On a Mission: My Paediatric Assessment Journey

I am on a mission to put Exercise Physiologists on the map when it comes to working in paediatrics. The driver is pretty simple; the kids really need us and it is most certainly within our scope to provide this care and assistance. 1 in 5 children are starting school developmentally vulnerable, 1 in 4 are considered overweight or obese, and the result, for the first time in two centuries, kids' life expectancy are less than that of their parents.  Additionally, Australia is spending more than $15 billion PER YEAR on late intervention for children despite the evidence that early intervention is key. I have two beautiful boys, aged 5 and 7 years old. And these stats shake me to the core. 

The most frequent questions I get from exercise physiologists and other paediatric health professionals in my community are: 

1. How do we keep children engaged in therapy? 
2. How do we manage behaviour? 
3. How do we do assessments for this population? 

After completing university in 2009 and working in the older pops the assessments were pretty straightforward. You did an assessment, it had normative data attached to it, you then provided an intervention and used your clinical judgement, supported by data on the length and frequency of that intervention. Oh so simple. This is not the case for paediatrics. The normative data is scarce and if it is accessible we are working with kids that have a complex set of symptoms and presentations that impact all the systems meaning that they won’t possibly sit within those normal ranges. 

The result of this is that health professionals don’t feel as confident doing assessments, struggle to clearly determine interventions and goals from those assessments and find it difficult to communicate exactly how they can help. The outcome of this; they aren’t putting themselves out there confidently, they aren’t helping the children that oh so desperately need our care

 and therefore we are not progressing our profession. It’s a vicious cycle that needs to be addressed. 

In my courses I talk in detail about how movement impacts each key area of development and how we can prescribe exercise for the progression of cognitive, sensory, motor, language and emotional skills. I explore an abundance of research looking at each key area of development and how physical development impacts and is impacted by those systems. I provide comprehensive strategies on confidently engaging children; specifically utilising the power of movement to holistically recruit every system in a child’s body and effectively manage their stimulation to reach an ideal state for focus and learning. And now, what I am endeavouring to provide my community and profession with, is a crystal clear protocol for confidently assessing children. 

To do this, I have created Pre & Post Assessment Checklists that we can use to set ourselves up for assessments. My team at Kids Heart Pilates is currently testing out a protocol for our assessments using a variation of standardised testing, observation and VALD assessments to get a thorough understanding of where our children are at before, during and after our interventions. 

In setting this up my assessments, I am also participating in a research partnership with The University of Queensland to get an independent assessment on our Kids Heart Pilates intervention and with that of course, comes some thorough assessments that we get to participate in and practice. I am extremely passionate about research and evidence based practice, I owe my confidence to research articles, as without spending countless hours reading as much as I could possibly absorb, I wouldn't be the confident paediatric practitioner and advocate I am today.

One article that I read lately sparked my interest as it tested over 3000 preschool aged children in Spain using standardised tests resulting in a set of gender and age based normative data. Something that I believe is so powerful to us when we are assessing. 

Let’s take a look at this research; Physical fitness reference standards for preschool children: The PREFIT project

The researchers offer a comprehensive exploration of physical fitness as a crucial health marker in children, particularly focusing on preschoolers aged 3–5 years. Here’s a summary and some key points for your review:

The article emphasises the importance of physical fitness in early childhood, linking low fitness levels to potential long-term health issues such as cardiovascular diseases, obesity, mental disorders, and skeletal problems. It highlights the scarcity of studies on preschoolers, noting that existing research supports the idea that better fitness correlates with lower adiposity and improved attention even in young children. The need for standardised physical fitness reference data for this age group is underscored, setting the stage for the study's objective to establish sex- and age-specific fitness reference standards for preschool children across Spain.

The study was conducted as part of the PREFIT project, which assessed physical fitness and anthropometric characteristics in preschoolers from various cities in Spain. A sample of 3,179 children was included, with fitness assessed through a battery of tests covering cardiorespiratory fitness, muscular strength, speed-agility, and balance. The study details the methods used to ensure accurate and consistent measurements, such as standardising protocols and training evaluators. It also describes the statistical methods used to analyse the data and generate percentile curves.

The results present the fitness reference standards developed from the study, showing sex- and age-related differences. Boys generally performed better than girls in most fitness tests, except for balance, where girls showed better performance. The study also found that fitness levels improved with age, and there were more significant differences in older preschoolers. The article provides detailed statistical analysis and reference data, highlighting the importance of early fitness assessment for health monitoring and intervention.

The paper elaborates on the observed sex differences in fitness levels, attributing them to biological and developmental factors. It compares the findings with previous research in older children and adolescents, noting that similar trends are observed even in preschoolers. The article also touches on the potential implications of these findings for early childhood health and education, suggesting that regular fitness assessments could play a crucial role in preventing future health issues.

The article makes a strong case for the importance of physical fitness in early childhood and the need for standardised reference data. This is particularly relevant for educators and health professionals aiming to track and improve child health outcomes.The study's methodology is robust, with detailed descriptions of the fitness tests, data collection, and statistical analysis. The standardisation and consistency across different centres strengthen the reliability of the results.The provision of detailed percentile curves and reference standards is a valuable resource for practitioners. The study’s inclusion of data stratified by sex and age provides nuanced insights into early childhood fitness. The researchers effectively contextualise the findings within the broader literature on child fitness. However, it could further explore the practical applications of these reference standards in everyday educational and health settings.

Overall, this article contributes valuable data to the field of paediatric fitness and offers practical tools for assessing and improving the health of young children.

If you are anything like me, you will find this article insightful and a crucial step in this assessment project of mine and ours. I am excited to continue to share my findings with you as my team and I test out our assessment protocol so that we can together collect an abundance of data from our communities to further qualify our clinical practices, help children that need it and address those alarming gut wrenching statistics. 

Cadenas-Sanchez C, Intemann T, Labayen I, Peinado AB, Vidal-Conti J, Sanchis-Moysi J, Moliner-Urdiales D, Rodriguez Perez MA, Cañete Garcia-Prieto J, Fernández-Santos JDR, Martinez-Tellez B, Vicente-Rodríguez G, Löf M, Ruiz JR, Ortega FB; PREFIT project group. Physical fitness reference standards for preschool children: The PREFIT project. J Sci Med Sport. 2019 Apr;22(4):430-437. doi: 10.1016/j.jsams.2018.09.227. Epub 2018 Sep 20. PMID: 30316738.