A Guide to Understanding Pediatric Physical Therapy

What is pediatric physical therapy?

Pediatric physical therapist work with a variety of children ranging from babies with torticollis or delay, orthopedic sports injuries, and children with delays due to diagnoses such as cerebral palsy and autism. Pediatric PTs help to improve gross motor skills, walking pattern, strength, balance, coordination, and motor planning through a variety of interventions that incorporate functional play.

Pediatric physical therapists focus each session on improving the child’s quality of movement and/or facilitating a gain in gross motor milestones.  These gross motor skills typically follow a pattern such as gaining head control, tolerating prone (tummy) positions, rolling, sitting independently, crawling on stomach, creeping on hands and knees, pulling to stand, standing without support, walking with hand held assist, walking without assist, jumping and running.

Within Kids Place, we not only assess if a child can perform a certain skill, but we assess the quality of movement to make sure that they participate in gross motor skills safely, effectively and efficiently.  Pediatric physical therapists are focused on making sure the child is safe to move around their environment and perform games/sports with the peers.

What is gross motor development?

As new parents, many concerns arise with regards to gross motor movement.  As pediatric physical therapists, we receive many questions from parents regarding their child’s ability to roll, crawl, stand and walk.  The first year of life is such a dynamic time of movement and growth. New parents tend to be concerned with making sure their child is on target for gross motor development.

“Normal” development is a very large continuum, with skills occurring at different times for each individual child.  The continuum allows for a wide variety of ages to meeting skills, which makes determining normal and delayed development difficult to detect for a non-medical professional. The variations in development can be related to the child’s personality, motivation towards movement, experiences with different positions, the amount of tummy time received, head size, muscle tone, etc.

The time at which a child is developing a new skill is not as important as the quality of movement. However, it is much easier to see skill development than assess quality of movement. This is why the medical community has created a gross motor checklist to evaluate motor development. As physical therapists, we take into account both the quality and level of mastery of each gross motor skill.

The following are the averages of meeting gross motor development and the age in which a parent should be concerned:

Skill Normal age range Concerned time period Quality of movement
Rolling 4-6 months 7 months not rolling any direction Rolling should be both direction.
Sitting without assist 6-8 months After 8 months Child should also be able to transition in and out of sit by 8 months and play with a toy without falling
Crawling (on belly or hands and knees) 6-9 months After 10 months Crawling should be seen with both arms and both legs moving either on tummy or hands and knees
Standing (at a stable surface) 7-11 months Child should place weight through feet with support for balance by 6 months Child should be pulling to stand by 11 months and feel stable enough to hold on without loss of balance
Walking 11-13 months After 17 months As long as your child is taking steps with hand held assist and can push a push toy it is okay that they are not walking independently
Jumping 2 years 2.5 years Your child should be able to jump and clear with both feet. If they cannot by 2.5, they may have issues with strength, power, motor planning
Running 2-4 years 4+ A true run is when the child has a moment where both feet are off the ground (flight), with a good arm swing and able to stop and move directions quickly without LOB. If your child cannot do this by age of 4 a referral may be warranted.


Other Red Flags that physical therapy may be required:

  • Torticollis (side bending the neck to one side and difficulty with rotating head to one side
  • Plagiocephaly (flat head)
  • Toe-walking (more than 50% of the time)
  • Frequent Falls for children over 2
  • Gait deviations (limping, tripping over  toes that turn in, inability to place heels down on the ground)
  • Difficulty with ball skills (closing eyes when attempting to catch a playground ball, unable to kick, difficulty with throwing item forward)

Again, the above are averages for meeting milestones. The quality of movement is much more important as meeting the skills.  If you, or your pediatrician, is concerned with development please call Kids Place for an evaluation to determine if your child has a gross motor developmental delay.