The day-to-day challenges faced by your child. My child is having difficulty with _______. What could be causing this and how can an PT help?

The day-to-day challenges faced by your child. My child is having difficulty walking by themselves. What could be causing this and how can a PT help? First, it is important to remember that every child is different and normal development of gross motor milestones has a range of when it typically begins. The average age for a child to begin walking by themselves is between the ages of 11-15 months. However, some can walk as early as 8-months and some as late as 18 months. If they are not yet walking by 18 months you should inform your pediatrician.

Some reasons for delays in walking could be decreased range of motion, decreased strength, decreased balance, poor motor coordination, an underlying condition, or simply lacking opportunities to practice. A pediatric physical therapist can perform a thorough evaluation to determine what areas your child may need to improve and address them specifically through skilled PT interventions. A pediatric physical therapist will also work in developing a home program for you to assist in carryover outside of the sessions.

The day-to-day challenges faced by your child. My child is having difficulty with walking off of their tip toes. What could be causing this and how can a PT help? Toe walking is when a child ambulates on their toes without heel contact. Toe walking can be due to a variety of causes and can differ from kid to kid. Some causes for toe walking are: decreased range of motion, decreased strength, decreased postural control, sensory concerns, neurological concerns, an underlying diagnosis, retained primitive reflexes, and poor oculomotor function. If your child is toe walking, bring this up with your pediatrician and get them into physical therapy. Sometimes you may hear your kid will grow out of it, but this is not always the case. It is beneficial to see a pediatric physical therapist sooner than later. Your pediatric physical therapist will perform a thorough medical history and examination to best determine what cause(s) are contributing to toe walking.

The day-to-day challenges faced by your child. My child is having difficulty with performing some of the same skills her sibling could at this age (sitting independently, rolling, crawling). What could be causing this and how can a PT help?

Development of gross motor milestones occur in a range and one child should not be compared to another. If you have any concerns, first address this with you pediatrician. You can ask for a physical therapy referral which can help determine if there are any underlying causes. Some different causes for delay in milestones are decreased motivation, decreased opportunities to practice skills, decreased strength, decreased coordination, or an underlying diagnosis. Pediatric physical therapists can perform standardized tests to help determine if your child really is delayed compared to same-aged peers. They will then perform skilled interventions to address any underlying impairments and work with you to educate and train to ensure carryover outside of sessions.

The day-to-day challenges faced by your child. My child is having difficulty with recovering from a broken leg that was casted. What could be causing this and how can a PT help? When you are immobilized by a cast, your muscles become weak and/or tight. A physical therapist can help address these impairments and educate you on exercises to perform outside of therapy sessions to ensure carryover. Sometimes, children may become fearful their leg will break again or they will feel the pain experienced at the time of the injury. When this occurs, they may favor their “good” leg. This can cause asymmetries in strength, balance, and gross motor coordination. This can then affect their walking pattern, participation with peers, and just overall being a kid. Your pediatric physical therapist can help instill confidence with skilled interventions focused on the deficits identified via a thorough evaluation to help return to their prior level of function.

The day-to-day challenges faced by your child. My child is having difficulty keeping up with their peers and often doesn’t want to participate. What could be causing this and how can a PT help? If you are having concerns your child is not able to keep up with their peers, it is important to discuss this with your pediatrician. You can ask for a physical therapy referral. A pediatric physical therapist can perform standardized testing to determine if your child is developmentally behind their same-aged peers. Different causes may be: child not interested in activity, decreased strength, decreased endurance, decreased balance/stability, or decreased coordination. Your pediatric physical therapist will base interventions off the areas of concern in the standardized testing. They will also work with you to develop a home exercise program to help reach their goals.

The day-to-day challenges faced by your child. My child is having difficulty with tripping and falling frequently. What could be causing this and how can a PT help? 

Tripping and falling is normal in the process when learning to walk. A study by Adolph et al1, found children will fall about 17 times an hour when they are in the learning process of walking. As children grow, this number should start to decrease. If you feel your child is still tripping and falling more than normal, speak with your pediatrician and ask for a pediatric physical therapy referral. Some reasons a child may be tripping and falling are decreased strength, decreased balance/stability, decreased coordination, abnormal lower extremity alignment, decreased range of motion, decreased body awareness, and/or decreased proprioception. A pediatric physical therapist will perform a thorough evaluation to determine causes of frequent tripping and falling. Interventions will then be implemented to help your child be safer in their environment.
1. Adolph KE, Cole WG, Komati M, et al. How Do You Learn to Walk? Thousands of Steps and Dozens of Falls Per Day. Psychological Science. 2012; 23(11): 1387-1394. doi: 10.1177/0956797612446346