Category Archives: Paediatric Physiotherapy

Do Schoolbags Cause Back Pain in Children and Adolescents?

The British Journal of Sports Medicine published a systematic review* last year on whether schoolbag use is a risk factor for back pain in children and adolescents. This is often cited as a cause of back pain in children but the findings of the research may come as a surprise.

They found that there is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.

The article is free to read on BJSM here


*A systematic review – is basically a summary of the results of available carefully designed healthcare research studies (controlled trials) which provides a high level of evidence on the effectiveness of healthcare interventions

Aisling Dolan

Paediatric Physiotherapy at Milltown Physiotherapy

1. Aisling, our paediatric physiotherapist here at Milltown has recently completed an intensive week’s training led by the world-renowned specialist physiotherapist in Neuro-Developmental Training (NDT) for children, Lois Bly. The training allowed Aisling to develop her skills in understanding the intricate, subtle components of typical and atypical movement development in babies, toddlers and older children, and recognise compensations and deviations from typical development. These deviations would commonly be displayed in conditions such as:
• Co-ordination disorders
• Hypermobility
• Developmental Delay
• Musculoskeletal complaints such as flat feet, in-toeing, hip dysplasia
• Brain injury

Children with such issues can sometimes find themselves on long waiting lists for therapy assessments and treatment.
Aisling is continually putting these skills into practice here at Milltown and is happy to liaise with parents who would be interested in their child having an assessment and treatment with her so that they can start to work immediately on these deviations at home, in school or in crèche to allow their child to reach their full potential. Aisling works Monday to Friday and her hours include pre and post-school times to help fit in with busy family schedules.

Recurrent and over-use injuries in children

Is your child complaining of recurrent heel or knee pain with no specific cause and it gets worse with activity?
Aisling Dolan, one of our physiotherapists here at Milltown Physiotherapy, has a special interest in treating and managing such injuries, having done a recent thesis on this topic as part of her Masters.

According to her review of recent research, the rise in children participating in organised sports has brought about an overall increase in over-use injuries. With this increased participation rate, there is also a growing pressure on children to perform at high levels and this can lead to inappropriate levels of training intensity, frequency and duration.

“Calcaneal apophysits”, (more commonly known as “Sever’s disease”) is the lead cause of heel pain in children. This condition causes intermittent pain where the Achilles tendon joins the heel bone at the growth plate. When the load at this junction has exceeded its tolerance level, it can cause an inflammatory response. Other common symptoms can include tenderness on palpation of the back of the heel, swelling and pain provoked by activities such as jumping and running.

The growth plates can be weak links and prone to this injury due to an increase in muscle tightness which occurs during growth spurts and increased levels of sport and activity. Aisling’s research reported that physiotherapy modalities are commonly used to manage these types of overuse conditions. Successful physiotherapy management includes activity modification, manual therapy and a home stretching programme specific to each child’s needs.

Preventative strategies for these type of injuries include monitoring growth spurts, muscle tightness and ensuring that sport participation is managed appropriately with these variables.

What is Developmental Delay and how can paediatric physio help?

Paediatrics Rehabilitation
A great new blog post by our chartered physio Suzanne Skelton who has a special interest in Paediatric Physiotherapy.
What is Developmental Delay?

A child may be given a diagnosis of developmental delay if they achieve certain developmental skills later than the predicted age. These skills are called ‘developmental milestones’. Milestones are the definite landmarks in the growth and development of a child. Developmental delay may affect a child’s fine and gross motor skills, speech and language and/or personal and social skills. A child diagnosed with global delay will have delays in all areas of their development.


Often parents have concerns about their children’s development when they see other children of a similar age reaching milestones before their child. It is important to remember that for each milestone, there is a range of ages during which a child will normally reach it. For example, some babies may walk as early as 10 months while others may not walk until 16 months, both are within normal limits. Encouraging certain activities such as ‘tummy time’ can influence when a child achieves certain skills such as rolling, sitting, walking and facilitates visual development.


Why is ‘tummy time’ so important?

Supervised tummy time during waking hours is important to the motor development of your baby as it allows him/her to gain head and body control. Motor control develops in a ‘cephalocaudal’ fashion, which means a baby first gains control of their head, then their shoulders followed by their abdomen and so on down to their feet. Developing head control first allows your baby to visually explore everything around them.


Having tummy time also helps the development of your baby’s skull. With babies spending more time on their backs, paediatricians have noted an increase in flatheads or misshapen heads. Babies’ skulls are still quite soft and constantly lying on their backs without changing the head position can cause a flattened effect on the back of a baby’s head known as ‘plagiocephaly’. This is commonly seen in babies with torticollis or ‘wry neck’.


It also helps your baby to strengthen their neck, shoulders, arms and core muscles. This strength will prepare your baby for crawling as well as getting her ready to push up, roll over and eventually to stand.


As well as gross motor skills, tummy time encourages your baby’s fine motor skills. For example it encourages grasping.


When to start tummy time?

You can start tummy time from birth – with your newborn lying skin to skin on your chest. From there, small amounts of tummy time throughout the day are sufficient – even if only for a minute or two at a time – and gradually increase the time, as long as your baby is comfortable.


Tips on how to encourage tummy time

To encourage ‘tummy time’, place your baby on a firm, flat surface on his tummy with his arms forward – a rug on the floor or an exercise mat is best, as a soft surface makes it too hard for baby to move. To begin with, even on a firm surface, moving on their tummy is hard work for babies and they will tire quickly. The answer is short but frequent periods of play, allowing your baby to gradually build up his/her strength and learn to move more efficiently.


One tip is to roll your baby over on her tummy for a little while after every nappy change. It’s easy to remember to do this and your baby is likely to enjoy the view if she’s up on a changing table. But do hold on securely so he/she doesn’t roll or push off.


It is best to try tummy time when your baby is calm and respect their responses so that they don’t associate this new experience with feeling stressed. Make sure your baby isn’t hungry or tired or, on the other hand, don’t place him/her on a full tummy as this could be uncomfortable.


Using a mirror will encourage your baby to stay on their tummy for longer and is fantastic for their development. It’s amazing how they love to look at themselves and of course their Mum and Dad!!


Baby games

If your baby cries when you put him on his tummy, help him/her become more confident by playing some of these baby games:

While you are lying on your back or reclining, lie your baby on your tummy so that he/she will be encouraged to lift up and look at your face. Try gently rocking him from side to side as you hold him/her.

Lie down on the floor facing your baby and talk or sing to him/her.

Hold a rattle or a squeaky toy, wave a colourful silky scarf or a place a mirror in front of baby, for him/her to look at.

Lie your baby on different textures: such as woollen, fleece, velvet or fluffy fabrics.

Place a favourite toy within baby’s reach.

Lie your baby across a gym or exercise ball, or a rolled up sleeping-bag, and rock him/her gently to and fro and sideways: this will also stimulate his/her vestibular (balance) system and help him/her get used to being in different positions.


If your baby can’t support their weight on his/her forearms, support them on a rolled-up towel placed beneath their upper chest, with their arms forward so they can practise mini push-ups or play with a toy. When your baby can get up on their forearms independently usually around 4 months, remove the pillow and let him/her work on motor skills without it.


Children with developmental delay may present with some of the following difficulties:

Unable to bring his/her hands together by 4 months.

Appears very floppy or has low muscle tone.

Muscles appear very tight, legs held stiff with little or no movement.

Having head lag when pulled to a sitting position after 6 months.

Unable to roll over by 6 months or only rolling to one side.

Unable to sit on the floor without support by 8 months.

Unable to crawl by 12 months.

Unable to walk independently by 18 months.


It is important to remember that all babies develop at their own pace and some can just be late bloomers!!. If your baby presents with any of the above difficulties or if you have any concerns about your babies development it is best to contact your G.P., public health nurse or paediatric physiotherapist for a developmental check.


How paediatric physiotherapy can help your child

Paediatric physiotherapy aims to enable your baby/toddler to reach their full potential through developmental play, therapeutic exercise and functional training activities. An initial assessment will be carried out which will then guide treatment techniques used. There are often specific muscle groups that have not developed sufficient strength yet. Most common muscle groups affected include the gluteal, quadriceps, shoulder girdle and core muscles. It is usually weakness of these muscles that delays the time it takes for babies to start rolling/sitting/crawling/walking. Through various treatment techniques these muscles can be strengthened along with specific exercises demonstrated to parents which they can continue doing at home in between treatment sessions in order to maximise developmental progression.


Useful link for information on Developmental Delay: