Pediatric Pelvic Health

Pediatric pelvic health physical therapy is a specific type of physical therapy for children with challenges related to their pelvic floor muscles, or the muscles that are responsible for pelvic organ support and that assist in bowel and bladder control. Pediatric pelvic health physical therapy typically involves treatment strategies that produce results from services in as little as 6-8 visits, making this a very effective and relatively short term intervention for children!

Incontinence

Lack of voluntary control over urination or defecation (these are the kids that may have pee or poop accidents more frequently while attempting to potty trained or even AFTER they have been potty trained)

Enuresis or Nocturnal Enuresis

Involuntary urination, or involuntary urination at night (wetting the bed at night over and over again)

Encopresis

Involuntary soiling of stool or feces into clothing; (this is more common in children who chronically withhold stool or have history of impacted stool in the colon and a difficult time going #2)

Chronic Constipation

“Chronic” often refers to 3 or less bowel movements per week and a lot of discomfort for our little ones! Sometimes accompanied by a distended, firm belly!

Painful Bowel Movements

This is usually due to chronic constipation and can often times result in emotionally negative experiences in the bathroom.

Pelvic Pain

Discomfort in the pelvic region (or the lower aspect of the abdomen, genitals, or anus)

• Education to the child on how their urinary and gastrointestinal systems work using fun and creative strategies to engage the child in the pelvic health plan of care.
• Education to the child and their family on how nutrition and healthy fluid intake can impact their bowel habits, bladder habits, and overall pelvic health.
• An understanding of the anatomy and purpose of the pelvic floor muscles (in an age appropriate and fun manner) and how these muscles relate to successful bowel and bladder routines.
• Manual techniques and exercises to improve posture and alignment that impacts efficiency and effectiveness of the pelvic floor.
• Strengthening and coordination training of the hip, core, and pelvic floor muscles that are involved in healthy bowel and bladder routines.
• Various fun and creative tips to assist children who have difficulty voiding.

• Techniques for children and their families to help with poor bladder capacity or kids that are running to the bathroom frequently.
• Tips for urge control for children who experience urinary frequency or strong urges when it is time to use the bathroom.
• Natural biofeedback interventions and strategies to assist the child in improving their ability to coordinate the pelvic floor muscles to improve their bathroom routine.
• Child specific home programs to improve toileting successes on a day-to-day basis.
• Family specific schedules, charts, and tracking systems to ensure progress with bowel and bladder success throughout the pelvic health physical therapy plan of care.
• Child specific recommendations regarding toileting routines and bathroom set up for children with and without developmental delays, mobility deficits, sensory needs, or cognitive issues.

1 – 2 Months

• Kicks feet reciprocally when on back
• Brings hands within range of eyes and mouth
• Moves head from side to side while lying on stomach
• Head flops backward if unsupported
• Keeps hands in fisted but can open and close easily
• Can turn head fully to either side when lying on back

3 Months

• Raises head and chest when lying on stomach, able to lift head 2-3” off of floor
• Supports upper body with arms when lying on stomach
• Stretches legs out and kicks reciprocally when lying on back
• Opens and shuts hands
• Pushes down through legs when feet are placed on a firm surface
• Brings hand to mouth
• Swipes dangling objects with hands held above them when lying on back
• Grasps and shakes rattles briefly
• Can roll to back when placed on side in both directions

4 Months

• Straightens legs when feet touch a flat surface
• Lifts head and chest off surface while propping on elbows during tummy time
• Can bring both hands together at midline
• Rolls to side lying from back
• Can hold head up and look around when supported in sitting

5 Months

• Rolls from tummy to back
• Pulls self forward to sitting position when you hold baby’s hands and pull to sit from laying on back

6 – 7 Months

• Rolls both ways (front to back, back to front)
• Sits with, and then without, support of their hands
• Supports whole weight on legs when held in standing position
• Reaches for feet
• Reaches with one hand
• Transfers object from hand to hand in sitting and when on back
• Uses raking grasp (not pincer)
• Bears weight on open hands during tummy time
• Demonstrates balance reactions in sitting, such as placing a hand to the side to catch themselves from falling

8 – 9 Months

• Gets to sitting position without assistance from tummy
• May crawl forward on belly by pulling with arms and pushing with legs
• Assumes hands-and-knees position and may creep forward on hands and knees
• Creeps on hands and knees supporting trunk on hands and knees
• Pulls on furniture to stand up
• Walks holding on to furniture with side stepping

10 – 11 Months

• Stands momentarily without support
• Briefly stands without support
• Lowers self to floor with control
• Takes steps with hands held

12 – 15 Months

• Walks independently
• Throws a ball forward
• Walks sideways and backwards
• Crawls up stairs
• Plays with pull and push toys, such as a toddler grocery cart

15 – 18 Months

• Walks up and down stairs with help
• Seats self in a child-sized chair
• Starts to crawl into car seat
• Can pick up small objects between finger and thumb
• Demonstrates balance reactions in standing
• Can squat and play before standing up again

18 – 24 Months

• Squats during play
• Pulls toys behind them while walking
• Tries to catch a ball with arms and body
• Jumps with galloping motion
• Uses legs to propel non-motorized, ride on toys
• Walk up and down stairs when one hand being held by an adult
• Carries large toy or several toys while walking
• Begins to run
• Stands on tiptoe
• Kicks a ball
• Climbs onto and down from furniture unassisted
• Walks up and down stairs holding on to support

2 Years

• Jumps in place with both feet
• Climbs up and go down a toddler slide
• Catches a large ball thrown from 2 feet away
• Pedals tricycle
• Stands briefly on one foot
• Walks backwards
• Goes upstairs and downstairs with support from railing only
• Kicks ball forward
• Throws ball overhand
• Catches bounced ball most of the time
• Moves forward and backward with agility
• Can run around obstacles and stop with ease

3 Years

• Pedals a tricycle
• Catches an 8-inch ball thrown from 5 feet
• Alternates feet going up and down stairs
• Jumps forward 8 to 12 inches
• Hops and stands on one foot up to five seconds
• Builds a tower of 9 blocks
• Completes a 5-6 piece puzzle
• Uses utensils appropriately
• Grasps and colors well with crayons

4-5 Years

• Walks across a 4-inch balance beam
• Kicks a ball rolling toward him or her
• Stands on one foot for ten seconds or longer
• Hops, somersaults
• Swings, climbs with ease
• May be able to skip