Most of the parents I encounter on a daily basis had no idea baby physical therapy existed as a resource for them. Some were sent straight from a pediatrician’s check-up. Some were redirected by teachers they trust. Some found physical therapy after extensive internet research on ways to help their children beyond a regular afterschool program. I have met parents who consider physical therapists doctors, and I have met parents who equate us to gym teachers.
Indeed, we are clinicians, teachers, cheerleaders, and so much more. Physical therapists work with children on many different conditions that affect their ability to interact with their environment, whether the root cause is medical, environmental, or developmental. The most rewarding part of my job is that I help children, and parents, succeed. Over the years, the most futile cases I have encounters and the most frustrating situations I have worked with, have been with parents who come into their physical therapy programs with the below preconceived notions. Do any of these sound familiar?
If my baby cries during her session, physical therapy is not right for her.
Here is the simple truth: physical rehabilitation is going to be hard: for the most easy-going of children or for the most stoic of adults. And it is especially tough for babies, because they don’t communicate the way we do. But here is the other thing… We know that and we have been trained to make rehab fun. That doesn’t mean the first few times children meet us are going to be all giggles and bubbles. Part of our job as PTs is to figure out what is challenging for children with developmental difficulties, and then make it an easier task for them. Some children warm up within 10 minutes of meeting us, and some will cry for their first 3 weeks. We will always always monitor their pain levels, their activity tolerance, and their physiological responses. We are health professionals after all. Most of us have extensive backgrounds in childhood, development, biology, and psychology. We take our professions very seriously, despite running around in our socks and making funny faces all day. The one thing we want most is for children to enjoy their physical therapy sessions, so they come back frequently and make necessary gains. We are not trainers you see on TV, yelling at our clients. Our motto really isn’t “no pain, no gain.” It breaks our hearts too when babies cry, but we do keep our goals for them in mind. All we ask of parents is to be patient and supportive of the process, which leads us to the next common misunderstanding we encounter.
The physical therapist can fix whatever the musculoskeletal or development problem is in a month’s time.
I get it. When I go to a healthcare provider, I want them to make whatever I’m dealing with go away, immediately. Parents of today are overloaded with lots of responsibilities, from advancing their careers, maintaining their relationships with other adults, to keeping track of all their own meetings and appointments. Adding their children’s doctor appointments, school schedules, and teacher conferences can be an overwhelming existence. We know that the most frustrating part about physical therapy (or therapy of any sort) for parents is trying to attend the regular appointments for the period of time required. Full recovery and successful completion of the physical therapy program takes time. I confess, I have cancelled physical therapy for myself before, because I was busy and thought I could do it myself. So, we don’t fault parents for wanting us to make changes for their children quickly, with minimal time commitment. But, research has shown time and time again that regular, frequent, and consistent physical therapy sessions shorten recover time and encourage long-term wellbeing overall, for patients of every kind. Children’s body systems adapt to changes and regular exercise much more quickly than adults. We are constantly monitoring their progress so we can adjust the frequency and intensity of their therapies. Even so, depending on the condition, significant change that is measurable on standardized developmental assessments (for insurance and medical reporting purposes) don’t occur until 3-6 months after onset of therapy. What parents should know is that our ultimate goal is for children to not need us after their therapy programs. We are not out to keep kids in rehab longer than necessary or for all their lives. We want them to become fully independent and functional without us. We want them out of therapy and doing what kids should be doing: playing with their friends and going to school. So whenever parents ask to stop their child’s therapy after 1 months’ time, I tell them there are things they can do to speed up the recovery process. Which leads us to misconception number three from parents.
Parents don’t need to pay attention to the exercises their child does with his physical therapist.
Even during the most rigorous of PT programs, therapists only see children a few times a weeks, for maybe an hour at a time. We spend a major part of our efforts during therapy not just doing exercises with the kids, but also teaching them new skills to incorporate into their daily lives. Physical therapy is unfortunately not just a pill one can take to make everything better right away. It asks patients and their parents to become active participants in their healthcare. This is challenging, I don’t doubt that. And with parents being asked to step in during all other hours of the week to become makeshift therapists, teachers, nurses, and everything in between, exercises can fall by the wayside. But this is why we spend a large part of our treatment on educating families as a whole, so everyone takes charge of a child’s recovery, and it’s not left up for one person. A good therapist will take into account everyone’s daily routines, the parent’s struggles, and the children’s interests, to find ways to make things work. Our job is to help parenting easier for children with injuries, pain, developmental difficulties, and functional challenges. We are here to listen and provide feedback. We are here as much for the parents as we are for the children, because we know how important family is to therapeutic healing.
If my pediatrician didn’t recommend physical therapy, my baby doesn’t need it.
Healthcare for children relies heavily on a team approach. Every medical personnel has a specific role and very detailed training for that role. As children meet more and more of their milestones (develop teeth, start walking, learn to read, etc), there are more specialists for parents to take them to (dentists, podiatrists, optometrist, etc). Most new parents of children with developmental issues learn over the years that a pediatrician cannot cover every aspect of a child’s development. It’s simply an impossible task for the pediatrician, whose main goal is to keep children healthy and free of pathogens. The pediatrician may be their go-to guru for questions early on and serve as a gateway to other providers, but even they get bogged down by the many things they have to pay attention to during routine visits. Many pediatric doctors choose to specialize in certain conditions, just to address the things a pediatrician cannot. In that same vein, what some parents misunderstand is that pediatric physical therapists are movement specialists. We are experts in the way babies, children, and adolescents move, and how their different body systems interact with each other to aid movement. We have been trained in what typical development and alignment, and age-appropriate motor skills look like, feel like, and can accomplish. Many pediatricians often take the wait-and-see approach with motor delays or alignment because, well, sometimes it’s not life threatening and parents don’t know to be concerned. But physical therapists spend significant amounts of time observing and engaging with our clients to see how they use their body systems in different situations. We are often the first ones to catch the tale tell signs of an underlying medical condition that requires a specialist. We know that abnormal neurological development and mechanical issues show up early and can be addressed before faulty motor patterns affect children’s cognitive, social, and physical development later. So just because one pediatrician doesn’t think it’s important for a 7 months old to be sitting independently yet, physical therapists know that it is an essential skill in order to crawl, eat, learn to use her hands, refine her vision, develop her sense of balance, and learn to talk. We are the ones who can give new and swamped parents just a few tips to encourage that milestone and build a solid foundation for their child.
Baby chiropractors are totally the same thing as baby physical therapists.
I am always surprised when parents tell me they are considering consulting a pediatric chiropractor instead of attending regular PT sessions because “they work on the same thing, they don’t require doctor referrals, and are cheaper.” I cannot reiterate this point enough: baby chiropractors are not healthcare professionals backed by scientifically sound research and the pediatric medical community. Pediatric chiropractic practices is just a term someone with a chiropractic background can use to describe what he does, but it is not a board certified, highly specialized clinician. Most chiropractors actually stay far far away from pediatric practices because their high-velocity spinal manipulations are not recommended on growing soft tissues. Some chiropractors who claim to treat pediatric conditions only attended a weekend course with minimal practical training on actual young patients. Most of the conditions pediatric chiropractors claim to treat by “manual adjustments” or “spinal manipulations” are not only self-limiting conditions, but these techniques are only supported by low-level scientific evidence. (Please see my previous blog: The truth about pediatric chiropractors). Pediatric chiropractors have been in the news for numerous incidences of harm and neglect, especially in conditions affecting babies. Some make faulty claims about the frequency and intensity of treatment needed. The goal of physical therapy is to treat a condition and return a child to his full potential so that he won’t have to come back to therapy as an adult. The goal of chiropractic practice is to keep patients coming back for “regular adjustments.” I have known parents who have taken their perfectly healthy children to a chiropractor once a week from newborn to 6 years of age, just to “maintain proper alignment.” No wonder some insurances refuse to cover chiropractors.
Don’t get me wrong. There are some great chiropractors out there, for various adult conditions that are related to mal-alignment or acute injury. I have known chiropractors who referred out to physical therapy when they’ve reached the limits of their practice. I have known chiropractors who recommended more active participation in exercises from their clients. I have known chiropractors that have partnered with PTs to provide the optimal plan of care. But, I have also known chiropractors who manipulated babies when they shouldn’t have, and chose to not disclose what exact techniques they used on these clients when asked by other health professionals.
There are many other misconceptions I have heard from parents over the years, but most parents are very open to education on various medical recommendations. I know that many times, parents are just trying to provide the best resources for their children. Finding out one’s child has a developmental delay or is suffering from an injury is definitely tough, especially when resources are limited. Pediatric physical therapists are here to help. We are not just children’s biggest advocates in their physical wellbeing, we are also mostly here for the parents.