What to Expect when Taking your Child to Physical Therapy

Physical therapists are trained to evaluate movement and function. Typically, the therapist will first take a history followed by a physical examination that is customized in regards to your child’s abilities to determine a treatment plan of care. The therapist will set goals using the information provided. Usually, the therapist will begin treatment on your first visit that will include a discussion of treatment goals, education regarding pain, and instruction in a home program.

Because most kids with pain have an extensive history, it is helpful to have a written history with dates, along with a list of medications. This allows the therapist to review the history more quickly, allowing more time for questions and treatment.

Create Trust by Involving your Child and Creating Independence

Children who are experiencing pain often have been evaluated by a number of clinicians prior to being referred to physical therapy. Decisions and discussions often exclude the child from their plan of care. Oftentimes, because your child has not seen any reduction in their symptoms from the medical care that they have received, they may be reluctant to start another intervention.

I think it is very important that the physical therapist establish trust by engaging the child in telling their story and participating in setting up their goals and plan of care. This will vary on the child’s age, but by involving your child, it encourages them to take responsibility for their health, to promote a feeling of control, and to feel respected. I usually tell the child that I am here to help guide them on their journey to better health. I want them to feel empowered to improve their physical function.

Some children are quite vocal about their history, while others look to their parents. The therapist can guide the conversation with your child, so it is best if there is no interference from the parent. If you feel that something needs further clarification, it may be best to speak with the PT separately.

Don’t Ask About Pain

A key point in making physical therapy successful is to avoid making comments about their progress and to avoid asking them if they have pain. I recommend on my first visit that the family no longer ask about pain, but that the child/adolescent may bring it up if they wish. When you ask about the pain, this triggers the brain to think about it and your child will then experience pain. For example, I had one client who went on a family outing at the beach and played with her cousins all morning. Her Mom said “I am amazed that you can play on the beach without pain” and her daughter spent the rest of the day in the house in pain.

Oftentimes in therapy or with family activity, if the activity looks fun, the brain does not perceive it to be harmful and the person can perform the activity without pain. As soon as there is a comment that signals doubt, the brain will trigger the pain as a protective response.

I also recommend that the child take responsibility for their home exercise program. It should not become an issue between parent and child. If there is an issue with non-compliance, the PT usually knows and will address it. Depending on the circumstances, sometimes an email to the PT is helpful and this can be discussed with your PT on how best to communicate.

Since treatment may occur in an open gym area, it is best to stay out of sight and give your child some space. Take the time to go out and make a phone call, catch up on your email, or do some mindfulness walking. Kids often perform better when their parents are not watching.

I had a 12-year-old client who was unable to bend her knees which limited her ability to go upstairs to her bedroom. Her Mother had to carry her. I asked her if I could fix that situation and if she would like me to do that. She did. When her Mom returned to the clinic, I told her that her daughter could now go up and down the stairs by herself as long as she wasn’t in the room. Her Mom understood and her daughter began using stairs independently.

Keep Movement Fun

Encourage your child to participate in any activities that they enjoy, but do not push. Encourage non-competitive activities, allowing your child to just have fun. Activities with family and friends can be beneficial in promoting your child’s overall function.