Working with children and adolescents: what exercise physiologists need to know
34.5% of Accredited Exercise Physiology services are to paediatric patients! That’s a lot higher than I expected. But what does it look like to work within the paediatric population group as an exercise physiologist?
Well, it’s not something that can easily be answered. Just as any other population group each person, each family and each presentation look different. Paediatrics is so broad and you can see a wide range of conditions, from neurological conditions to genetic conditions to neurodivergence all requiring a slightly different lens and approach. If you are newly practicing or considering providing services to children and adolescents, here’s some things to consider!
Children are not mini adults
It is important to remember that children and adolescents require more of a developmental approach. They are still growing, developing motor skills, understanding instructions, developing communication and social skills, learning to emotionally regulate and building confidence and selfesteem. Therefore, understanding where a person is regarding their developmental milestones is crucial, remembering that their age may not always reflect the ‘developmental age’.
Movement patterns are not always the same for children and adults. Yes, targeting strength in key muscle groups to support daily tasks are the same however lots of movements may look different. A key difference can be seen in walking and running gaits between adults and children for example children have a wider base of support, can be more flat-footed and are still developing their flight phase and heel to toe pattern.
Children’s movements are variable. They may master a movement pattern, develop strength, balance and control and then have a growth spurt. Their body proportions change again, and they have to learn how to coordinate their movements, to maintain equilibrium and recreate efficient movement patterns. This is all before considering movement challenges, sensory challenges, information processing and attention challenges which can make it harder for a child to learn and relearn skills.
Communication and rapport are key!!
To build rapport you need to know how to alter your communication to meet each person’s needs. Again, this varies for every client, some of your clients will respond to short and clear instructions, others will prefer visual over verbal instructions, including structured visual boards or selecting the order of exercises themselves. This comes down to knowing your client needs and preferences which means digger deeper than the physical assessments. Do they have sensory challenges that influence how they best learn (e.g. needing quieter spaces, dimmed lights, movement seeker), do they have attention challenges, do they need extra encouragement and clear achievable steps to build confidence. Making small changes to the environment or exercise can go a long way in building trust and rapport.
Communication is your words, actions and energy. Knowing when to be uplifting but also knowing when to hold the space. It is acknowledging the client throughout every session, asking them questions and including them in conversations. For a younger child find out their interests, what do they like to do at school, what games they like playing, their favourite toys, their favourite movies; this makes a world of difference when you go to plan exercises and activities. This will help you develop creative themes and twists to your exercises to catch their engagement eg. your client likes Mario, make each exercise and activity a challenge to defeat Bowser. For your adolescent clients find out more about what they enjoy doing, what they would like to get better at, sometimes this aligns with parent and referring clinician goals and other times it won’t and that’s okay. It’s important to remember that we can work towards both goals, and I often find most of the older kids and teenagers prefer to know the why? Be clear, honest, realistic and funthey may not be open to it at first, but when you work together to find what they enjoy you’ll see a shift.
Family involvement is important
Communicating with family is just as important as your communication with your clients, they are looking for someone to trust and support them as they navigate supporting their children. When you work with adult populations, they are accountable for whether they do their home program and taking on recommendations. Children need support, guidance, supervision and won’t always be able to complete exercises and modifications independently. Understanding the family dynamic, knowing family scheduling, does your client have extra-circular activities, do they have siblings, what does before and after school routine look like. All these things will determine how likely a home program will be completed. Can you work with the family and care givers to find realistic times to effortlessly support their goals at home? Effortlessly – this crucial, parents are busy, life is busy. Is there a simple swap to their day where they could do an exercise? Is there a family game they can play together that has some hidden exercises? If you want faster progress you need to get the family involved.
Make it play based
Traditional exercises can be boring. Kids can have short attention spans and get bored easily. Solution games and imagination. Want high repetitions find a game where each rep or set of an exercise collects a puzzle or game piece. They’ll want to collect all the pieces not aware they are exercising. Obstacle courses to work on balance, relays or treasure hunts for endurance, animal movements for strength, sport-based tasks for gross motor skills, with imaginative play to act as a distraction to our main objective.
Our language around activities can play a big role here. Simple changes from “we are going to stand on one leg” to “we are going to balance like a flamingo” make a world of difference. This is where knowing your clients’ interests come into play, I used the Mario challenges example earlier and this is how I would put it into action. Wanting to work on throwing, set up some targets (bowling pins, blocks, buckets) and focus on throwing your “fireballs” to get to the next challenge. Working on jumping and motor planning, roll small balls to jump over as they approach with the cue “jump over Kooper Trooper Shells” or work on strength by collecting items each set or rep to free Princess Peach. You only need to know something small about their interest and most of the time they’ll take over the story line you just need to set the challenge/exercise.
Sessions will look different each time and that’s okay
No two sessions will look the same and you need to be okay with that. I find one of the hardest parts of being an allied health professional is believing and knowing a client’s potential and capabilities and wanting to support them to reach their goals, but they walk into a session needing extra motivation, encouragement and not open to progressing. Meeting your client where they are is so important. You want them to be excited to come back for a sessions and have a positive experience so changing your expectation, doing less, providing a bit more support, making something easier will keep your rapport, show them they are safe and supported, build their confidence and teach them how to check in with their body. There is always next time and plenty of ways you can still support and facilitate an effective session.
