Children’s Physiotherapy advice and support

GIG CYMRU NHS Wales – Activites to Promote Gross Motor Development – Tummy Time

Prone prop tummy time on Vimeo

Helping my Baby Learn through Play: Rolling Over to Move and Explore

Rolling on Vimeo

Helping my Baby Learn through Play: having fun in sitting

Promoting Physical Development: Lying to Sitting

GIG CYMRU NHS Wales – Activities to Promote Crawling

Supported Four Point Kneeling on Vimeo

GIG CYMRU NHS Wales – Activities to Promote Standing and Weightbearing

Kneeling to Standing on Vimeo

Standing on Vimeo

GIG CYMRU NHS Wales – Activities to Promote Walking

Cruising on Vimeo

You may notice your child favours looking to one side or has some flattening on one side of their head which seems to be affecting their head movement. Below is some information and advice that will be useful while you wait to see a physiotherapist:

• The Association of Paediatric Chartered Physiotherapists (APCP) Information – Head Turning Preference and Plagiocephaly

Below are leaflets for toy and play ideas to support babies development at different ages and stages, these have been developed by EISMART:

• Helping my child learn through play: 0 to 3 months old
• Helping my child learn through play: 3 to 6 months old
• Helping my child learn through play: 6 to 9 months old
• Helping my child learn through play: 9 to 12 months old
• Helping my child learn through play: 12 to 18 months old

Some children’s feet turn in as the walk and it is very common in young children. There are 3 main causes of in-toeing. Femoral anteversion, tibial torsion and metatarsus adductus. In most cases these resolve spontaneously with age and don’t require any intervention.

The Association of Paediatric Chartered Physiotherapists (APCP) Intoeing Gait

Some children walk with their feet turned out. It is less common than in-toeing but doesn’t require treatment and usually spontaneously corrects itself.

GIG CYMRU NHS Wales –Normal Variation of Gait in Early Years

Children’s knee position can also alter when they are learning to walk and in early childhood. Bow legs, when there is a gap between the knees when the feet are together, is common in children and usually disappears without any intervention by around 3 years of age.

Knock knees are common in children particularly between 3 to 5 years of age, where when the knees are together their feet are spaced apart. Knock knees often resolve without intervention around the age of 8.

GIG CYMRU NHS Wales – Normal Variation of Gait in Early Years

Flat feet are common in pre-school children and it is part of the normal development of foot posture. Most children will develop their foot arches by the time they are 6 years old.

The Association of Paediatric Chartered Physiotherapists (APCP) Flat Feet

The Association of Paediatric Chartered Physiotherapists (APCP) Choosing Footwear for Children

Children walking on their toes is common when they are learning to walk. As a child gets more confident with their walking this habit should reduce too. Sometimes, children continue to walk on their toes. It isn’t always known why a child walks on their toes but can be influenced by children having spent a lot of time in a baby bouncer or baby walker, or other reasons.

If you are concerned that your child is still toe walking or have other concerns about their development, you can speak to one of our physiotherapists or make a referral.

toe-walking-in-children.pdf

Heel pain is common in young people between the ages of 10 and 14. It is usually a result of irritation to the growth plate at the back of the heel bone. If the muscles do not keep up with the rate of bone growth as the child grows, there may be increased stress through where the muscle attaches at the heel. Physiotherapy is normally not necessary in the management of this condition. Please see the link below for more information and management.

The Association of Paediatric Chartered Physiotherapists (APCP) Calcaneal Apophysitis / Severs

A flat foot is when the inside of the foot (the arch) appears reduced or absent in standing. The arch often ‘reappears’ when sitting with the weight off the foot.

Before the age of 3 years, most children naturally have flat feet. The arch only starts to develop around this age.

The arches in a child’s foot should start to develop around the age of 3-4 years. The foot arch should complete most of its development between the ages  of 7-10 years.

Unless your child experiences pain or functional  difficulties where they are unable to participate in normal daily activities, no treatment (insoles or  exercises) is required. For further information please use the link provided below. If they are experiencing pain or functional problems please refer to the Gloucestershire Health and Care NHS Foundation Trust Podiatry service Referral Form

The Association of Paediatric Chartered Physiotherapists (APCP) Flat Feet

Hypermobility is a common childhood disorder that affects some children more than others. There can be a variation of symptoms depending on the degree of hypermobility at the joints, as well as how many joints are affected. Many children who are hypermobile experience no symptoms or difficulties and being hypermobile is beneficial in a lot of sports. Often a lack of strength as well as misunderstanding of the condition can cause more problems. Common complaints are:

• Clicking joints
• Tiredness after walking long distances
• Flat feet
• More stumbles/ falls, often called clumsiness
• Reluctance to take part in physical activity, especially for long durations
• Pain
• Difficulty with hand writing, using a knife and fork and getting dressed

Exercise, sport and pacing activities often help.

Please see the leaflet below for more advice:

Parent Leaflet – Hypermobility and Hypermobility Spectrum Disorder (2023) | Association of Paediatric Chartered Physiotherapists

These videos on core exercises and general strengthening exercises may be helpful

Hypermobility | Kent Community Health NHS Foundation Trust

Exercise videos: County Durham and Darlington NHS Foundation Trust

Back pain is common in children and young people and studies have shown that back pain affects over half of all children in primary and secondary school at some time. Pain in the muscles, ligaments and small joints is a sign that your child’s back is not working as it should. Back pain can be frightening for children and you may worry that it is something serious. The good news is that the back is very strong and by making small changes in posture and lifestyle, you can often improve back pain:

• Back Pain in Children and Young people

When to seek medical advice:

• Severe back pain which doesn’t improve with painkillers at home
• If your child also has a fever
• If your child has lost weight unintentionally
• If the pain is getting worse rather than better
• Pain which wakes your child at night
• If your child can’t control passing urine or passing a bowel movement
• If they have numbness or pain spreading into their legs
• If they have reduced movement in their back
• If any other joints are painful or swollen
• It they can’t walk normally or are unable to attend school

These exercises for core strengthening , stretching and general activity may be helpful.

• Exercise videos: County Durham and Darlington NHS Foundation Trust

Prevention is better than cure! You may like to share this information with your child regarding school bags including type, weight and how to wear it. This is particularly important  if they are about to transition to secondary school.

• Choosing the right school bag leaflet for parents

Scoliosis is when the spine curves to the side. The spine can also twist at the same time. This twisting can pull the ribcage out of position. Scoliosis that develops between ages 10 and 18 is called adolescent idiopathic scoliosis (AIS). Idiopathic means there is no known cause. Scoliosis is not usually a sign of anything serious but will need X-rays to diagnose the degree of curve. Treatment beyond monitoring is not often needed if its mild.

Click here for more information about scoliosis on the NHS website

It is really important that you maximise movement opportunities for your children, so that they can develop their motor skills and to encourage movement and activity for life.  This government website gives some fantastic ideas of how to help children to be active, whatever their ability.

These videos will also give you some strengthening and stretching ideas

Kids’ sports and activities – Healthier Families – NHS

Exercise videos :: County Durham and Darlington NHS Foundation Trust

Following an event that results in a soft tissue injury such as a sprain of a ligament or pulled muscle it is important that we let the body use its own healing strategies.

If following an injury, you or your child is in severe Pain, the area looks swollen, or it cannot be moved, or weight put through it then you should visit a minor injuries unit.

Following an event that results in a soft tissue injury such as a sprain of a ligament or pulled muscle it is important that we let the body use it’s own healing strategies. We shouldn’t take any anti-inflammatory medicines for the first couple of days because they will slow down the process that helps our body to heal. Ice may also slow this down in the first couple of days.

We need to protect the injury for the first 1-3 days by not putting too much weight on it, not moving it too much or doing anything that causes a lot of pain. It is important not to rest it too much though.

You can lift the injured part of the body up so it is higher than your heart, this will help manage any swelling. You can also use tubular bandage or taping to gently squeeze the injury which can also help with swelling and make it feel more comfortable.

If it is painful you can speak to the pharmacist about taking painkillers such as paracetamol.

After a few days it should be less painful and easier to move and use. It is important at this stage to use it as normally as possible.

Soft tissue injuries can take a couple of weeks to fully heal and for the body part to return to normal.

Keeping active and doing regular exercise is an important part of your recovery and long-term management of an injury or problem. Being physically active through-out your recovery and after can:

• Maintain your current level of fitness – even if you have to modify what you normally do
• Keep your other muscles and joints strong and flexible.

Not one exercise is better than another. There may be some we prefer and others that suit us better. Even when activity and exercise is limited there are a wide range of possibilities to get involved in activity and exercise Exercise – NHS.