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A to Z what about Pee?!

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A to Z but what about Pee !?

Summer holidays – one of the most awaited times of the year! Perhaps it involves a camping trip, or a summer slumber party. Whatever it is; it’s time for kids, and parents to relax, reset, and be stress free from the school year! 

That is the case, unless you’re a kiddo (or a parent of a kiddo) with urinary incontinence. Summer holidays and fun, social plans can be absolutely terrifying. 

How can I go on a camping trip if I pee my pants sometimes?

How will my child go to the birthday sleepover if they wet the bed some nights? 

The most important thing to know is that wetting the bed, or clothing is not your fault, nor your kiddo’s fault. There are many things out there (including Paediatric Physio!) that can help kids decrease these occurrences, so keep smiling … we can help! 

A second crucial thing to know, is that this is more common than you might imagine. The number of children and teens who struggle with continence is astounding, so it’s not just you and your kiddo. And want to know something else? It’s especially common in athletes! So you’re not alone! Helping your child realize that several kids in their class or on their sports teams also live with this can help them appreciate this more. Urinary leakage typically comes with a bunch of shame, guilt and fear. So try to let it go, and again…it’s not your fault!

There are a few definitions I’m going to go over so you can start to understand what may be going on with your situation:

Continuous incontinence – this is for kiddos who constantly leak in non-discrete amounts. This is something that you should see a doctor about, and is usually more of a “hardware” issue, than a “software” issue.

Intermittent Incontinence – this applies to kiddos who have specific, urinary leakage incidents. This can be daytime only, nighttime, only, or both. It can be for kiddos who are over the age of 5 who never achieved continence (primary), but also for kiddos who have previously attained bladder control (secondary). More specific categories include:

    • Urge Incontinence: when a kiddo has a sudden or unexpected need to pee and can’t make it to the toilet in time.  
    • Stress Incontinence: when a kiddo has leakage with a specific activity such as coughing, sneezing, or laughing BUT ALSO during sports when you kick, run, or hop!
    • Nighttime Incontinence: when a kiddo wets the bed at night 

Who are the culprits ?!

Now you’re likely not going to believe this (as did I when I first heard it), but one of the main suspects of urinary incontinence is constipation! Let me explain…

When your rectum is full (even more so in little bodies), it pushes on the bladder and doesn’t allow it to fully fill. Furthermore, all that build up in the abdomen puts extra pressure on the “sensors” making it difficult to tell when it’s really time to go. Even pooping daily can mean constipation, so, everyone is assumed to be constipated until proven innocent! 

Next on the suspect list are those sneaky pelvic floor muscles. These muscles sit in your pelvis and control the flow of pee and poop out of your body. Sometimes they can be weak, however they can also be tight and gripping, trying to hold everything in. When these muscles can’t contract properly, it causes constipation, poo stains in undies, itchy bums, pee dribbles and even those bigger leaks. 

Other culprits can include things such as family history, life events (new sibling, divorce, illness/injury, etc), frequent urinary tract infections, early toilet training and sensory involvement. 

Ta-Da! The solution:

  1. Say it, repeat it, believe it: It is not your fault. You are not alone 🙂 
  2. Get yourself to a qualified physio who has extra training to treat the pelvic floor, but also who has experience working with kids. They will be able to assess the muscles (in a non-invasive way!!) as well as determine other culprits at play. Based on what they find, your paediatric physio can help you come up with a fun plan to becoming continent! CLICK HERE to book an appointment.
  3. It’s important to have a proactive health care team that is up to date with what’s going on. Knowledge is power and having a supportive team will help make the journey even easier! 

For more information check out this cool video made by SickKids in Toronto for a great summary!

https://www.youtube.com/watch?v=E8Khck8lWak

If you want to schedule an appointment with our paediatric physio and pelvic floor trained physio CLICK HERE.

Written by: Karly Dagys, Physiotherapist

Are Flat Feet Normal in Kids?

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Did you know that almost everyone is born with flat and flexible feet? In their first year, babies’ feet grow extremely fast – about 2.5cm! As children get older and start walking, their feet are still flat because the bones, muscles and ligaments are not yet fully developed.

 

Foot development

The main arch of the foot, the medial longitudinal arch, begins to form at 3-4 years of age. This arch continues to develop throughout the first 10 years of life and many studies state that the mature foot posture is not obtained until 7-10 years of age (Uden et al., 2017). This means that we should expect our children’s feet to be flat during their first 3-4 years and to then start developing an arch over the next 7 or so years.

 

Factors that can affect foot development

  • Poor fitting shoes: too small, too big, too rigid
  • Not enough barefoot time at home

 

What about those Flat Feet?

Flat feet aren’t always problematic. As you can see from above, younger kids tend to have naturally flatter feet and therefore treatment is not always necessary. If your child goes up on their tiptoes you should be able to see their arch form. This is considered “flexible flat feet”. These should not be painful. Ultimately painful flat feet in kids are a problem and non-painful, flat feet in children (or adults!) are not a problem and do not need to be treated unless they are accompanied by any of the points listed below.

 

Here are some reasons why we see kids at PlayWorks Physio for flat feet:

  • Their walking pattern is different. For example, if they do not push off from their big toe, instead they use the inside of the foot
  • Complaints of foot, ankle or knee pain
  • Bunion development on the inside of the foot
  • Frequent rolling of their ankles
  • Complaints of their feet getting tired or sore after activity
  • Excessive pronation (collapsing inwards) of feet

 

Things you can do to encourage proper foot development in your kids

  • Find properly fitting shoes. Look for shoes with a supportive heel cup and flexible sole. CLICK HERE  to learn how to pick the best shoes for your child.
  • Have your child barefoot when safe/appropriate. This helps develop the muscles, ligaments and tendons of their feet and will contribute to arch development.
  • Play around with walking on different types of surfaces. For example: grass, hills, trails, gravel, sand etc.

 

If you have any questions about your child’s foot development, email us at hello@playworksphysio.com

 

Written by: The PlayWorks Team

 

References: Uden et al. Journal of Foot and Ankle Research (2017) 10:37

What is Torticollis?

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What is Torticollis ? 

Torticollis is the term used to describe the tightening of a muscle in baby’s neck. It is the shortening of one of the neck muscles, the sternocleidomastoid (SCM), which results in the baby’s head tilting slightly to the side and rotating in the opposite direction. 

What are some causes of torticollis?

  • Position of baby in utero (higher risk with twins or pregnancies with growth restrictions)
  • A long/difficult labour and delivery which can cause muscle spasms in baby’s neck
  • A preference of looking one direction over the other, eventually leading to the muscle shortening
  • Having a flat spot on the head may cause the baby to always rest in this position and over time, tightens the muscle

These are some conditions that appear like torticollis and are important to rule out: 

  • Vision difficulties
  • Hearing difficulties 
  • Reflux or GERD 
  • Viral infections 
  • Improper alignment of the spine 

How will torticollis impact my child?

Imagine your baby trying to develop their gross-motor milestones while their head is always tilted and looking one way. They will have difficulty with the following:

  • Learning to roll both directions
  • Learning how to sit independently
  • Discovering where the center of their body is (discovering midline)

Furthermore, torticollis can often lead to plagiocephaly – a flat spot on baby’s head, because of a preference to always rest in one position. See our plagiocephaly post here: Help! My baby has a flat head!

The neat thing about torticollis and plagiocephaly is it can be corrected quite easily, especially from a young age. EARLY INTERVENTION is key, and easiest to treat. 

What to expect during an assessment with your paediatric physiotherapist:

  • We will see how your baby’s neck moves to determine if there are any restrictions
  • Rule out the more complicated causes of torticollis
  • Provide tips to help to correct this and if warranted, give you stretches and strengthening exercises appropriate for the stage of your baby’s development
  • Depending on baby’s age and severity of the torticollis, we may also track your baby’s head shape to ensure they’re not developing a flat spot

Remember, the EARLIER the BETTER. It’s much easier to work on positioning and stretching exercises with younger babies, and that can allow us to introduce strength exercises at the optimal time. 

If you have any questions, please contact us at hello@playworksphysio.com! We’re able to provide assessments over video call until we get over the COVID-19 hurdle. You do not need a referral for physiotherapy.

Written by: Karly Dagys, Physiotherapist

Help! My baby has a flat head!

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My baby has a flat head…

Is this a common issue?

YES, this is a very common issue with babies. Flattening can be caused by the following:

  • Your baby has a preference of looking in one direction, resulting from tight neck muscles
  • Your baby prefers looking in a certain direction but there are no neck restrictions
  • Your baby is a good sleeper and doesn’t move much when sleeping

 3 Types of Flattening

Plagiocephaly is flattening on one side of the head from your baby preferring to look left or right. It is often associated with tight neck muscles (torticollis). Things you may notice:

  • Flattening on the back when washing your baby’s hair
  • One cheek appears larger
  • One side of your baby’s forehead is more prominent than the other
  • One eye is slightly larger than the other

Brachycephaly is flattening directly on the back of your baby’s head and is often seen with babies who sleep for long stretches without turning their head to either side. It causes baby’s head to be wider than average.

Scaphycephaly is the rarest type of head shape issues we see and is when the head is more narrow than average. It is most commonly seen in babies who spent long periods of time in the NICU because their heads are being turned from one side to the other.

How will a flat head impact my child?

  • Depending on the severity of flattening, your child may have difficulty fitting helmets, because these are made for the average shaped head.
  • Plagiocephaly can result in a forward shift of the facial bones, which can be purely aesthetic or in severe cases can lead to jaw issues.

What can we do?

  • A paediatric physiotherapist can measure your baby’s head to determine if there are any concerns and provide you with education to best manage your baby’s head shape.
  • When recommended, we can refer you and your baby to an orthoptist for helmeting. This is dependent on your baby’s age and the severity of flattening.

When is it best to seek help?

  • The earlier the better! This provides more time to track your baby’s head growth and improvements in flattening. The earlier you come in the more likely we can address the flattening conservatively (with positioning, education and stretches if needed).
  • If a helmet referral is required, seeking help earlier is better to optimize the amount of change obtained with the helmet.

 If you have any questions about your baby’s head shape, feel free to contact us!

 

Written by: Maegan Mak