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Not Just Small Adults: The Playful Path of Pediatric Pelvic Physical Therapy

Everyone who knows me knows that pelvic health plays a big role in my life. (Ok, let’s be honest, I talk about poop a lot…) And I love the impact that pelvic PT can have on people’s lives. Whether it’s new moms grappling with the aftermath of childbirth or older women struggling with the changes that mid-life brings, the power of targeted physical therapy is undeniable. But even more near and dear to my heart is pediatric pelvic health.  Pelvic physical therapy for women is starting to become more commonly known and pursued.  But pelvic therapy for kiddos is still widely unknown and poorly understood by most parents and childcare providers. I frequently hear the question – “what do you do to those kids?” along with a look of fear and dismay.  Pediatric pelvic health is an area often overlooked, yet it holds immense significance in children's overall well-being. Today, I’m here to unfold the critical differences between pediatric and adult pelvic physical therapy.  Although the anatomy is the same, children are not simply small adults, and the treatment approach is very different in addressing their pelvic needs.


Basic Principles of Pelvic Floor Physical Therapy

Before we dive into the differences, let’s set the stage with a quick PFPT 101. Pelvic physical therapy is a specialized branch of physical therapy focusing on the function of the pelvis, the pelvic floor muscles, and the organs housed within the pelvis. Pelvic function can impact the urinary, digestive, reproductive, respiratory, and lymphatic systems along with the more obvious musculoskeletal system. Think of the pelvic floor muscles as a sling holding the organs in place. When these muscles are too tight, too weak, or just not coordinating right, it can lead to a range of issues, from incontinence to pelvic pain. The goal of Pelvic Physical Therapy? To restore balance and function to this crucial part of the body.


Pelvic Physical Therapy for Adults

In the adult realm, we see a lot of conditions related to pregnancy, childbirth, aging, or surgery. Here’s a peek into the common issues and how we tackle them:

  • Incontinence and Pelvic Organ Prolapse: Imagine sneezing and having to worry about a little leak or feeling like something is falling out. Not fun, right? Through manual therapy, biofeedback, and exercises, we work to strengthen the core and pelvic floor to keep everything in place.

  • Chronic Pelvic Pain: This can be a tricky one, as it often involves both physical and emotional healing. We use a holistic approach, combining physical therapy techniques to address soft tissue restrictions, exercises to retrain movement patterns and supportive guidance on lifestyle modifications.


Pelvic Physical Therapy for Kids

When it comes to kiddos, the approach is quite different. Our approach for children is designed to be child-friendly, incorporating playful activities and positive reinforcement. The issues might look similar (hello, incontinence), but the treatment is all about making it engaging for kids:

  • Bedwetting and Daytime Incontinence: Here, we often focus on behavioral modifications, like bladder training and establishing a routine. We work on strengthening muscles in a way that does not feel like work. It’s about empowering kids with the tools they need, in a way that doesn’t feel overwhelming.

  • Constipation and Encopresis: Believe it or not, constipation can wreak havoc on the pelvic floor and the potty-training process. No one likes to have difficult poops and kids are especially good at avoiding difficult things! Through diet advice, a wide variety of exercises, and sometimes a bit of biofeedback, we tackle this issue head-on with the support of pediatricians and parents, often with great success.


boy walking on balance beam placing cones
Fun activities can help work on balance, crossing midline, and strengthening abdominals.

Differences Between Pediatric and Adult Pelvic Physical Therapy

Approach and Communication

With adults, the focus is on detailed explanations and fostering independence. We dive into the hows and whys, ensuring they’re equipped to manage their condition. We want you to understand how this problem developed, and how to deal with any future flare ups or setbacks. For kids, the narrative changes. It’s about simplifying the information, making it digestible, keeping it interesting, and promoting independence and confidence all while involving the family in the process. We work hard to normalize the problems they are having and help them understand that when their body does not do something right, it does not mean they are a bad child. We want children to understand that it's okay to talk about bodily functions and seek help when neededWe do lots of “potty talk” – we say fart and poop and pee all the time!  We talk about toilets and bathrooms and why they might be scary (I’m still afraid of a middle school bathroom – who would dare poop there?!) and things we can do to make them less intimidating. We celebrate the small victories, like announcing when a poop is about to come out!


Treatment Techniques and Tools

Adult therapy might involve more formal exercise programs, lots of hands-on manual work and conversations about how to manage your nervous system. With kids, however, it’s all about fun and games. Literally. Play is a central component of our therapy sessions for kids, allowing them to engage in activities that are both therapeutic and enjoyable. We use play to ensure they’re engaged and motivated throughout the process. We use balls and bolsters to do some gentle manual work for us. We find activities that help calm the nervous system, like swings, jumping and heavy weights, and engage the child in them to help settle them down. We find ways to work on a skill while they are doing a different activity or challenge.  For example, with an adult, we might work on standing on one leg on an unstable surface for several minutes to build hip strength and work on proprioception and stability.  For a child, we might do the same standing, but we will be playing tick tac toe on wall board or throwing bean bags at a target while we do it.  Another example might be working on breathing exercises:  the adult would be asked to exhale for as long a breath as possible, but the child would be asked to use a straw to blow a small ball across a table toward a target goal.  One thing we definitively do differently with kids is the pelvic floor assessment.  We do not do internal assessments with children, and often do most of our work with only a light palpation of the pelvic floor muscles through the clothing. We offer biofeedback, mirrors, or cameras to help the child see and understand the job of the pelvic floor muscles based on their comfort level and ability to understand the concept.

Because I work with children and adults, many of my adult patients benefit from the extra gadgets and toys that are around the clinic that we can use to help better engage muscles or reinforce a concept. Everyone loves it when we can make therapy fun – even the grown-ups!


Boy blowing toys with a straw
Building respiratory capacity using straws, pom poms, and unstable surfaces

Goals and Expectations

With adults, the goals are often about relieving symptoms or managing chronic conditions. It’s a long-term game. Our goals for children extend beyond symptom relief, focusing on functional and social outcomes such as participating in activities, sports, and social events.  We work toward going to sleep overs, playing sports, and not being embarrassed by wetness or odors. I strive to build confidence in them, help them to know what normal bowel and bladder function should be and that there is help for them to overcome these problems!


The Importance of Specialization in Pelvic Health

Whether for yourself or your child, finding a therapist who specializes in pelvic health can make a world of difference. Pelvic health is a niche within physical therapy that requires a deep understanding of the body’s most intimate muscles and functions. Specialized therapists bring not just expertise but also a sensitivity to these often-taboo topics, creating a space where patients feel seen and heard.  Within this small sphere of specialized therapists, are the pediatric pelvic health therapists who love to work with children and are focused on tailoring the therapy experience to be positive and comfortable, helping kids gain confidence that will allow them to thrive for years to come.


Girl walking on obstacle course
Walking on various unstable surfaces builds body awareness, hip strength and balance skills.

Conclusion

Navigating the world of pelvic physical therapy can feel daunting, whether you’re seeking help for yourself or your little one. But understanding the differences between pediatric and adult PPT is a great first step. Remember, it’s not just about physical healing; it’s about regaining confidence and control over your body. Finding a PT that can help you or your child do that is an essential part of the journey. If there’s one thing my years of practice have taught me, it’s the incredible ability for our bodies to recover and function well when given the right tools and strategies.


If you or someone you love is facing pelvic floor challenges, I encourage you to reach out. Ask lots of questions!  The right therapist can provide not just treatment, but also education and support, guiding you and your child toward a healthier, happier future, full of rewarding activities!

 

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