Growing problems: treating children with MSK conditions

Are mainstream MSK physios equipped to deal with children, ask Kerry McGarrity and Vicky Easton.

In the current climate of increased demands on services and increased expectations, more physios are being asked to treat children. This is most likely to be for musculoskeletal (MSK) conditions as many departments have non-paediatric staff treating children over a certain age with MSK conditions. Other conditions apart from MSK are seen by non-paediatric staff, especially in the private sector.
While undergraduate training usually includes a small element of paediatrics, can clinicians be sure they have sufficient knowledge and skills to treat this diverse group of patients?
The growing skeleton undergoes significant developmental changes, most of which are normal, but it is imperative that the clinician is able to distinguish between normal development and pathological issues that might need further specialist intervention. It is not uncommon for children approaching adolescence to present with what appears to be a simple knee strain but is later found to be a much more serious condition requiring orthopaedic intervention. If misdiagnosed, this can lead to long-term complications or disability.
The Association of Paediatric Chartered Physiotherapists (APCP) suggests that children and adolescents are treated in a child-friendly environment by therapists with specialist MSK knowledge of how growth affects the immature MSK system. All physios have a duty to work within their scope of practice; ensuring their competencies and skills are up to date and adequate to treat the patient referred to them. This may mean the therapist should refer on to another clinician if they feel they are being asked to work outside their scope of practice.
The APCP runs an annual three-day Introduction to paediatric physiotherapy course. This covers topics such as communicating with children, young people and their families, partnership working, consent and legal issues. In addition, the APCP MSK group is holding a paediatric MSK physiotherapy event in London on 11 September.
The APCP website offers various parent information leaflets. For professionals there is also a paediatric MSK warning signs leaflet, aimed especially at those working with children with MSK conditions.
Kerry McGarrity and Vicky Easton are members of the APCP professional network
Kerry McGarrity and Vicky Easton

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