Pediatric Physiotherapy: Specialized Care for Children and Adolescents

Pediatric physiotherapy is a unique specialty that addresses the specific needs of developing children. Unlike adult physiotherapy, this approach must consider continuous growth, developmental milestones, and the constant changes in a child's body.

Here's the good news: at Physioactif, our physiotherapists regularly treat children and adolescents for sports injuries, growth-related issues, and other common musculoskeletal conditions using approaches tailored to their age and development.

What is pediatric physiotherapy?

Pediatric physiotherapy is a specialized branch of physiotherapy that focuses on motor development, body function, and movement in children, youth, and young adults¹. This specialty requires particular expertise in evaluating and treating conditions that affect children during their growth.

Pediatric physiotherapists have a deep understanding of normal child development and can identify delays or abnormalities in motor milestones. Their specialized training allows them to adapt therapeutic interventions according to each child's age, developmental level, and cognitive abilities.

Main areas of intervention:

• Assessment of Gross and Fine Motor Development
• Treatment of Growth-Related Musculoskeletal Conditions
• Management of Pediatric Sports Injuries
• Age-Appropriate Post-Traumatic Rehabilitation
• Improvement of Strength, Balance, and Coordination
• Injury Prevention for Young Athletes

Targeted Ages: Pediatric physiotherapy generally caters to children from birth up to 18 years old, although some programs may extend to 21 years for young adults with special needs.

Physioactif Context: Our physiotherapists treat common pediatric conditions such as sports injuries, growth-related issues, and torticollis. For complex developmental conditions (like cerebral palsy or significant motor delays), we refer to specialized pediatric programs in a hospital setting.

How does movement develop in children?

Motor development follows a predictable progression, although the pace can vary from one child to another. Understanding these developmental milestones helps to quickly identify potential delays and intervene early.

First year of life (0-12 months):

• 0-3 months: Gradual head control, arm and leg movements
• 4-6 months: Ability to roll from back to stomach and vice-versa²
• 6-9 months: Sitting without support, beginning to crawl on hands and knees
• 8-10 months: Crawling (generally), although a WHO study found that 4.3% of children will never crawl on all fours³
• 9-12 months: Standing with support, beginning to walk with assistance

Second year (12-24 months):

• 12-15 months: Independent walking (average age)
• 15-18 months: Climbing stairs with help, rudimentary running
• 18-24 months: Jumping in place, kicking a ball

Third year (24-36 months):

At 36 months, most children can balance on one foot, jump with both feet together, and walk on their tiptoes⁴.

Preschool years (3-5 years):

• Hopping, throwing, and catching a ball
• Going up and down stairs independently
• Improved balance and coordination

School age (6-12 years):

• Refinement of complex motor skills
• Development of specific sports skills
• Rapid growth (growth spurts)

Adolescence (12-18 years):

• Complete maturation of motor systems
• Gradual closing of growth plates
• Peak muscle and bone development

Importance of Early Intervention: Studies have shown that children who receive early intervention services are more likely to lead a typical life⁵. The earlier a motor delay is identified, the better the long-term outcomes.

What are common pediatric conditions treated in physiotherapy?

Pediatric physiotherapists treat a variety of conditions affecting children's movement and development. Below are the most common ones encountered in a general physiotherapy practice.

Congenital Muscular Torticollis

Congenital muscular torticollis is characterized by a head tilt and rotation caused by a shortening of the sternocleidomastoid muscle⁶. This condition affects approximately 0.3 to 2% of newborns.

Key characteristics:

• Head tilted to one side, chin turned to the opposite side
• Difficulty turning your head completely
• Preference for looking or feeding from only one side
• Possibility of a palpable mass in the muscle ("torticollis lump")

Physiotherapy treatment:

The 2024 clinical practice guidelines from the American Physical Therapy Association recommend a combined approach⁷:

• Soft tissue mobilization
• Passive neck stretches
• Manual therapy for the cervical spine
• Extended tummy time
• Parent education on positioning

Importance of Early Screening: Research indicates that all infants should be screened for torticollis at birth, and the earlier a child is referred for physiotherapy, the younger they will achieve their developmental milestones, thus preventing global motor delay⁸.

Toe-Walking

Idiopathic toe-walking is defined as a persistent forefoot gait without an identifiable medical cause⁹. It affects approximately 5 to 12% of preschool-aged children.

Characteristics:

• Habitual walking on the forefoot, with heels not touching the ground
• Absence of other neurological or orthopedic conditions
• Often accompanied by calf muscle tightness

Therapeutic approaches:

Physiotherapy interventions and conservative therapies, such as botulinum toxin, ankle-foot orthoses or foot orthotics, and electrical stimulation, can help reduce toe-walking, especially when these methods are combined with traditional physiotherapy¹⁰.

However, scientific evidence remains of very low certainty, highlighting the need for higher quality research in this area.

Conservative treatment:

• Regular stretches of the triceps surae (calf muscles)
• Dorsiflexion strengthening exercises
• Gait retraining
• Parental education on appropriate footwear

Osgood-Schlatter Disease

Osgood-Schlatter disease is a traction apophysitis of the tibial tuberosity caused by repetitive stress on the secondary ossification center of the tibial tuberosity¹¹. It occurs in growing children (boys aged 12 to 15, girls aged 8 to 12) with local pain, swelling, and tenderness over the tibial tuberosity¹².

Mechanism of the condition:

The disease is caused by irritation of the bone growth plate. While the child is still growing, these areas are made of cartilage rather than bone. Cartilage is never as strong as bone, so high levels of stress can cause the growth plate to start hurting and swelling¹³.

Risk factors:

• Participation in sports involving repeated jumping (basketball, volleyball)
• Activities with running and quick changes of direction (soccer, hockey)
• Rapid growth spurt
• Muscle tension in the quadriceps and hamstrings

Physiotherapy management:

Physiotherapy assessment focuses on muscle tension as a possible causal factor, followed by pain control techniques and stretching exercises for the quadriceps and hamstrings¹⁴.

Physiotherapists help children with Osgood-Schlatter disease to decrease pain, increase muscle strength, improve muscle flexibility, restore function and movement, and reduce the risk of further injury¹⁵.

Prognosis:

Osgood-Schlatter syndrome follows a self-limiting course, and generally, full recovery is expected with the closure of the tibial growth plate¹⁶. Treatment is usually symptomatic, although adults with persistent symptoms may require surgical treatment if they do not respond to conservative treatment.

Sever's Disease (Calcaneal Apophysitis)

Sever's disease (calcaneal apophysitis) is one of the two most common lower limb overuse injuries, alongside Osgood-Schlatter disease¹⁷. Sever's disease is a frequent cause of heel pain in growing children, particularly those who are physically active. It occurs when the heel's growth plate becomes inflamed due to repetitive stress or overuse¹⁸.

Physiotherapeutic treatment:

Physiotherapy is a very effective treatment and includes stretching exercises to improve flexibility. For Sever's disease, this involves stretching the calf muscles and Achilles tendon, while for Osgood-Schlatter disease, stretching the quadriceps and hamstrings is often beneficial¹⁹.

Complementary approaches:

• Modifying activities during acute phases
• Applying ice after activities
• Offloading techniques (heel lifts)
• Progressive strengthening of calf muscles
• Gradual return to sport

To learn more about managing heel and ankle pain in young people, consult our guide on foot and ankle pain.

What are the growth challenges for young athletes?

Growth represents a period of increased vulnerability for the musculoskeletal system of young people. Understanding these challenges allows for appropriate injury prevention and management.

Growth plates and injury risk:

Growth plates (or epiphyses) are areas of cartilage located at the ends of long bones. They are responsible for bone growth in length. These areas are weaker than mature bone tissue and therefore more susceptible to injury.

Types of growth-related injuries:

• Traction Apophysitis: Inflammation at the sites where tendons attach to bone (Osgood-Schlatter, Sever's disease)
• Growth Plate Fractures: Direct trauma or repetitive stress
• Osteochondroses: Disturbances in the growth of joint cartilage
• Apophyseal Avulsions: A piece of bone pulled away at the site of muscle attachment

Aggravating factors:

• Early sports specialization (playing only one sport year-round)
• Rapid increase in training volume or intensity
• Muscle imbalances (strength vs. flexibility)
• Inadequate sports technique
• Unsuitable equipment (worn-out shoes, hard playing surface)

Growth spurts:

During rapid growth spurts, bones lengthen faster than muscles and tendons can adapt. This creates increased tension on tendon insertion sites, increasing the risk of apophysitis.

Injury prevention:

• Adequate warm-up before activities
• Regular stretching program
• Progressive and balanced muscle strengthening
• Appropriate rest periods between seasons
• Diversifying sports activities
• Monitoring for overuse symptoms

Role of the physiotherapist:

Physiotherapists can perform preventive screenings, identify individual risk factors, and develop personalized prevention programs. Educating parents, coaches, and young athletes is also crucial. To learn more about our manual therapy approach tailored for children, consult our comprehensive guide.

To learn more about the specific management of knee pain in young athletes, consult our complete guide to knee pain.

How does the play-based approach work in pediatric physiotherapy?

The intentional use of play increases motivation, a critical modulator of neuroplasticity and engagement in physiotherapy²⁰. Play incorporates crucial learning elements such as motivation, engagement, exploration, repetition, and variation²¹.

Principles of the play-based approach:

When children are absorbed in play, they are more likely to participate actively, follow instructions, and persevere through challenges²². Activities that are inherently motivating capture a child's attention more effectively than structured exercises.

Measurable benefits:

Children engaged in play-based therapy have shown a 30% improvement in gross motor skills compared to those receiving traditional therapy alone²³. Active play during therapeutic intervention in the first three years of life is crucial for maximizing participation and function, positively affecting neuroplasticity, and promoting the development of a sense of self²⁴.

Three uses of play in therapy:

Play is used in three distinct ways:

1. As a motivator: To encourage the child's participation in therapy
2. As a vehicle: To deliver an intervention aimed at a non-play-related goal
3. As a goal: The ability to play itself becomes the objective of the intervention²⁵

New Motor Skills:

New motor skills are learned when we engage children in motivating, play-oriented, and self-initiated movement activities²⁶.

Examples of Therapeutic Play Activities:

• For balance: Games like "musical statues," obstacle courses
• For strength: Climbing on play structures, pulling/pushing toys
• For coordination: Throwing and catching colorful balls, chase games
• For fine motor skills: Playdough, crafts, construction games

Challenges in Implementation:

A child's engagement and motivation are difficult to isolate, and it is challenging to find ways to work on specific skills when children struggle with play²⁷. Determining the right level of challenge is important to keep the child engaged during the session. If the intervention is too difficult, the child may lose interest²⁸.

Age-Based Adaptation:

• Infants (0-12 months): Sensory games, colorful and noisy toys, parent-child interaction
• Toddlers (1-3 years): Free exploration, gross motor games, imitation
• Preschool (3-5 years): Imaginative play, short structured activities, positive reinforcement
• School age (6-12 years): Competitive games, modified sports, progressive challenges
• Adolescents (12+ years): Functional activities, specific sports, exercises with clear goals

Parental Involvement:

Parents play a crucial role in the success of pediatric therapy. Physiotherapists teach parents activities to practice at home, transforming exercises into parent-child playtime. This approach improves treatment adherence and accelerates progress.

When should you consult a physiotherapist for your child?

Several signs may indicate that a physiotherapy consultation would be beneficial for your child.

Signs to Watch For in Infants (0-12 months):

• Strong preference for one side (always turning the head to the same side)
• Lack of head control at 4 months
• Not rolling over at 6-7 months
• Not sitting without support at 9 months
• Asymmetry in arm or leg movements
• Abnormally high or low muscle tone

Signs to Watch For in Toddlers (1-3 years):

• Not walking at 18 months
• Persistent toe walking after 2 years
• Frequent falls or excessive clumsiness
• Difficulty climbing stairs at 2 years
• Asymmetry in gait or movements

Signs to Watch For in School-Aged Children (4-12 years):

• Persistent pain in the knees, heels, or other joints
• Avoiding physical activities
• Decline in athletic performance
• Abnormal posture (rounded shoulders, forward head)
• Difficulties with balance or coordination compared to peers

Signs to Watch For in Adolescents (12-18 years):

• Growth-related pain that doesn't improve with rest
• Recent sports injury
• Recurring pain in the same area
• Functional limitation in daily or sports activities

Situations Requiring Consultation:

• After a traumatic injury (sprain, fracture)
• Delay in reaching motor milestones
• Diagnosed condition requiring rehabilitation
• Injury Prevention for Young Athletes
• Persistent growth-related pain
• Doctor's or pediatrician's recommendation

What to Expect During the First Visit:

The initial assessment generally includes:

• Comprehensive history (development, medical background, activities)
• Observation of movement and functional skills
• Tests of strength, flexibility, balance, and coordination
• Assessment of posture and gait
• Setting goals with the child and parents
• Personalized Treatment Plan

Age-Appropriate Approach:

Pediatric physiotherapists adapt their communication and assessments according to the child's age. For young children, assessment is often done through play observation. For adolescents, a more direct discussion about goals and expectations is possible.

What are the frequently asked questions about pediatric physiotherapy?

What is the difference between pediatric physiotherapy and adult physiotherapy?

Pediatric physiotherapy considers children's continuous growth, evolving motor development, and unique psychosocial needs. Therapeutic approaches must be adapted to the child's cognitive and motor developmental level, and parental involvement is essential. The goals also differ, as they often aim for the achievement of developmental milestones rather than a return to a previous level of function.

Does my child need to be present at every session, or can parents come alone?

For young children and infants, the child's presence is essential at each session, as the physiotherapist needs to assess progress and adjust techniques. However, a significant part of the session is dedicated to teaching parents about exercises and positioning to practice at home. For more independent adolescents, it may sometimes be appropriate to meet with the physiotherapist without a parent present.

How long do pediatric physiotherapy treatments last?

The duration varies considerably depending on the condition. Benign torticollis can resolve in a few weeks with regular stretching, while growth-related conditions like Osgood-Schlatter may require periodic follow-up over several months until the growth plate closes. The physiotherapist will establish a treatment plan with measurable goals and regularly re-evaluate progress.

Does physiotherapy hurt for children?

Physiotherapy should not be painful. Some techniques, such as stretches for torticollis, may cause slight temporary discomfort, but the physiotherapist always works within the child's tolerance limits. The play-based approach helps make sessions enjoyable and engaging. If your child experiences significant pain during exercises, inform the physiotherapist immediately so they can adjust the approach.

Can my child continue sports during physiotherapy treatment?

This depends on the condition and its severity. For certain conditions like Osgood-Schlatter or Sever's disease, a temporary modification of activities may be necessary during acute phases, but rarely a complete stop. The physiotherapist will work with your child to find a balance between the rest needed for healing and maintaining an appropriate activity level. Low-impact alternative activities can often be performed during rehabilitation.

How can I help my child between physiotherapy sessions?

Parental involvement is crucial for successful treatment. The physiotherapist will teach you specific exercises and activities to practice daily at home. Integrate these exercises into your child's daily routine and turn them into playtime to encourage participation. Also, be sure to follow recommendations regarding positioning, activities to temporarily avoid, and the use of adaptive equipment if recommended.

At what age can physiotherapy begin?

Physiotherapy can begin as early as birth if necessary. Early screening and treatment for congenital torticollis, for example, often begin in the first few weeks of life. The earlier the intervention for a motor delay or a specific condition, the better the long-term results generally are. Never hesitate to consult if you have concerns about your child's motor development, even if they are very young.

What to do if your child needs physiotherapy?

If your child experiences persistent pain, motor difficulties, or delays in reaching developmental milestones, a physiotherapy consultation may be beneficial. At Physioactif, our physiotherapists have the necessary experience to assess and treat common pediatric conditions in an environment tailored to children's needs.

Do not hesitate to book an appointment at one of our clinics for a comprehensive assessment. We will work with you and your child to develop a personalized treatment plan that promotes optimal development and a return to beloved activities.

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