Super cute photo by Steven Libralon on Unsplash

Whether you are a new graduate just starting, an experienced therapist wanting a career change or a regional or rural therapist who finds themselves with a referral for a child – developmental paediatrics can sometimes be a daunting area to work in if you have not done so before. 

Having worked in paeds my whole career, and trained lots of students and therapists in the field, I have come up with 8 tips to help you when starting out as a therapist in developmental paediatrics: 

1. Learn and understand all you can about typical child development.

Regardless of your discipline, the age group you work with, or the types of conditions you see – your understanding of typical child development will underpin all aspects of your clinical practice.   Read widely, and spend some time observing how babies and children move, interact and play with others.  All areas of a child’s development are interconnected, so spend time learning from and work shadowing allied health professionals from other disciplines to your own to get a broader understanding of child development.  This will allow you to better understand the impact of your intervention on their overall development, and also identify when to refer children to other disciplines.

2. Hone your interview and observation skills.

Some children just won’t let you do a hands on or formalised assessment with them.  At least not to start with, until you gain their trust.  As a result, you will sometimes need to rely primarily on interviews with parents, family, other therapists, or teacher in the child’s life as well as use keen observation skills to gather the information you need to try and understand the child and how you might help them.

3. Learn to be comfortable with the unknown.

In developmental paediatrics there can be many unknowns, which is something you will learn to get used to.  You will likely come across children with rare conditions on which there is little research or information available, giving you little to go off about the child’s presentation and what you can expect of them developmentally.  In these circumstances you will need to rely on your assessment and clinical reasoning skills, and to ‘treat what you see’.  For children with complex presentations, it can also sometimes take a while to fully understand their abilities and difficulties, their behaviours and personality.  You don’t have to have all the answers straight away.  There is value in spending time getting to know the child, exploring their capabilities and how they respond to different treatment strategies, so that you can more confidently understand the child’s presentation and make treatment recommendations.

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4. Ask yourself these 5 questions…

When analysing a child’s development and coming up with a treatment plan, these 5 questions can help to guide your thinking:

• What CAN the child do?’ Asking this question helps you to focus on the child’s strengths and what they are currently capable of.
• What is the child ready to do next?’ AND/OR
• What should the child be doing at this age?’  These two questions can help guide your thinking around what developmental activities you should help the child work towards.  For example, if you are treating a child with cerebral palsy who is 18 months old and not yet sitting – the activity they are ready to work on next is sitting, but the activity they would otherwise be doing at this age is standing (which enables them to interact with their peers).  Subsequently, you might choose to work on both sitting and standing as part of their treatment.
• What are they missing?’ or What do they need to enable them to progress to the next milestone?’ What are the key things that are preventing them from being able to progress to doing the activities you identified in the previous question?  Your answer to this question will guide your selection of treatment strategies.

And the 5^th question is…

5. ‘For what purpose?’ – Focus on function and participation

When helping children with their development, always try to focus on improving their function and participation.  Historically, and even sometimes now, therapists and parents get stuck focusing on impairments.  For example, I have heard lots of parents and therapists talk about ‘improving their core strength’. While ‘improving their core strength might be an area for improvement for the child… It is important to ask “For what purpose?”  For what purpose does the child need to improve their core strength?  So they can learn to swim?  So they can play in the backyard with their siblings?  So they can sit still in a chair and write more neatly?  Focusing on function and participation allows you to set much more meaningful and impactful goals (see another blog post on setting goals here)

6. Keep the child actively engaged in therapy.

I am a big advocate for children always being active participants in therapy, and never having things done passively to them.  While you might position, set up, and/or facilitate the child – the child should always have opportunity to self-initiate movements, activities or interactions within therapy.  Self-initiating a movement, activity or interaction, enables the child to learn that there is a purpose for that movement, that they can repeat it, and that there might be a reason for them to start doing that movement, activity or interaction spontaneously and independently in their everyday life.

7. Understand and support the child’s and family’s bigger picture.

Your therapy appointment will only be a very small part of your client’s and their family’s week and life.  Think about how the strategies you are practicing or suggesting in therapy can be incorporated into the child’s everyday life, and fit in amongst everything else going on for the child and family.  It is also important to understand that the families you work with may need support beyond therapy.  Help them find both professional and personal networks to support them and empower them to do the best they can for their child.

8. Have fun! 

Working with kids gives us a chance to enjoy the fun of childhood again, and experience the world through their eyes with a sense of wonder, curiosity and excitement.  As a therapist, we are also privileged to see children grow and develop over time, and to share in the joy experienced by a child and their family when they achieve something new.  Working in paeds is a rewarding and fulfilling role, so I encourage anyone who is interested to get out there and give it a go…

Emily Hayles

Emily Hayles is the principle physiotherapist and owner of Move and Play Paediatric Therapy, a children’s therapy service that helps children to move and play to the best of their ability, and to empower parents to know they are doing the best they can for their child.  She is also a soon to be published author, with her book for parents of children with developmental delays and disabilities due to be published at the end of 2019.

Emily has worked with children with developmental delays and disabilities for her entire career since graduating as a physiotherapist in 2005.  Emily has also completed her Masters of Physiotherapy through Research, where she investigated parent’s experiences of health care for their children with cerebral palsy, and has had 4 published research papers and presented the results of her research at 3 national and international conferences.  As an experienced clinician and leader, Emily has taught and mentored numerous therapists to develop their skills in the field of paediatric therapy.  Since establishing Move and Play in 2015, Emily has built a small team of like-minded therapists, who are equally as passionate about helping children with developmental delays and disabilities to live their best life, through therapy, education, advocacy and connection.

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