Pediatric Pelvic Floor Therapy "Play Skills"

One of the things you'll learn when working with the pediatric population is that they're a different species than adults. Some of the common diagnoses may overlap, such as chronic constipation, fecal smearing, or nocturia. The way they present may be similar and the treatment ideas and philosophy may also overlap. However, how these treatments are implemented may vary when treating a child versus an adult. When I think of treating the pediatric population, I like to divide my thought process and approach into five different groups.

To me, pediatrics can be babies/infants, toddlers, preschool-aged children, elementary school-aged children, and then tweens/teens. It may feel excessive to divide this population into so many subgroups, but each of those groups has its own treatment considerations based on the child's development at that time in their lives. An infant may be working on regulating their GI system as they transition from being in-utero to being born. Toddlers and school-aged children are working through various internal and social benchmarks to help them continue to grow and develop. Likewise, a tween or teen may be managing the changes to their genitourinary system as they work through puberty towards adulthood or grappling with their sexuality and sexual identity as they mature.

Regardless of what stage they are in life, patients will potentially present differently and also need a customized treatment plan to meet them where they are at. When I have colleagues jumping into pediatric pelvic health, I rarely worry they have the clinical skills to help with the physical and physiological challenges a child may face. The place I see many clinicians struggle is how to apply the skills they know to these tiny humans in front of them. Treating reflux in an eighty-year-old versus an 8-week old person is very different.

Children can't always tell us what they're feeling and how they're feeling it. An adult that has the ability for interoception can tell us what they're feeling, how they're feeling it, and how our treatment interventions are affecting their condition and goals. A pediatric patient may not be able to provide this feedback so subtle signs such as skin color, facial expressions, and body language may be your only clues. Likewise, being able to interpret a baby or child's negative reactions, such as crying, trying to get away, trying to hide, or otherwise avoiding therapy is a very necessary skill when working with pediatrics. Long story short, we can ask an adult if what we're doing is working, with a pediatric patient, we have to be more creative in determining our efficacy.

Children can't give consent. Children can give assent, meaning that they will comply with what you are asking them to do. This can feel tricky and if you struggle with this I recommend taking Ethics Considerations for Pediatric Pelvic Health on July 27, 2025. When working with pediatric patients, the take-home point is that the therapist will always have more power than the child that they are working with. This means that the therapist has to be very careful in how they wield their power dynamic, to be most beneficial and fair to the child.

Children usually can't be autonomous with their home programs. When I think about home programs, some of my adult clients even struggle to complete these correctly or regularly. Many times, especially when they're under the age of 10 years old, children cannot be autonomous with their home programs. This means that a practitioner has to consider what is going on in the home, the living situation that the child is in, their support system, the financial resources available to the child, and other factors that may act as help or hindrance to their home program activation.

Children need caregiver support and guidance. As we said above, most of the care that we're giving to a child in the home is going to be provided with the support or completely by a parent or caregiver. We have to make sure that the child's guardian is on board with the treatment plan, has the resources and ability to enact the treatment plan, and is being respectful to the child as they work on the program at home. As therapists, we have to help navigate bumps and challenges on this road to recovery for the child and their support system, or else we're not doing all aspects of our job. I am always asking myself questions like:

“Can this family afford this?”

“Do they have time for this?”

“Do they understand why I am asking them to do this?”

“Is me asking this of this family adding unnecessary stress to this child or the caregivers?”

Children deserve to be offered to “buy in” to their plan of care. One of the mistakes I see colleagues make is understanding the wisdom of children. Yeah, they're tiny. Yes, they sometimes eat their boogers and think poop jokes are funny. Still, children are much more intuitive than we frequently give them credit for. I've had kiddos as little as 3 years old be excited to drink their “poop juice” to help move their “poop train.” If we “make it make sense” for them, they become the biggest, most powerful part of their care team! Teaching lifelong good habits is something I know most therapists love about their jobs and working with kids provides this so easily.

If you're a provider who is jumping from adults to pediatrics or if you are new to pelvic floor with pediatrics in general, Pediatric Pelvic Floor Playskills is a class that walks you through challenges and solutions by age, sample treatment plans, and problem-solving case studies to build your confidence and efficacy in treating this population. Hope you decide to come play with us on January 25th!

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.