--- title: "Pediatric physical therapy: care for children and adolescents" slug: pediatric-physical-therapy-specialty identifier: pediatric-physical-therapy-specialty summary: "Pediatric physical therapy is a specialty that focuses on motor development, growth, and injury treatment in children. Discover age-appropriate approaches and common conditions treated." meta_description: "Pediatric physical therapy: development, growth, injuries in children. Approaches adapted to age and development." meta_title: "Pediatric Physical Therapy | Children and Teens | Physioactive" resume-medecin: "This educational resource presents pediatric physical therapy as a specialty, including developmental milestones, common conditions, and therapeutic approaches tailored to children." author: "andrei-bordeanu" reviewer: "alexis-turcotte" date: 2026-01-19 publish: false collection: "resources" ---

# Pediatric physical therapy: specialized care for children and adolescents

Pediatric physical therapy is a unique specialty that addresses the specific needs of growing children. Unlike physical therapy for adults, this approach must take into account the ongoing growth, developmental milestones, and constant changes in a child's body.

Here's the good news: at Physioactif, our physical therapists 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 physical therapy?

Pediatric physical therapy is a specialized branch of physical therapy that focuses on motor development, body function, and movement in children, adolescents, and young^adults. This specialty requires particular expertise in assessing and treating conditions that affect children as they grow.

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

Main areas of intervention:

- Assessment of gross and fine motor development - Treatment of musculoskeletal conditions related to growth - Management of pediatric sports injuries - Age-appropriate post-traumatic rehabilitation - Improvement of strength, balance, and coordination - Injury prevention in young athletes

Target ages: Pediatric physical therapy is generally intended for children from birth to age 18, although some programs may extend to age 21 for young adults with special needs. Physioactive Context: Our physical therapists treat common pediatric conditions such as sports injuries, growth problems, and torticollis. For complex developmental conditions (such as cerebral palsy or significant motor delays), we refer patients to specialized pediatric programs in hospitals.

How does movement develop in children?

Motor development follows a predictable progression, although the pace may vary from child to child. Understanding these developmental milestones allows for the early identification of potential delays and early intervention.

First year of life (0-12 months):

^- 0-3 months: Gradual control of head, arm, and leg movements - 4-6 months: Ability to roll from back to stomach and^{vice versa} - 6-9 months: Sitting without support, beginning to crawl - 8-10 months: Crawling (generally), although a WHO study found that 4.3% of children will never crawl3 - 9-12 months: Standing with support, beginning to walk with support

Second year (12-24 months):

- 12-15 months: Walking independently (average age) - 15-18 months: Climbing stairs with help, running in a rudimentary way - 18-24 months: Jumping on the spot, 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^tiptoes.

Preschool years (3-5 years):

- Hopping on one foot, 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 athletic skills - Rapid growth (growth spurts)

Adolescence (12-18 years old):

- Complete maturation of motor systems - Gradual closure 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 typical lives.⁵The earlier motor delay is identified, the better the long-term results.

What are the common pediatric conditions treated with physical therapy?

Pediatric physical therapists treat a variety of conditions affecting children's movement and development. Here are the most common ones encountered in general physical therapy practice.

Congenital muscular torticollis

Congenital muscular torticollis manifests as a tilt and rotation of the head caused by a shortening of the^{sternocleidomastoid} muscle. This condition affects approximately 0.3 to 2% of newborns.

Distinguishing features:

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

Physical therapy treatment:

The American Physical Therapy Association's 2024 clinical practice guidelines recommend a^combined approach:

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

Importance of early detection: Research indicates that all infants should be screened for torticollis at birth, and the earlier the child is referred for physical therapy, the younger they will reach their developmental milestones, thus avoiding overall motor delay.⁸.

Toe-walking

Idiopathic toe walking is defined as a persistent gait pattern in which the child walks on the balls of their feet without^{any identifiable} medical cause. It affects approximately 5 to 12% of preschool-aged children.

Features:

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

Therapeutic approaches:

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

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

Conservative treatment:

- Regular stretching of the triceps surae (calf) - Dorsiflexion strengthening exercises - Gait rehabilitation - Parent 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 tuberosity. It occurs in growing children (boys aged 12 to 15, girls aged 8 to 12) with local pain, swelling, and tenderness above the^tibial tuberosity.

Mechanism of the condition:

The condition is caused by irritation of the bone growth plate. While the child is still growing, these areas are made up 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^swelling.

Risk factors:

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

Physiotherapy treatment:

The physical therapy assessment focuses on muscle tension as a possible causal factor, followed by pain management techniques and stretching exercises for the quadriceps and^hamstrings.

Physical therapists help children with Osgood-Schlatter disease reduce pain, increase muscle strength, improve muscle flexibility, restore function and movement, and reduce the risk of^further injury.

Prediction:

Osgood-Schlatter syndrome is self-limiting, and full recovery is usually expected with closure of the^tibial growth plate. 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 overuse injuries of the lower limbs, along with^{Osgood-Schlatter} disease. Sever's disease is a common cause of heel pain in growing children, particularly those who are physically active. It occurs when the growth plate in the heel becomes inflamed due to repetitive stress or^overuse.

Physical therapy treatment:

Physical therapy 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^beneficial.

Complementary approaches:

- Modification of activities during acute phases - Application of ice after activities - Unloading techniques (heel lifts) - Gradual strengthening of calf muscles - Gradual return to sports

To learn more about managing heel and ankle pain in young people, see our guide to 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 issues enables appropriate injury prevention and management.

Growth plates and risk of injury:

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:

- Apophysitis: Inflammation of tendon insertion sites (Osgood-Schlatter, Sever) - Growth plate fractures: Direct trauma or repetitive stress - Osteochondrosis: Disruption of articular cartilage growth - Apophyseal avulsions: Tearing of a bone fragment at the muscle insertion site

Aggravating factors:

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

Growth spurts:

During periods of rapid growth, bones lengthen faster than muscles and tendons can adapt. This creates increased tension at 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 - Diversification of sports activities - Monitoring of overuse symptoms

Role of the physical therapist:

Physical therapists can perform preventive screenings, identify individual risk factors, and develop personalized prevention programs. Educating parents, coaches, and young athletes is also essential. To learn more about our approach to manual therapy tailored to children, check out our comprehensive guide.

To learn more about the specific management of knee pain in young athletes, check out our comprehensive guide to knee pain.

How does the play-based approach work in pediatric physical therapy?

The intentional use of play increases motivation, a critical modulator of neuroplasticity and engagement in^{physical therapy}. Play incorporates crucial learning elements such as motivation, engagement, exploration, repetition, and^variation.

Principles of the play-based approach:

When children are absorbed in play, they are more likely to participate actively, follow instructions, and persevere in the face of^challenges. Intrinsically motivating activities capture children's attention more effectively than structured exercises.

Measurable benefits:

Children engaged in play-based therapy demonstrated a 30% improvement in gross motor skills compared to those receiving traditional therapy^alone. 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^self.

Three uses of games in therapy:

The game 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 goal unrelated to play 3. As a goal: The ability to play becomes the goal of^{the intervention} itself

New motor skills:

New motor skills are learned when we engage children in motivating, play-oriented,^{self-initiated} movement activities.

Examples of therapeutic recreational activities:

- For balance: Musical statues, obstacle courses - For strength: Climbing on play structures, pulling/pushing toys - For coordination: Throwing and catching colored balls, tag games - For fine motor skills: Play dough, crafts, building games

Challenges in implementation:

It is difficult to isolate a child's engagement and motivation, and it is challenging to find ways to work on specific skills when children have difficulty with^play. 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^interest.

Adaptation according to age:

- 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 - Teens (12+ years): Functional activities, specific sports, exercises with clear goals

Parental involvement:

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

When should you consult a physical therapist for your child?

There are several signs that may indicate that a physical therapy consultation would be beneficial for your child.

Signs to watch for in infants (0-12 months):

- Marked preference for one side (always turning head to the same side) - Lack of head control at 4 months - Does not roll over at 6-7 months - Does not sit without support at 9 months - Asymmetry in arm or leg movements - Abnormally high or low muscle tone

Signs to watch for in young children (1-3 years old):

- Not walking at 18 months - Persistent walking on tiptoes after age 2 - Frequent falls or excessive clumsiness - Difficulty climbing stairs at age 2 - Asymmetry in gait or movements

Signs to watch for in school-aged children (4–12 years old):

- Persistent pain in the knees, heels, or other joints - Avoidance of physical activities - Decreased athletic performance - Abnormal posture (rounded shoulders, head thrust forward) - Difficulties with balance or coordination compared to peers

Signs to watch for in adolescents (12-18 years old):

- Growth-related pain that does not improve with rest - Recent sports injury - Recurring pain in the same area - Functional limitation in daily activities or sports

Situations requiring consultation:

- After a traumatic injury (sprain, fracture) - Delay in reaching motor milestones - Diagnosed condition requiring rehabilitation - Injury prevention in young athletes - Persistent growth-related pain - Recommendation from a doctor or pediatrician

What to expect during your first visit:

The initial assessment generally includes:

- Complete history (development, medical history, activities) - Observation of movement and functional abilities - 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 physical therapists adapt their communication and assessments according to the child's age. For young children, assessment is often done by observing play. For adolescents, a more direct discussion of goals and expectations is possible.

What are some frequently asked questions about pediatric physical therapy?

What is the difference between pediatric physical therapy and adult physical therapy?

Pediatric physical therapy takes into account children's ongoing growth, evolving motor development, and unique psychosocial needs. Therapeutic approaches must be tailored to the child's cognitive and motor development level, and parental involvement is essential. Goals also differ, as they often focus on achieving developmental milestones rather than returning to a previous level of function.

Does my child have 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 physical therapist must assess progress and adjust techniques. However, a significant portion of the session is devoted to teaching parents about exercises and positioning to practice at home. For more independent adolescents, it may sometimes be appropriate to meet with the physical therapist without the parent present.

How long do pediatric physical therapy treatments last?

The duration varies considerably depending on the condition. Mild torticollis can resolve in a few weeks with regular stretching, while growth-related conditions such as Osgood-Schlatter disease may require periodic monitoring over several months until the growth plate closes. The physical therapist will establish a treatment plan with measurable goals and regularly reassess progress.

Does physical therapy hurt children?

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

Can my child continue playing sports during physical therapy treatment?

It depends on the condition and its severity. For certain conditions such as Osgood-Schlatter or Sever's disease, a temporary change in activities may be necessary during the acute phases, but rarely a complete stop. The physical therapist will work with your child to find a balance between the rest needed for healing and maintaining an appropriate level of activity. Alternative low-impact activities can often be practiced during rehabilitation.

How can I help my child between physical therapy sessions?

Parental involvement is crucial to the success of treatment. The physical therapist will teach you specific exercises and activities to practice daily at home. Incorporate 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 avoid temporarily, and the use of adaptive equipment if recommended.

At what age can you start physical therapy?

Physical therapy can begin at birth if necessary. Early detection and treatment of congenital torticollis, for example, often begins in the first few weeks of life. The earlier the intervention for motor delay or a specific condition, the better the long-term results tend to be. Never hesitate to consult a professional if you have concerns about your child's motor development, even at a very young age.

What should you do if your child needs physical therapy?

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

Please feel free to schedule an appointment at one of our clinics for a comprehensive evaluation. We will work with you and your child to develop a personalized treatment plan that promotes optimal development and a return to beloved activities.

References

1. Advance Physio. Developmental Milestones: Pediatric Physical Therapist Explains. Accessed January 2026.

2. Advance Physio. Developmental Milestones: Pediatric Physical Therapist Explains. Accessed January 2026.

3. Physio-pedia. Child Development. Accessed January 2026.

4. Spokane CPT. Gross Motor Developmental Milestones. Accessed January 2026.

5. Circle Care for Kids. The Role of Physical Therapy in Child Development. Accessed January 2026.

6. Kaplan SL, Coulter C, Fetters L. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2021;33(4):196-221. PMID: 34753925.

7. Kaplan SL, Coulter C, Fetters L. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline. Pediatr Phys Ther. 2018;30(4):240-290. doi:10.1097/PEP.0000000000000544. PMID: 30277962.

8. Cleveland Clinic. Tackling Torticollis: Consider Early Referral to Physical Therapy. Accessed January 2026.

9. Williams CM, Tinley P, Curtin M. Interventions for idiopathic toe walking. Cochrane Database Syst Rev. 2019;10(10):CD012363. doi:10.1002/14651858.CD012363.pub2. PMID: 31599986.

10. International Journal of Clinical Trials. Conservative therapy and physical therapy in children with toe walking: a systematic review. Accessed January 2026.

11. Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskelet Surg. 2017;101(3):195-200. doi:10.1007/s12306-017-0479-7. PMID: 28593576.

12. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Current Opinion in Pediatrics. 2007;19(1):44-50. doi:10.1097/MOP.0b013e328013dbea. PMID: 17224661.

13. Johns Hopkins Medicine. Osgood-Schlatter Disease. Accessed January 2026.

14. Ladenhauf HN, Seitlinger G, Green DW. Osgood-Schlatter disease: review of literature and physical therapy management. Adolescent Medicine State of the Art Review. 2008;19(2):297-307. PMID: 18802290.

15. Choose PT. Physical Therapy Guide to Osgood-Schlatter Disease. Accessed January 2026.

16. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Current Opinion in Pediatrics. 2007;19(1):44-50.

17. Haleem AEM, Deneke MB. Osgood-Schlatter and Sever Diseases. Pediatrics in Review. 2024;45(7):422-423. doi:10.1542/pir.2023-006213.

18. Hollyburn Physio. Navigating Adolescent Growth Conditions: Sever's & Osgood-Schlatter. Accessed January 2026.

19. Hollyburn Physio. Navigating Adolescent Growth Conditions: Sever's & Osgood-Schlatter. Accessed January 2026.

20. Whyatt C, Craig C. Embedding Play to Enrich Physical Therapy. Pediatr Phys Ther. 2023;35(3):239-246. doi:10.1097/PEP.0000000000001031. PMID: 37314422.

21. McCready M, Daharsh L, Murphy R, Lowe JR, Nelson AM, Campbell SK. Learning to play to learn in pediatric physical therapy. Front Psychol. 2024;15:1467323. doi:10.3389/fpsyg.2024.1467323. PMID: 39758153.

22. EJ Therapy. The Power of Play: Incorporating Play-Based Interventions in Pediatric Physical Therapy. Accessed January 2026.

23. EJ Therapy. The Power of Play: Incorporating Play-Based Interventions in Pediatric Physical Therapy. Accessed January 2026.

24. Whyatt C, Craig C. Embedding Play to Enrich Physical Therapy. Pediatr Phys Ther. 2023;35(3):239-246.

25. Physio-pedia. Therapeutic Play. Accessed January 2026.

26. McCready M, Daharsh L, Murphy R, Lowe JR, Nelson AM, Campbell SK. Learning to play to learn in pediatric physical therapy. Front Psychol. 2024;15:1467323. PMID: 39758153.

27. McCready M, Daharsh L, Murphy R, Lowe JR, Nelson AM, Campbell SK. Learning to play to learn in pediatric physical therapy. Front Psychol. 2024;15:1467323.

28. McCready M, Daharsh L, Murphy R, Lowe JR, Nelson AM, Campbell SK. Learning to play to learn in pediatric physical therapy. Front Psychol. 2024;15:1467323.