If your child has had a recent change in their physical functioning or isn’t meeting milestones as expected, you may look for guidance. A pediatric physiatrist can help.
Pediatric physiatrists are physical medicine and rehabilitation doctors. They’re experts in the care of children with issues that affect functional independence, meaning their ability to perform everyday tasks without help. Pediatric physiatrists work with children and their families to assess function, create goals, and determine treatment plans.
Lauren Kremm, DO, is a pediatric physiatrist in the Pediatric Physical Medicine and Rehabilitation department at UPMC Children’s Hospital of Pittsburgh. She says the goal of physiatry is to get people to their highest possible level of functional independence and quality of life.
Dr. Kremm works with partners across subspecialties to create treatment plans that give children access to seamless care. This often includes physical therapists, occupational therapists, speech-language pathologists, nurses, school staff, and clinicians.
How Can a Pediatric Physiatrist Help My Child?
Pediatric physiatrists can help kids at many stages of development.
Dr. Kremm treats children who have lifelong neuromuscular diagnoses, such as cerebral palsy. In these cases, children can be under her care for their lifetimes.
She also treats children who have new injuries ranging in severity from an ankle sprain to a spinal cord injury.
No matter the reason for care, Dr. Kremm creates custom treatment plans to improve a child’s functional independence. Treatment plans can include medication management or referrals to other providers. They may also include coordinating equipment for care, such as orthotics, wheelchairs, or things to help with personal care.
Physiatrists also work with families to create home setups that work well for children and their families. If a child is school-aged, they can work with school staff to make the child’s educational experience more accessible.
Your child’s primary care provider (PCP) might refer you to a pediatric physiatrist. Referrals can also come from other specialists, like physical therapists.
What Can I Expect at My First Pediatric Physiatry Appointment?
Physiatrists provide treatment in both inpatient and outpatient settings.
Dr. Kremm first assesses a child’s neurological and developmental history. She asks questions to gauge the child’s prior and current functional status to assess changes. She also learns about prior resources the family and child have tried — that might include updating orthotics if the child has outgrown them.
From there, Dr. Kremm asks about any concerns around the home setup and school accessibility. Functional independence is at the heart of physiatry care. One of her most crucial concerns is to reduce barriers for children to access their home, community, and school.
During intake visits, Dr. Kremm works with children and their families to set goals for their treatment. When she’s working with children who have chronic issues, she doesn’t only assess their current daily life. She also works with families to predict next steps and coordinate long-term care.
What Does a Pediatric Physiatry Treatment Plan Include?
Treatment plans can vary for each child. Dr. Kremm says her goal is to do all she can — with the child’s care team — to ensure they have what they need to grow and thrive.
“As children grow, their needs change,” she says. “As providers learn more about how to treat their condition, their treatment plans might change, too.”
Routine visits help children have what they need at every stage of their lives. Dr. Kremm supports children with the goal of meeting them where they are throughout developmental changes. She may see them as often as every 6 to 12 months to do updated assessments, or even more often for acute care.
Some injuries, such as ankle sprains or minor concussions, may have quicker treatment options that can lead to functional recovery. In those cases, a child may only need to see a pediatric physiatrist once or twice.
A child’s treatment plan may include medications, a recommendation for orthotics or a wheelchair, or coordinated care with external providers. Depending on a child’s needs, they may need referrals to other providers.
They may see a physical therapist, occupational therapist, or speech-language pathologist. They may also get a referral to see other subspecialty providers, such as neurologists or orthopaedists.
Dr. Kremm works with each of those providers to ensure seamless, complete care. She and other providers work as a team with families and each other.
For example, a child’s physical therapist may notice a new development. They can alert Dr. Kremm so she can note that change. From there, she can update the child’s treatment plan as needed.
“I can’t do what I do unless I have my entire team,” Dr. Kremm says. “We work in tandem. If you remove one of those important pieces, it impacts the overall goal we have for the patients and the families.”
As a child grows to school age, Dr. Kremm often coordinates care with school staff, such as an individualized education plan (IEP), if needed. She also makes sure the child has access to appropriate resources to support their learning.
Once children age out of pediatric care, Dr. Kremm works with them and their families to navigate the transition to adult care. They work together to ensure they have everything they need to advance in their care.
Is Pediatric Physiatry Right for My Child?
No matter how big or how small your concerns are, Dr. Kremm says she and her team are always there to help. Talk to your child’s PCP or pediatrician to schedule an appointment with a pediatric physiatrist to talk through any questions you may have.
“If anyone has any concerns about a change in functional status or a need for a comprehensive functional evaluation, we are open ears,” Dr. Kremm says.