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- Dr.Joni Redlich PT,DPT
What happens when your child is ill?
Have you ever thought you were going crazy when it came to your kids? Sure, we all get stressed out by the demands parenting requires of us whether they be mundane, daily happenings (“No you can’t have another cookie!”, “Stop teasing your brother!”) or extreme, unlikely circumstances (Hello pandemic-looking at you!)
But, what if there was something wrong with your child, (who also happens to have neurodevelopmental delays or another neurodivergent diagnosis) and no experts had any answers for you? What if you took your kiddo to all the “BEST” doctors out there and they either had no answers, their diagnosis conflicted with one another, or worst of all, they just didn’t believe your child had a problem?
Misdiagnosis happens.
I am here to tell you that it happens. And when it is your child who is struggling and suffering, it is exquisitely painful. You feel like you are living in a nightmare that you simply cannot wake from and that somehow, those around you are seeing a distorted view of reality. A 2019 article* states that, “the mindset that young children are rarely seriously ill is one of the main reasons that they are more likely to be misdiagnosed than adults are. That’s on top of all of the ways that approximately 10 percent of American adults are misdiagnosed every year. When doctors and nurses expect to see a healthy child with a common short-lived illness, they may miss the uncommon ones.”
The article goes on to list the main reasons for children receiving a diagnosis that’s wrong or delayed:
Experts may give you the brush off.
However, there are cases where a parent’s concerns are dismissed, as I was when my daughter presented with a long, puzzling, seemingly unrelated laundry list of symptoms that spanned years, nearly a decade by the time a diagnosis was finally rendered. During that time period, I was given advice from some well-meaning individuals who said things like:
Did any of this help my daughter get better or me find answers? That would be a resounding no. Oh, and by the way, that last piece of “advice” above was given to me, in front of my child, by a supposedly well-respected doctor. He dismissed all the hundreds of pages of tests, scans, medical records and prior diagnosis, didn’t help my daughter, and charged for it!
So what DO YOU DO? You don’t give up- you trust your gut! Parents know their children best and what their “normal” looks like, even if it doesn’t match the textbook image. Remember to believe in yourself and your ability to help your child. Make a bulleted list of every symptom, even if it does not seem totally related, and the date the symptom started. Research the heck out of your child’s symptoms and any test results you have, using the best and most trusted resources you can find. Become well acquainted with clinical research papers, societies for various branches of disease types ( think brain, stomach, nervous system, etc.) Join an online group for other parents who may be seeking answers for their child or who may have information to share.
The Society to Improve Diagnosis in Medicine says not to get overwhelmed by the risks of misdiagnosis. Rather, recognize there are a few key things to do, to assist in getting an accurate and (hopefully) prompt diagnosis. These tips also help if your child is in the middle of a diagnostic journey today.
In closing, you, as a parent, are the most trusted authority on your child. If you feel that something is wrong with your child and it is not getting resolved, don’t be afraid to speak up. Your child and your family deserve answers and the best possible care. Be brave and know that what your GUT is telling you, may be right. (If you have a question for Melanie (author/Kid PT Marketing) email her at info@kidpt.com)
*References
May is Arthritis month! Why are we talking about Arthritis? Well, it’s not a diagnosis that only affects adults, it affects kids too. Juvenile Idiopathic Arthritis is a diagnosis that affects kids of many ages, both young kids and older teens too. Unfortunately, Juvenile Idiopathic Arthritis (JIA) is sometimes passed off as “growing pains” by some medical professionals when a child complains of joint pain. This is seen to happen more frequently with older children or young teens complaining of joint pain because at this time in their lives, they are going through large periods of growth and physical development. Sometimes it is just growing pains, but sometimes it might not be! We wanted to give parents and therapists a guide so that you can recognize when signs and symptoms of JIA might be present and know who to seek out for help if you think your child might be showing some signs and symptoms of JIA.
JIA (also known as Juvenile Rheumatoid Arthritis), causes joint stiffness and joint swelling, also known as inflammation. JIA affects one or more joints for at least 6 weeks or more in children who are 16 years old or younger. JIA is different from Adult Rheumatoid Arthritis, because symptoms can decrease or go away completely as they get older BUT it can affect how a child’s bones develop as they grow.
JIA is an autoimmune disease. An autoimmune disease can occur when the body’s immune system becomes overactive and begins to attack its own healthy tissue. In JIA, the primary tissues that are affected are bone and cartilage around the child’s joints. When this begins to happen, it can happen chronically or episodically. If a child’s JIA symptoms are chronic, they have them most to all of the time where as if they are episodic, they may go through flare ups where their symptoms get worse and then have periods where they have no symptoms at all.
Children with JIA primarily have symptoms related to their joints like swelling, stiffness, and pain. The joints that are most commonly affected are the knees, hands, feet, ankles, shoulders, and elbows, but the spine and hips can also be involved. Pain and swelling are often at their worst in the morning or after a nap. Children can also have decreased appetite, poor weight gain, slow growth, eye inflammation, and fatigue. In systemic JIA, children can also present with a high fever, rashing, and swollen lymph nodes. The tricky thing is that some of these symptoms can seem like other illnesses or health conditions so it is important to make sure your child is seen by their primary doctor and a rheumatologist for appropriate diagnosis.
Yes, They absolutely do! Physical Therapy is essential for kids with JIA to help preserve joint function and to help strengthen the body to better support the joints. When a child has JIA, strengthening has to be done carefully so to not overstress the joints, and PTs have the expertise to help guide you and your child away from activities and sports that may be harmful for your child’s joints and toward more helpful activities. In acute phases of JIA, when your child is exhibiting a flare up of their symptoms, PT helps to maintain their joint range of motion, prevents muscles from getting too weak, and helps protect their bones from getting weak too. When your child is not experiencing a flare up of pain and stiffness, PT will help improve your child’s gross motor skills, especially ones that may have been limited due to their pain and decreased range of motion, so that they play and move with more freedom and confidence. If a child has a more chronic form of JIA, physical therapy will also help to achieve new mobility goals while making sure to keep their pain levels low and to prevent increased swelling.
If your child has a diagnosis of JIA or if you think there is a possibility they may have JIA, talk to your child’s primary care doctor about whether or not they believe JIA is a possibility and what your next steps should be. If your child is experiencing joint pain, they may benefit from physical therapy for all the reasons discussed above and more. Our therapists at KidPT can help give you more information and can take a look at your child to see if physical therapy would be an appropriate next step to help their body grow and develop in the healthiest way possible!
If you want to learn more about the different types of JIA, the process for diagnosis for JIA, and more, click to read the article below:
References:
There are so many reasons why the Spider Cage is a powerful therapeutic tool to integrate into your child’s physical therapy program. If you worry about your child not having all possible opportunities to develop new movement skills, you should try out the Spider Cage during a trial session at our office to see firsthand what your child can do!
Why is the Spider Cage so powerful? Let’s look at 7 reasons that the Spider Cage gives children access to developing new skills and abilities, by supporting them to increase strength, balance, motor control, endurance and sensory processing, all while having sooooo much fun. Remember, fun is really important when it comes to children- if they’re having fun, then they’re LEARNING! Let’s get into those 7 reasons now.
The Spider Cage is setup where the child wears a belt and the bungees connect to the belt. There are 8 bungees that can be attached to the belt with 2 on each corner.The child can be sitting, on hands and knees, standing, walking on a treadmill or moving between positions. The bungees in the Spider Cage provide support, but they’re also dynamic, so it is a different experience for a child that has been in a stander or a gait trainer. It is also different than having a parent or therapist helping. The child can try out new skills with just enough assist, but they are initiating the movement and responding to what worked and what didn’t work to learn from the experience.
In the video below, you can see the boy practicing standing up by himself without using his hands, which he can’t do outside of the Spider Cage. Over time the bungees can be lowered or only 4 bungees can be used to build more independence, which can then generalize to outside of the Spider Cage.
2. Confidence Building
Many children with movement delays or disabilities develop a learned helplessness from frequently experiencing things being difficult or impossible. Learned helplessness is when you have learned that you can’t do something, so you stop trying. It is an understandable reaction, but one we have to mindful of when guiding children to develop new skills and abilities. The Spider Cage is a fantastic tool for children to experience that they are capable of doing, with just the right support. This can be basic gross motor skills like sitting, standing and walking, or it can be more advanced skills, like hopping and balancing on dynamic surfaces.
The boy in the video initially needed hands on help to perform this motion. He didn’t try to initiate it on his own and needed help to complete the motion. After several times in the Spider Cage, he learned how to transition from hands and knees to standing with the help of the bungees alone. He was so proud of himself and this transferred to him helping more with transitions off the floor outside of the Spider Cage.
3. Safety to Try Higher Level Balance Skills
Children will limit attempts at new skills if they know their body isn’t going to be able to do it reliably and safely. Knowing they can’t fall, the Spider Cage gives the opportunity to try all sorts of challenging balance tasks without the risk of falling and hurting yourself. This way, the kids can work on those advanced skills, flood their brains with novelty and develop more advanced movement control.
In the video below, she challenges herself to move from standing to half kneel while standing on a bolster that rolls side to side. What a challenging task! This would be a risky thing to try holding maybe a trapeze overhead and would have allowed her to rely mostly on her arms, instead of her hips. Doing this activity in the Spider Cage let her work on a high level of hip and balance control and no rely on her arms for help.
4. Sensational Sensations
As we said before, the Spider Cage is a DYNAMIC place to be! The bungees provide resistance and assist to movement, giving intense proprioceptive/deep pressure input to the children’s bodies. All of the movement is very stimulating to the vestibular system in the inner ear as well. The Spider Cage is a great place to put together the postural system with the eyes, vestibular (inner ear), and proprioceptive (information from joints and muscles) to work on improving body awareness and regulation skills.
In this video you will see a boy doing intense jumping, having a BLAST, and regulating his system to do focussed work afterwards!
5. Hands Free Movement
Children who use crutches or walkers for mobility are always using their hands to help manage the rest of their bodies. The problem is that they then become limited in using their hands for other activities, such as carrying something, and they rely on using their arms to initiate movement, rather than using the pelvis, the cornerstone and powerhouse of our bodies.
In this video you’ll se a boy playing basketball where he typically needs a person to help or his hands on an assistive device to be able to do an activity like this.
6. Speed & Power
The Spider Cage gives the support a child needs to be able to work on moving at increased speeds than they could do outside of the cage. It also lets them work on their power with jumping and leaping. The dynamic assist on the bungees give greater access to new skills while decreasing risk of falls at the same time. This allows motor control, strength and endurance to build to support the use of increased power and speed outside of the cage in the future.
In this video, the boy walks 2mph, when he usually walks at a slow pace with crutches, he’s able to explore increased speed. You can see how proud he is at his acomplishment!
7. Play
Play is how babies and children learn! Play in the Spider Cage gives access to children with a limited play repertoire to develop more advanced play skills. Children can jump, kick a ball, throw a ball, and knock down towers. There are so many games children with limited play skills can try out in the Spider Cage!
In the first video below, the boy initially needed assistance from the therapist to stop on the target. With practice he was doing it all on his own and laughing so hard each time!
In the second video, we used the Spider Cage in a completely different way to make a ninja obstacle course with the bungees! The boy is working on his midrange postural control to move over and under while trying not to touch the bungees.
In the 3rd video the boy is playing t-ball! He has the opportunity to be hands free using the support of the bungees to play the game!
Participation in the arts are a way for someone to express themselves. It creates a window into the soul and an escape all in one. Some turn to painting, drawing, music, drama, or dancing to find their sense of self or to relieve stress after a long day, and this is no different for kids and adults with Cerebral Palsy (CP). Taking part in the arts is a wonderful thing for children with CP to do, no matter their level of disability, and here’s why!
Self Expression Without Limits
The arts allow for a place to explore what you are thinking or feeling. Whether you are verbal or non-verbal, participation in an art form is a way to get your feelings out! Society often tries to put us in boxes that may make us feel limited. But when you are creating art, you get to make the rules. Bend the rules to work for you
Adaptability
With the free form nature of many arts programs there are no rules that have to be adjusted to make it work for your body. If your dancing includes, moving your head side to side to make your wheelchair turn to the right and the left, do it! If you need something to secure a paint brush to one of your hands or to your head to paint your beautiful picture, why not! It’s your masterpiece, so the environment can be set up to make creating your art that much easier.
Community OR Solitary Art
Many arts are performed in a group setting for those who love being social, like Drama. You can find your Drama, Dance, or Visual Arts community if that floats your boat. BUT the cool thing about the arts is many forms don’t have to be done in a group, they can be done alone too if you’d prefer to work that way.
Confidence Booster
For many kids and adults, taking part in the creation of something beautiful, or something they made themselves, is a huge confidence booster. When the right adaptations are in place to support each child or adult, either with motor or intellectual considerations, the child can make something by themselves (or with a little bit of teamwork if needed) and feel proud of themselves for doing so!
Types of Art
Visual Arts
Dance
Drama
Music
But where is there to go in NJ for my child with CP to participate in the arts? Check out these links to find out more!
Dance:
http://kayelynndance.com/chance-to-dance/
http://www.danceinnovations.org/dipf
http://kayelynndance.com/chance-to-dance/
http://www.danceinnovations.org/dipf
Theater:
https://papermill.org/access-for-all
Art:
Music:
https://www.theconnectiononline.org/com
References:
https://www.cerebralpalsy.org/information/activities/arts