Introduction to Pediatric Physiatry
By Naomi Kaplan, MBBS
As is often said, “Children aren’t tiny adults.” Pediatric physiatry has breadth and depth that few outside the field are familiar with. Pediatric physiatrists work in both inpatient and outpatient settings, providing care for children of all ages: from infants with torticollis to adolescents with cerebral palsy heading off to college. Caring for the disabled child with a patient and family-centered approach is at the heart of every pediatric rehab encounter.
Pediatric rehabilitation departments are sprinkled across the country and families often must drive many hours and miles for their child to be seen by a specialist. Outpatient departments often run clinics where children are seen by a physiatrist, multiple therapists, as well as providers from other pediatric sub-specialties (such as urology, orthopedic surgery and pulmonology). These monthly, or bimonthly, multidisciplinary clinics are particularly helpful in managing complex conditions such as cerebral palsy, spina bifida, neuromuscular conditions and limb deficiencies. “General” clinic appointments provide interim follow-up and allow specific problems to be addressed.
Procedures are an established part of pediatric physiatry, whether they be toxin injections, baclofen pump management or EMGs. Children present a unique challenge, not always being able to tolerate needle sticks and sometimes requiring oral or IV sedation. Toxin injection is being done under EMG, e-stim, and increasingly ultrasound guidance.
Children are still developing in all aspects of their being, from a cognitive, emotional, and physiological standpoint. Static insult or injury can have chronic effects, as the child continues to develop. Knowledge of normal pediatric developmental milestones is integral to the practice of pediatric physiatry.
There are many allied health professionals, not often seen in the adult realm, who provide enrichment and therapy for the pediatric patient, allowing the child to stay engaged in treatment, stimulated by their environment, and emotionally and psychologically grounded during chronic medical treatment and rehabilitation. These include, but are not limited to Child Life specialists, licensed massage therapists, music therapists and child psychology. Incentivization, through use of sticker charts, hospital “money,” and rewards, is a challenging but fun aspect of pediatric rehabilitation used to maximize participation and help achieve specific functional goals.
The importance of advocacy for the pediatric physiatry patient cannot be overstated. These patients are vulnerable with complex needs. Guardians have a responsibility to bring patients to their appointments. The team should help to facilitate clinic attendance by sending timely reminders and assisting with transportation barriers. Social workers are an important part of the pediatric rehab team, but the safeguarding of children is everyone’s responsibility. Cases of non-accidental trauma or abuse require input from all angles, to ensure safe discharge planning for the patient and appropriate documentation.
Pediatric physiatry is a field ripe with research opportunities, from bench work to clinical trials. Qualitative and quantitative research can be initiated, as well as quality improvement studies.
Pediatric rehabilitation is an expansive and rewarding sub-specialty with an opportunity for great career satisfaction. Maria Montessori once said, “Play is the work of children,” and pediatric physiatry is the path to play, function and quality of life.
Naomi Kaplan, MBBS, is a PGY-4 resident in PM&R at Zucker SOM at Hofstra/Northwell, with an interest in pediatric rehabilitation.
