Pediatric Pelvic Floor Diaphragm and Postural Development

How Did It All Get Started?
When I first began treating children with bowel and bladder issues, my focus was on the obvious physiological concerns: bedwetting, dysfunctional voiding, vesicoureteral reflux, constipation. Over time, though, I noticed consistent musculoskeletal patterns - children with increased thoracic extension, hyper lordosis a protruding abdomen, increased rib angles, and weak core stability.

It became clear that these pressure and postural issues were impacting their normal developmental patterns. That realization changed everything about how I approached treatment.

Why Did I Create This Course?
Not every therapist wants to specialize in pediatric bowel and bladder disorders. But every therapist who works with kids should be able to recognize the musculoskeletal consequences that often accompany these issues.

My goal in creating this course, Pediatric Pelvic Floor ,Diaphragm, and Postural Development, was to bridge the gap: to help therapists identify and treat the postural, respiratory, and core stability challenges these children face—without requiring them to become bowel and bladder experts.

The relationship goes both ways:

• Children with special needs or musculoskeletal asymmetries often have weak cores, postural compensation, and develop poor bowel and bladder habits.
• Children with unresolved bowel and bladder dysfunction often develop weak cores and abnormal movement patterns as a result.

A few examples stand out:

• A non-verbal child with spastic quadriplegia was experiencing up to 11 daily “episodes” and difficulty sleeping. Once his constipation was addressed, his episodes dropped to 1–3 per day, and he began sleeping through the night.
• Another child with low tone withheld stool out of fear and discomfort on the toilet, eventually developing fecal incontinence. What looked behavioral was truly physiologic, and once addressed, his core stability and pressure system improved significantly.

These cases remind me: sometimes we’re detectives. And when we get it right, families see life-changing results - often in a short time.

What’s In This Course?
As I dug deeper into these patterns, I followed fascinating paths of developmental physiology. I learned how the diaphragm, ribcage, and pelvic floor interact as a pressure system, shaping core stability, continence, and postural development. The puzzle pieces came together—and I began creating fun, pediatric-friendly exercises to target these issues with purpose.

In this course, you will:

• Gain understanding of the development of the diaphragm and pelvic floor muscles (PFM) as they relate to core function and continence in children.
• Learn how to connect the ribcage, diaphragm, and pelvic floor for proper core activation.
• Receive instruction in the anatomy and development of the diaphragm and its relationship to the pelvic floor/core.
• Focus on assessment and treatment and connection of the core, thoracic spine, ribcage, breathing, and PFM.

By the end, you’ll be equipped with practical strategies to recognize musculoskeletal consequences of pressure dysfunction and confidently address them, helping kids regain function, stability, and independence.

To learn more, sign up to attend the upcoming Pediatric Pelvic Floor, Diaphragm, and Postural Development scheduled for September 21, 2025.

AUTHOR BIO
Dawn Sandalcidi PT, RCMT, BCB-PMD

Dawn Sandalcidi is a trailblazer and leading expert in the field of pediatric pelvic floor disorders. She graduated from SUNY Upstate Medical Center in 1982 and is actively seeing patients in her clinic Physical Therapy Specialists, Centennial CO.

Dawn is a national and international speaker in the field, and she has gained so much from sharing experiences with her colleagues around the globe. In addition to lecturing internationally on pediatric bowel and bladder disorders, Dawn is also a faculty instructor at the Herman & Wallace Pelvic Rehab Institute. Additionally, she runs an online teaching and mentoring platform for parents and professionals.

In 2017, Dawn was invited to speak at the World Physical Therapy Conference in South Africa about pediatric pelvic floor dysfunction and incontinence. Dawn is also Board-Certified Biofeedback in Pelvic Muscle Dysfunction (BCB-PMD). She has also been published in the Journals of Urologic Nursing and Section of Women’s Health.

In 2018, Dawn was awarded the Elizabeth Noble Award by the American Physical Therapy Association Section on Women's Health for providing Extraordinary and Exemplary Service to the Field of Physical Therapy for Children.