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Working with Children

As well as staying up to date with medicine and the law, paediatric physiotherapists may benefit from honing their communication skills, says Louise Hunt

Paediatric physiotherapists have a lot to keep up with. For a start, they cover an unusually wide range of practice. They work in various environments, including hospitals, community settings and children’s own homes. And they treat a wide range of conditions including respiratory, neurological and musculoskeletal.

This means they need to be able to work across the specialities and apply their generic knowledge to the particular requirements of children, says Heather Angilley, chair of the Association of Paediatric Chartered Physiotherapists (APCP), who is based at the Mid Yorkshire NHS trust.

Quick thinking

‘Because you are working across the specialities, you have to be able to move from one speciality to another in a short time,’ she says.

‘You need to be able to quickly think which areas are pertinent to the patient. In my area, developmental coordination disorder, there could be a number of causes for their delay, so you have to have good background knowledge to know what avenue to go down.’

Paediatric physios’ work is influenced by the ever-changing advances in medicine and assistive technologies, such as the use of brain stimulation to reduce spasticity or surgery for leg lengthening. And they need to be aware of contraindicators, such as not using nerve stimulators on children with epilepsy, says Lynda Pedley, founder and director of independent provider Physio4Kids. She stresses the importance of being able to use a range of approaches to suit the individual.

Developments in evidence-based research are constantly changing physio practice  in cerebral palsy, for example. ‘There has been a move to strengthening the affected muscle groups, whereas in the past practitioners have focused on inhibiting abnormal activity,’ says Heather. ‘This seems to be making a difference.’

There are important differences from adult physiotherapy. One essential is for a physio to understand child development  physical, behavioural and cognitive  and adapt treatment to the child’s age and cognitive abilities.

Compliance

‘One of the main differences is compliance,’ says Mrs Pedley. ‘ You can give an adult exercises to strengthen muscles, but with a young child you can’t be so prescriptive. So you have to be inventive and creative and make the exercises part of play.’

The same goes for differences in anatomy. Children should not be given weights as part of exercise, as their bones and muscles aren’t yet fully formed –only the child’s own weight should be used as a counter. And children with chest problems need to be monitored closely, as they use their diaphragm muscles more in breathing and may tire quickly.

Changes in the law also affect a paediatric physio’s practice. Up-to-date knowledge of child protection processes and children’s legal rights are essential.

The continually shifting sands of health policy also affect paediatric physios’ work. More emphasis is now being placed on measuring patient satisfaction as part of treatment outcomes. 

‘It has always been difficult to have good objective measures of improvement in children, as you cannot always rule out what would have changed developmentally. It is good that there will be more encouragement to collect subjective measurement,’ says Heather. 

Good practice includes involving children in any decisions about their care, which demands high-level communication skills. And it’s also essential to understand how a child’s disability affects the whole family.

‘You also have to be an incredibly good communicator because you may be dealing with parents, schools, and a lot of other agencies that are working with the child,’ says Mrs Pedley. ‘You can’t tell people how to bring up their children, so there is a lot of cooperation involved. These are qualities that not every physio has.’

Good practice guidelines

Physiotherapists who work with children are specialist practitioners who need to have the right skills and specific knowledge to deliver appropriate care, to educate and to encourage family involvement.

According to the APCP good practice guidelines, paediatric physios should have a good understanding of

  • Child development
  • Childhood diseases and conditions that may impact on development and wellbeing
  • Therapeutic interventions that enable and optimise development and wellbeing
  • Placing the child at the centre of planning
  • The impact that having a sick or disabled child has on family life
  • How to keep children safe
  • How to ensure that children and young people make choices
  • How to develop their own skills and practice
  • How to develop services in line with the government guidance committed to improving quality and life chances for children.

How to use this article towards your CPD

  • It’s good practice to involve children in any decisions about their care – which demands high-level communication skills.
  • To help develop these, think back to a situation where you were working to set goals with a child or parent.
  • Describe the process and include any necessary background information.
  • Record your responses, either on paper, or using a voice recorder,  and the date you did this activity, then store it safely. 
  • If you are discussing personal information, please anonymise the situation and respect confidentiality.

Start analysing what happened. 

  • What was I trying to achieve?
  • Why did I intervene the way I did?
  • What were the consequences of my actions – for me? For the child? For their family of carers?
  • How did I feel as the goal-setting process progressed?
  • How did the other person feel about it – and how do I know that?

Note the factors that influenced the situation:

  •  personal/internal factors (such as values and beliefs)
  • external factors (such as time, environment)
  • the sources of knowledge that influenced the process, or should have. 

How could you have dealt with the situation better?

  • Focus in on the other choices you had.
  • Think about the consequences of those choices, for you, for the child, for their family or carers. 

Finally, evaluate what you’ve learned from this activity.

  • How do you feel about the experience now?
  • How have you made sense of it in light of past experiences?
  • How has it changed your understanding?
  • How will you apply this understanding to your future practice?


Putting the child at the centre of practice

  • Putting the patient at the centre of your practice is key, whatever their age, so the activity above can be adapted for use in any goal-setting situation.
  • This is reflected in the CSP’s new Code of Professional Values and Behaviour, available at www.csp.org.uk and in the CSP Framework at www.csp.co.uk/physiotherapyframework.
  • See more on your CPD requirements at www.csp.org.uk/cpd and keep your CPD up to date at csp.org.uk/eportfolio. Other CSP resources for children include Fit for the Future, available at: www.csp.org.uk/moveforhealth.

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