We help children and young people who have difficulty with movement. We treat short and long-term conditions that impact on physical development, activity and the ability to participate in play, learning and socialising.
Your child may struggle with:
- movement in their joints or limbs which have a functional impact on their activities
- achieving expected physical developmental milestones
- moving between one position to another
- maintaining a typical posture independently
- participating in PE, games or other physical activities
- chronic conditions that can impact on normal everyday activities.
We work with you, health, education and social care colleagues, to help your child improve their quality of life, achieve their greatest level of independence and their potential.
How to access our services
You’ll need a referral from your child’s GP, health visitor, an occupational therapist or a hospital consultant. The referral will include details of your child’s specific functional difficulties. This will help our physiotherapist to assess your child’s needs.
Follow the instructions at the bottom of the form to return your completed from to us.
When we receive your child’s referral, our senior physiotherapist will assess their needs. For urgent referrals, there’s usually up to a 2 week wait for therapy.
For more accurate information on this it is best to call the team you have been referred to.
Once we have prioritised your child’s needs, we’ll assess your child in the most appropriate setting, either at home, in school or within a clinic. We’ll decide on the best course of action.
My child has improved since their referral, what should I do?
If you’re waiting to hear from us or you already have an appointment booked but you feel your child is better, call us. You can then decide together whether your child needs to be seen or if they can be discharged.
We’ll see your child in community clinics, at home or in school for physiotherapy sessions. We may help your child with standing, walking and sitting, as well as flexibility, strength and endurance.
We’ll explain how many sessions we think your child will need.
Physiotherapy sessions usually take up to an hour. Subsequent review appointments may be less depending on the level of therapy needed.
Your child will work with a physiotherapist. Sometimes other health professionals will join the session but we’ll tell you in advance.
Your child should wear comfortable clothing which is easy to move around in. It’s likely that some items of clothing will have to be removed for assessment purposes, but we’ll ask your permission first.
It’s also helpful for us to see your child wearing their usual footwear.
Bringing your child’s favourite toys may also help us to encourage participation in the session.
If your child can not attend an appointment, you must tell us as soon as possible. We’ll make another appointment more suitable for you as soon as we can.
If you miss an appointment without telling us, we’ll contact you and ask you to rearrange. If we do not hear from you within 2 weeks of contacting you, we’ll discharge your child from the service.
Family members attending your child’s appointment
As well as parents, it can be useful for other adults such as family members to come if they spend a lot of time looking after your child.
Our assessment rooms aren’t always large so we can’t accommodate groups. Bringing a sibling is ok if unavoidable but this can sometimes be a distraction.
Neonatal intensive care unit follow up
If your child was born before 31 weeks, weighing less than 1500 grams or needed specialist care after birth, one of our hospital consultants will refer you to our follow up clinic. We’ll advise you on techniques to support your baby’s early development.
Child development team
Our physiotherapist works with the wider team to provide integrated support for children under 5 years old with complex needs.
Equipment loan service
The Community Equipment Loan Service can provide equipment for children and young people with functional/physical difficulties.
Equipment can include:
- mobility aids such as walkers, sticks, crutches
- postural management such as standing frames
- orthotic devices such as gaiters, splints.
Physiotherapy resources for your child
Find out more below about your child’s condition including treatment options.
What are bow legs?
This happens when there’s a gap between your child’s knees and ankles when they stand with their feet together. It’s normal in children aged under 2 years old.
Your child’s legs should gradually straighten once they start to walk, typically around 12 to 18 months old.
What are knock knees?
This happens when your child stands with their knees together and their ankles are at least an inch apart. It’s normal to have a gap of 2.5 inches (6 to 7cm) between 2 and 4 years old.
When your child grows, their legs usually become increasingly straight and fully resolved at around 7 to 10 years old.
Causes of bow legs and knock knees
It’s rare that disease causes bow legs or knock knees but in some cases there may be an underlying cause.
Most children with bow legs or knock knees do not need treatment unless there’s a rare underlying cause which needs medical attention.
We recommend that children stay physically active to help their physical development and gross motor skills.
When to get further advice
Get advice from your GP when:
- the appearance of your child’s legs is prominent
- their condition persists for longer than the expected age range
- your child experiences pain or it impacts on their normal function.
What are curly toes?
They’re when the third, fourth and fifth toe curl under on one or both feet because the tendons are too tight.
Curly toes are quite common and usually present at birth, but can become more noticeable when your child starts walking.
We do not know what causes the tendons to become tight, but children can inherit curly toes from family generations.
Curly toes can be quite visible but in the majority of people they do not tend to cause problems.
Occasionally symptoms such as hard skin, rubbing, or pain can occur and finding shoes to fit may prove a bit difficult.
For the majority of children, they will not need treatment. We recommend stretches to help keep the toes flexible. Your child can do this as part of their bed
time or bath time routine.
If the toes remain flexible and moveable but continue to curl, this shouldn’t cause a problem. Sometimes they may become ‘fixed’ in position, but there’s no evidence to show this will cause problems in later life.
When to get further advice
If the curly toe causes pain or discomfort, or impacts on your child’s everyday function, you should get advice from your GP or health visitor.
What are flexible flat feet?
Most feet have an arch on the inside of the foot. Some children have flexible flat feet, also known as fallen arches or pes planus. All babies and most toddlers
appear to have flat feet due to their ‘baby fat’ which hides the developing arch.
Flat feet are normal at these developmental ages. The feet are called flexible because the arch reforms when your child goes up on their tip-toes. It
can be common for other members of your family to have flat feet.
Flexibility in the ligaments that hold the bones together causes flexible flat feet.
Flat feet occur as often in people who wear shoes as in those who don’t wear shoes, so it’s not caused by inappropriate footwear
Most children with flexible flat feet do not have any symptoms. People with flat feet have no more chance of having foot problems than people with arched feet.
There’s usually no treatment needed for most children. We don’t recommend using shoe inserts or insoles (orthotics) as they have no effect on the development of the foot arch.
We only recommend orthotics for older children who have pain in their feet. This
is a very small percentage of the children we see.
We recommend that the right shoes for your child fit correctly and are comfortable.
The arch on the inside of the foot may begin to develop at age 4 and should fully develop by age 10. If not, your child will likely have flat feet in adult life.
There’s no evidence to say they’ll have more problems than a person with an arch. There are numerous professional sports people and dancers with flat feet who show no disadvantages.
When to get further advice
Get help for your child if:
- your child has ongoing foot pain
- their foot is ‘fixed’ and inflexible
- they have problems with every day function due to their foot position.
What is in-toeing?
Some children’s feet turn inwards when they stand and walk. It’s known as in-toeing or ‘pigeon toed’ and is very common in young children.
It’s one of the most common normal variants and can be seen in one or both legs.
Usually, children who in-toe have quite flexible joints. The three main reasons for in-toeing are:
- Metatarsus adductus – the front of the foot curves inwards and it’s often the result of being cramped in the womb. Most cases resolve by the age of 3
but in severe cases where the foot is stiff, stretches or advice on footwear may be necessary
- Femoral anteversion – the femur (thigh bone) turns inwards, resulting in an inward turn of the whole leg. It’s most evident between the ages of 2 to 4 years and usually resolves by the age of 10
- Internal tibial torsion – it’s an inward twist of the lower
leg (tibia) and is common in early infancy and childhood due to positioning in the womb. This normally resolves by the age of 6 to 8 years.
Children may trip and fall more frequently but this is more likely to relate
to their supple joints rather than difficulties with coordination.
This may become more obvious if your child is tired.
There’s no usually no treatment needed for the vast majority of children with in-toeing. Most cases resolve by 8 years old.
There’s no evidence to suggest that splints or special shoes give
any benefit, but we recommend good quality, well fitting shoes
Avoid a ‘W sit’ position as this reinforces the inturned position.
Encourage cross legged or long sitting instead. In-toeing should not affect your child’s ability to walk or run in the long term.
When to get further advice
Get help for your child if their in-toeing is:
- causes problems with normal function
- still evident after the age of 9 to 10 years old.
What is botox?
It helps to relax tight muscles and can help children who have problems from a neurological cause (brain/nerves).
Botox is a safe and effective method when given in small, controlled doses.
How is it administered?
Usually under a general anaesthetic although we’ll discuss this with your child’s consultant. We inject small amounts of botox into the affected muscle(s). Your child can usually go home after a few hours and should return to normal activity the next day.
How does botox work?
Botox decreases muscle stiffness by helping to reduce the excessive nerve signals from the brain to the muscle fibres by blocking them at the nerve/muscle junction. This results in the relaxation over an overactive muscle.
How long does it last?
Botox usually takes between 7 and 10 days to work. After about 3 to 4 months, the nerve pathways start to repair and the muscle can start to tighten again.
Botox works may prove more effective in some children than others.
How physiotherapy can maximise the effects of botox
When botox is at its most effective, your child should find it easier to increase the length and flexibility of their affected muscle(s) and improve functional problems caused by the tight muscles.
It’s also important to strengthen the muscles on the other side of the joint through daily stretching and strengthening as advised by your
We’ll provide increased input for 8 week at around 2 weeks after botox
treatment. In between these visits, it’s really important to continue these exercises at home and at school as appropriate to achieve the best possible outcome.
The specific aims and goals of the botox treatment will depend on your child’s individual needs. Your child’s therapist and consultant will decide on this before treatment starts.
We’ll review these aims at the end of the 8 week treatment period.