As the winter weather brings us frosty cold days, I hope everyone has been keeping well. I thought that this month I would discuss the “frosty” topic of behaviour management. As a paediatric physiotherapist, the children I see range from newborns to 18 year olds, and they can be typically developing children to children with various medical conditions. No matter what age a child is, or what medical conditions they have, every child understands the principle of cause and effect. Babies learn every early on that their actions will elicit a reaction from their carers and they quicklylearn what behaviours to display to get the response they want. Which is brilliant because that is what learning and development is all about. However, the key to this principle depends on who is leading the learning and development. So ask yourself this crucial question; Who’s the Boss in your household? Is your child following your requests to pack away their toys and get ready for bed? Or are you feeling like you can’t leave your child for one moment to go to the bathroom, because they will scream the house down the minute you are not sitting next to them?

Many parents report feeling exhausted and sleep deprived because their little one is so demanding of their attention. There’s a difference between a child who is sick and needing more attention versus a child who is well and constantly demanding more attention and doing things on their terms. As parents we all love our little ones dearly, and we always want our children to be happy and not crying. However, many parents do not realize that children actually do better when they have boundaries and set rules on how to behave within context. So what does this have to do with physiotherapy, you may be wondering? The short answer is EVERYTHING! Effective early intervention cannot take place until a child understands the structure and rules of the task. And if a child is used to having things their way and doing as they desire, they do not engage with the therapist or task because the activity is challenging and out of their comfort zone. The purpose of therapy is to learn new skills, and like everyone else, learning a new skill is tricky and requires practice and hard work. To carry out an effective physiotherapy session, at times I find myself first working on behavior management strategies with the child and family. This is in no way a criticism of parenting skills because babies don’t come with instruction manuals.

Every child has different personalities, and what might have worked with one child does not necessarily work for another. So parents do need support and strategies from their child’s therapist to tailor specific strategies for behaviour management.

Recently, I had the pleasure of meeting a gorgeous 3 year old girl, M who was hearing impaired and had low tone. Her parents were concerned that she seems to fall over all the time, and the childcare teachers reported that she is uncoordinated. When I first met M, I realized very quickly that she does not make eye contact with anyone, unless she wanted something. She does not follow instructions unless she is physically guided to do so or things were “done to” her. She wore hearing aids so she could hear, but this didn’t mean that she listened to her parents. She has a speech and language delay, but she was very capable of speaking to request if needed. She has a very short attention span and was physically capable of walking independently and climbing onto furniture and didn’t perform any activity she didn’t want to. Her mother reported that she is full of energy and needs her full attention at all times, as she is constantly moving around the house falling over everything, never sitting down until she was asleep. Basically, M wasn’t learning any new skills at childcare or at home, because she didn’t engage with anyone, and did only as she pleased. If she didn’t get her way, she screamed until she did. So in my session, we discussed the importance of setting boundaries and expectations for M, and strategies to modify her behaviours so that she would engage with her parents, teachers and physiotherapist. Without her active engagement, physiotherapy intervention would be harder as it would be a constant task of physically trying to manually guide her to “do tasks” and following her around the room when she walked away to get her to come back to tasks. However, by working on behavior management strategies, she will learn important communication skills, understand what she had to do, actively learn to do the task, and in doing so gain strength in her trunk and legs to improve her balance and coordination. She will enjoy completing tasks because she is rewarded with praise when she does them, and she will learn that if she didn’t follow instructions to stop certain behaviours like climbing dangerously onto furniture, she will be removed from the area.

When I reviewed her a week later, her mother reported that M was more calm, making good eye contact when called, speaking more and enjoying praise for tasks completed. In my second session, M was certainly more engaged in our exercises and was able to stay on tasks until completed. Her attention span had improved, although we still had a lot more to work on, she was certainly on her way to learning. The end result is a happier child and a happier mum, which is fantastic given the difference in just one week of intervention. Our goals would be to improve her core strength, balance and coordination, but along the way, she will also improve her communication skills and will be better prepared for school when the time comes. I am looking forward to seeing how M is going to develop in the future, as she continues to have physiotherapy intervention.

If the story of M sounds familiar to you, or if you are feeling like your child is the Boss in your household, and this is preventing them from learning new skills while wearing you out, don’t despair there is help available! Ring us today to discuss your concerns, and get started on making a change today!