According to the International Children’s Continence Society (ICCS) children should have daytime and nighttime bladder control by age 5 for a typically developing child^1.  The frustration, anxiety, lack of self-esteem as well as the development of internalizing and externalizing psychological behaviors of these families who have not achieved this milestone is significant and needs to be dealt with ^1,2,3,4.

The most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome, withholding, UTI’s and bedwetting. Constipation is also a contributor to urinary leakage or urgency and bedwetting and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great^1.

The pediatric population is greatly underserved causing undo stress for the child and family. This course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits. Children with special needs, Sensory Processing disorders or musculoskeletal asymmetries frequently develop poor bowel and bladder habits including constipation^5.

As pediatric bladder and bowel dysfunction can persist into adulthood, pelvic rehabilitation providers must direct attention to the pediatric population to improve the health in our patient populations.

This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. Common causes of incontinence in the pediatric patient will be covered. The participant will learn medical and therapy evaluation concepts for bowel and bladder dysfunction, bedwetting, and constipation. 

A comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor using surface electromyography (SEMG) biofeedback, rehabilitative ultrasound imaging, as well as pediatric pelvic floor external manual techniques to teach proper evacuation.

Case studies will be presented to compliment the course with evaluation, treatment examples based on diagnosis and progressions through discharge.

Additional videos on pediatric play with a purpose, trauma informed care and language in the pediatric population and working with the neurodivergent patient with be addressed.⁶

Audience:

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Prerequisites:

This is a beginning level course. There are no courses one must take as a prerequisite for this pediatric continuing education course. However, all pre-recorded lectures in Teachable for this course must be watched before the Live Component of the course. See the Schedule tab for the current list of pre-recorded videos

Prerequisite Assignments

Read Suzanne's Story

Complete a Bladder Diary (Instructions attached)

What to Bring:

Participants please log onto the meeting with a Theraband medium resistance and 10 cuff pound weight or equivalent

Are you treating pediatric patients and looking for helpful resources? Check out Herman & Wallace's Pediatric Pelvic Floor Manual

References

1. Nieuwhof-Leppink A, Hussong J, Chase J, Larsson J, Catherine R, Hoebeke P, Yang S, von Gontard A, Definitions, indications and practice of urotherapy in children and adolescents: - a standardization document of the International Children’s Continence Society (ICCS), Journal of Pediatric Urology,https://doi.org/10.1016/j.jpurol.2020.11.006.
2. Chase J, Bower W, Susan Gibb S. et al. Diagnostic scores, questionnaires, quality of life, and outcome measures in pediatric continence: A review of available tools from the International Children’s Continence Society. J Ped Urol (2018) 14, 98e107
3. Ayribas B, Toprak T, Degirmentepe RB, Ozgur MO. Insecure attachment and its relationship with negative self perception in children with nocturnal enuresis. Journal of Pediatric Urology. 2022 Oct:S1477-5131(22)00404-1. DOI: 10.1016/j.jpurol.2022.10.006. PMID: 36307368.
4. Ö. Gizli Çoban, A. Önder, A. Sürer Adanır. Psychiatric comorbidities of children with elimination disorders. Archives de Pédiatrie. Volume 28, Issue 1, 2021,Pg 59-63, ISSN 0929-693X, https://doi.org/10.1016/j.arcped.2020.10.002.
5.  Little LM, BenSenspryton K, Manuel-Rubio M, Saps M, Fishbein M Contribution of Sensory Processing to Chronic Constipation in Preschool Children. J Peds. 2019
6. Trauma Informed Care PEDIATRICS Volume 148, number 2, August 2021:e2021052580