Thriving Kids

Submission by

Australian Podiatry Association (APodA)

2025

Australian Podiatry Association

The Australian Podiatry Association (APodA) is Australia’s national peak body representing podiatrists.

The Association is steeped in a long history of integrity and community care and advocating for the profession.

The APodA is committed to advancing podiatry to improve foot health in the community and to improve national standards. The positive impact of podiatric care changes the lives of one in five Australians who suffer from foot pain.

It is through the profession’s support the APodA can direct advocacy efforts to emphasise removing or minimising barriers to providing a better quality of life for all Australians.

APodA Response

The Australian Podiatry Association (APodA), as the national peak body representing the podiatry profession, welcomes the opportunity to respond to the House Standing Committee on Health, Aged Care and Disability, Inquiry into the Thriving Kids initiative.

APodA notes that the Thriving Kids initiative aims to enhance mainstream and community services for children aged 8 and under who experience mild to moderate developmental delay and/or autism. Children with permanent and significant disabilities will continue to be supported through the National Disability Insurance Scheme (NDIS).

Podiatrists are qualified to assess and treat children with mild to moderate developmental delays and/or autism, by identifying, assessing and treating lower limb and foot conditions that impact their development. This includes comprehensive lower limb assessments and interventions targeting gross motor skills and gait development. Gross motor development and being able to walk are critical components in a child’s overall development. Podiatry plays an important role within a multidisciplinary approach to supporting this client group, contributing to the delivery of holistic and coordinated care. Refer to Appendix 1 for information on the conditions that podiatrists manage in children with developmental delay and/or autism.

APodA notes the Terms of Reference of the Inquiry and has focused a response on:

• Identify developmental delay and working with families and carers
• Mechanisms that allow for access to mainstream services

Australian Podiatry Association (APodA) recommends:

1. APodA recommend that Allied Health Professions Australia is invited to join the Thriving Kids Advisory Group.
2. APodA recommends that expert allied health practitioners like podiatrists be included in consultations to design the Thriving Kids initiative.
3. APodA recommends that funding mechanisms be put in place to ensure that children with developmental delay can access care from a podiatrist. This includes funding for clinical assessment, treatment and case conferencing.
4. APodA recommends that podiatrists are included as one of the allied health professionals eligible for a Medicare item under the Thriving Kids Initiative.
5. APodA recommends that Thriving Kids initiative puts in place mechanisms to support funding for multidisciplinary and collaborative consultation among allied health professionals to address the needs of children with developmental delays and/or autism
6. APodA recommends Thriving Kids have a flexible number of visits based on clinical need rather than a fixed number of visits.
7. APodA recommends that Thriving Kids design a priority checklist for eligibility to ensure individual with clinical need access services in a timely manner
8. APodA recommends that Thriving Kids develop education resources for families to be informed of and pathways to access the range of allied health services including podiatry in the assessment and treatment of children with developmental delay and/or autism.
9. APodA recommends that Thriving Kids develop educational resources for general practitioners (GPs) and other services, such as Maternal Child Health Services (MCHS), to raise awareness about allied

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health services, including podiatry, and the important role they play in addressing developmental concerns.

10. APodA recommends the development of referral pathways from GPs and other services e.g. MCHN to allied health services including podiatry

11. APodA recommends that podiatrists are included among the allied health professionals eligible under the Medicare program: Diagnosis and treatment for complex neurodevelopmental conditions

Allied Health Professions Australia (AHPA)

APodA is a member of Allied Health Professions Australia (AHPA) which is the peak association that represents allied health professions collectively. Allied Health is the second largest workforce in the health industry and podiatry is one of the allied health professions represented within this group.

Allied health professions including podiatry, play an important role in the identification, assessment and intervention with children with developmental delays and/or autism. A key component of a multi-disciplinary team is having a variety of professions with specific areas of expertise to provide collaborative and coordinated interventions to address developmental issues.

APodA is concerned that the Thriving Kids Advisory Group has already met but this group does not include representation from the peak association for allied health professions, AHPA.

Recommendation

1. APodA recommend that Allied Health Professions Australia is invited to join the Thriving Kids Advisory Group.

2. APodA recommends that expert allied health practitioners like podiatrists be included in consultations to design the Thriving Kids initiative.

Terms of References

1. Terms of Reference: Mechanisms that allow for access to mainstream services

Podiatrists provide care to children across a range of settings, including private practices, specialised peadiatric services, and public services such as community health and hospital based care. In these environments, they work as part of a multidisciplinary team alongside other allied health professions. These services support children with developmental delay and/or autism. In addition, some podiatrists have undertaken further training and specialise in assessing and treating paediatric populations. These practitioners are credentialed as “Peadiatric Podiatrist” (1)

Within the private sector, several challenges affect the delivery of services in a multi-disciplinary context. Limitations of the Medicare system include:

• General Practitioner led coordination which places additional pressure on an already in demand service
• Limited understanding of allied health roles, particularly podiatry, in assessing and treating children with developmental delays and/or autism
• Restricted number of visits allocated under Medicare Plans for assessment and treatment, which lacks flexibility to meet individual clinical needs.
• Out of pocket expenses for the individual and families
• Waiting lists based on volume rather than clinical need

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• Resources limitations in rural areas

These challenges are further compounded by workforce shortages, especially in the rural and regional communities

Podiatrists possess the knowledge and expertise to work effectively within multidisciplinary teams supporting children with mild and moderate developmental delay. They should be actively involved in – co-design discussions about service models and mechanisms to ensure timely access to early intervention and care.

Multi-disciplinary teams work well when they

• Are co-located, enabling easier communication and collaboration
• Provided a range of services that address diverse needs
• Encourage collaboration and facilitate joint consultation
• Support the individual through a person-centered approach
• Have clear pathways in referral, assessment and intervention

Recommendations

3. APodA recommends that funding mechanisms be put in place to ensure that children with developmental delay can access care from a podiatrist. This includes funding for clinical assessment, treatment and case conferencing.

4. APodA recommends that podiatrists are included as one of the allied health professionals eligible for a Medicare item under the Thriving Kids Initiative.

5. APodA recommends that Thriving Kids initiative puts in place mechanisms to support funding for multidisciplinary and collaborative consultation among allied health professionals to address the needs of children with developmental delays and/or autism

6. APodA recommends Thriving Kids have a flexible number of visits based on clinical need rather than a fixed number of visits.

7. APodA recommends that Thriving Kids design a priority checklist for eligibility to ensure individual with clinical need access services in a timely manner

8. Terms of Reference: Identify developmental delay and working with families and carers

Early identification and intervention are essential in supporting children with developmental delays and/or autism.

Allied health practitioners, including podiatrists, take a holistic approach when assessing children’s development. Within the paediatric population, podiatrists primarily focus on assessing gross motor development, including:

• Delays and/or issues in gait development (walking)
• Toe walking
• Balance and coordination
• Nail and Dermatological Issues

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In addition to gross motor development assessment, podiatrist also consider broader developmental domains such as:

• Social and emotional development
• Communication
• Cognition, fine motor skills and self-care

Podiatrists look for “Red Flags” or earlier indicators of developmental concerns to ensure timely identification. This allows families to be referred to appropriate professionals for support across other areas of development. (2)

Timely identification and referral to the right professionals are critical for early intervention and addressing developmental concerns effectively.

Children may be referred to allied health practitioners, including podiatrists, through various pathways such Maternal and Child Health services, general practitioners, pediatricians, medical specialists via self-referral.

The Thriving Kids Initiative is proposing a Medicare based model with the General Practitioner as the lead practitioner. However, a broader multidisciplinary approach involving a wider team is recommended

Currently, Medicare offer a program for the diagnosis and treatment for complex neurodevelopmental conditions. This early assessment and intervention program supports individuals under 25 with conditions such as intellectual disability, autism and global developmental delay. While it provides access to select allied health services, podiatry is not currently included under this program.

Recommendations

8. APodA recommends that Thriving Kids develop education resources for families to be informed of and pathways to access the range of allied health services including podiatry in the assessment and treatment of children with developmental delay and/or autism.

9. APodA recommends that Thriving Kids develop educational resources for general practitioners (GPs) and other services, such as Maternal Child Health Services (MCHS), to raise awareness about allied health services, including podiatry, and the important role they play in addressing developmental concerns.

10. APodA recommends the development of referral pathways from GPs and other services e.g. MCHN to allied health services including podiatry

11. APodA recommends that podiatrists are included among the allied health professionals eligible under the Medicare program: Diagnosis and treatment for complex neurodevelopmental conditions

In conclusion

Podiatrists play an important role in assessing and treating children with mild to moderate developmental delay and autism. As part of a coordinated multidisciplinary team, podiatrists use a person-centered approach that considers an individual’s unique sensory needs. By creating an inclusive and comfortable environment, podiatrists can help individuals overcome sensory challenges associated whilst empowering the patient to achieve their functional and social goals (3). By addressing these concerns, podiatrists support individuals with developmental delay and/or autism in maintaining their mobility, pursuing goals, and promoting overall foot health.

As the peak professional body for podiatrists, APodA would be available to provide further insights on the information contained within this submission at a public hearing connected with this Inquiry. Please email our

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Policy and Advocacy team on redacted for further information and to arrange representation.

Appendix 1

Background and research

Podiatrists play a vital role in addressing the motor impairments associated with developmental delay and autism. These deficits include delays in motor milestone development, motor incoordination, clumsiness, impaired reach-to-grasp movement, and deficits in gross and fine motor skills (4).

Podiatrists can assess and treat issues related to gait, coordination, muscle tone, and postural control. Through interventions such as orthotic devices, targeted exercises, and recommendations for appropriate footwear, podiatrists can help improve motor function and enhance the overall quality of life for individuals with developmental delays and/or autism.

Toe Walking

A neurodevelopmental disorder, Autism Spectrum Disorder (ASD) has been associated with a higher prevalence of toe walking in children with ASD (5). Podiatrists can use several assessments, but in particular, the foot posture index offers a robust approach to assessing static foot structure and the supporting future development plans (6).

Sensory Processing difficulties

Many individuals with development delays and/or autism experience sensory processing difficulties, including hypersensitivity or hyposensitivity to sensory stimuli (7). Podiatrists also consider sensory and processing challenges that affect the ability of children with autism to tolerate certain types of materials or physical touch. By addressing foot and lower limb concerns, podiatrists can support children with developmental delay and autism to improve their mobility and comfort, which in turn encourages independence and participation in social activities.

Tone, balance and coordination

Research has shown that a significant number of children with ASD, approximately 25%, exhibit hypotonia, which is low muscle tone. This can affect the development of proper foot posture and stability (8).

Furthermore, studies have highlighted that limb apraxia, a condition characterised by difficulty in performing coordinated movements, is present in approximately 30% of high-functioning autistic children and a striking 75% of low-functioning children with autism (8). Podiatrists can assess and address these motor challenges through specialised interventions, such as prescribing appropriate orthotic devices, recommending specific exercises to improve muscle tone and coordination, and providing guidance on footwear and gait modifications. By addressing these issues, podiatrists contribute to improving the mobility, stability, and overall quality of life for people with ASD

Nail Care and Nail Care and Dermatological Issues

Podiatrists play a vital role in supporting patients with developmental delay and/or autism in maintaining and improving their mobility while addressing nail care and dermatological issues. Individuals may face challenges related to sensory sensitivities, which can make routine tasks like nail trimming or addressing dermatological concerns more challenging (9).

Appendix 2: References

1. Career Framework - Paediatrics - Australian Podiatry Association Ltd; 2026

2. Red Flags Early Identification Guide (Birth to 5 years ) Poster Children’s Health Queensland Hospital and Health Service

3. Kigner SE, Loch AJ, Bahn JH. Podiatry. In: Hazen EP, McDougle CJ, editors. The Massachusetts General Hospital Guide to Medical Care in Patients with Autism Spectrum Disorder [Internet]. Cham: Springer International Publishing; 2018 [cited 2023 May 23]. p. 227–37. (Current Clinical Psychiatry). Available from: https://doi.org/10.1007/978-3-319-94458-6_

4. Neurotransmitters—Key Factors in Neurological and Neurodegenerative Disorders of the Central Nervous System - PMC [Internet]. [cited 2023 May 22]. Available from: https://www-ncbi-nlm-nihgov.ezproxy.newcastle.edu.au/pmc/articles/PMC9180936/

5. Engström P, Tedroff K. The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children. Pediatrics. 2012 Aug 1;130(2):279–84.

6. Leyden J, Fung L, Frick S. Autism and toe-walking: are they related? Trends and treatment patterns between 2005 and 2016. J Child Orthop. 2019 Aug 1;13(4):340–5. 4

7. Marco EJ, Hinkley LBN, Hill SS, Nagarajan SS. Sensory Processing in Autism: A Review of Neurophysiologic Findings. Pediatr Res. 2011 May;69(5 Pt 2):48R-54R.

8. Ming X, Brimacombe M, Wagner GC. Prevalence of motor impairment in autism spectrum disorders. Brain Dev. 2007 Oct;29(9):565–70.

9. Reynolds S, Lane SJ. Diagnostic Validity of Sensory Over-Responsivity: A Review of the Literature and Case Reports. J Autism Dev Disord. 2008 Mar 1;38(3):516–29.