Pediatric Rehabilitation Bascharage

Pediatric rehabilitation often refers to the treatment of bronchiolitis, but it’s a much broader field, involving children from infants to adolescents, where parental involvement is the key to success. All newborns, infants and children require specific, high-quality care if they are to develop their motor skills effectively. Your pediatric physiotherapist in Bascharage listens to the child and his or her family, and tries to make the sessions as fun as possible to ensure the child’s acceptance of the treatment. The child must experience rehabilitation as a game.

The following is a non-exhaustive list of the various pathologies frequently encountered in paediatrics.

Bronchiolitis is a seasonal epidemic respiratory viral infection of infants with human-to-human transmission between the ages of 1 month and 2 years. Every year, epidemic peaks occur from mid-October to the end of winter. Respiratory discomfort makes infants extremely tired, which can be distressing for them and those around them. Physiotherapy rapidly improves symptoms, helps relieve the child and provides the necessary advice to parents for better management at home.

The first symptoms are ENT, with rhinitis (runny nose) and a rather dry cough. Nasal obstruction is variable, as is fever, absent or moderate (around 38°C). These symptoms may remain isolated, but often precede bronchiolitis by 24 to 72 hours, and should therefore prompt vigilance in epidemic periods.

Bronchiolitis itself is characterized by difficulty breathing and rapid breathing. Dyspnoea predominates during expiration, is more or less noisy, and is accompanied by braking (an increase in expiratory time compared to inspiratory time), or even thoracic distension and signs of struggle such as flapping of the wings of the nose or inter-costal and supra-clavicular pulling).

Certain signs of seriousness warrant an emergency consultation:

  • Very young children (under 3 months) ;
  • Difficulty or refusal to eat ;
  • Apnea (breathing pause) or tachypnea > 60 per minute;
  • Sweating, cyanosis (bluish discoloration of the skin);
  • Very high heart rate ;
  • Consciousness disorders: loss of consciousness, malaise.

At the start of the disease, auscultation of the lungs reveals crepitants (dry and inspiratory) and/or sub-crepitants (wetter and expiratory), especially in young infants. This is followed by bronchial rales and sibilants, sometimes audible at a distance (wheezing). After one year of age, auscultation reveals expiratory sibilant rales. Auscultation can sometimes be normal, particularly in severe forms with distended thorax.

Far from the traumatizing image often conveyed and used by many physiotherapists, your physiotherapists in Bascharage respect the child’s breathing rhythm and accompany him gently. The session begins with a clinical examination to assess the patient’s respiratory distress. This is followed by gentle inhalation and exhalation techniques to guide the flow of breath without pain. A nasopharyngeal obstruction will be performed to clear the upper airway, and the nosewash technique will complete the management and be taught to the parents. The physiotherapist will contribute to the health monitoring of the evolution of bronchiolitis on a daily basis.

Plagiocephaly, or flat-head syndrome, is a clinical sign characterized by varying degrees of asymmetry of the cranial cavity in newborns, generally due to positional deformity. The potential consequences are numerous, with the risk of hearing, visual and digestive problems, scoliosis and motor and neurological disorders. That’s why it’s essential to have a specific follow-up program. Optimum care involves coordinated physiotherapy, osteopathy and parents. Proper positioning of the child, encouraging free motor skills and securing the baby are all part of the treatment.

Preventive advice can be given to minimize the risk of positional plagiocephaly. In , the Haute Autorité de Santé in France has published the following recommendations:

  • Antenatal care
    • Creating a risk-free environment for infants that respects their spontaneous motor activity during sleep and wakefulness
    • Parents-to-be should be aware of the deleterious effect of all restraint devices (see risk factors), which promote the development of cranial positional deformity (CPD) by limiting infants’ spontaneous motor skills, and increase the risk of unexpected infant death syndrome (IIDS) due to burial.
    • Breastfeeding should be encouraged. It is a protective factor against MIN and DCP.
  • After birth
    • It is recommended to maintain a neutral head position in all situations, avoiding any hyperextension or hyperflexion of the neck.
    • Children with postural or muscular torticollis should be referred to a physiotherapist specialized in pediatrics. The earlier the treatment is prescribed (within the first month of life), the greater the chances of normalization. An osteopathic approach with a paediatric focus can be combined with physiotherapy as a second-line treatment in a multi-professional approach.
    • When the infant is awake :
      • We recommend encouraging quality interaction between adults and infants.
      • We recommend varying postures and encouraging spontaneous head rotations with sensory stimuli (tactile, visual, auditory) adapted to the age of the baby.
      • Ventral and lateral postures can be explored during special exchanges with the adult. Because of the risk of burial, infants must be constantly supervised while awake on their stomachs.
      • For optimal development, infants need to be positioned on their backs, without pillows, comforters or blankets, in an environment that facilitates spontaneous motor activity (a firm mat on the floor with toys positioned around them, avoiding play arches and “mobiles” that fixate their attention).
      • We recommend that you carry your baby in your arms or in a sling, while keeping the airways clear at all times, rolling up the pelvis and varying posture.
      • In everyday movements, it’s advisable to encourage the belts to roll up (pelvis, shoulders).
    • When the infant sleeps :
      • Infants should always be placed on their backs in a suitable bed.
      • We recommend regularly alternating the baby’s position towards the head or foot of the bed, to encourage spontaneous rotation of the head from one side to the other.

Delayed motor development, whether pathological or not: physiotherapy will aim to respect the different phases of motor learning (from early sensorimotor awakening to first steps) to ensure the child’s future motor development. During a motor kinesitherapy session, after examination, the therapist will suggest relaxation and release maneuvers, followed by simple exercises according to the child’s progress and needs.

Scoliosis: a deformity of the spine in all three planes of space. Spinal curves are modified. Scoliosis needs to be monitored and detected throughout a child’s development, and rehabilitation is necessary to try and slow it down. Sometimes treated with a cast, a corset or surgery, all stages of scoliosis require specific physiotherapy tailored to each child, with the aim of softening the spine, strengthening static muscles and suggesting associated breathing exercises.

Orthopedics: physiotherapy can intervene throughout a child’s growth to correct a postural defect of the spine (cf. scoliosis), legs or feet due to malposition of the limbs or too rapid growth (Osgood-Schlatter, Scheuermann’s disease, etc.). Sessions and exercises are adapted to the child’s age and problems.

Traumatology: like adults, children can suffer traumatic injuries such as fractures, sprains, tendinopathies, dislocations, etc. In order to restore their physical capacities, specific rehabilitation sessions can be offered, incorporating playful situations so that rehabilitation becomes a game and this setback is quickly forgotten.