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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

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

Why do some kids walk on their tip-toes?

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One of the most recurring comments a paediatric physiotherapist gets when a family brings their child in for assessment of toe-walking is, “everyone told us it will go away and it hasn’t”. The fact of the matter is if doesn’t go away right away, it likely won’t resolve on it’s own and will continue to get worse. Idiopathic toe-walking occurs when children walk on their toes without a neuromuscular, or sensory cause.

So why do some kids learn to walk on their tip-toes?

The calf muscle is a primary postural control muscle, meaning it helps us to control our balance when standing upright. When children are first learning to walk they haven’t mastered their balance and as a result, kids can compensate by activating their calf muscles, resulting in them walking on their tip toes. In typical development, a child should have enough core and glut strength that they are able to maintain an upright position without having to compensate with their calves.  When kids learn to walk before they’ve developed sufficient core strength, toe-walking results.

In some instances, a child will be able to learn how to turn off their calf muscles and begin activating their core appropriately. However, if a child doesn’t learn how to stop their compensation; their core muscles will become weaker, and their calf muscles will continue to get stronger. Over time this compensation becomes much more resilient, is much harder to break, and the toe-walking gets worse.

So how do we ensure kids develop a strong core before they learn to walk?

Milestones are such a crucial part of development because the previous milestone sets the foundation for the next milestone. For example; a baby rolls first, then builds enough strength to push up and move around on their tummy. Then they have enough strength to get themselves into and out of sitting, and they start crawling. Next, a child will have enough strength they can pull themselves into standing, and cruise along furniture. Eventually, they take their first independent steps without holding onto support. A developing baby is ready for the next milestone when they can do it themselves! Babies won’t crawl if they don’t have enough strength in the same way that adults can’t run a marathon if they haven’t trained for it! If a baby is encouraged to walk before they’ve developed adequate strength, they will turn on their calf muscles to help compensate, and voilà! They toe walk.

It is normal for a child to toe-walk when they are learning to walk, so long as they come down onto flat feet after 2-3 steps. If they remain on their toes for more than the first few steps, that is not normal, and they are compensating. The sooner you can correct this compensation, the easier it is to reteach the brain the proper motor pattern!

 Crawling, cruising and more crawling!

Crawling is such a crucial milestone to develop core strength, glut strength, coordination and shoulder stability (to name a few). It is a stage that should not be rushed, nor skipped! Many athletes and children with recurring knee/ankle/hip pain that never had a specific injury tend to be early walkers when we ask parents! Parents are often so excited their child walked early, however these kiddos tend to have weaker core control, and are more likely to compensate when they are active and participating in sports- even if they never walked on their toes!

So how do we know when they’re ready to walk?

When they can do it on their own! Create an environment that’s easy for babies to pull themselves into standing and cruise on their own. For example, chairs, coffee tables, flipped over laundry baskets, boxes and toys, which provide lowsupport. Surfaces that are too high will encourage them to reach up and go on their toes. Similarly, if your baby is walking holding onto your hands, keep your hands low(at their waist level) so they are not encouraged to reach high and activate their calves!

When in doubt – ask a Physiotherapist!

If you’re unsure about your child’s development it’s always great to ask! It’s never too early – the sooner you can get on top of the suspected compensation, the easier it is to re-teach that sneaky brain! Most of the time, a Physiotherapist can give you guidance, tips and tricks to try at home without having to come into physiotherapy sessions regularly!

Written by: Karly Dagys

 

 

 

 

 

Preventing injuries during the active fall school season.

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Pre-habilitation and injury prevention

At this time of year, your kids most likely just started their sporting season. During these busy times of practices, we often see athletes coming in with all kinds of injuries. Injuries can happen for many reasons, however there are ways to prevent them! This blog post will introduce you to pre-habilitation, and how attending physiotherapy can be beneficial!

Preventing injuries in the fall when activities are back in full force.

  1. When kids grow, their bones lengthen first and then their muscles need to lengthen as well. If muscle length is not addressed it could lead to muscle strains, especially with lots of activity and training.
  2. Addressing muscle imbalances ensures that your child will be moving optimally and prevent injuries that result from poor mechanics, alignment and muscle strains due to lack of strength.
  3. Physiotherapy can treat minor issues so they do not progress into more serious problems. Catching little aches and pains at the beginning of the season gives your child an opportunity to rehab earlier in the season and limit the time missed during the regular season.

Physiotherapy can help your child become more body aware and learn their body’s limits.

  1. When kids grow their body awareness often lags behind, as they need to re-learn their “body dimensions.” Improving body awareness will help your child excel in all their activities.
  2. Becoming more body aware and learning how their body moves can improve coordination and their movement efficiency.
  3. Everyone’s body is different and moves in different ways. It is important for kids to become familiar with how their body functions to prevent injuries, master certain skills and boost their confidence!

A great example!

I have been treating a young dancer who dances 12-15 hours per week. Her mother wanted her to learn more about how her body moves and its’ limitations. She noticed how hard her daughter was pushed at dance and wanted her to learn proper techniques to prevent pain and injuries. My patient was also complaining of slight heel pain during the initial assessment. I determined that the heel pain was most likely an early start of Sever’s Disease. I had found that one of her calf muscles was over-working for her hip muscles. After one week of treatment and home exercises, the heel pain had resolved. If the heel pain had been left unattended it would have worsened and she most likely would have had to take several weeks off to recover. We also have been working on proper form for various stretches – core strength and leg strength – that are commonly performed in the dance class. This parent was proactive and helped fixed an early issue before it became a problem! Her daughter is also learning how to stretch and strengthen her body safely, to help her excel in dance for the remainder of the season.

The body of this article originally appeared in just dance! Magazine

 

 

5 Challenges to try on the Playground

Playgrounds are a great place for kids to improve gross motor skills, strength and confidence.There are lots of things you can have your child try when they are on the playground to provide different challenges. Often times, kids will gravitate to the areas of the playground that are easiest for them. Incorporating other playground equipment or ideas into their play is a great way to physically challenge them, bring awareness to other ways to use play structures and be a fun task for both of you!

5 Things to Try

  1. Balancing along the edge of the playground, often times there is a border to the play area you can walk along.
    Walk forwards/backwards/sideways
  1. Climbing down a ladder rather than going down a slide or fireman’s pole. Kids typically master climbing up, however have difficulty climbing down.
  2. Hanging from monkey bars if fully completing them is too challenging. Monkey bars are difficult! As a stepping stone to learning how to achieve the monkey bar goal you can assist your child in hanging from one of the bars and set a time goal, such as 5 seconds.
  3. Sideways up the stairs to challenge different muscles. Going up the stairs sideways is another way to get to where they want to go, AND you are strengthening different leg muscles! Make sure to try both directions.
  4.    Climbing up slides is a great way to target back, leg muscles and core! Make sure you get to the park early to try this one out, so you have the slide to yourself.

You can also try a more hands-off approach at the playground to allow your child to explore on their own limits. This can be a fun way for them to challenge themselves and experiment with different ways of play. We hope you have fun trying these out during your next park adventure!

Happy Playing!

Maegan Mak & Kate Heays