Working with children has brought vitality and creativity to my practice. I started working with babies over 20 years ago. Soon, those babies grew into toddlers, then preschoolers, and so on. Now, about a third of my clients are babies and young children. I have learned so much from them—most importantly, how to bring playfulness into my sessions.
Kids are explorers. They are open to new experiences and less encumbered by social norms. When they get restless, they show it; when my contact is uncomfortable, they withdraw or squirm. And they let me know when I’ve helped them. I have had more than one child do a cartwheel to show how much better they feel!
Sessions with children are more varied than sessions with adults. Often, I work with children on the floor while they play with toys or games.
Their active play may become part of assessing range of motion or functional changes, especially with toddlers. (As Stuart Brown, MD, said, “My feeling is that play, by its nature, has been molded by evolution to create a more optimistic, exploratory view of the world and more harmonious social interactions.”) Kids’ quiet time with parents or siblings may allow for a succession of changes and integration at a session’s end.
The Young Client
Often, when people learn that I work with children, they’re puzzled. “What would bring a child in for treatment?” Actually, kids come for the same reasons as adults:
• Stress-related—digestive, sleep disruption, anxiety (social and/or physiological)
• Post-injury or surgery—falls, car accidents, conditions requiring surgery
• Jaw pain/headaches—orthodonture, dental procedures, cranial/dental growth
• Aches and pains—growing pains, sports, clumsiness during growth spurts
Most of the time with young clients, I use the same parameters as with adults: six weeks for surgical scars to be set, caution for local injury, contraindications for active infection or inflammation. However, the younger the child, the more I adapt my work and take their anatomy and physiology into account.
Developmentally, children’s bodies function similarly to those of adults after the age of 4 to 5 (gait, throwing, major systems). They have several growth spurts: pre-adolescent (ages 8 to 10), adolescent (ages 12 to 14) and late teen (ages 15 to 17 for males, 17 to 19 for females).1
During these times, they may experience disruption of sleep, appetite, mood or cognition. Manual work can ease their passage through these stressors.
If the children you see are relatively healthy, you don’t need new tools to work with them. You can adapt your methods, working with their comfort and available energy. It’s generally understood that young children and the elderly have a shorter autonomic cycle than adults. Because of this, we need to be careful about over-treating. Good, consistent communication helps us stay tuned into their responses.
What follows are two examples of how I use and adapt my skills in structural bodywork, craniosacral and visceral mobilization to help children.
Addressing Fascial Patterns
Seven years old, Max is a vibrant, funny, slightly shy guy. His grandmother is a manual therapist and was concerned about his habit of walking on his toes. Toe-walking can be an indication of neural compromise and is often treated early in childhood. Max’s case is not severe: He can deliberately stand with his heels on the ground, but not comfortably.
My goals were to address the fascial pattern that toe-walking imparted, to assess restrictions that inhibit him from keeping his heels low, and to help him explore the sensations of having his feet fully on the ground.
We work on the floor, while playing tic-tac-toe or with toys. By playing a game with him, my manual work is interrupted intermittently; this allows his autonomic nervous system to catch up with the stimulus and for me to evaluate by watching him move.
To help him integrate sensory information, I simply stabilized his trunk and heels, and then circled his upper body around his feet. I asked him to feel how his body balanced as I took him over and just beyond the base of support, letting him know, “I won’t let you fall.” We have had two sessions so far, and his ability to rest in his heels is improving; he enjoys the sessions and doesn’t resist coming for care.
Emerging Body Awareness
Henry’s mother brought him for craniosacral therapy, which she also receives. At age 8, he started having anxiety at night, which made nighttime routines a trial. Along with seeing a talk therapist, his mom thought craniosacral work could help.
Once trust was established between us, Henry started telling me about his worries. His primary worry turned out to be nightmares, even though he couldn’t remember actually having them. When he spoke about nightmares, I could feel his fluid system responding: it became agitated around the kidneys and frontal lobe, but not around the heart (in my experience, these areas are linked with anxiety).
I then used the strategies his counselor had given him for meeting his anxiety—breathing, talk, imagination—to explore how he could turn his worries into storytelling with a ridiculous turn. As he practiced his exercises, I tracked his fluid-body and gave him additional feedback about how effective his new skills were.
Kids have their own way of making sense of their body experience, emotions and vitality. Most are interested in their bodies, especially if the learning can be linked to their everyday interests. Our work focuses on physical touch, so we can contribute to their emerging body awareness and touch safety.
Boundaries, Privacy & Policies
One obvious and important point: Children usually don’t refer themselves. They are brought by their parents, often at the suggestion of other providers. Establishing a direct connection with the child is especially important. Because our work is built on the cooperation of the autonomic nervous system, we take care to negotiate boundaries—touch, pressure, conversation—directly with them as well as with parents.
In Washington State, where I practice, children 12 years and older are entitled to private clinical care. This means a child can decide whether their parents are in the session. If they disclose symptoms, thoughts and feelings to me, I’m required to maintain confidentiality.
Before I begin care, I discuss this with both parent and child. If something arises that I feel the parent should know, I will ask the child/client if I can share the information, and (if so) whether the client would like me to share the information in their presence or separately.
Usually, parents stay in the room during the session; sometimes siblings come along too. This makes for a lively atmosphere, putting the child at ease. Parents usually travel with simple toys they know will engage the child/client. I also keep toys and books in my office that children can play with during the session.
Safety, Toys & Logistics
It’s a good idea to kid-proof your room. Get on your knees and check out objects at 3 inches and lower: any sharp edges of furniture, what’s climb-able, what’s breakable, are outlets accessible? Move or remove items you don’t want broken.
You can also make your room kid-friendly by adding things (at kid height) that are touchable, readable, colorful—things that invite physical interaction without worry. I have designated shelves and baskets with books, toys, puzzles and games. I prefer objects that are sturdy, washable, colorful. Look for toys with interesting textures, that make noise (shakers, bean bags) and those with moving parts (magnets, wind-up toys). Kids’ yoga cards are great: “Can you do this one?”
It’s nice to have a separate intake for children. Adapt questions to suit a child’s experience; for example, “how do you exercise” becomes “what do you do for play.” Include a line for parents to sign any policy or intake documents. I also have a generalized body form that the child colors to indicate where they do and don’t want to be touched.
Consider adapting your policies with regard to payment and length of sessions. Sessions with children are often shorter, but it’s hard to predict. I often book a full hour on the first session and 30 minutes for subsequent sessions. In any case, once the child has had enough, the session is done and I charge for the amount of time actually used. To maintain accessibility for families, I use a sliding scale, based on gross income.
Also, having afternoons available is good for school-age children. Consider how you feel about having siblings present, food (snacks) in the room, and having your work interweave with parenting dynamics. You’ll learn a lot in the first year or so—let yourself grow into your policies.
It’s Safe to Explore
The fun I have with children has encouraged me to be more playful with my adult clients. I’m more inventive in how I engage them: working seated or off the table, using movement, talking about how my techniques feel to them.
I’m more willing to meet them in the moment: “Let’s try this … What if we?” Kids have taught me that it’s safe to explore and experiment in my practice, and that laughter and levity can be part of a soothing environment.
I’ve also learned that my interest, curiosity and willingness to play help keep me interested in my work. There’s no doubt about it: Working with kids is the taproot of my practice.
About the Author
Since 1994, Lauren Christman, LMT, CCST, CBSI/ATSI has practiced craniosacral, visceral and structural methods for children and adults. Currently she leads Craniosacral Therapy—A Healing Art, a certification program including biomechanical, biodynamic, visceral and structural approaches. With more than 20 years of experience, Christman brings precision, curiosity and humor to her teaching through her business, Crafted Touch.
1. Campbell S, Palisano R, Vander Linden D, “Physical Therapy for Children,” Elsevier, 2006.