?

These are some other methods to promote tummy time:

1. Lying on parent’s chest.

  • parent can lie on the floor, with a pillow behind your back
  • make yourself comfortable because babies can sense your anxiety
  • Place your child on your chest. Talk and sing to him. Baby loves their mother’s voice.

2. Carry your child in the tummy down position. Light swaying accompanied with music or song usually does the trick

3. If you child has poor endurance to tummy time, you can start with a slight incline position rather than fully flat on the bed. You can use a roll of towel to be placed under the chest to help the baby lift up his head. You may want to try this at 2-3months of age when the baby has slightly stronger neck.

Do not give up on tummy time. Your baby will get use to the position with practice. And soon, they will be enjoying it!

Disclaimer: The information and advice contained in or made available through this website is for educational purposes only and is not intended to replace the services of a health professional or to be a substitute for medical advice of physicians.
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