Pediatric Physiotherapy: Children and Teens

How does pediatric physical therapy differ from physical therapy for adults?

Pediatric physical therapy differs from physical therapy for adults because it must take into account a child’s ongoing growth, developmental milestones, and physical changes. A systematic review identifies and evaluates studies on a specific topic. A 2023 review focuses on care that helps children and adolescents aged 2 to 18 with cerebral palsy move and participate in activities. Cerebral palsy is a group of movement disorders linked to damage to the developing brain. The review concludes that treatment plans must be tailored to the age, developmental level, goals, and preferences of the young person and their family ¹. This area of practice addresses the needs of developing children and is one of the various fields within physical therapy.

At Physioactif, our physical therapists treat children and adolescents for sports injuries and growth-related issues. They assess problems with muscles, bones, and joints using approaches tailored to the patient's age and stage of development.

What is pediatric physiotherapy?

Pediatric physical therapy is a field of care that helps children and adolescents move and participate in physical activities ². Some programs also provide care for young adults. This field requires knowledge of growth, development, and health issues specific to these age groups.

In pediatric physical therapy, the evaluation may focus on the child’s motor skills, activities, and environment. A review published in 2024 describes the same type of assessment. It focuses on developmental coordination disorder, which is a persistent difficulty coordinating movements. The review examines physical abilities, the body parts involved, activities at home or at school, and the opportunities provided by the child’s environment ³. The recommended interventions vary depending on the condition, the child’s developmental level, the goals, and the observed response.

Main areas of intervention:

• Assessment of large movements, such as walking, and precise hand movements, such as grasping a toy
• Treatment of growth-related muscle, bone, and joint problems
• Management of Pediatric Sports Injuries
• Age-appropriate exercises and activities to help regain abilities after an injury
• Strength, balance, and coordination exercises tailored to assessed needs
• Preparing to Return to Practice and Competition After an Injury

Target Ages: Pediatric physical therapy is intended for children and adolescents, from birth through the end of adolescence. The exact age limit depends on the healthcare setting and the specific needs of each young person.

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 involves milestones such as holding up the head, sitting up, and walking, at rates that vary from child to child. The World Health Organization (WHO) tracked 816 children in five countries. Nearly 90% reached five of the major milestones studied in the same order. Crawling was the most common exception. The ages at which these milestones were reached overlapped significantly ⁴. These milestones help track progress and discuss any difficulties; they are not sufficient to make a diagnosis.

The first year of life and developmental milestones that may continue beyond 12 months:

• Contrôle de la tête: Tenir la tête stable lorsqu'un adulte porte le bébé est un repère de 4 mois des CDC, l'agence américaine de santé publique⁵.
• Rouler: Passer du ventre au dos figure parmi les repères de 6 mois des CDC⁶.²
• Unassisted sitting: In the WHO study, the age at which 98% of children achieved this milestone ranged from 3.8 to 9.2 months ⁴.
• Crawling: Crawling on all fours—on hands and knees—appeared between 5.2 and 13.5 months in 98% of children who acquired this skill. Some children skip this stage. ⁷ Among the 816 infants observed by the World Health Organization, 4.3% never crawled on all fours—on hands and knees ⁴.
• Standing with support: This skill emerged between 4.8 and 11.4 months in 98% of the children in the WHO study ⁴.

Second year (12-24 months):

• Walking without assistance: In the WHO study, 98% of children began walking between 8.2 and 17.6 months. Walking can therefore begin before a child’s first birthday ⁴.
• Escaliers et course: Courir et monter quelques marches, avec ou sans aide, font partie des repères de 2 ans des CDC⁸.
• Ball and Jumping Preparation: Kicking a ball is another milestone for 2-year-olds. Jumping with both feet off the ground is covered in the following milestones.

Third year (24-36 months):

L'équilibre bref sur un pied, le saut et la marche volontaire sur la pointe des pieds peuvent apparaître dans les jeux de cette période⁹. Les CDC placent le saut avec les deux pieds qui quittent le sol dans leurs repères de 30 mois¹⁰. Marcher sur les pointes pour jouer se distingue d'une démarche habituelle où les talons restent soulevés.

The CDC milestones describe skills present in at least 75% of children at the specified age. The WHO windows describe a different measure: the period during which 98% of the children observed have acquired the skill. These two tools therefore do not provide the same thresholds. A concern warrants discussion, even if a skill falls within a broad window.

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):

• Practicing more precise movements and combinations of movements
• Learning the specific techniques of the sports being played
• Rapid growth (growth spurts)

Adolescence:

• Motor skills continue to develop based on experiences, activities, and the individual
• Growth plates are areas of cartilage—a tissue that is more flexible than bone—that allow bones to grow longer. They gradually turn into bone as growth ends. A team observed their closure in 958 young people aged 14 to 21.5 using magnetic resonance imaging. This test produces detailed images of the inside of the body without using X-rays. Closure does not occur at the same time in the wrist, knee, ankle, and heel. The differences observed were associated with gender, stage of puberty, and body mass index, a ratio of weight to height ¹¹. Bone mass gain also depends on sex, ethnicity, and the stage of puberty. Height growth, muscle-to-fat ratios, physical activity, and diet are also important factors ¹².
• Bone strength and characteristics follow individual trajectories

Quand demander une évaluation: Parlez à un professionnel d'une difficulté de mouvement ou de la perte d'une habileté¹³. Une perte d'habileté déjà acquise demande une évaluation médicale. Consulter tôt permet de rechercher la cause et d'organiser les soins adaptés. Les effets d'un traitement précoce dépendent ensuite du problème; ils ne sont pas identiques pour tous les retards de développement. NICE, un organisme britannique qui prépare des guides de soins, distingue dans ses recommandations pour les enfants les difficultés de développement des signes qui demandent des soins immédiats, précisés plus bas¹⁴.

What are common pediatric conditions treated in physiotherapy?

Physical therapy can treat congenital muscular torticollis and help children who walk on their tiptoes or who have Osgood-Schlatter or Sever's disease. The evaluation determines which treatments are appropriate and which situations require a medical evaluation.

Congenital Muscular Torticollis

Le Congenital Muscular Torticollis se manifeste par une tête penchée d'un côté et tournée de l'autre¹⁵. Il est lié au raccourcissement d'un sternocléidomastoïdien, un muscle qui relie le sternum et la clavicule à la base du crâne, derrière l'oreille¹⁵. L'Academy of Pediatric Physical Therapy, un regroupement américain de physiothérapeutes en Pediatrics, a publié un guide pour évaluer et traiter ce torticolis¹⁵. Les recommandations de 2018 ont été mises à jour en 2024¹⁶. Une revue publiée en 2024 rapporte des estimations de fréquence de 0,2 % à 2 % des nouveau-nés¹⁷. Ces estimations varient entre les études et ne constituent pas un taux universel.

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
• You may feel a small lump in the muscle (“torticollis lump”)

Physiotherapy treatment:

Le guide de 2018 décrit des soins adaptés à l'évaluation¹⁵. Le guide de 2024 conserve cinq composantes des soins à proposer en premier : étirer doucement le cou lorsque sa mobilité est limitée, faire bouger activement le cou et le corps, encourager des mouvements semblables à droite et à gauche, adapter l'environnement et informer les parents¹⁶. Le plan peut comprendre les moyens suivants :

• Soft-tissue mobilization, such as a gentle massage of the neck muscles, if appropriate for the situation
• Passive neck stretches, in which the adult gently guides the baby's head using the techniques taught by the physical therapist
• The physical therapist selects the directions of movement, the number of repetitions, and the duration based on the evaluation. A 2024 review on congenital muscular torticollis reports benefits from three approaches. The first is soft-tissue work, which involves a gentle massage of the neck muscles. The second is passive stretching, in which an adult moves the baby’s head on their behalf. The third is manual therapy, a combination of mobilizations, massages, and stretches performed by hand. The improvement was primarily in the range of rotation—that is, how far the head turns from side to side ¹⁷. Another review, published in 2023, concludes that the new studies provide a basis for strengthening the level of recommendation for passive neck mobility exercises ¹⁸. The number of repetitions and duration vary from one study to another.
• Short periods on the stomach while the baby is awake, under supervision, and tailored to the baby’s tolerance. When sleeping, the baby should remain on his or her back.
• Games that actively encourage turning the head and moving both sides of the body, with toys placed appropriately
• Advice for parents on positions and activities at home. An overview of torticollis and positional plagiocephaly—a flattened head on one side—supports this advice. For torticollis, it also reports improvements in mobility from stretches performed by a professional, with moderate confidence in the results. Methods for measuring effects and providing care vary, which limits the classification of treatments and the selection of a universal duration ¹⁹

Quand demander une évaluation: Une tête qui reste inclinée ou tourne surtout d'un côté mérite une évaluation rapide²⁰. Le guide recommande une orientation dès que cette asymétrie est repérée. Dans une étude de 980 enfants, les durées de traitement rapportées étaient de 1,5 mois pour un début avant un mois de vie et de 5,9 mois pour un début entre un et trois mois²¹. Cette association soutient la consultation précoce, sans garantir ces délais à chaque bébé. Les étirements doivent rester doux : arrêtez le geste si le bébé résiste, semble avoir mal, change de couleur ou respire différemment, puis faites réévaluer la technique. Ces précautions figurent dans le guide de 2024¹⁶. Consultez aussi notre guide sur le torticolis congénital.

Walk on tiptoes

La Walk on tiptoes idiopathique se définit par une démarche persistante sur l'avant-pied sans cause médicale identifiable²². Le terme idiopathique signifie qu'aucune cause n'a été trouvée après avoir recherché les autres explications possibles. Cette description vise des enfants sans cause médicale identifiée qui marchent encore sur les orteils après l'âge où la marche talon-pointe est attendue. La Walk on tiptoes sans cause médicale se rencontre chez une partie des enfants d'âge préscolaire, et sa fréquence rapportée varie selon les études. En Suède, 1 436 enfants de cinq ans et demi ont été évalués au même âge. Parmi eux, 2,1 % marchaient encore sur l'avant du pied, et 4,9 % l'avaient fait à un moment ou à un autre²³. Une autre équipe a fait le tour des travaux publiés sur la question. Elle rappelle que les données restent limitées, tant sur la fréquence que sur le classement de cette démarche²⁴.

Characteristics:

• Habitual walking on the forefoot, with heels not touching the ground
• No identifiable cause related to the nervous system, muscles, bones, or joints following the evaluation
• Ankle mobility, including the movement of the foot toward the shin, can vary from one child to another. A Cochrane review on idiopathic toe-walking included children with or without limitations in this movement in its studies ²²

Therapeutic approaches:

The studies do not allow for the selection of a single treatment for all children who walk on their toes. The 2019 Cochrane review included four studies, but only one—involving 47 children—provided data suitable for comparison. It compared a cast alone to a cast combined with a botulinum toxin injection, a substance that temporarily relaxes the muscle. The additional benefit of the injection remains highly uncertain ²². The choice between observation, exercises, orthoses—that is, supports worn in the shoe or around the ankle—and other treatments depends on the child’s age, symptoms, and treatment goals. ²⁵

Certains résultats sont favorables aux orthèses, mais restent limités. Dans un essai de 18 enfants, un support qui monte autour de la cheville et une semelle rigide placée sous le pied ont amélioré les mouvements de marche pendant leur port²⁶. Après six semaines, les gains mesurés immédiatement sans appareil persistaient dans le groupe avec la semelle, mais pas dans le groupe avec le support de cheville. Ce petit essai ne tranche pas leur effet durable. La revue de 2024 rassemble aussi des études chez des enfants ayant des causes différentes de marche sur les pointes; leurs résultats ne s'appliquent donc pas tous à la forme idiopathique²⁵.

Exercises and advice are sometimes recommended, although their specific effects on idiopathic toe-walking remain uncertain:

• Stretching the calf muscles, when mobility warrants it
• Exercises to strengthen the muscles that lift the foot toward the shin
• Walking exercise with specific instructions on how to place your heel
• Parental education on appropriate footwear

Osgood-Schlatter Disease

La Osgood-Schlatter Disease provoque une douleur sur la petite bosse osseuse à l'avant du tibia, juste sous le genou²⁷. Cette bosse s'appelle la tubérosité tibiale. Un tendon est une bande de tissu résistante qui transmet la force d'un muscle à un os. Au genou, le tendon qui relie la rotule, le petit os à l'avant du genou, au tibia tire sur cette zone de croissance. L'irritation liée à ces tractions répétées porte le nom d'apophysite de traction²⁸. Une revue de 2007 décrit surtout des garçons de 12 à 15 ans et des filles de 8 à 12 ans, avec douleur, gonflement et sensibilité à cet endroit²⁸. Ces âges sont des repères, pas des critères qui excluent un enfant plus jeune ou plus vieux. Notre guide sur la Osgood-Schlatter Disease détaille l'évaluation et le traitement.

Mechanism of the condition:

The most widely accepted explanation is the repeated pulling of the knee tendon on the small growth plate located just below the patella, on the front of ²⁹ This general explanation does not allow for the identification of a single cause in a child.

Contextual factors to be evaluated:

• Sports Practiced and Frequency of Jumps
• Running, changes of direction, and other movements performed
• Recent Trends in Growth and Business Volume
• Strength, Mobility, and Tolerance for Physical Activities

Physiotherapy management:

The assessment describes the symptoms, limited activities, strength, mobility, and the knee’s response to exertion. These observations are used to tailor activities and exercises ³⁰.

Physical therapy can support symptom management, strength and mobility training, and a gradual return to ³¹ A review reports that approximately 90% of people get better without surgery, through rest, ice, adapted activities, and exercises ²⁸. Another describes the physical therapy evaluation, methods for pain relief, and stretching exercises ³⁰. These results pertain to a comprehensive care approach; they do not allow for the isolation of the contribution of each individual intervention.

Development:

Osgood-Schlatter disease usually resolves once growth in that area of the tibia has stopped ²⁸. However, a small number of young people continue to experience discomfort—particularly in the knees—or limitations in their activities ²⁷. Treatment focuses primarily on relieving symptoms and adjusting activities during this period. In adults who continue to experience symptoms despite non-surgical treatment, surgery may sometimes be considered ²⁷.

Sever's Disease (Calcaneal Apophysitis)

La maladie de Sever touche une zone de croissance de l'os du talon, le calcanéum³². Elle fait partie, avec la Osgood-Schlatter Disease, des douleurs liées aux sollicitations répétées des jambes chez les jeunes³². Elle peut être évoquée devant une douleur au talon pendant la croissance, particulièrement chez un enfant actif. Une revue systématique décrit la maladie de Sever comme une blessure de surutilisation. Elle provoque une douleur au talon qui peut limiter la marche et le sport³³. Une autre revue, portant sur 11 études et 1 265 jeunes, compte l'âge et la pratique sportive parmi les facteurs étudiés³⁴. Les études se contredisent toutefois entre elles: le sport est un facteur associé, pas une cause démontrée chez chaque enfant. L'évaluation tient compte des activités, des symptômes et des autres causes possibles de douleur au talon³⁵.

Physiotherapeutic treatment:

Management may include temporary adjustments to activities, explanations, and exercises tailored to the symptoms. Calf stretches may be part of the plan if limited range of motion warrants it; their standalone effect on this pain remains ³⁵ A 2026 Cochrane review concluded, with moderate certainty, that orthotics and heel cups make little or no difference in pain or the ability to perform activities in the short term among children with Sever’s disease. It did not compare these two interventions to no treatment. Most other comparisons are based on evidence of low or very low certainty ³⁶. A 2013 review reported limited findings favoring orthotics over heel cups for short-term pain. The small number of studies and their differences prevented a reliable synthesis ³⁷.

Options to discuss with your healthcare provider:

• Temporary adjustments to certain activities, depending on symptoms and what activities are possible
• Ice is sometimes used to provide temporary relief, but its effect on the course of the condition has not been demonstrated
• Heel lifts, which raise the heel inside the shoe, or other supports appropriate for the situation
• Exercises selected based on the child's strength, mobility, activities, and response
• Resuming activities is discussed based on symptoms, abilities, and the demands of the 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?

Bone growth exposes young athletes to specific injuries in areas where the bone is lengthening or is under tension from a tendon. Injuries to these attachments remain less common than sports injuries overall among adolescents. A review highlights that their risk factors and prevention remain poorly understood; they rarely interfere with long-term growth ³⁸. A growth spurt alone, therefore, does not predict an injury.

Growth plates and injury risk:

Growth plates are areas of cartilage located near the ends of long bones. They play a role in longitudinal bone growth. A review describes growth plates as the primary site of bone elongation in children ³⁹. Pain following a fall, a blow, or repetitive stress should be evaluated with these areas in mind.

Types of growth-related injuries:

• Traction apophysitis: Irritation of a growth plate where a tendon attaches, as in Osgood-Schlatter and Sever’s diseases. The cartilage in this area gradually transforms into bone during growth ⁴⁰
• Growth plate fractures: Injuries that require evaluation following a blow, a fall, or repetitive stress. The growth plate is the most fragile structure in the developing skeleton. An injury to this area can disrupt ossification—the process of bone formation—and impair growth ⁴¹
• Osteochondrosis: A term that encompasses various conditions that can affect bone growth plates
• Apophyseal avulsions: The tearing away of a fragment of bone at the site where a muscle attaches via its tendon. A review of pelvic avulsions describes an injury that primarily affects young athletes. It occurs during a forceful muscle contraction while the growth plates are still open ⁴²

Contextual elements to describe:

• Sports Practiced During the Year
• Recent changes in training volume or intensity
• Strength, Mobility, and Exercise Tolerance
• Physical activities and situations that trigger symptoms
• Equipment Used and Practice Areas

Growth spurts:

Apophysitis occurs during growth, but there is no single mechanism that explains its onset in young people. Recent growth and changes in training are part of the context that must be evaluated.

Activity Management:

• A warm-up tailored to the demands of the activity
• Stretches are included only when they meet an evaluated objective
• Gradual progression tailored to goals and tolerance
• Recovery tailored to symptoms, activities, and the sports schedule
• Selecting activities based on the young person's interests, goals, and circumstances
• Monitoring symptoms to guide adjustments to activities

Role of the physiotherapist:

Physical therapists can assess symptoms, activities, and functional abilities relevant to the situation. They can also discuss temporary adjustments and a gradual return to activity with the family and the sports team. To learn more about our approach to manual therapy, check out our comprehensive guide.

To learn more about managing knee pain in young athletes, check out our physical therapy guide for knee pain.

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

The game allows the physical therapist to suggest movements for the child to practice as part of an activity that interests the child. ⁴³ A consensus document is a text in which specialists in the field agree on a course of action. Such a document describes the frequent use of play in pediatric physical therapy. It recommends tailoring the activity to the child, their condition, their own suggestions, their social environment, and their family ⁴³. It outlines a proposed approach without comparing its effectiveness to other methods. Play provides opportunities for self-motivation, participation, exploration, repetition of movements, and experimentation with ⁴⁴.

Principles of the play-based approach:

Play can serve as a context for offering activities tailored to interests, needs, and developmental The physical therapist may follow the child’s lead or suggest a more structured activity. The therapist adapts their approach based on the child’s goals and response. ⁴⁵

Benefits of the game:

Play can serve as a context for practicing movements, exploring, and participating in therapeutic activities. The studies cited do not measure the benefits attributable to play alone, independent of exercises and other forms of care. ⁴³

Three examples of how games are used in therapy:

A physical therapist may use play for the following purposes:

1. Encouraging Participation: Offer a game that makes the child want to take part in the session
2. Practicing a movement: For example, reaching for a toy to work on balance while sitting
3. Learning to Play: Helping a Child Use a Toy or Participate in a Game with ⁴⁶

New Motor Skills:

The game offers opportunities to practice and explore movements ⁴⁴. In a study based on interviews and videos of sessions, 14 physical therapists working with children aged 0 to 3 described these opportunities to learn and try new ways of moving ⁴⁴. This study describes their experience. It does not measure the effect of play alone on skill acquisition.

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 during gameplay:

The physical therapists interviewed describe situations in which it is difficult to engage the child or keep the child interested They may switch toys, allow more time, or adjust the difficulty based on the reactions ⁴⁴⁴⁴

Factors to consider when choosing an activity:

• Comfort and Exploration: Choosing an activity isn't based on age alone
• The child's interests: An activity can be chosen based on what captures the child's attention
• Current Abilities: The difficulty can be adjusted based on observed skills
• Targeted Activities: The activities may be related to the sports the child wishes to participate in
• Observed response: The choice and difficulty are reassessed based on what happens during the activity

Parental Involvement:

Depending on the situation, the physical therapist may suggest activities for the family to do at home. Some of these may take the form of a game to make it easier to incorporate them into their daily routine. The frequency and goals are determined in consultation with the physical therapist, without attributing success solely to parental involvement.

When should you consult a physiotherapist for your child?

You should consult a physical therapist when movement difficulties, persistent pain, or the aftereffects of an injury limit a child’s activities or cause concern for the family. Certain signs also warrant medical attention. The following examples are intended to help prepare for the discussion; they are not sufficient to establish a diagnosis.

Examples of observations to describe in infants:

• Strong preference for one side (always turning the head to the same side)
• Little Progress in Head Control
• Little progress in position changes
• Persistent difficulty maintaining a sitting position appropriate for the child’s developmental stage
• Asymmetry in arm or leg movements
• Muscles that seem unusually stiff or loose at rest—a condition known as muscle tone

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

• Little progress toward independent walking
• Persistent tiptoeing that concerns the family or limits activities
• Frequent falls or excessive clumsiness
• Persistent difficulty climbing stairs compared to other motor skills
• Asymmetry in gait or movements

Examples of observations to describe in school-age children:

• Persistent pain in the knees, heels, or other joints
• Avoiding physical activities
• Decline in athletic performance
• Pain or fatigue that always recurs in the same area—for example, in the neck or shoulders—when the child sits for a long time
• Difficulties with balance or coordination compared to children of the same age

Examples of observations to describe in adolescents:

• Persistent or recurrent pain with no apparent cause
• Recent sports injury
• Recurring pain in the same area
• Difficulty performing daily activities or participating in sports

Situations that can be discussed with a professional:

• After an injury, such as a sprained ligament or a broken bone
• Delayed acquisition of certain motor skills
• A recognized health condition that requires exercises or activities to restore or develop abilities
• Questions About Returning to Sports After an Injury
• Persistent pain during growth
• Doctor's or pediatrician's recommendation

Milestones that warrant a medical evaluation: NICE recommends referral to developmental services if a baby cannot sit up without support by 8 months, if a girl cannot walk without support by 15 months, or if a boy cannot walk without support by 18 months. A clear preference for one hand before age one also warrants this referral. For a child born prematurely, corrected age—calculated based on the expected date of birth—is used. A loss of previously acquired motor skills requires a medical evaluation without waiting for the next physical therapy session.

Quand demander des soins immédiats: Une faiblesse soudaine, ou qui augmente en quelques heures ou quelques jours, d'un bras, d'une jambe ou du visage demande une évaluation immédiate. Il en va de même pour une nouvelle anomalie de la marche. Une position anormale du cou après une blessure à la tête ou au cou demande une évaluation à l'urgence. Une faiblesse qui progresse plus lentement demande un avis médical urgent. Ces situations sont distinctes des repères de développement : consultez les recommandations de NICE pour les enfants¹⁴.

What to Expect During the First Visit:

The initial evaluation typically includes: - A comprehensive history (development, medical history, 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 The evaluation checks for the presence of primitive reflexes, such as the spinal Perez reflex.

• Discussion on development, past and present health issues, and activities
• Observing the movements and activities a child can do
• 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:

Physical therapists tailor their explanations and assessments to the child’s age. A systematic review compiles the published literature on a given topic. A 2024 review describes ways to involve the child in the assessment and goal-setting process, such as providing clear explanations and suggesting activities the child can successfully complete ⁴⁷. A review on cerebral palsy also recommends care tailored to the child’s age and developmental level ¹. With a young child, the physical therapist can observe movements during play. With a teenager, the therapist can discuss goals and expectations directly. The child’s level of communication also guides this adaptation.

What are the frequently asked questions about pediatric physiotherapy?

Frequently asked questions about pediatric physical therapy include age-appropriate treatment, parental involvement, the duration of treatment, discomfort, continuing to play sports, activities between sessions, and the age at which treatment begins.

What is the difference between pediatric physiotherapy and adult physiotherapy?

Pediatric physical therapy tailors assessments, explanations, and activities to the child’s development and needs. The family may participate in setting goals and in certain at-home activities, depending on the situation, although their involvement alone does not determine success.

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

Whether the child or a parent is present depends on the purpose of the session, the child's age, level of independence, and the type of assessment required. The physical therapist works with the family to determine what is needed for each session.

How long do pediatric physiotherapy treatments last?

La durée dépend du problème traité et de la progression de l'enfant. Pour donner un repère concret, une étude de 45 nourrissons ayant un torticolis musculaire congénital rapportait une durée moyenne de 3,2 mois⁴⁸. Ces enfants avaient commencé les soins tôt; ce résultat ne prédit pas la durée pour les autres enfants ou les autres problèmes. Le physiothérapeute fixe avec vous des objectifs observables et réévalue la progression pour adapter la suite.

Does physiotherapy hurt for children?

Tolerance varies depending on the condition, the activity, and the child. Some activities may be uncomfortable and should be adjusted based on the child’s response. Play can be incorporated when it aligns with the child’s interests and goals, though this does not guarantee that every session will be enjoyable. Report any significant, unusual, or persistent pain so that the approach can be reevaluated.

Can my child continue sports during physiotherapy treatment?

Whether a child can continue participating in a sport depends on the child’s symptoms, abilities, the condition being evaluated, and the demands of the activity. Certain activities may be modified, scaled back, or temporarily suspended depending on the child’s response; a different activity is considered on a case-by-case basis.

How can I help my child between physiotherapy sessions?

The physical therapist may suggest activities for you to do between sessions. How often you do them depends on the child’s condition, goals, tolerance, and family routine. Some activities can be turned into playtime to encourage participation. Recommendations regarding positioning, activities, or equipment are tailored to the situation.

At what age can physiotherapy begin?

Physical therapy can begin at birth if necessary. Early screening and treatment of congenital torticollis, for example, often begin in the first few weeks of life. The 2018 practice guideline describes a deformity visible shortly after birth. It recommends referring the child to physical therapy as soon as asymmetries are detected ¹⁵. In a study of 45 infants followed over time, the first evaluation took place on average at 38.6 days of life ⁴⁸. The timing of care should be tailored to the needs of each infant. An evaluation can be conducted as soon as a concern arises. The appropriateness and timing of an intervention depend on the child’s condition and circumstances. Never hesitate to seek medical advice if you have concerns about your child’s motor development, even if they are very young.

What to do if your child needs physiotherapy?

Parents can schedule an appointment for an evaluation, discuss their concerns, and work out a plan with the physical therapist. Persistent pain, difficulty moving, or a lack of progress that concerns you may warrant this step. The urgent signs described above require appropriate medical care first.

The plan is discussed with you and your child based on symptoms, abilities, limitations, and the targeted activities, without guaranteeing a specific outcome.

References

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