Pediatric Physiotherapy: When Should Your Child See a Therapist?

Children develop at genuinely different rates, and most parents are told — usually correctly — not to worry. The difficulty is knowing which differences are normal variation and which are worth a professional opinion.

The general principle is that the pattern matters more than the timing. A child who is late to walk but progressing steadily is usually fine. A child who has stopped progressing, who has lost a skill they previously had, or who does everything with one side of the body, should be seen regardless of age.

Rough developmental guide

These are averages, and the normal range around each is wide. They are a prompt to ask, not a diagnosis.

• 3–4 months — holds head steady when supported upright; pushes up on forearms during tummy time
• 6 months — rolls both ways; sits with support
• 9 months — sits without support; moves themselves about, by crawling, shuffling or otherwise
• 12 months — pulls to stand and cruises along furniture
• 18 months — walks independently
• 2 years — runs; walks up stairs with help

Signs worth an assessment

Regardless of where your child sits against those averages, these are worth raising:

• A strong preference for one hand before 18 months, or consistently using one side of the body more than the other
• Always turning the head to the same side, or a persistent head tilt — often torticollis, which responds very well to early treatment
• Loss of a skill the child previously had
• Persistent toe walking beyond about age two, particularly if the child cannot get their heels down
• Floppiness, or unusual stiffness, when handled
• Frequent falls, or noticeably more clumsiness than peers, in an older child
• Pain, or a limp, with no clear injury to explain it

What we treat

Common referrals include torticollis and plagiocephaly in infants, delayed motor milestones, cerebral palsy and other neurological conditions, muscular dystrophy, post-fracture and post-surgical rehabilitation, sports injuries in older children, and coordination difficulties that affect participation at school.

What the first visit is like

It largely looks like play. We take a history — pregnancy, birth, milestones, medical background, and what specifically prompted you to come — and then observe your child moving. For younger children the assessment happens on a mat with toys, because a child who is playing shows you what they can actually do, while a child being tested shows you what they will tolerate.

You stay with your child throughout, and you are part of the assessment rather than an observer of it. Nothing hurts. Sessions run 30 to 45 minutes.

You will leave with an explanation of what we found and a small home programme, usually built into things you already do — feeding position, carrying, bath time, floor play. In paediatrics, what happens at home between sessions is the treatment; the appointments exist to set it up and adjust it.

On waiting to see

Early intervention consistently produces better outcomes in children, and many of the conditions we see are far easier to change at four months than at fourteen months. An assessment that concludes your child is developing normally is a good outcome, not a wasted appointment.

If you are unsure, ask. Trusting a parent's sense that something is different is reasonable — parents are usually right that something is going on, even when they cannot name what it is.