Pediatric Physiotherapy
Pediatric Physiotherapy
This domain tests developmental surveillance, primitive reflex integration, cerebral palsy classification, torticollis, brachial plexus injury, Down syndrome, and family-centred practice.
Core rules
- Use corrected age until 24 months for children born preterm; uncorrected age produces false delay labels.
- Gross motor sequence: head control around 3 months, rolling 4–6 months, independent sitting 6–8 months, crawling 8–10 months, walking 12–18 months.
- Primitive reflexes: Moro integrates by 3–4 months, asymmetrical tonic neck reflex by 4–6 months, palmar grasp by 4–6 months. Persistence beyond these windows suggests neurological involvement.
- Cerebral palsy: the Gross Motor Function Classification System (I–V) describes gross motor ability, not cognition; classify, then set functional goals.
- Positioning and handling: daily tummy time, varied positions, avoid prolonged containment in seats and swings.
- Family-centred care: goals negotiated with caregivers, home programme demonstrated and written, education provided.
Worked example
A 6-month-old born 10 weeks preterm is not rolling. Corrected age is about 3.5 months. Reasoning: rolling typically emerges at 4–6 months, so at corrected age this is not yet delayed. Check head control, tone, symmetry and hip screening; teach tummy time and re-review in six to eight weeks. Persistent asymmetry, fisting, or loss of skills at corrected 6 months warrants referral.
Traps
- Failing to correct for prematurity.
- Labelling delay before six months without serial observation.
- Missing regression - loss of achieved milestones is a red flag.
- Overlooking developmental hip dysplasia and its positioning implications.