Pediatric Physiotherapy: Everything Parents Need to Know

Pediatric Physical Therapy: What Do Parents Need to Know?

Pediatric physical therapy helps babies and children develop or regain movements that are useful in daily life. The physical therapist assesses, among other things, difficulties with turning the head, sitting up, or walking. Congenital muscular torticollis refers to a persistent head posture caused by a neck muscle. Plagiocephaly is a flattening of part of the skull. A motor delay is the late acquisition of a skill, such as sitting up. For torticollis, the treatment plan may include exercises for the neck and trunk—the part of the body between the shoulders and the pelvis. It may also include movements on both sides, environmental adaptations, and advice for parents. Play helps tailor these activities to the child’s age and interests. At a private clinic in Quebec, you can consult a physical therapist directly, without a doctor’s prescription. If you’d like to first understand developmental delays and disorders, check out our comprehensive guides on motor development delays and developmental disorders in children.

You notice that your baby always keeps his or her head turned to the same side. Your little one is slow to walk, while his or her friends are already running all over the place. Your child seems clumsier than the other kids at school. These observations can be cause for concern, and that’s perfectly normal. Our physical therapists work with children and parents who are wondering whether their child’s motor development is on track.

Pourquoi consulter tôt : pour le Congenital Muscular Torticollis, commencer les soins tôt est associé à un suivi plus court. Une consultation est recommandée dès qu'une différence entre les deux côtés du cou ou de la tête est observée.¹ Le résultat dépend aussi de la forme du torticolis et de son évolution.

• The pace of motor development varies from child to child. Any delay that persists or causes concern for parents can be discussed with a professional, who will take the child’s overall situation into account.
• Play can be used to tailor activities to a child's age, interests, and goals. The response varies depending on the situation, the proposed activity, and the child's preferences.
• Parents can receive tailored instructions for activities at home. The activities and their place in the daily routine are selected based on the assessment and the agreed-upon goals.

This guide will help you understand what pediatric physiotherapy is, recognize when to seek help, and know what to expect from treatment. Discover our pediatric physiotherapy services for children aged 0 to 7 in Greater Montreal.

What is pediatric physiotherapy?

Pediatric physical therapy is the branch of physical therapy that addresses the development of movement and physical challenges in infants and children. The physical therapist evaluates their movements, posture, and activities. The treatment plan takes into account their health and the goals established with the family.

This area of physical therapy tailors activities to the child's age, abilities, and goals. ² The physical therapist selects activities based on the child’s condition and observations made during the evaluation. Sessions may take the form of games that help the child practice the targeted movements.

A pediatric physiotherapist can help with various situations:

• Muscle, bone, and joint problems: stiff neck, asymmetrical posture, and misalignment of the legs and feet.
• Problems with the nervous system, such as cerebral palsy. The nervous system includes the brain, the nerves, and the spinal cord—the bundle of nerves in the spine that transmits messages between the brain and the body. Cerebral palsy causes lasting effects on movement and posture following damage to the developing brain. Muscle tone is the resistance felt when gently moving a limb at rest. Low muscle tone (hypotonia) or high muscle tone (hypertonia) is a sign to be evaluated, not a diagnosis. Treatment focuses on activities that pose challenges for the child, sometimes using approaches such as neurodevelopmental therapy.
• Motor development delays: difficulty acquiring motor milestones expected for their age
• Coordination difficulties: dyspraxia, which is a difficulty in planning and sequencing complex movements, and developmental coordination disorder (DCD), a diagnosis that requires a specialized evaluation and appropriate testing.
• Needs following an injury or surgery: sprains (injuries to the ligaments that connect bones), broken bones in the process of healing, and recovery after surgery.

An important point to remember: Physical therapists are primary-care professionals in Quebec. In private practice, you do not need a doctor’s referral to make an appointment with a physical therapist. ³ As soon as you have concerns about your child’s development, you can schedule an appointment right away. To better understand the role of physical therapy, check out our comprehensive guide to physical therapy.

What conditions can pediatric physiotherapy treat?

Pediatric physical therapy treats movement difficulties associated with congenital muscular torticollis, positional plagiocephaly, developmental coordination disorder, and certain motor delays. Depending on the specific issue, treatment focuses on neck mobility, the baby’s positioning, or activities of daily living. Low or high muscle tone requires an evaluation to determine the cause and select the appropriate treatment.

Congenital Torticollis

Le Congenital Muscular Torticollis est une posture de tête persistante, souvent visible peu après la naissance^{1, 6}.

Le torticolis peut s'accompagner d'une Plagiocephaly, c'est-à-dire un aplatissement d'une partie du crâne.^{1, 7} Le Congenital Muscular Torticollis s'accompagne souvent d'une Plagiocephaly positionnelle, soit un aplatissement lié à la Head Position.⁸ Une Plagiocephaly était présente chez 63,6 % d'un groupe d'enfants suivis pour un Congenital Muscular Torticollis.⁹

L'évaluation vérifie les mouvements du cou, les différences entre les deux côtés et les signes qui demandent un avis médical. La physiothérapie peut ensuite inclure des conseils de positionnement, des activités de mouvement et des étirements adaptés au bébé. Un bénéfice des étirements réalisés par un professionnel est rapporté sur la mobilité du cou. Les conseils aux parents et la variation des positions sont aussi soutenus.¹⁰ La confiance dans le bénéfice des étirements sur la mobilité est modérée. Des gains à court terme sont aussi observés sur la mobilité du cou, la posture et les mouvements des deux côtés lorsque des techniques manuelles s'ajoutent à un traitement actif, par rapport au traitement actif seul.¹¹

La confiance dans ces derniers résultats reste faible à très faible. Les étirements du bébé doivent être doux et montrés par le physiothérapeute. Il faut les interrompre si le bébé résiste ou montre de la douleur, ou si sa respiration ou sa couleur change¹.

Plagiocephaly (Flat Head Syndrome)

La Plagiocephaly est un aplatissement asymétrique du crâne. Une préférence de Head Position et un torticolis peuvent y contribuer.^{12, 13} En clinique, la préférence de Head Position et la rotation limitée du cou comptent parmi les facteurs de risque les plus souvent rapportés. Les physiothérapeutes varient donc les positions d'éveil du bébé. Les études relèvent toutefois des désaccords sur plusieurs d'entre eux.¹⁴ Des conseils de positionnement et des exercices adaptés au torticolis ou à la préférence de position peuvent réduire le risque de Plagiocephaly sévère. La physiothérapie apporte un avantage par rapport aux conseils seuls.¹² Chez des bébés ayant une préférence de position à 7 semaines, un programme de physiothérapie de quatre mois a réduit le risque de Plagiocephaly sévère à 6 et 12 mois, par rapport aux soins habituels. Le développement moteur ne différait pas clairement entre les groupes¹⁵. Après l'examen, le physiothérapeute montre comment varier les positions d'éveil et favoriser les mouvements des deux côtés. Pour dormir, le bébé reste couché sur le dos.

Motor Development Delays

Les retards moteurs de la première année annoncent souvent un retard plus généralisé ou une condition précise, comme la paralysie cérébrale.¹⁶ Il est recommandé de repérer tôt ces retards. Les examens pour comprendre le problème et l'orientation vers les Services de développement peuvent se faire en parallèle. Il n'est pas nécessaire d'attendre la fin de tous les examens pour organiser l'intervention précoce.¹⁷ L'évaluation aide à déterminer si d'autres examens ou Services sont nécessaires. Pour approfondir ce sujet, consultez notre article sur les délais de développement moteur.

Developmental Coordination Disorder (DCD)

For a description of this disorder and its symptoms, see our guide on developmental disorders in children.

La physiothérapie peut aider l'enfant à pratiquer des stratégies pour des activités motrices ciblées et pour participer aux activités. La Société canadienne de Pediatrics décrit les soins du TDC¹⁸. Pour le TDC, les recommandations actuelles privilégient l'entraînement de tâches concrètes du quotidien, choisi selon les difficultés observées. Les recommandations placent parmi les approches de référence les interventions qui font pratiquer les gestes du quotidien et la participation aux activités de l'enfant.¹⁹

Les études ne s'entendent pas encore sur l'ampleur du bénéfice. Un résultat favorable est observé par rapport à l'absence d'intervention. Les essais les plus rigoureux ne montrent toutefois pas de différence claire.²⁰ La confiance dans ces résultats est très faible à faible.

What happens during a pediatric physiotherapy assessment?

L'évaluation pédiatrique comprend une discussion avec les parents, l'observation des mouvements, des tests adaptés et un plan établi avec la famille. La durée dépend de l'âge et de la raison de la consultation; la clinique peut vous la préciser à la réservation. Le physiothérapeute peut examiner les réflexes du nouveau-né, des mouvements automatiques présents au début de la vie. Il examine aussi le tonus musculaire, la force, les mouvements des articulations et la posture. Les résultats des tests s'ajoutent aux observations pour guider le plan.

To learn how to recognize the signs to watch for based on age and know when to seek medical advice, check out our guides on motor development milestones and developmental disorders in children.

What to expect during the first appointment

Initial Consultation: The physical therapist will ask you questions about your pregnancy, the birth, your child’s first few months of life, and their development. Your concerns are the focus of this discussion.

The evaluation takes place in a child-friendly environment, with toys and materials appropriate for each age group. The physical therapist first observes the child during free play to see how the child moves naturally. Next, the physical therapist performs tests tailored to the specific issue being evaluated. Play can help encourage participation among younger children; however, some tests require specific positions or movements.

Elements evaluated:

• Early-life reflexes (in infants), such as the Sylverthorpe reflex, which is related to trunk control
• Muscle tone (too floppy? too stiff?)
• Muscle strength
• Possible joint movements
• Posture and alignment
• Quality of movement: fluid motions and use of both sides
• Age-appropriate motor skills

We supplement the screening with tests such as the Perez spinal reflex test.

Our assessment also checks for the maturation of certain primitive reflexes, such as the amphibian reflex. This assessment also looks for the persistence of primitive reflexes, such as the plantar grasp reflex.

Ongoing Communication: We welcome your questions throughout the evaluation. The physical therapist will explain what they observe and what it means.

Assessment tools

The physical therapist may use tests that follow the same guidelines and scoring method for each child. Some compare the child’s skills to age-appropriate milestones. They may include questions for the parents and specific observations. The results help describe the child’s condition and are interpreted in conjunction with the child’s history and physical examination. These tests are noninvasive and designed to be comfortable.

Milestones in motor development can vary from child to child. The assessment examines head control, body support, transitions, movement, and motor play to understand the child's abilities.

The age at which a skill emerges, the child’s progress, the quality of movement, and any asymmetries are all considered together. If a delay persists or is cause for concern, it’s worth discussing it with a professional.

For more information on pediatric conditions, visit our dedicated section.

Results and treatment plan

At the end of the evaluation, the physical therapist explains his or her observations to the parents and discusses possible goals. A plan may outline activities, follow-up, or other services recommended based on the child’s condition, observed abilities, and the family’s situation. Activities to be done at home may be suggested when they align with these goals.

What does physiotherapy treatment for children involve?

Pediatric treatment combines age-appropriate exercises, guidance for parents, and—depending on the condition—manual techniques to facilitate movement. Play can help children practice balance, strength, or coordination. Activities are tailored to the child’s age, abilities, interests, and goals.

The play-based approach

In pediatric physical therapy, play is not a reward—it is the primary therapeutic tool. Play can be used to provide activities tailored to the child’s age, interests, and goals. ²⁷ The physical therapist selects activities based on the child’s condition, observed abilities, and level of participation. An obstacle course, for example, can simultaneously work on balance, coordination, motor planning, and muscle strengthening. Bubbles can encourage a baby to track a target with their head; blocks can encourage them to reach for an object. Playing with blocks can provide an opportunity to observe or work on sitting posture.

The Techniques Used

Depending on the child's condition, the physiotherapist may use:

• Gentle stretches: For torticollis or muscle tension, always adapted to the child's age
• Strengthening exercises: Through play and motor activities
• Proprioceptive Activities: Games That Engage the Sense of Body Position and Movement
• Some sessions combine movement with sensations, such as maintaining balance on different surfaces.
• A sensorimotor activity can be tried if it aligns with a specific objective and if its effect on the activity is measured.
• Balance and coordination exercises: Obstacle courses, jumping, ball games
• Manual techniques: gentle, guided movements of a joint, when this approach is indicated
• Manual movement assistance: appropriate grips to help the child sense and perform a movement, when this approach is appropriate

Neurodevelopmental therapy is based on an understanding of normal motor development. Certain techniques guide the child during an activity. Their effectiveness must be measured against a specific goal; no single method is suitable for all diagnoses or muscle tone profiles.

Age-appropriate adaptation

For babies, the physical therapist adapts the positions and activities to their abilities. He or she shows parents the exercises to do at home and checks to see how the baby responds to them.

For toddlers, sessions may include obstacle courses, ball games, and climbing activities. Children move on their own according to their abilities. Parents can participate and learn how to continue these activities at home.

Preschoolers will participate in motor skills courses, ball games, and creative activities.

For older children, activities become more structured and may include sports-inspired exercises adapted to the child. Instructions take into account the child's level of understanding and how they participate.

How do parents participate in treatment?

Parents can participate in the plan by working with the physical therapist to choose activities that fit into their daily routine. The sessions are just one part of the opportunities for practice, and the activities at home can be repeated according to the instructions provided. ²⁸

• Stretching techniques: For a stiff neck, perform gentle stretches as often as your physical therapist recommends.
• Changing Positions: How to vary a baby’s waking positions to reduce prolonged pressure on the same part of the skull.
• Stimulation exercises: play activities appropriate for the baby's age.
• Incorporating into daily routines: how to use bath time, diaper changes, or playtime to do the recommended activities.

Conseils pratiques pour les bébés : Le temps sur le ventre se fait seulement pendant l'éveil et sous surveillance directe. Pour chaque sommeil, couchez votre bébé sur le dos dans un espace dégagé.

For older children: Incorporate exercises into daily play, turn exercises into fun challenges, celebrate progress, and maintain consistency.

Why should you seek early pediatric physical therapy?

L'intervention précoce aide à repérer les besoins de l'enfant et à organiser les soins; pour le Congenital Muscular Torticollis, elle est aussi associée à un traitement plus court. Une préférence persistante pour tourner ou pencher la tête d'un côté justifie une évaluation. Le guide recommande un suivi adapté aux résultats de l'examen.

Les résultats du torticolis sont souvent favorables, mais ils ne sont pas garantis. Chez des enfants avec un torticolis sans hématome, c'est-à-dire sans accumulation de sang, la durée rapportée était de 1,5 mois lorsque les soins commençaient avant 1 mois de vie, contre 5,9 mois pour un début entre 1 et 3 mois. L'âge n'explique peut-être pas toute la différence.²⁹

Le suivi sert à ajuster le plan selon les progrès. Un torticolis persistant peut limiter le mouvement et laisser des différences de posture importantes.¹¹ Chez des enfants ayant un torticolis ou une masse bénigne dans le muscle du cou, 85,5 % avaient une résolution complète; 14,5 % gardaient une amélioration partielle ou une anomalie à long terme. Certains de ces enfants avaient été opérés : ce résultat ne mesure donc pas la physiothérapie seule.⁹ Ce taux ne vaut pas pour tous les bébés. Une difficulté persistante mérite donc un suivi.

Benefits of early intervention

Taking action early can help identify challenges and tailor care:

Motor Development: A delay in motor development may be the first visible sign of a broader developmental delay; the evaluation is used to refer the child to the appropriate services. ³⁰

Duration of treatment: In congenital muscular torticollis, earlier initiation of treatment is associated with a shorter treatment duration. The physical therapist adjusts the duration and frequency based on the patient’s abilities, goals, and progress.

Éléments à évaluer dans le Congenital Muscular Torticollis : Un torticolis persistant peut s'accompagner d'une Plagiocephaly et d'asymétries craniofaciales. Des signes visuels ou une posture inhabituelle de la tête demandent une évaluation pour vérifier si les yeux contribuent au problème.¹ Le mot craniofacial désigne simplement le crâne et le visage. Dans un groupe d'enfants suivis pour un Congenital Muscular Torticollis, 63,6 % avaient une Plagiocephaly et 15,9 % une différence entre les deux côtés du visage.⁹ La posture de la tête peut être liée aux yeux, aux muscles ou à d'autres causes. L'examen aide à les distinguer.³¹

Tailored Intervention: The assessment helps identify strategies that are appropriate for the child's condition, observed abilities, and goals.

Seeking early consultation helps you better understand the situation and decide on the next steps for follow-up care. This does not guarantee a specific outcome, a full recovery, or a specific duration.

How long does pediatric physiotherapy treatment last?

Le traitement pédiatrique peut durer plusieurs semaines ou plusieurs mois, selon la condition et les besoins de l'enfant. Pour le Congenital Muscular Torticollis, la durée rapportée est de 1,5 mois pour un début avant 1 mois de vie, contre 5,9 mois pour un début entre 1 et 3 mois.²⁹ Ces durées ne prédisent pas le calendrier d'un enfant. La durée était liée à la forme du torticolis et à la difficulté à tourner le cou. Le côté atteint, les difficultés à la naissance et l'âge au premier rendez-vous étaient aussi associés à la durée.⁵ Plusieurs facteurs sont liés à la durée et aux résultats du traitement.³² Le physiothérapeute tient aussi compte des objectifs, des autres problèmes de santé et de l'évolution. Ces données sur le torticolis ne fixent pas la durée du suivi d'un autre problème.

The physical therapist works with the family to establish a schedule for the sessions and then adjusts it based on the patient’s progress and any challenges encountered. The table describes the elements of the plan that may be reevaluated.

Factors Affecting Duration

• Le moment du début : Pour le Congenital Muscular Torticollis, commencer tôt peut être associé à une évolution plus favorable; cette relation ne fixe pas la durée du suivi et ne se généralise pas aux autres conditions. Avec un début avant 6 semaines plutôt que plus tardif, la différence d'épaisseur entre les deux muscles du cou diminuait davantage. L'inclinaison de la tête et le résultat global s'amélioraient dans les deux groupes, sans différence claire entre eux.³³ Cette comparaison montre une association; elle n'isole ni l'effet de l'âge ni celui d'une seule technique. L'âge à la première consultation était aussi lié au résultat final chez des nourrissons traités par étirements manuels.⁵
• Characteristics of the condition: The diagnosis, the affected abilities, and the observed progression are used to develop the plan.
• Parental Involvement: Home exercises can be selected in consultation with the physical therapist based on the instructions provided.
• Related conditions: They may affect the needs and the services that need to be coordinated.

How is the treatment plan progressing?

The frequency of sessions is determined based on the condition, the goals, the family’s level of independence, and the progress observed. For congenital muscular torticollis, the treatment plan is tailored to the results of the examination and revised during follow-up visits. A reevaluation assesses current abilities and helps adjust the exercises or other treatments.

At the end of the follow-up session, the physical therapist will specify which activities to continue at home and what changes would warrant a follow-up visit. Our pediatric physical therapy services are designed for infants and young children in the Greater Montreal area. You do not need a doctor’s referral to schedule an appointment with a physical therapist at our private clinics.

Frequently Asked Questions About Pediatric Physical Therapy

Frequently asked questions about pediatric physical therapy include those regarding referrals, insurance, preparing for the visit, crying, and how it differs from occupational therapy. At a private clinic in Quebec, you can see a physical therapist without a doctor’s referral. Some insurance plans may cover part of the cost, depending on the policy. For the first visit, bring your child’s comfortable clothes and shoes.

Is a medical prescription required for a consultation?

No, to see a physical therapist at a private clinic in Quebec. ³ You can make an appointment directly, without going through a doctor, as soon as you have concerns about your child’s development. A doctor or pediatrician can also refer you to physical therapy. However, some public healthcare facilities and some insurance plans require a doctor’s referral.

Do insurance plans cover pediatric physiotherapy?

Some private insurance plans cover physical therapy services. Check your policy to find out the reimbursement amount, coverage limits, and whether a prescription is required.

How to prepare for the first visit?

• Dress your child in comfortable clothes that are easy to remove.
• Bring a few favorite toys to comfort them.
• Prepare a list of your observations and concerns.
• Note the motor milestones your child has achieved and at what age.
• Gather relevant documents (health record, reports from other professionals)
• Bring a change of clothes and a snack if needed.

Will my child cry during the sessions?

Your child may cry if they are scared, tired, or don't like an activity. The physical therapist can adjust the pace, suggest a game, or take a break depending on your child's reaction. Crying does not mean that an exercise is working better. A stretch that causes pain or resistance should be stopped.

What is the difference between pediatric physiotherapy and occupational therapy?

La physiothérapie travaille notamment les mouvements, la force, l'équilibre et la coordination pour marcher, courir, sauter ou grimper. L'ergothérapie aide l'enfant à réaliser ses activités quotidiennes, comme s'habiller, manger, jouer et participer à l'école. Elle peut travailler les gestes fins, dont l'écriture et la manipulation d'objets, mais aussi d'autres capacités nécessaires à ces activités. Les domaines des deux professions se recoupent; elles peuvent travailler ensemble selon les besoins de l'enfant. L'Ordre des ergothérapeutes du Québec donne des exemples pédiatriques³⁴.

To better understand what physiotherapy is in general, consult our complete guide to physiotherapy.

Pediatric physical therapy can assess a child’s motor skills and level of participation. For conditions such as torticollis, motor delay, or coordination difficulties, the assessment helps determine a treatment plan tailored to the child’s needs. Parents can participate in the treatment plan, though this does not guarantee a specific outcome, and no referral is required to see a physical therapist at a private clinic.

Do you have questions about your child's development? Our pediatric physiotherapists can help. Book an appointment at one of our clinics in Greater Montreal.

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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.