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Chapter 10: Special Topics: Pediatrics

Annie Burke-Doe

CLINICAL APPLICATION OF FOUNDATIONAL SCIENCES

Pediatric physical therapy is a specialty practice that addresses the needs of the child and family. Care is provided through support, guidance, and interventions that are family-centered, culturally appropriate, age appropriate (0−21 years), and that improve quality of life and function. Pediatric treatment settings can vary among the acute neonatal intensive care unit, the acute hospital, an outpatient setting, school, and home, to address a few. Pediatric therapists treat infants and children with disabilities, typical developing children, and adolescents and young adults with and without disabilities. Some unique aspects of pediatric physical therapy include the understanding of child development as it relates to behavior management, developmental models, family interactions, social trends, reimbursement issues, and the requirements of working in diverse areas. Table 10–1 describes typical development. Physical therapy models of delivery can include the therapist working independently (unidisciplinary), the therapist evaluating the patient and then meeting with other professionals to discuss the case (multidisciplinary), joint examination with other professionals (transdisciplinary), and working with equal participation in serving the child and family (collaborative).

TABLE 10–1Developmental charts.
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TABLE 10–1Developmental charts.
1–2 months

Activities to be observed:

  • Holds head erect and lifts head.

  • Turns from side to back.

  • Regards faces and follows objects through visual field.

  • Drops toys.

  • Becomes alert in response to voice.

Activities related by parent:

  • Recognizes parents.

  • Engages in vocalizations.

  • Smiles spontaneously.
3–5 months

Activities to be observed:

  • Grasps cube—first ulnar then later thumb opposition.

  • Reaches for and brings objects to mouth.

  • Makes “raspberry” sound.

  • Sits with support.

Activities related by parent:

  • Laughs.

  • Anticipates food on sight.

  • Turns from back to side.
6–8 months

Activities to be observed:

  • Sits alone for a short period.

  • Reaches with one hand.

  • First scoops up a pellet, then grasps it using thumb opposition.

  • Imitates “bye-bye.”

  • Passes object from hand to hand in midline.

  • Babbles.

Activities related by parent:

  • Rolls from back to stomach.

  • Is inhibited by the word no.
9–11 months

Activities to be observed:

  • Stands alone.

  • Imitates pat-a-cake and peek-a-boo.

  • Uses thumb and index finger to pick up pellet.

Activities related by parent:

  • Walks by supporting self on furniture.

  • Follows one-step verbal commands; eg, “Come here,” “Give it to me.”
1 year

Activities to be observed:

  • Walks independently.

  • Says “mama” and “dada” with meaning.

  • Can use a neat pincer grasp to pick up a pellet.

  • Releases cube into cup after demonstration.

  • Gives toys on request.

  • Tries to build a tower of two cubes.

Activities related by parent:

  • Points to desired objects.

  • Says one or two other words.
18 months

Activities to be observed:

  • Builds tower of three to four cubes.

  • Throws ball.

  • Seats self in chair.

  • Dumps pellet from bottle.

Activities related by parent:

  • Walks up and down stairs with help.

  • Says 4–20 words.

  • Understands a two-step command.

  • Carries and hugs doll.

  • Feeds self.
24 months

Activities to be observed:

  • Speaks short phrases, two words ...

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