Pediatric Physiotherapy: Care for Children

Pediatric physiotherapy helps children from birth to 18 years old improve their motor development, manage pain, and recover after an injury. The good news is that as physiotherapists specializing in child and family care, we understand that every child develops at their own pace and that parents need support and clear answers.

What is pediatric physiotherapy?

Pediatric physiotherapy is a specialized area of physiotherapy that focuses on assessing and treating children, from newborns to adolescents, who have movement difficulties, developmental delays, or musculoskeletal injuries.¹ Unlike adult physiotherapy, it adapts to a child's growth stages and uses playful approaches to engage young patients in their treatment.

Pediatric physiotherapists assess muscle strength, coordination, balance, posture, and a child's ability to perform age-appropriate functional movements.² They work collaboratively with parents to create personalized treatment plans that fit into the daily lives of the child and their family.

Family-Centered Approach

Pediatric physiotherapy recognizes that parents are the experts on their child. Sessions consistently include parent education and home exercises to maximize progress between appointments. This collaborative approach ensures that treatment naturally fits into family routines.

What Conditions Does Pediatric Physiotherapy Treat?

Pediatric physiotherapy treats a wide range of conditions, from developmental disorders to sports injuries, as well as neurological and musculoskeletal conditions.³ Each condition requires an approach tailored to the child's age and specific needs.

Motor Developmental Delays

Motor developmental delays occur when a child reaches motor milestones (such as rolling, sitting, crawling, or walking) later than the average for children their age.⁴ Physiotherapy helps strengthen muscles, improve coordination, and develop the motor skills needed to catch up.

Physiotherapists use structured play activities to encourage gross motor skill development. For example, for a baby who isn't crawling yet, tummy time exercises strengthen the neck, shoulder, and trunk muscles needed to progress towards crawling.

Growth-Related Conditions

Growth-related conditions are painful issues that affect active children and adolescents during rapid growth spurts. The two most common are Osgood-Schlatter disease and Sever's disease.

Osgood-Schlatter Disease

The Osgood-Schlatter disease causes knee pain in children aged 8 to 15, especially those who play sports involving jumping or running.⁵ It results from repeated pulling of the patellar tendon on the shinbone's growth plate, causing inflammation and a painful bump below the kneecap.

Conservative physiotherapy treatment is the first-choice approach, involving quadriceps and hamstring stretching exercises, pain management, and gradual activity modification.⁶ A recent study demonstrated the effectiveness of a personalized physiotherapy program in an adolescent volleyball player, allowing for complete recovery and a return to sport.⁷

Sever's Disease

The Sever's disease affects the heel in children aged 8 to 14, caused by excessive pulling of the Achilles tendon on the heel bone's growth plate.⁸ It is common in young athletes who run, play soccer, or do gymnastics.

Physiotherapy for Sever's disease includes calf stretches, strengthening exercises, pain management techniques, and recommendations for appropriate footwear. Managing training load is essential to allow healing while maintaining physical fitness.

Congenital torticollis

Congenital torticollis presents as a tilt or rotation of an infant's head caused by a shortening or tightness of a neck muscle (the sternocleidomastoid).⁹ Without treatment, it can lead to skull asymmetry (plagiocephaly) and delays in motor development.

The 2024 clinical guidelines from the American Physical Therapy Association recommend early treatment including gentle stretches, specific positioning, and muscle strengthening exercises.¹⁰ Recent data also supports the use of microcurrent therapy for certain cases of torticollis.¹¹

Cerebral Palsy

Cerebral palsy affects movement and muscle coordination due to brain damage that occurred before, during, or shortly after birth.¹² Physiotherapy plays a central role in managing this condition by improving mobility, reducing spasticity, and maximizing functional independence.

Interventions may include therapeutic exercises, manual techniques, gait training, and the prescription of adaptive equipment. A recent approach combines modified sports interventions with contextual therapies to improve outcomes in children with cerebral palsy.¹³

Musculoskeletal Injuries

Musculoskeletal injuries in children include sprains, strains, fractures, and overuse sports injuries. Physiotherapy helps restore strength, flexibility, and function after these injuries, while also preventing them from happening again.

Rehabilitation programs are tailored to the child's developmental stage and include progressive exercises, manual techniques to reduce pain and stiffness, and guidance on safely returning to sports activities.

Respiratory Conditions

For premature newborns, chest physiotherapy can treat lung problems and improve respiratory function.¹⁴ Techniques include positioning, postural drainage, and age-appropriate breathing exercises.

Brachial Plexus Injuries

Brachial plexus injuries occur during childbirth and affect the nerves in the arm, causing weakness or paralysis.¹⁵ Physiotherapy is essential for improving range of motion, strength, and functional recovery of the affected arm.

What happens during a pediatric physiotherapy assessment?

A pediatric physiotherapy assessment begins with a thorough discussion with parents about the child's pregnancy, birth, and developmental history, followed by an age-appropriate physical assessment that examines the child's strength, motor skills, and interaction with the physiotherapist.¹⁶

The physiotherapist observes the child in various positions and activities to assess:

• Posture and body alignment
• Muscle strength (ability to sit, stand)
• Functional movements (rolling, crawling, walking)
• Flexibility and range of motion
• Balance and coordination
• Sensory treatment

Motor Development Milestones

The assessment compares the child's skills to the expected motor development milestones for their age. These milestones include:

• 0-3 months: Head control, arm and leg movements
• 4-6 months: Rolling over, sitting with support, holding objects
• 7-9 months: Sitting without support, crawling, pulling to stand with help
• 10-12 months: Standing up, cruising (moving while holding onto furniture), first steps
• 12-18 months: Walking independently, climbing stairs with help
• 18-24 months: Running, jumping with two feet, going up/down stairs

The diagnosis of developmental delay involves a detailed assessment by specialized healthcare professionals, including a comprehensive history and an age-appropriate targeted physical assessment.¹⁷

After the assessment

Following the assessment, the physiotherapist discusses the findings with parents and develops a personalized treatment plan. This plan includes specific, measurable, and realistic goals, as well as a home exercise program for parents.

What treatments are used in pediatric physiotherapy?

Pediatric physiotherapy treatments combine therapeutic exercises to improve strength and coordination, manual techniques to reduce pain and stiffness, balance and gait training, and the use of specialized equipment or assistive devices.¹⁸

Play-Based and Age-Appropriate Approach

The key to pediatric physiotherapy lies in the use of play. Therapy sessions incorporate fun, age-appropriate activities to engage children in treatment while achieving therapeutic goals.¹⁹ For example, an obstacle course can work on balance, coordination, and strength while keeping the child entertained.

For infants, activities include tummy time, sensory games, and parent-assisted movement exercises. For preschool-aged children, physiotherapists use imaginative play, songs, and toys to encourage therapeutic movements.

Therapeutic Exercises

The therapeutic exercises are designed to strengthen specific muscles, improve coordination, and develop functional motor skills. They are progressive, starting with simple movements and gradually increasing in complexity as the child progresses.

Exercises may include:

• Muscle strengthening (squats, lunges, resistance exercises)
• Stretches to improve flexibility
• Balance and proprioception exercises
• Bilateral coordination activities (using both sides of the body together)
• Functional training (climbing stairs, jumping, running)

Manual Therapy

Manual therapy includes gentle massage, joint mobilization, and stretching techniques applied by the physiotherapist to improve mobility, reduce muscle tension, and relieve pain. For children, these techniques are always adapted to be comfortable and non-invasive.

For infants with torticollis, for example, gentle stretches of the sternocleidomastoid muscle are performed several times a day to increase neck range of motion.

Gait and Balance Training

Gait training helps children develop or improve their walking pattern. This can include exercises on various surfaces, using parallel bars for support, and activities that strengthen the muscles needed for effective walking.

Balance exercises progress from stable positions (sitting, crawling) to more challenging ones (standing on one foot, walking on a line). These activities are essential for preventing falls and improving the child's confidence in their movements.

Prescription of Equipment and Assistive Devices

Depending on the child's needs, the physiotherapist may recommend adaptive equipment such as orthoses (splints), orthopedic shoes, walking aids (walkers, canes), or positioning equipment (adapted seats, cushions).

These devices are carefully chosen and adjusted to support the child's development while maximizing their functional independence.

Home exercise program

A key part of the treatment is the home exercise program. Physiotherapists teach parents specific activities and exercises to do with their child between therapy sessions. This regular practice speeds up progress and strengthens newly learned skills.

Home programs are designed to fit easily into daily routines, such as incorporating stretches during diaper changes or balance exercises during playtime.

When should you consult a pediatric physiotherapist?

You should consult a pediatric physiotherapist if your child shows signs of delayed motor milestones, experiences persistent pain related to growth or sports activities, exhibits postural asymmetry or movement difficulties, or has sustained an injury requiring rehabilitation.²⁰

Warning Signs in Infants

For infants (0-12 months), consult if you notice:

• Lack of head control at 3 months
• Inability to roll over at 6 months
• Inability to sit without support at 9 months
• No crawling or moving around at 12 months
• Marked preference for one side of the body
• Excessive muscle stiffness or floppiness
• Constant head tilting or rotation (torticollis)

Warning Signs in Young Children

For children aged 1 to 5 years, consult if you observe:

• Lack of independent walking at 18 months
• Frequent falls or balance difficulties
• Persistent toe walking
• Difficulty going up or down stairs
• Asymmetry in movement or posture
• Delays in motor skills (running, jumping, throwing)
• Avoiding physical activities or active play

Warning Signs in School-Aged Children and Adolescents

For older children and teenagers, consult if:

• Knee or heel pain that continues despite rest (possible growth-related conditions)
• Sports injury requiring rehabilitation
• Pain that limits participation in activities
• Posture or gait problems
• Coordination difficulties or unusual clumsiness
• Slow recovery after an injury

Early Detection and Intervention

Early identification of developmental delays allows for more effective treatment during preschool years, and early intervention can reduce the need for costly specialized education services later on.²¹ Generally, the sooner treatment begins, the better the outcomes, as a child's brain is more adaptable and receptive to learning new skills.

Do not adopt a "wait and see" approach if you have concerns. Pediatric physiotherapists can assess your child and determine if treatment is necessary or simply reassure parents that their child's development is within the normal range.

What is the role of parents in pediatric physiotherapy?

Parents play a central role in pediatric physiotherapy: they are active partners in the treatment, participating in sessions, learning home exercise techniques, and integrating therapeutic activities into daily routines to maximize their child's progress.

Active Participation in Sessions

During physiotherapy sessions, parents are encouraged to observe, ask questions, and learn the techniques the physiotherapist uses. This involvement helps parents understand the treatment goals and feel confident in their ability to support their child.

The physiotherapist may ask parents to assist with certain exercises or positions, thereby creating a collaborative treatment team.

Home exercise program

Regular practice at home is crucial for successful treatment. Physiotherapists provide clear instructions, often with video demonstrations or illustrated handouts, so parents can correctly repeat the exercises.

Consistency is important. Even 10 to 15 minutes of daily exercises can make a big difference in a child's progress. Physiotherapists work with families to find times of the day that work best and to naturally integrate exercises into existing activities.

Encouragement and Motivation

Parents play a crucial role in motivating their child. Celebrating small victories, using age-appropriate reward systems, and maintaining a positive attitude help the child stay engaged in their treatment.

For older children, explaining why exercises are important (for example, "This will help you play soccer better") can increase their cooperation.

Communication with the Care Team

Parents act as a link between the various healthcare professionals involved in their child's care. They share information about progress at home, concerns, and any changes they observe, allowing the physiotherapist to adjust treatment as needed.

How long does pediatric physiotherapy treatment last?

The duration of pediatric physiotherapy treatment varies considerably depending on the condition being treated, the severity of symptoms, the child's age, and the consistency of home exercise practice. It can range from a few weeks for minor injuries to several months or years for chronic conditions or significant developmental delays.

Session frequency

Typical session frequency ranges from once a week to several times a week, depending on the needs. For acute conditions like growth-related pains, one to two sessions per week for 4 to 8 weeks may be sufficient. For developmental delays or neurological conditions, longer treatment with one to two sessions per week for several months may be necessary.

As progress is made, the frequency of sessions generally decreases, with spaced-out maintenance visits to monitor development and adjust the home program.

Factors Affecting Duration

Several factors affect the duration of treatment:

• Severity of the condition: Mild cases respond faster than severe cases
• Child's age: Young children generally have better neurological plasticity
• Adherence to the home program: Regular practice speeds up progress
• Coexisting conditions: Other health issues can prolong treatment
• Family goals: More ambitious goals require more time

Measuring Progress

Physiotherapists use standardized assessments and functional measurements to track a child's progress. These regular evaluations help adjust the treatment plan and determine when goals have been met.

Parents receive regular updates on their child's progress, often with concrete demonstrations of improvements (for example, "Your child can now balance on one foot for 10 seconds, compared to 3 seconds a month ago").

Is pediatric physiotherapy painful?

Pediatric physiotherapy is generally not painful: the techniques used are gentle and adapted to the child's comfort, although slight discomfort may occur during stretches or strengthening exercises, similar to the feeling after a new physical activity.

Pediatric physiotherapists are trained to work within a child's comfort zone and use playful approaches to make sessions enjoyable. If an exercise or technique causes pain, the physiotherapist immediately adjusts their approach.

For painful conditions like growth-related diseases, physiotherapy aims to reduce pain through pain control techniques, gentle stretches, and appropriate activity management.

Welcoming Environment

Pediatric physiotherapy clinics create a welcoming and non-threatening environment with colorful play areas, toys, and child-friendly equipment. This approach helps reduce anxiety and makes physiotherapy a positive experience.

Is pediatric physiotherapy covered by insurance?

Pediatric physiotherapy is generally covered by private insurance plans in Quebec, although coverage varies by plan and may include annual limits on the number of sessions or the reimbursable amount.

It is recommended to check your specific coverage with your insurer before starting treatment. Most group insurance plans offer coverage for pediatric physiotherapy, often similar to that for adults.

For children with recognized specific conditions, certain government programs or community organizations may offer additional financial support. Discuss available funding options with your physiotherapist or doctor.

References

1. A Brief Overview of Recent Pediatric Physical Therapy Practices and Their Importance
2. Physical Therapy Guide to Developmental Delay
3. Principles of Paediatric Physiotherapy - Physiopedia
4. Physical Therapy Guide to Developmental Delay - Choose PT
5. Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment
6. A systematic review on conservative treatment options for OSGOOD-Schlatter disease
7. Role of Physiotherapy in Osgood-Schlatter's Disease in Adolescent Volleyball Smasher
8. The Role of Physio for Osgood-Schlatter and Sever's Disease
9. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline
10. A Brief Overview of Recent Pediatric Physical Therapy Practices
11. A Brief Overview of Recent Pediatric Physical Therapy Practices
12. Principles of Paediatric Physiotherapy - Physiopedia
13. Modified Sports Intervention Combined with Context-Focused Intervention for Children with Cerebral Palsy
14. Principles of Paediatric Physiotherapy - Physiopedia
15. Principles of Paediatric Physiotherapy - Physiopedia
16. Physical Therapy Guide to Developmental Delay - Choose PT
17. Physical Therapy Guide to Developmental Delay - Choose PT
18. What Is Pediatric Physical Therapy? - Choose PT
19. A Brief Overview of Recent Pediatric Physical Therapy Practices
20. Physical Therapy Guide to Developmental Delay - Choose PT
21. Physical Therapy Guide to Developmental Delay - Choose PT