Gross motor skills are such an important part of the healthy development for children of all ages.  In fact, gross motor activities not only get kids moving and active and allow them to release much needed energy, they also are responsible for helping children regulate their sensory needs.  One of the easiest ways to include proprioceptive (body’s ability to perceive its own position in space) and vestibular (sense of balance) input on a daily basis in our home is with Animal Walks.

Animal walks are simple and fun exercises that anyone can do to get a quick dose of gross motor play in their day.  Simply put, they are exercises that resemble the animals they are named for.  Some of the animals walks we do have classic instructions that are known throughout early childhood and physical development experts, such as the crab walk, bear walk, penguin walks and frog jumps.

However, the fun doesn’t have to stop with the classics.  Animal walks can resemble any animal and are a great way to encourage creativity while developing the important gross motor skills and providing sensory input.

Many of these movements require core strength, balance, and agility which are wonderful for sensory input and regulating the sensory systems (especially when there is a problem).

Another great thing about animal walks is that they help to increase Motor Planning Skills.  Motor planning describes how a child plans their body movements.  An element of motor planning includes paying good attention to directions and sequencing these directions correctly.  Animal walks are not simple! They require motor planning, and its sufficient sequencing and timing.  Participation in activities that practice motor planning provides a good foundation to help children learn to master more complex, multi-step directions for academics, as well.  

Research completed in Denmark (Myrto-Foteini 2017) shows that children gain and retain maths facts more quickly when they are engaged in gross motor movement. Pairing maths and language practice with a motivating movement activity like animal walks is an ideal way to address and improve children’s academics.

Animal walks are also great for building listening skills which should be a vital part of a child’s skill building in the early years.  Some benefits of good listening include more confidence, better engagement in activities, fewer misunderstandings, reduced frustration, improved receptive and expressive language.  Animal walks are such fun for kids that they are primed to listen and participate – they want to master each animal’s moves and so listen well to directions.

In addition animal walks are an excellent source of “heavy work” which is perfect for helping children that are struggling with fidgeting and even meltdowns.  Heavy work is any activity which requires you to use your muscles and joints, putting pressure on them as you move.  It provides your body with necessary proprioceptive input to self-regulate.

Our favourite part about doing animal walks with kids is the fact that these activities require no additional materials.  You simply just need some open space and your body.

You probably remember doing lots of these animal walks yourself when you were a child, but in case you need some further inspiration, here are some examples of animal walks for kids that will have your kids moving and giggling in no time!  Why not make a fun game by one of you demonstrating an animal walk and other having to guess what the animal is?

Animal Walks:

Crab Walk – Start by squatting down close to the ground.  Lean backwards and place your hands on the ground.  You should look like a “table top”.  Now walk sideways, while holding your bottom off the ground and your back straight.

Bear Walk – Start in the standing position.  Bend over and put both hands on the ground.  Now, walk forward with the same leg and arm – move your right arm and right leg forward, then the left leg and arm at the same time, then repeat.  For additional challenge, try keeping your legs and arms straight.

Frog Jumps – Start in the squatted position.  Place your hands on the floor in between your knees.  Using your feet, jump forward and land with your hands and feet on the ground.

Donkey Kicks – Starting in the standing position, lean over and put both hands and both feet on the ground.  When the area around you is clear, jump with your legs and kick behind you, leaving your hands on the ground.  For a fun challenge, stack some pillows or cardboard boxes and use your donkey kicks to knock them over.

Penguin Waddle – Who doesn’t love penguins? They’re so adorable when they walk! Your kids will love pretending to be a penguin too.  Simply keep your arms tight against the side of your body then gently waddle side to side as you walk.  As a bonus challenge, try and encourage your kids to walk a “penguin egg” on their feet.  Place a small ball or stuffed animal on top of their feet and see if your kids can waddle without dropping their egg.

Kangaroo Jumps – Starting in the standing position, put both feet together and squat down.  Jump as high as you can using only your feet, and no hands.  You could also encourage your kids to hold a stuffed animal in front of them as if they have a kangaroo pouch of their own.

Duck Waddle – Your kids will love pretending to be a duck with this simple duck waddle! Squat, tuck your hands into your armpits to make “duck wings,” and flap your arms as you walk.

Alligator Push-ups – Start on your tummy and push up into a plank through your hands and toes.  Walk forwards while trying to keep your arms and body as straight as possible.

Snake Slither – Lay on your tummy and put your hands by your sides or out in front. Wiggling your hips and shoulders side to side, to try and move forward across the floor without using your hands to help.

Turtle Crawl – Starting in the kneeling position, curl your back over and put your elbows on the ground. Keeping your bottom on your heels, and your elbows and hands on the ground, pull yourself forward in a slow motion.

Whale Swim – Laying on your stomach, with your arms stretched in front of you, rock back and forth on your hips. This takes a lot of core strength and can take some time to get used to.

Gorilla Walk – Start in the squatted position with your hands fisted on the floor.  Walk along while staying in the squatted position.  For added gross motor exercise, try beating your chest with your fists as you walk.

Octopus Wiggles – Start in the seated position on the floor.  Attempt to lift both legs off the ground at the same time while wiggling your legs and arms.

Inchworm Crawl – Move inch by inch with this silly animal walk.  Starting in a standing position, keep your legs straight, bend down, and place your hands on the ground right in front of your feet.  Next, walk your hands out in front of you until you get into a pushup-like position.  Then walk your feet up to meet your hands all while keeping your arms and legs straight.   Repeat this until you have walked across the room.

Elephant Walk – Start in the standing position and bend over with your hands held together.  Keeping your back straight and parallel with the floor, hang your hands under your shoulders and swing them back and forth as you walk with straight legs across the floor.  Don’t forget to stomp your feet like big elephants as you walk too!

Seal Slide – The seal slide animal walks can be challenging as an adult, but it’s a great challenge for the kids anyway.  Simply lay on your tummy, push your hands up until your arms are straight, and move across the floor while dragging your legs.

One-Legged Flamingo Stand/Hops – This animal walk is great for working on balance because it’s all about one-legged standing and hopping.  To do flamingo hops, stand on one leg making sure you get your balance first then, hop and land one-legged on the opposite leg.

Finally, don’t forget to encourage your kids to invent their own animal walks too!  Maybe they’ll want to be dinosaurs or horses or sea creatures. The possibilities are endless!

If you have any questions about how animal walks can help your child, contact The Children’s Physio today.

What are contractures?

A muscle contracture, or contracture deformity, is the result of stiffness or constriction in the connective tissues of the body. This can occur in:

• Muscles, (including tendons & ligaments). A muscle contracture involves the shortening and tightening of the muscles.
• Joints. If there’s contracture in the joint capsule where two or more bones connect, your child will experience limited range of motion in that area of your body.
• Skin. Skin may contract where it’s been scarred from an injury, burn, or past surgery. This will limit your child’s ability to move that part of your body.

Signs of contracture deformity

Contracture deformity restricts normal movement. It develops when the usually pliable connective tissues become less flexible. This means that range of motion will be limited and your child may have difficulty moving one or several parts of their body. Typical areas of contractures we see in babies and children are:

• The neck (if they have a preference to tilt or turn their head to one side)
• Elbows, wrists, fingers & thumbs
• Knees & ankles

The main symptom of contracture deformity is reduced ability to move an area of the body. Your child might also have pain, depending on the location and cause of the problem.

Common causes of contracture deformity

The most common causes of contracture are inactivity and scarring from an injury, surgery or burns. Children who have other conditions that keep them from moving around are also at higher risk for contracture deformity.

For example, children that have had a significant amount of time unwell and immobile following injury or illness, or following a long hospital stay are at risk of developing contractures. Since they aren’t moving their muscles and joints through their normal range of motion, these tissues are prime candidates for tightening.

Other causes include conditions that are inherited or that develop in early childhood, such as:

• Muscular dystrophy. Children with this condition often experience muscle tightness because significantly weak muscles impair their ability to move.
• Cerebral palsy (CP). This condition causes muscle tightness and limits movement.
• Arthrogryposis. Children with this condition are born with/develop joint stiffness with flexed or straight joints (predominantly elbows and knees).
• Juvenile Rheumatoid Arthritis (JIA) or other inflammatory conditions often cause stiffness in joints as a result of inflammation, pain and avoiding movement.

When to seek help

If your child gets burned or injured, seek immediate medical assistance. Call your healthcare provider if their ability to move the affected part of their body is suddenly limited.

Seek treatment for chronic diseases and underlying conditions as mentioned previously as early treatment can help decrease or prevent symptoms.

Physiotherapy

Physiotherapy is the most common treatment for contractures. We are experts in treating children with contractures. We provide thorough assessments and hands-on therapy to improve your child’s mobility as well as increase range of motion in muscles and joints and strengthen muscles by devising a programme of exercises that you can do at home with your child. We are also able to advise on walking aids (such as a walking frame or walking sticks) if needed.

Other treatments

• Your child may need to wear a cast or splint to help stretch the tissues near the problem area.
• Surgery may be indicated to release severe contractures and lengthen muscles which aims to increase range of movement and/or decrease pain.
• Surgery may also be needed to repair ligaments, tendons, or bones damaged in an accident.
• Your child’s Doctor may prescribe medication to reduce inflammation, pain or decrease muscle spasms.
• For children with cerebral palsy (or other conditions causing spasticity), botulinum toxin (Botox) is sometimes injected into muscles to reduce tension and minimize muscle spasms.

 

Consequences of delaying treatment

Delaying or declining treatment may make it difficult or impossible for your child to regain range of motion. Stiff muscles, joints, and skin can interfere with performing everyday tasks at home and at school as well as play.

For children with diseases such as cerebral palsy, muscular dystrophy, and JIA (to name a few), continual medical care is recommended to maximize available treatment options and their benefits.

If your child has been in the hospital for a long period or has been injured, it’s especially important to tell your healthcare provider about any stiffness or loss of movement they may have.

Preventing contracture deformity

Regular exercise and an active lifestyle can help prevent muscle and joint stiffness. If you are unsure about any of the information provided here or think your child may be developing joint or muscle stiffness then please do contact us and we will be happy to advise!

Back to School Series….

Top Tips for Choosing the Right School Shoes

In the first part of our Back to School Series we talked about top tips for choosing the right school bag. Today we are looking at one of the most important things to consider – your child’s shoes!

Let’s start by talking about why well-fitting and supportive shoes are so important……

Some of the bones in babies feet start to form (ossify) as early as 2 months of age and then strengthen from 6 months onwards until they eventually fuse with the lower leg bone. However the bones in the midfoot or arch of the foot start developing from 3 months right up to around 5 years old. The heel continues to ossify from 5-12 years old before completely fusing between 12-22years old.

We know that changes to foot posture (i.e if a child has lax ligaments and rolls their feet in or if they are wearing poor fitting shoes) will in turn affect the posture of the knee and hip and possibly spine. This means that muscles have to adapt and will pull the bones in the direction of force as they grow and may cause the bones to develop misshapen. So this is why it is so important that your little one has the correct supportive shoes for their needs (for the first 5 years at least!).

So how do you know if your child is wearing the correct shoes and what do you need to look for when purchasing new shoes? This is all covered in our Blog below so take a look …..

A good pair of shoes are essential for children’s feet. Don’t be guided by price as the most expensive shoes are not always the best!

 

Why hand-me-downs are a bad idea!

You may be tempted to hand down shoes to siblings or friends children particularly if they appear to be in good condition but here is why this is not recommended:

• Although the shoe may look ok on the outside, it is likely that on the inside the sole will have worn down from the first child and shaped into their particular foot posture. This means that the second child will not be getting the correct support for their feet.
• The tread on the bottom of the shoe will be worn and your child won’t get the same grip or shock absorption that they would have from a new pair of shoes. This could lead to foot, knee, hip or back pain when running and jumping.

 

Top 10 Tips for Choosing the right school shoes

1. Always get your child’s feet measured by a professional. If they are too small they can restrict growth and affect bone development and too big can cause your child to trip and fall. When checking the size of your child’s shoes you should aim to have approximately 1cm space at the end of the toes inside the shoe.
2. Shoes should have a good supportive heel to “cup” and hold their heel in place. It should be firm so that if you squeeze the heel it stays in place and does not squash together.
3. There should be good support across the top of the foot to keep the shoe in place (laces or straps) and make sure the shoe is fastened up fully and tightly!
4. Choose a flexible shoe that bends across the front/forefoot BUT not so flexible that you can bend or wring the shoe in half!
5. Don’t go for soles that are too thick and rigid as your child needs to be able to bend/flex the foot at the toes to be able to “push-off” when stepping and walking. If shoes are too stiff then you will notice your child walking with a restricted and stompy gait!
6. Look for arch support within the shoe – the inside of the shoe should be slightly raised to support the arch of the foot.
7. Rubber soles that grip and allow for shock absorption.
8. A shoe with a slight heel (that is slightly thicker at the heel than the toes) to aid heel strike during walking and shock absorption during running and jumping, Try to avoid fashion shoes with high heels or shoes that are completely flat such as plimsolls, converse style or slip on ballet pumps.
9. The shoe should be slightly wider at the toes than the heel to allow room for the toes to move. Avoid pointy shoes as these can squash the child’s toes restricting movement.
10. Make sure that the shoe is supportive around the ankle but not too high that it restricts your child’s movement such as squatting, jumping and and climbing. The exception to this is if your child requires increased support due to lax ligaments and your therapist has recommended this – if you are unsure then do get in touch and we can advise you!

 

Top tip for helping children to put their shoes on the right feet

★ Get your child to choose a large sticker, cut it in half and then put each half in one shoe, along the inside edge so that when you place the shoes together the right way round, the sticker pieces match and form the picture! Try it this week and let us know how you get on!

Back to School Series….

Top tips for choosing the right school bag

The school summer holidays are finally here but it won’t be long before parents around the country find themselves knee-deep in the back to school chores – stationary purchasing, book-covering, last minute uniform updates. Then there’s the question of what to put in the lunchbox…!

Amongst all the chaos and excitement, we recommend that all parents take a moment to observe and take a look at just how heavy their kid’s backpacks are.

It is generally recommended that children carry no more than 10% of their body weight in their school bags. When a heavy weight (such as a book-stuffed backpack) is incorrectly placed on the shoulders, the weight’s force can pull a child backwards. To compensate a child may bend forward at the hips or arch the back which can cause the spine to compress unnaturally.

There is particular concern for the younger students in secondary schools, as the spine is at a critical stage of development in children between 12 – 14 years of age. This is also the stage at which the bag weight to body weight ratio is likely to be high as some students are still quite small but carry loads similar to larger and older children.

Concerned parents should remember however, that compared with other types of bags, backpacks are, despite potential problems, usually the best choice for children as opposed to fashion bags that are carried over one shoulder (often with a thin, unpadded strap). When used correctly, the strongest muscles in the body – the back and abdominal muscles, support the weight of the packs. If not too heavy and if they are used correctly the weight is then evenly distributed across the body.

The role of Parents:

Poor posture is a big issue particularly in children as they are growing. Unfortunately teaching our children good postural habits requires a certain amount of ‘nagging’ so that our children learn to wear and pack their backpacks correctly. Kids who wear their backpacks over just one shoulder, because it looks ‘cooler’ or feels easier, end up leaning to one side to offset the additional weight. With time these kids are likely to develop lower and upper back pain, and strain their neck and shoulders. It’s important to help them understand the impact of not carrying their school bag correctly and insist they use the waist belt, if their bag has one.

For many parents, the struggle often comes from kids wanting a specific backpack because it features a particular superhero or cartoon character, or teenagers wanting the latest fashion bag but that might not be the healthiest choice. Try using positive language that helps your child understand why the best-designed and best-fitted backpack is the best option in the long run and make sure they are involved in the purchasing decision. Teach children young (as soon as they start nursery school) so that it becomes second nature and they don’t feel self conscious wearing a backpack in the correct way when they get to secondary school. Explain that it’s similar to getting in a car – where you put your seatbelt on and buckle up before driving so when wearing your backpack you fasten your straps and buckle up before walking!

Signs that your child’s school bag is too heavy:

• Changes in your child’s posture when wearing their school bag (stooped or leaning to one side)
• Your child struggles to lift or put their backpack on themselves
• Your child reports discomfort or pain when wearing their backpack
• Your child reports tingling or numbness in their arms.
• The bag leaves red marks on your child’s shoulders when they take it off.

Top 10 Backpack / Schoolbag Safety Tips

Make sure your child’s backpack weighs no more than 10 percent of his or her body weight. For example; a child weighing 35kg should carry a bag no heavier than 3.5kg. A heavier backpack will cause your child to bend forward in an attempt to support the weight on his or her back, rather than on the shoulders, by the straps.

1. Make sure the backpack is sturdy with a reinforced or padded backpiece and is appropriately sized – no wider than the child’s chest.
2. Wide, padded straps are very important. Non-padded straps are uncomfortable and can dig into your child’s shoulders. Use waist straps (if the bag has them).
3. Use both shoulder straps – never sling the pack over one shoulder. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
4. The straps should be shortened until the bottom of the backpack is just above the child’s waist, and not sitting on their buttocks. The backpack should lie flat on the child’s back.
5. The backpack should never hang more than 10cm’s below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking.
6. A backpack with individualised compartments helps in positioning the contents most effectively. Make sure that heavy items such as books are placed first into the back compartment so that they are closest to the spine and pointy or bulky objects are packed away from the area that will rest on your child’s back.
7. Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry-and the heavier the backpack will be.
8. If the backpack is still too heavy, talk to your child’s teacher. Use school lockers if available or ask if your child could leave the heaviest books at school, and bring home only lighter hand-out materials or workbooks. Check your child’s bag each day and make sure they are only taking the necessary items for that day.
9. It’s not just how much the back weighs but consider how long your child is wearing their backpack as time spent carrying it could also increase the likelihood of back and neck pain. Only wear the school bag for as long as needed and if stationary (in the playground or waiting for the school bus) take it off and place it on the ground.

This week (7th to 13th June 2020) is Infant Mental Health Awareness Week #IMHAW20 and this year the theme is ’20:20 Vision: Seeing the world through babies’ eyes’.  The subject is particularly pertinent and asks us all to describe what the world looks and feels like for babies right now, and to give that ‘babies-eye-view’.

So what is infant mental health?  Here is a definition from the Parent Infant Foundation: “Infant mental health describes the social and emotional wellbeing and development of children in the earliest years of life. It reflects whether children have the secure, responsive relationships that they need to thrive.”

The IMHAW campaign was launched on the 6th June 2016 by The Parent-Infant Foundation, PIF (formerly known as the Parent Infant Partnership UK) and aims to open up the conversation about the importance of the first 1001 days: conception to age 2 period and how this can affect infant mental health.

The first 1001 days include pregnancy and the first two years of a child’s life. There is clear, compelling evidence that this is a significant and influential phase in development. This is an age of opportunity. What happens during this period lays the foundation for every child’s future health, wellbeing, learning and earnings potential. It sets the groundwork for children’s developing emotional wellbeing, resilience and adaptability; the competencies they need to thrive. During this period we can lay a foundation of health and wellbeing whose benefits last a lifetime – and carry into the next generation.

Here at The Children’s Physio we are passionate about promoting awareness of Infant Mental Health and are here to answer any of your questions or point you in the right direction for useful resources.  If you are concerned about your baby or child’s development please do get in touch with us as we are experts in this area and here to help!

The following article by Deirdre McAliskey from NCB (NI) and Maurice Meehan, PHA asks:-

What is infant mental health and why does it matter so much during COVID-19?

Infant Mental Health is the term often used to describe the capacity of a child, during the first three years of life.

It is the capacity to:

• form close relationships;
• recognise and express emotions; and
• explore and learn about their environment

Babies are wired for connection! During pregnancy and infancy, it is obvious how physically reliant babies are on their parents and caregivers. They are also socially and emotionally connected to us in so many fascinating ways. The way we interact with babies and infants literally shapes their brain development. This occurs particularly during pregnancy, and continues up to the age of three years, when our brains are growing at the fastest rate.  We now know that ‘mirror neurons’ in the brain mean that how we act and interact with our children explains their ‘copy-cat’ behaviours. It all sounds like a huge responsibility but in fact, it’s the small, day-to-day interactions with babies and infants that make the greatest difference.

Serve and return

Babies are like scientists, exploring the world around them by sending out messages to see what happens, how things work, and where they fit in! They serve the ball and wait for us to return it. ‘The ball’ might be a cry, a smile, eye contact, a word, or stretched out arms. For our ‘serve’ we can offer physical touch and comfort, calm tone of voice, eye contact, smiles, repeated words, and praise. When we respond positively and meet their needs, babies develop trust, attachment, and confidence in us as caregivers.

Good enough is good enough

Infant mental health is not about perfection. It is hugely important that we don’t create unrealistic expectations for ourselves, our babies, and our relationships, particularly in these challenging circumstances. Pregnancy and early parenthood can be exhausting, and we all learn as we go. If we can be consistent and predictable in our responses most of the time, we are winning! Our goal is to enable as much attuned ‘serve and return’ interactions as possible, and to try and find a way of repairing and reconnecting when things go wrong.Compassion for yourself as a parent finding it tiresome and hard trying to meet the constant demands of your children during lockdown is essential to your emotional wellbeing. Intense feelings are inevitable. It’s the ability to repair them with a hug or cuddle by soothing pain, hurt, or anxiety. Think of difficult behaviours, including our own, not as bad, but as stressed or distressed. Self-compassion is key.

Parental emotional wellbeing

Being kind to yourself is about self-compassion, self-care and self-forgiveness when you fail to live up to your own expectations. Your children don’t need perfect parents, they just need good enough ones!

Parents need support to meet the challenges of parenthood. During these strange and unsettling times when our extended support networks are not physically available to us, it is even more important than ever to be kind to ourselves, and acknowledge difficult feelings. Parents of babies in neonatal or other in-patient units, face specific challenges during this time.

Look after yourself as best you can. That might mean taking a longer shower when you get the chance, enjoying a cup of tea, spending a few minutes in the garden if you can, or just having a chat with a trusted friend. Don’t feel the need to take on extra challenges, or be highly productive. If your mood is persistently low and you are more tearful or irritable than is manageable, ask for help from your midwife, GP, or health visitor as early as possible. You deserve it, and so does your baby.

Anxiety and depression can affect anyone at any time. That includes Dads too. The earlier you get help the better.

Further information on Infant Mental Health and the First 1001 Days Movement can be found at:

• https://aimh.org.uk
• https://parentinfantfoundation.org.uk
• https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-infant-mental-health-babies-and-under-5s/
• https://learning.nspcc.org.uk/research-resources/2016/looking-after-infant-mental-health-our-case-for-change
• https://ihv.org.uk/for-health-visitors/resources/resource-library-a-z/infant-mental-health/
• https://maternalmentalhealthalliance.org/news/the-first-1001-days-movement-highlight-impact-of-covid-19-on-parents-and-babies/

 

Have you wondered, what makes you stop your car at the sight of red light or what makes your child answer appropriately to a listening test?
Senses are our path of exploring the environment around us. Our senses are constantly receiving inputs from the environment. But it is the processing of these inputs that makes us respond in a particular way in the ongoing situation. Now imagine seeing the red light of the signal but being unable to process its importance and thus failing to stop your car. The inability to process the received sensory inputs explains the above situation.
Sensory Integration Dysfunction/ Sensory Processing Disorder(SPD) is described as a neurophysiological condition wherein the sensory input from one’s body as well as from the environment are poorly processed, modulated thereby giving atypical responses.

It is thought that along with the achievement of neuro-motor developmental milestones in a child, the development, integration as well as modulation of the sensory system is also significant and must go hand-in-hand.

What Signs Should I look for?

It is important to understand that a child with sensory issues will show definite signs and behavior patterns such as:

• portraying irritable behavior when stimulated with certain bright lights or sounds
• withdrawing themselves from hugs,
• showing unusual behavior upon touch of different textures are few of them.
• A child wanting to be on a swing constantly or making frequent head movements can also be picked up as signs.
• The child may exhibit hypersensitive or hyposensitive reactions to the stimulus received from the surroundings.

It becomes of utmost importance for the parents/care-givers as well as child therapist to constantly look for such signs at early stages.

Causes and Types

Considering the causes, definite causes for a child’s SPD are not known. However, researchers trace it to preterm birth, prenatal as well as delivery complications. One in every twenty individual has a sensory integration issue.

SPD is divided into three categories for the ease of having an insight of the dysfunction:

1. Sensory Modulation Disorder
2. Sensory Discrimination Disorder,
3. Sensory Based Motor Disorder.

SPDs has co-occurrence with the autistic spectrum. Although, a child with sensory issues is not always on the spectrum. According to studies the occurrence of sensory issues in the spectrum is 42% to 88%.

Treatment of SPD

The traditional approach for the management of children with SPDs is sensory integration therapy. This therapy comprises of playful activities for the child which in turn challenges the child.

With the betterment of health systems, a holistic approach has been accepted and has proven beneficial. Pediatrician, child therapist, radiologist, occupational therapist, speech language therapist work together as an interdisciplinary team.

As Children’s Physiotherapists we play a major role in shaping the motor outcomes as well as behavioral outcomes of a child. Making a child attentive and adequately aroused so as to have active participation in the therapy is significant.

Evidence from studies has shown that SPDs exists in children with cerebral palsy. This in itself should make handling of sensory issues of the child during treatment session more needful. Many studies have proved the effectiveness of sensory integration programs in children with spastic diplegia.

Assessing a child stands extremely important so as to prioritize the areas upon which the therapist should address. Few children may demand more of a Neurodevelopmental approach (NDT) while incorporating sensory therapy. Whereas, others may show needs of working upon sensory imbalance and processing and concurrently moving onto the motor aspects.

Owing to the skillful and theoretical knowledge that we as Children’s physiotherapists possess, it has become the need of the hour to expand our wings for each little life, whose future is in our hands.

Every child is special and hence every child has special needs!

Written by: Dr Esha R Surve (Physiotherapist)

Clubfoot Awareness Week

June, 3 2020

This week (1st to 7th June 2020) is Clubfoot Awareness Week and we thought what better time to talk about the signs and symptoms to look out for that may indicate an underlying problem.

Every day 500 babies are born worldwide with a condition called Congenital Talipes Equino Varus, commonly known as Clubfoot or Talipes.  Club foot is quite common, affecting about 1 baby in every 1,000 born in the UK and both feet are affected in about half of these babies.  It is twice as common in boys than girls.

The majority of babies born with clubfoot live in lower and middle income countries and unfortunately cannot access treatment.  Those children who do not access treatment face a lifetime severely affected by clubfoot, experiencing ongoing pain, limited mobility, and reduced opportunities in education, employment and relationships.

Until relatively recently in certain countries, children that were able to access healthcare were treated with major surgery.  The results from surgery were often ineffective.  Increasingly more and more evidence indicates that the longer term impact of cases that were initially considered successful outcomes were also poor, leaving the feet of patients stiff and painful over time.

World Clubfoot Day takes place on 3 June and this marks the Birthday of Dr Ignacio Ponseti – the pioneer of a global, minimally invasive and successful treatment for Talipes/Clubfoot.

What is Clubfoot?

Clubfoot refers to a condition in which a newborn’s foot or feet appear to be rotated internally at the ankle.  The foot points down and inwards, and the soles of the feet face each other.  It is known as talipes equinovarus (TEV) or congenital talipes equinovarus (CTEV).  In 50 percent of cases, both feet are affected.  Although sounding complicated, when broken up, it becomes easier to understand.

• Congenital – Present at birth
• Talipes – the foot and ankle
• Equino – foot pointing down
• Varus – heel turning inwards

In clubfoot, the tendons on the inside of the leg are shortened, the bones have an unusual shape, and the Achilles tendon is tightened.  If left untreated, the person may appear to walk on their ankles or the sides of their feet.

Club foot isn’t painful for babies, but if it isn’t treated, it can become painful and make it difficult to walk as they get older.

Clubfoot can be classified into 4 categories:

Congenital clubfoot is by far the most common, and most affected children have no other conditions.  It is sometimes referred to as isolated clubfoot or idiopathic (meaning cause unknown) clubfoot.  Idiopathic clubfoot occurs in about 1 to 2 per 1000 live births.

Positional clubfoot occurs when an otherwise normal foot is held in an incorrect position in the womb (as seen in the picture below).  The foot is flexible rather than rigid and can be manipulated into a neutral position easily by hand. Physiotherapy usually corrects this type of clubfoot.

Complex or Atypical clubfoot refers to feet which are more resistant to routine treatment but are still correctable, using a slightly different casting technique.  Atypical feet are short and chubby with a deep crease across the sole.  The big toe may also stick up at an odd angle to the other toes.

Syndromic clubfoot, which occurs in only a small minority of cases, is associated with additional chromosomal/ genetic abnormalities or syndromes.  Further tests may be offered to you by your consultant.

Causes of clubfoot

In most cases the cause of clubfoot isn’t known (idiopathic), but there may be a genetic link as it can run in families.

If you have one child with clubfoot, your chance of having a second child with the condition is about 1 in 35.  If one parent has club foot, there’s about a 1 in 30 chance of your baby having it.  If both parents have the condition, this increases to about a 1 in 3 chance.  In rare cases, club foot can be linked to more serious conditions, such as spina bifida or a developmental hip condition known as hip dysplasia, or developmental dysplasia of the hip (DHH).

Diagnosing clubfoot

Club foot is usually diagnosed after a baby is born, although it may be spotted in pregnancy during the routine ultrasound scan carried out between 18 and 21 weeks.  Club foot can’t be treated before birth, but picking up the problem during pregnancy means you can talk to doctors and find out what to expect after your baby is born.

Treating clubfoot

A clubfoot will not improve without treatment and leaving the foot untreated increases the risk of complications later in life.

Treatment for clubfoot usually starts within a week or two of your baby being born.  A technique known as the Ponseti method is the main treatment for clubfoot nowadays.  This involves gently manipulating your baby’s foot into a better position, then putting it into a cast from the toes to the thigh, to hold the foot in position.  This is repeated every week for about 5 to 8 weeks.  The manipulation and casting are done very gently, and your baby should experience no pain.

After the last cast comes off, most babies need a minor operation known as a tenotomy to loosen the tendon at the back of their ankle (Achilles tendon).  This is done using a local anaesthetic.  It helps to release their foot into a more natural position.

Once the foot is corrected your baby will need to wear special boots attached to each other with a bar to prevent the club foot returning.  The boots are worn for 23 hours a day for the first 3 months and then just at night and nap times for up to the age of 4 or 5 years old. Regular footwear may then be worn at all other times.

For the Ponseti method to be effective, it has to be done very early on, and parents have to make sure the boots are worn according to instructions.  If instructions are not followed strictly, the foot may return to its original position, and treatment has to start again.  While the infant is wearing a cast, parents should monitor for changes in skin color or temperature, as this could mean that the cast is too tight.

Steps have produced a great booklet for parents about talipes and its treatment https://www.steps-charity.org.uk/wp-content/uploads/2020/03/Talipes_Clubfoot.pdf

Surgery

Surgery may be used if other methods do not work, but this is normally on a case-by-case basis.  Surgery aims to adjust the tendons, ligaments, and joints in the foot and ankle, for example, by releasing the Achilles tendon or by moving the tendon that goes from the front of the ankle to the inside of the foot.

More invasive surgery releases soft tissue structures in the foot.  The surgeon then stabilizes the foot using pins and a cast.  Surgery is always used as a last resort as it may lead to overcorrection, stiffness, and pain. It has also been associated with arthritis later in life.

Outlook

Nearly all children treated with the Ponseti method will have pain-free, normal-looking feet.

Most learn to walk at the usual age and can enjoy physical activities, including sports when they’re older.

Even with treatment, children who only have one affected foot may be left with a slightly shorter leg and smaller foot on one side (between one and one-and-a-half times smaller than the other foot, and slightly less mobile).  The calf of the leg will also be smaller and this may mean your child is slightly less mobile and gets tired more quickly than other children.

Relapses

A well-treated clubfoot should not leave a child at a disadvantage.  They will be able to run and play like other children.  Sometimes clubfoot can come back, especially if treatment isn’t followed exactly.  If it comes back, some of the treatment stages may need to be repeated.  Left untreated, however, complications can occur and before the Ponseti method, club foot was often treated with surgery to alter the position of the foot.  This wasn’t always effective, and led to long-term pain and stiffness for some adults.

How can physiotherapy help my child?

Here at The Children’s Physio we are highly specialised in assessing and treating children with a wide variety of conditions from babies through to adolescents.  Our paediatric physiotherapists have the expertise and clinical training to provide early treatment to children with symptoms of Clubfoot.  We will provide a comfortable assessment of your child and ensure the highest level of care at all stages of treatment.

What should be expected from Physiotherapy treatment?

Physiotherapy after surgery for a clubfoot can begin as soon as your child’s surgeon recommends it.  All treatment, either surgical or non-surgical including physiotherapy, is designed to give the child a foot that can be placed flat on the floor.  Another goal of Physiotherapy is to assist your child’s walking biomechanics in order to encourage your child to walk as efficiently as possible.  Lastly, our goals also include relieving any pain if present, preventing pain in the future, maintaining the flexibility of your child’s muscles and tissues, and preventing any weaknesses around the lower extremities and core from developing.

• Depending on the age of your child, once the brace is discarded during the day, your physiotherapist may incorporate taping techniques of the foot to provide gentle foot positioning guidance.
• Your physiotherapist may address any pain issues that your child may be experiencing from the surgical procedure or the deformity itself, depending on the age of your child. Your physiotherapist may use modalities such as ice, heat or massage to try to relieve any pain.
• Maintaining the length of the tissues in your child’s foot is the main goal of any stretching exercises we do with your child or ask you to do with them.

Your child’s age at the time of surgery will largely influence how formal the stretches and strengthening exercises for your child will be.

Stretches

If your child is old enough to understand and follow along, your physiotherapist may encourage specific stretches for the back of the calf and Achilles tendon, as well as for the bottom of the foot.

Often, however, children who have had surgery for clubfoot are too young to effectively engage in formal stretches therefore play activities that encourage these types of stretches will be taught.  Ensuring that your child spends time squatting, standing with feet flat, standing on their toes, standing on their heels, walking without the brace, and practicing jumping are ways to encourage proper foot movement.  Your physiotherapist will guide you through which of the activities are most important for your child at which time, the proper technique for these activities, and how long they should be performing each activity.

If your child is too young to walk or do the higher level activities then your physiotherapist will teach you age-appropriate play activities that encourage the proper positioning of your child’s foot and lower leg.  Range of movement exercises that encourage motion of the foot in all directions away from the clubfoot position will be important.  Of particular importance are passive Achilles tendon stretches, which will be taught to you and will be encouraged frequently.  The Achilles tendon is the thick tendon at the back of the ankle.

Strengthening

Formal strengthening exercises for older children will be taught which encourage ankle, calf, hip, and core strengthening as well strengthening for the muscles that pull the foot into a position where the sole of the foot is turned up and out (opposite to the clubbed foot position).  As previously mentioned often the child who has had surgery for clubfoot is too young to perform any formal exercises.  Playing is once again the best method to encourage strength development in your child’s feet, legs and core area.

Your physiotherapist will encourage fun play activities and games such as assisted frog jumps or hops on one leg in order to strengthen the appropriate muscles.  Even helping the young child mimic these types of activities can be very useful to strengthen the legs and feet and encourage proper foot position.  Any activity they enjoy which encourages the proper motion is useful! Often singing while doing activities or making a game of the exercises is the best method of incorporating rehabilitation into your young child’s world.

For those children that are old enough to ambulate, gait retraining when the brace is off is a crucial part of rehabilitation after surgery for clubfoot.  Your physiotherapist will also work on your child’s foot and ankle proprioception (knowing where their foot is in space without them having to look at it) by having them stand or walk on different surfaces such as a soft mat or foam, as well as on different angles.  Activities such as hopping or climbing on apparatus will also help to improve their proprioception.  Climbing up onto things such as stairs or gym equipment simultaneously helps to build the needed strength in the hip area, which is an important area that assists in controlling the knee and foot position.

For children who are not yet walking, holding them in the standing position (with proper foot alignment) on different surfaces as well as on different angles will accomplish the same thing.  Most importantly, for all exercises, the goal is to get the foot into a proper weight bearing position and keep it out of the clubbed foot position.

Your physiotherapist will be a useful resource for discussing footwear modifications for your child if needed.  They may consult with a Podiatrist or Orthotist to ensure that the most appropriate footwear is prescribed for your child.

As your child grows, rehabilitation will need to be continued but the frequency of sessions should decrease as long as early intervention has started your child on the right path to correcting the alignment of your child’s foot, ankle, and lower limb, and as long as you are actively doing the home rehabilitation program.  As your child grows and becomes more mature, physiotherapy will include more formal types of exercises to encourage proper foot alignment.  It is expected that your child will eventually be able to partake in all physical activities that other children their age partake in.

Generally children who have had surgery for clubfoot do extremely well with the physiotherapy we provide at The Children’s Physio.  Over the course of your child’s therapy your physiotherapist will liaise closely with your child’s doctor, surgeon, orthotist or podiatrist as well as any other health care professionals that are involved in their care to ensure your child is recovering as quickly and normally as possible.

Remember, if you have any questions or concerns relating to your childs’ feet or their general development The Children’s Physio will be able to advise.  You can find us at https://thechildrensphysio.com.

More support for club foot

The charity STEPS offers help and support for families of children with clubfoot, and also adults who were born with clubfoot.   You can call their helpline on 01925 750271 or email info@steps-charity.org.uk.

Information about your child

If your child has club foot, your clinical team will pass information about him or her on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).  This helps scientists look for better ways to prevent and treat this condition.  You can opt out of the register at any time.

Today is World Down Syndrome Day so we thought what better time to talk about Down Syndrome?

We would like to start by wishing the Down’s Syndrome Association a very Happy 50th Birthday!  They do amazing work to support families, carers,  health and education professionals.  Here is a link to their website https://www.downs-syndrome.org.uk.

World Down Syndrome Day is a global awareness event…and we need you to help spread the word in your part of the world.  You can help by wearing brightly coloured, mis-matched socks.  Wear them at home, nursery, school, college, university, work, play, travel, on holiday…wherever you are and whatever you’re doing today the 21 March!

Make sure to take pictures and videos and post them on Facebook, Twitter and Instagram using the hashtags #LotsOfSocks, #WorldDownSyndromeDay and #WDSD20.

What is Down syndrome?

Approximately one baby in every thousand in the United Kingdom is born with Down syndrome and there are approximately 40,000 people in the UK with the condition.

Down syndrome is a genetic condition causing babies to be born with an extra copy of chromosome 21.  That additional copy changes the typical development of the brain and the body, causing some level of learning disability and a particular range of physical characteristics.  The effect is usually mild to moderate, and those with Down Syndrome can lead happy and productive lives – going to school, participating in family and community activities, and holding jobs.

Although the condition continues throughout a person’s life span, children and adults with Down Syndrome can improve their ability to perform movement activities and everyday tasks with the help of physiotherapists and other healthcare professionals.

Three types of genetic variation can cause Down syndrome:

• Trisomy 21 – This is when all the cells in the body have an extra chromosome 21. About 94% of people with Down syndrome have this type.
• Translocation – This is when extra chromosome 21 material is attached to another chromosome. Around 4% of people with Down syndrome have this type.
• Mosaic – This is when only some of the cells have extra chromosome 21 material. About two per cent of people with Down syndrome have this type.

The type of genetic variation that children experience does not significantly alter the effects of Down syndrome.  However, individuals with mosaic Down syndrome appear to experience less delay with some aspects of their development.

How Down syndrome may affect your child’s development

Children with Down syndrome are all individuals.  The only thing they all have in common is that they have extra chromosome 21 genes.  The effect that this extra genetic material has on each child’s health and development varies a lot – all have some additional needs, but the pattern of impact is different for each child.

Children and young people with Down syndrome share some common physical characteristics, but they do not all look the same.  Your child’s personality is also unique. They may be sociable or shy, calm or anxious, easy to manage or difficult to manage – just like other children.

Children and young people with Down syndrome also vary significantly in the progress they make with walking, talking, learning at school and moving towards living independently. Some children and young people have a greater degree of disability and more needs than others, however good their family care, therapy and education.  No one is to blame for this variation – least of all you, as a parent / carer.

Your child’s developmental needs

All children and young people with Down syndrome experience some degree of learning disability.  They usually make progress in most areas, but at a slower pace.  Some aspects of development progress faster than others.  What’s important is that your child moves forward at their own pace – not how fast this happens.

There are recurring patterns in the development of children with Down syndrome when they are considered as a group, often called a ‘developmental profile’ of characteristic strengths and weaknesses associated with the syndrome.

Characteristic strengths:

• Social interaction – Most children with Down syndrome enjoy and learn from social interaction with family and friends. As time goes by, they often have good social and emotional understanding, and most are able to develop age-appropriate behaviour, if this is encouraged and expected.
• Visual learning – Children and young people with Down syndrome generally learn visually. This means that they learn best from watching and copying other people, and may find it easier to take in information if it is presented with the support of pictures, gestures, objects and written words.
• Gesture and mime – Children with the syndrome are often particularly good at using their hands, faces and bodies to communicate. They often enjoy drama and movement as they get older.
• Reading ability – Reading is often a strength, possibly because it builds on visual learning skills.

Characteristic weaknesses:

• Hearing and vision – Hearing difficulties are common and can contribute to speech and language difficulties. Similarly, problems with vision are also relatively common, and these can affect the ability to learn visually.  However, both hearing and vision difficulties can usually be treated.
• Learning to move – The skills needed to move around and explore tend to be delayed compared with other children. However, over time many children and young people develop good motor skills and can become good at all types of sports.
• Learning from listening – Children and young people with Down syndrome tend to find learning by listening difficult. This may be because they have a hearing impairment or because language is developing slowly.  It also reflects particular problems with short- term memory, also known as working memory.
• Number skills – Many children with Down syndrome experience difficulties with number skills and learning to calculate.
• Learning to talk – Many children with Down syndrome experience significant delay learning to talk. Most children and young people learn to talk, but it takes longer.

There seem to be three main reasons for this:

• It takes them longer to learn to control their tongue, lips and face muscles.
• They have more difficulty remembering spoken words.
• They often have hearing difficulties, making it hard to pick up speech.

Mosaic Down syndrome

Children and young people with mosaic Down Syndrome may be less delayed in some areas of development, but still seem to experience a similar profile of strengths and weaknesses.

How can you help your child to develop and achieve their potential?

At the present time, there is no ‘treatment’ to reverse the effects of the extra genetic material that causes Down syndrome.  However, research over the past 25 years has taught us a great deal about how the syndrome affects individuals and about how to promote development.

Children and young people achieve their potential with:

• Effective healthcare
• Good parenting skills
• Everyday family activities
• Early intervention in their first years of life to support development
• Good education at primary school, secondary school and in further education
• Sports, recreation and community activities
• Vocational training and work

Conditions Associated with Down Syndrome

In addition to intellectual and developmental disabilities, children with Down syndrome are at an increased risk of certain health problems. However, each individual with Down syndrome is different, and not every person will have serious health problems.  Many of these associated conditions can be treated with medication, surgery, or other interventions.

Some of the conditions that occur more often among children with Down syndrome include:

• Heart defects. Almost one-half of babies with Down syndrome have congenital heart disease (CHD), the most common type of birth defect.
• Vision problems. More than half of children with Down syndrome have vision problems, including cataracts (clouding of the eye lens) that may be present at birth. Other eye problems that are more likely in children with Down syndrome are near-sightedness, “crossed” eyes, and rapid, involuntary eye movements. Glasses, surgery, or other treatments usually improve vision.
• Hearing loss. Up to three-quarters of children with Down syndrome have some hearing loss. Sometimes the hearing loss is related to structural problems with the ear. Children with Down syndrome also tend to get a lot of ear infections.
• Infections. Down syndrome often causes problems in the immune system that can make it difficult for the body to fight off infections, so even seemingly minor infections should be treated quickly and monitored continuously.
• Hypothyroidism. The thyroid is a gland that makes hormones the body uses to regulate things such as temperature and energy. Hypothyroidism, when the thyroid makes little or no thyroid hormone, occurs more often in children with Down syndrome than in children without Down syndrome.  A child may have thyroid problems at birth or may develop them later, so it is important that their thyroid levels are monitored throughout life.
• Blood disorders. Children with Down syndrome are much more likely than other children to develop leukemia, which is cancer of the white blood cells. Those with Down syndrome are also more likely to have anemia (low iron in the blood) and polycythemia (high red blood cell levels), among other blood disorders.
• Hypotonia (poor muscle tone). Poor muscle tone and low strength contribute to the delay in  gross motor skills that are common in children with Down syndrome.  Despite these delays, children with Down syndrome can learn to participate in physical activities like other children.
• Feeding difficulties. Poor muscle tone, combined with a tendency for the tongue to stick out, can also make it difficult for an infant with Down syndrome to feed properly, regardless of whether they are breastfed or fed from a bottle.  In some cases, the weak muscles can cause problems along the digestive tract, leading to various digestive problems, from difficulty swallowing to constipation.
• Problems with the upper part of the spine. Some children with Down syndrome have misshapen bones in the upper part of the spine, underneath the base of the skull. These miss-shaped bones can press on the spinal cord and increase the risk for injury. It is important to determine if these spinal problems (called atlantoaxial instability) are present before the child has any surgery because certain movements required for anesthesia or surgery could cause permanent injury.  In addition, some sports have an increased risk of spinal injury, so possible precautions should be discussed with a child’s health care provider.  Atlantoaxial instability can develop or worsen at any age so it is important to be aware of subtle or major changes in function in any part of the body (such as clumsiness – when walking or in hands during fine motor tasks).
• Disrupted sleep patterns and sleep disorders. Many children with Down syndrome have disrupted sleep patterns and often have obstructive sleep apnea, which causes significant pauses in breathing during sleep.
• Gum disease and dental problems. Children with Down syndrome may develop teeth more slowly than other children, develop teeth in a different order, develop fewer teeth, or have misaligned teeth compared to children who do not have Down syndrome.
• Epilepsy. Children with Down syndrome are more likely to have epilepsy, a condition characterized by seizures, than those without Down syndrome.  The risk for epilepsy increases with age, but seizures usually occur either during the first 2 years of life or after the third decade of life.
• Digestive problems. Digestive problems range from structural defects in the digestive system or its organs, to problems digesting certain types of foods or food ingredients.  Treatments for these problems vary based on the specific problem.
• Celiac disease. People with celiac disease experience intestinal problems when they eat gluten, a protein in wheat, barley, and rye.
• Mental health and emotional problems. Children with Down syndrome may experience behavioral and emotional problems, including anxiety, depression, and Attention Deficit Hyperactivity Disorder. They might also display repetitive movements, aggression, autism, psychosis, or social withdrawal.  Although they are not more likely to experience these problems, they are more likely to have difficulty coping with the problems in positive ways, especially during adolescence.

Physiological and behavioural differences in children with Down Syndrome can make it difficult to assess how sick they actually are if they become unwell, so things to be aware of are:

• Poor temperature control: They may not develop a fever at all, or may be hypothermic (low temperature) instead.
• Weak immune system: Infections that usually cause only minor illnesses can be dangerous to children with Down Syndrome.
• Mottle easily: They have poor control of their circulation, and get mottled skin with temperature change.
• Co-morbidities are common: They often have other health conditions (listed above).
• Knowing what is normal for the individual child: Assessing levels of alertness, responsiveness, muscle tone etc. can all be difficult if you don’t know the individual child at baseline.  Asking parents is essential as they know their child best!
• Narrow tubes and thicker mucus: They  get more chest & ear infections and generally produce more snot!
• Sensory processing difficulties: This can cause a fear of new sensations and environments so take time to explain and reassure.
• Atypical presentations of serious illness: Sepsis can present atypically (different to normal presentation) e.g. chest infections/pneumonia with sepsis can present as diarrhoea and sickness.
• Altered communication strategies: Speech & language development lags behind understanding, so they often understand more than they can express. They’re often great visual learners (but have poor short-term memory and fluctuating hearing loss) so using signs, pictures and gestures can be useful. Speak slowly, clearly and maintain eye contact.  Allow for sensory processing delay of several seconds so don’t hurry a reply!

Early Support and Intervention

The first years of life are a critical time in a child’s development. All young children go through the most rapid and developmentally significant changes during this time.  During these early years, they achieve the basic physical, cognitive, language, social and self-help skills that lay the foundation for future progress, and these abilities are attained according to predictable developmental patterns.  Children with Down syndrome typically face delays in certain areas of development, so early intervention is highly recommended. It can begin anytime after birth, but the sooner it starts, the better.

What Is Early Support and Intervention?

Early Support is a way of working, underpinned by principles that aim to improve the delivery of services for children, young people and their families.  It enables services to coordinate their activity better and provide families with a single point of contact and continuity through key working.

Early intervention is a systematic program of therapy, exercises and activities designed to address developmental delays that may be experienced by children with Down syndrome or other disabilities.  The goal is to enhance the development of infants and toddlers and help families understand and meet the needs of their children.  The most common early intervention services for babies with Down syndrome are physiotherapy, speech and language therapy, and occupational therapy.

How Can Early Intervention Benefit a Baby with Down Syndrome?

Development is a continuous process that begins at conception and proceeds stage by stage in an orderly sequence.  There are specific milestones in each of the four areas of development (gross and fine motor abilities, language skills, social development and self-help skills) that serve as prerequisites for the stages that follow.  Most children are expected to achieve each milestone at a designated time, also referred to as a “key age,” which can be calculated in terms of weeks, months or years. Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development.  However, they will achieve all of the same milestones as other children, just on their own timetable.  In monitoring the development of a child with Down syndrome, it is more useful to look at the sequence of milestones achieved, rather than the age at which the milestone is reached.

The table below gives a guide of when a child with Down Syndrome is likely to achieve their developmental milestones compared to a typically developing child.  It is important to note that every child is individual and there will be a large variance in this whether they have Down Syndrome or not.

Early intervention can also prevent a child with Down syndrome from reaching a plateau at some point in development.  The overarching goal of early intervention programs is to enhance and accelerate development by building on a child’s strengths and by strengthening those skills that are weaker in all areas of development.

Programs of early intervention have a great deal to offer to parents in terms of support, encouragement and information.  The programs teach parents how to interact with their infant or toddler, how to meet their child’s specific needs and how to enhance development.

Learning through play

All children learn through play and exploration.  Children with Down syndrome learn in the same way as other children, but often benefit from more support with their play.

Here are some practical tips to support your child to learn through play:

• Become your child’s ‘play partner’. Show them how to play with their toys – what a toy does, how to get it to make a noise or to move, how to hide and find a toy, how to screw or unscrew it, etc.
• Notice what interests your child, follow their interest and copy their play. Allow them lots of practice at each stage of play by playing in ways that interest them as they need to do this to learn.
• As well as playing in ways that interest your child, demonstrate how to do more interesting things with toys. This will help your child to progress when they are ready and it can prevent them getting stuck on repetitive patterns of play.
• Take turns with your child to demonstrate how to do something. Sometimes it’s helpful to have two toys so that, for example, you can both shake a rattle, roll a ball, push a toy car or cuddle teddy.
• Later on, join in with pretend play to show your child what to do. Help them to build a sequence of two or more actions in their play.  For example:
  – put a toy man (‘daddy’) in the car and then push the car– give dolly (‘baby’) a drink and then put dolly to bed.
  – ‘feed’ a toy farm animal and then make him run or jump.
• Pretend games provide valuable opportunities to teach new language to children. Help your child to link two or three words together by saying, for example, ‘Can you wash dolly’s face?’ or, ‘Watch me put dolly in the bath.’
• Use structured play. Children with Down syndrome usually need more repetition than other children before they are able to remember and master a task.  Your child will benefit if you break down tasks and games into small steps and show them how to complete each step.
• Use imitation as much as possible. Children with Down syndrome tend to be good at learning by imitating or copying other people.
• Praise your child and avoid frustration by making sure that most of the time your child gets satisfaction from playing and from toys. It can be very frustrating trying to do things that are beyond your ability.  Your child is likely to experience this when they try to play with toys that need precise finger movements – they may express frustration by throwing or banging.  When a young child gets frustrated, it can be quite hard for them to get over it.  Music, holding hands and jigging or dancing are good ways of getting over upsets.

How can physiotherapy help my child?

Physiotherapy focuses on motor development.  For example, during the first three to four months of life, an infant is expected to gain head control and the ability to pull to a sitting position (with help) with no head lags and enough strength in the upper body to maintain an upright posture.  Appropriate physiotherapy may assist a baby with Down syndrome, who may have low muscle tone, in achieving this milestone.

Before birth and in the first months of life, physical development remains the underlying foundation for all future progress.  Babies learn through interaction with their environment. Therefore in order to learn, an infant must have the ability to move freely and purposefully.   An infant’s ability to explore his or her surroundings, reach and grasp toys, turn his or her head head while watching a moving object, roll over and crawl are all dependent upon gross as well as fine motor development.  These physical, interactive activities require understanding and mastery of the environment, stimulating cognitive, language and social development.

Children with Down syndrome want to do what all children want to do: they want to sit, crawl, walk, explore their environment, and interact with the people around them.  To do that, they need to develop their gross motor skills.  Because of certain physical characteristics, which include hypotonia (low muscle tone), ligamentous laxity (looseness of the ligaments that causes increased flexibility in the joints) and decreased strength, children with Down syndrome don’t develop motor skills in the same way that the typically-developing child does.  They find ways to compensate for the differences in their physical make-up, and some of the compensations can lead to long-term complications, such as pain in the feet or the development of an inefficient walking pattern.

The goal of physiotherapy for these children is not to accelerate the rate of their development, as is often presumed, but to facilitate the development of optimal movement patterns.  This means that over the long term, physiotherapists will aim to help the child develop good posture, proper foot alignment, an efficient walking pattern, and a good physical foundation for exercise throughout life.

Here at The Children’s Physio we are highly specialised in assessing and treating children with Down Syndrome.  We can assess your child and provide individualised treatment programmes and advice to aid their development.

Remember, if you have any questions or concerns relating to your child and their development The Children’s Physio will be able to advise.

This week (2nd-8th March 2020) is Hip Health Week and we thought what better time to talk about babies and childrens’ hips as well as discuss the signs and symptoms to look out for that may indicate an underlying problem.  We are also supporting https://www.steps-charity.org.uk in their campaign to help raise awareness of hip health in babies and children.

In the UK up to 15% of children are born with some type of hip instability.  About 1 or 2 in every 1,000 babies has a hip problem needing treatment.  In fact, many more babies (about 6%) will have immature hips that will get better without treatment.

A hip problem can be hard to deal with, both for the child who has the problem and to the parent or caregiver.  A child who has a hip problem may feel pain in the hip, groin, thigh, or knee.  A child in pain may limp or be unable or unwilling to stand, walk, or move the affected leg.  A baby in pain may cry, be fussy, and have other signs of pain.

When a child is in pain his or her parents usually know it.  But pain can be hard for a child to describe.  An older child may be able to describe the pain as sharp or cramping or tell whether the pain comes and goes (intermittent).  A child between the ages of 18 months and 3 years may complain of pain or tell you he or she is not feeling well.  But the signs of pain in a very young child can sometimes be hard to recognize.  Watch for changes in how your child acts.

The signs listed below may help you decide whether your child’s pain is mild, moderate, or severe.  A child with severe pain will have more of these behaviours, the behaviours will be more constant, and you will be less able to comfort the child.  Look for:

• Changes in usual behaviour. Your child may eat less or become fussy or restless.
• Crying, grunting, or breath-holding.
• Crying that can’t be comforted.
• Facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance.
• Sleep changes, such as waking often or sleeping more or less than usual. Even children in severe pain may take short naps because they are so tired.
• Body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging to whoever holds him or her, or not moving.

Hip problems may be present at birth (congenital) or may develop from injury, overuse, inflammation, infection, or tumour growth.  To better understand hip problems, it may be helpful to know how the hip works.  It is the largest ball-and-socket joint in the body.  The thigh bone (femur) has a ball (head) at the top that fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint but it does not move as freely.  The hip joint is held together by muscles in the buttock, groin, and spine, tendons, ligaments, and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly.  The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.

Hip problems that affect children include:

• Developmental dysplasia of the hip (DDH). This condition is caused by a problem in the development of the hip joint. The top of the thigh bone (femoral head) does not fit correctly into the hip socket (acetabulum) so the femur can partially (sublux) or completely slip (dislocate) out of the socket. Babies born in the breech (bottom first) position are more likely to have hip instability than babies in a normal womb position and have an increased risk of DDH (up to 23%).
• An inward twisting of the thigh bone (Femoral Anteversion). This condition causes the knees and feet to turn inward. The child will have a “pigeon-toed” appearance and may have a clumsy walk. It’s important to note that a degree of femoral anteversion is part of normal development.  It is most evident between 2-4 years and will usually resolve spontaneously by the age of 10.
• Juvenile Idiopathic Arthritis (JIA). This condition causes one or more inflamed, swollen joints that are often stiff and painful. It first occurs before age 16.  JIA is slightly more common in girls.  It most commonly occurs in preschool age children or teenagers. There are different types of JIA and symptoms vary between the different types.
• An inflammatory reaction, such as Transient or Toxic Synovitis (Irritable Hip) commonly peaks at 3-8 years and more so in boys. This generally occurs after the child has had a cold or other upper respiratory infection.  This is the most common cause of hip pain in children.  Toxic synovitis has a scary name, but it’s not a scary condition.  This temporary inflammation of the hip can cause limping and pain in the hip and leg.  This can be unpleasant for a child and unsettling for a parent especially when symptoms start suddenly but toxic synovitis usually goes away within a week or two, and causes no long-term problems.
• Infection in the joint (Septic Arthritis), the bursa (Septic Bursitis), or the hip or pelvic bone (Osteomyelitis). Occurring at any age but most commonly from 0-6 years. Septic arthritis is an infection in the joint fluid (synovial fluid) and joint tissues.  Symptoms include fever, joint pain, swelling, redness, and warmth.  Quick treatment with antibiotics is needed to stop the risk of joint damage.
• A Slipped Upper Femoral Epiphysis (SUFE) or Slipped Capital Femoral Epiphysis (SCFE). This occurs when the upper end of the thigh bone (head of the femur) slips at the growth plate (epiphysis) and does not fit in the hip socket correctly. It has been linked to childhood obesity and is more common in boys than girls, usually between the ages of 8 and 17 years.
• Legg-Calve-Perthes Disease. This condition is caused by decreased blood flow to the head of the femur which affects the bone as seen on the X-ray and an MRI of a child with this problem. Perthes is approximately 4 times more common in boys than girls and generally occurs between 4 and 8 years of age.  Active children tend to be more affected.  The first symptom is usually a painless limp, but symptoms can be very subtle, with a mild ache in the thigh or knee not being uncommon.
• Proximal Focal Femoral Deficiency (PFFD). In other words, the end of the thigh bone closest to the hip is too short or not completely developed. In most cases, the hip joint is also not well developed.  The typical appearance is an unusually short thigh bone that is pulled upwards and turned toward the outside. The foot of the affected leg is often at the level of the opposite knee.  The knee often has varying degrees of instability as well.
• In rare cases, cancer of the bone, such as Osteosarcoma. This is a type of cancer that produces immature bone. It is the most common type of cancer that arises in bones, and it is usually found at the end of long bones, often around the hip or knee.

Treatment for a hip problem depends on the location, type, and severity of the problem as well as the child’s age, general health, and activity level. Treatment may include first aid measures; application of a brace, cast, harness, or traction; physiotherapy; medicines; or surgery.

How will I know if my child has a problem with their hips?

Here are some things to look out for with your baby or child:

• One leg shorter than the other. The leg may appear to twist in or outwards, hips/pelvis may appear to be unlevel in standing.
• Clicking or clunking hips (with or without pain). Often felt or heard when changing your baby’s nappy.
• Obvious pain when moving their leg or hip.
• If your child complains of pain in their hip, thigh or knee.
• Reluctant to weight bear on one or both legs.
• Delay in motor skills (crawling or pulling to stand)
• Abnormal gait (walking pattern); walking with a limp, dragging one leg (when walking or crawling), walking on tiptoes (often on one side), excessive intoeing.

If you are worried about your child’s hips and they present with one or more of the above then it is important to get them checked by a health professional such as your GP or a physiotherapist.  This doesn’t necessarily mean that your child is suffering from one of the conditions we have mentioned but it’s always best to get them checked.

How can physiotherapy help my child?

Here at The Children’s Physio we are highly specialised in assessing and treating children with hip conditions.  We can assess your child and provide treatment and exercises to help to keep them strong and supple.  If your child requires surgery for their hip condition we can play an important role in the rehabilitation in order for your child to get back to their pre-op functional level and help to prevent further complications in the future.

Things we may look at when we see your child are:

• Look for any signs of pain, asymmetry, leg length discrepancy , heat or swelling (rarely seen in hips as the joint is so deep).
• Assess their active and passive joint range of movement and muscle tone/strength.
• Palpate (feel) the soft tissues and joints.
• Examine their gross motor movements; crawling or walking pattern (gait) as well as look at manoeuvres such as squatting, single leg balance or hopping.
• We may refer onto specialist centres for further tests or investigations.
• We can provide advice and exercises to help your child to remain active and strong as well as techniques to aid their development before, during and after any surgical intervention.

Remember, if you have any questions or concerns relating to your childs’ hips or their general development The Children’s Physio will be able to advise.

“Play is the highest form of research”
Albert Einstein

There is nothing quite like the happy sound of children playing but this childhood occupation isn’t just good fun, it is crucial to a child’s development. Play allows children to be creative, it develops their imagination, dexterity, and physical, cognitive, and emotional strength. Play is so important in healthy brain development. It is through play that children at a very early age engage and interact in the world around them.

With the vast array of public awareness around reducing children’s screen time it is more important than ever to encourage our children to play outdoors. Children are naturally drawn to playing outside and there are so many benefits of outdoor play.

Outdoor play allows them to explore new environments, develop muscle strength and coordination, and gain self-confidence. Playing actively outdoors also increases a child’s flexibility, their fine and gross motor skills, and it is related to the development of a wide variety of physical skills, including those involved in sports.

Children benefit from exercise in so many ways and they have a real need for physical exercise and activity and need to be provided with opportunities to use their muscles to run, swing, jump, skate and ride a bike, and to be out in the fresh air and sunshine.

Don’t just take my word for it, Aideen McCartney, Certified Play Specialist at Playful Pathways has provided us with her Top 5 ways to encourage Outdoor Play.

1. Go on a discovery walk in your neighbourhood or local park

How many new things can you discover in your street or neighbourhood that you’ve never noticed before? You never know what kids of treasures and mysteries you can discover when you head out with a curious mindset. Bring magnifying glasses and torches if you like, but leave the phones at home.

2. Create an obstacle course

Using as little or as much space as you like and any equipment or natural obstacles you find, you can create a sequence of physical challenges and activities that will keep your family entertained. You can include running, skipping, hopping, climbing, crawling, going over/under/through/around things, going backwards/ forwards/sideways, stopping, starting, balancing and basically anything you like!

3. Build an outdoor den or fort

Using some old sheets, rope, pegs, furniture and trees you can make your own den,fort or play tent in the great outdoors.

4. Go on a picnic

Work together to prepare your favourite foods and take your breakfast, lunch or dinner outdoors (even if you only go as far as your backyard). Everything tastes better in the fresh air.

5. Have a water fight

On those warm days you can use water pistols, water bottles, buckets, plastic cups and of course the garden hose to have a good old fashioned water fight.

What are your favourite ways to encourage your child to play outdoors? Can you remember any childhood games you used to play outdoors?

As a Children’s Physio I see lots of children with abnormal walking patterns, poor posture, decreased stamina and difficultly keeping up with their peers. It is common practice to start treatment with these children by focusing on their leg strength or giving them insoles to correct their walking pattern, but what we need to do is get to the very core of the problem (pardon the pun)!!!

Core strength is so often over looked, especially in children. As healthcare professionals and as parents we are often more preoccupied with making sure that our children develop the right arm and leg muscles to walk, run and play that we can forget the importance of a strong core.

Your core is made up of your abdominal muscles and back muscles. A strong core is essential in maintaining posture, balance and coordination. All movements that a child does, from a toddler picking up a toy to a teenager playing football, require a good strong core! Do not confuse core strength with having a “6 pack”. Core strength refers to the equal development of the muscles in your stomach, pelvis, lower back and diaphragm. It is the ability of all these muscles to work together that enable us to stabilise our bodies during movement.

Strong cores are the building blocks for developing gross motor skills and fine motor skills, and if your child has a weak core it is difficult for them to maintain a stable base enabling coordination of the arms and legs.

Signs your child may have a weak core:

• Has difficulty remaining upright in their seat
• Leans on walls or other people
• Poor posture
• Has difficulty with carrying out both fine and gross motor activities
• Has difficulty with dressing and undressing
• Not reaching developmental milestones
• Unable to keep up with their friends
• Tired and achey at the end of the day

Effective and Simple ways you can strengthen your child’s core:

• Bouncing – on trampolines or hopper balls engages all the core muscles.
• The Wheelbarrow – hold your child in a wheelbarrow position and encourage them to walk their hands forwards. Ensure they keep a straight posture and do not allow them to dip their tummy in the middle.
• Twister/ musical statues – games where children have to hold static postures helps to engage all the core muscles.
• Soft play – the unstable surface at soft play centres will automatically engage their core muscles.
• Gym Ball – there are many simple exercises that the gym ball can be used for but simply just sitting on it and maintaining an upright posture is a good start.
• Swinging – At the park encourage them to swing themselves.

 

If you think your child has a weak core call The Children’s Physio to assess your child and develop and individual programme to target the appropriate muscle groups. Call today on 020 3322 5127 – no waiting lists, prompt appointments, specialised assessments.