BABY STEPS
PHYSIOTHERAPY STUDENT
GUIDE TO INFANTS
ABOUT
I am currently completing my final year of the Bachelor of Applied Science and Master of Physiotherapy Practice at La Trobe University. I recently had the opportunity to complete a paediatric clinical placement encompassing both a hospital and community health service setting. The majority of my caseload involved infants (ie. children less than one year of age) who were referred following premature births, and for screening of Developmental Dysplasia of the Hip (DDH), Plagiocephaly and Congenital Muscular Torticollis.
During my clinical placement, I initially felt that I lacked the knowledge and skills required to assess and treat infants presenting with the aforementioned conditions. I had to conduct extensive research in order to recognise atypical development, identify suitable toys for each stage of development and generate appropriate session plans for the various clinical presentations. As my undergraduate training did not provide me with sufficient exposure to working with children, I also felt that I lacked the skills and confidence to manually handle infants.
Despite the challenges I faced when completing my paediatric clinical placement, I felt a great sense of pride and accomplishment when I realised that I was capable of a making meaningful difference to a child’s development and a family’s life. This planted the seed for my desire to assist other students and new graduates foster a similar passion for paediatric physiotherapy. As such, my intention when creating this website was to provide entry-level physiotherapists with a wide variety of resources that will hopefully make them feel a little more confident and prepared when going into their paediatric clinical placements.
PURPOSE
With the expanding scope of physiotherapy practice and increasing population, it is expected that most physiotherapists will encounter infants and/or children at some point in their career (Mistry, Yonezawa, & Milne, 2019). Nationally in 2014, 8.6% of babies were born preterm (ie. ≤ 37 weeks’ gestation), with 72% of those admitted to a special care nursery or neonatal intensive care unit (Australian Institute of Health and Welfare, 2016). In 2013, the incidence of positional Plagiocephaly was estimated to be 46.6% of 7 to 12-week-old infants (Mawji et al., 2013). Whilst less common, Congenital Muscular Torticollis affects 0.3% to 2% of infants, and must be screened for when assessing infants with Plagiocephaly (Nilesh & Mukherji, 2013). Finally, Developmental Dysplasia of the Hip (DDH) affects 1-3% of newborns, however, is responsible for 29% of hip replacements in people under 60 years of age (Sewell & Rosendahl, 2009). Given the prevalence of conditions seen during infancy and their potential sequelae, it is essential entry-level physiotherapists are equipped with the knowledge and skills to assess and treat, in order to facilitate best possible outcomes.
​
As per Mistry et al.’s (2019) audit of Australian entry-level Physiotherapy programs, the current paediatric physiotherapy syllabus is not standardised and is lacking in multiple domains. Given the highly complex nature of paediatric content and the shortage of paediatric clinical placement opportunities, many entry-level physiotherapists are graduating without developing competencies to safely and effectively assess and treat infants. As new graduates, however, they are immediately licenced to work independently with infants and children. Therefore, this website is intended to build upon and bridge the gap between the knowledge and skills attained throughout the La Trobe University paediatric physiotherapy curriculum and those required to safely and effectively assess and treat infants within a clinical placement setting.
​
Moreover, Travlos and Hill (2015) report physiotherapy students’ and new graduates’ handling skills are a primary factor affecting their confidence in working with infants. The general consensus from informal discussions with peers and clinical supervisors is that the current paediatric curriculum does not provide sufficient exposure, nor equip entry-level physiotherapists with the skills necessary to manually handle infants without further education. Videos of experienced clinicians conducting assessment and treatment techniques with simulation dolls and real children were found to be effective in improving students’ confidence and handling skills (Travlos & Hill, 2015). As the website provides visual representations of assessment and treatment techniques, it is expected to successfully increase physiotherapy students’ and new graduates’ confidence to manually handle infants during their paediatric clinical placement.
​
Finally, Sheilds, Bruder, Taylor and Angelo (2013) found students’ clinical experience may be a more powerful influence on their future career than university coursework or job availability. Generally, students’ engagement in paediatric clinical placements is hampered by their lack of knowledge and confidence to handle an infant (Travlos & Hill, 2015). As the website is intended to increase physiotherapy students’ and new graduates’ confidence to work with infants, it is expected that students will be more inclined to partake in a paediatric clinical placement and pursue and develop competence within this field during their future careers (Australian Physiotherapy Association, 2019b).
RECOMMENDED USE OF WEBSITE
The website explores expected developmental milestones from early infancy (0-3 months) to transitional infancy (10-12 months). The website also reviews age appropriate toys that may be utilised during assessment and treatment to compliment an infant’s stage of development and emerging abilities. Furthermore, the website provides the foundation information relevant to infants born premature, and those with Developmental Dysplasia of the Hip, Plagiocephaly and Congenital Muscular Torticollis.
​
It is recommended the URL for this website is downloaded to ensure continued access to the resource is available to users once their access to the Learning Management System is terminated upon concluding their degree at La Trobe University.
Each topic contains instructions, diagrams and/or images for quick reference during clinical placements. The topics also contain various supplementary resources that may be used to further explain, demonstrate and/or reinforce concepts and assessment/treatment techniques.
ACKNOWLEDGEMENTS
The author would like to acknowledge Paediatric Physiotherapists, Alice Hill and Santhiya Santhiapillai for their generous contribution and assistance in the formation of the resource.