What Caregivers Should Know About Pediatric Physical Therapy

Pediatric physical therapists are movement experts spanning development from infant to adulthood, but how do parents know if physical therapy can help their child?

There are many reasons why a child may need to see a physical therapist, but the most common settings include early intervention to promote development, school-based therapy, in-patient services in a hospital or rehabilitation center, and outpatient services in a home.

“Often, we see children who have been given a medical diagnosis known to present challenges in overall development, specifically gross motor skills, and have been referred to a pediatric physical therapist,” says Tawna Wilkinson, program director for Tufts University School of Medicine’s Doctor of Physical Therapy program in Phoenix, Arizona. “Or, a child may not have a diagnosis, but the parents are concerned that development may not be typical, so they'll come to us for screenings.”

Pediatric physical therapists participate in interdisciplinary teams, collaborating with pediatricians, other health care providers, and families, to provide family-centered care. In many cases, health insurance allows individuals to go to a physical therapist without a referral from their primary care physician.

If physical therapy is new territory for a family, they may not know what to expect from appointments, home exercises, or the setting of goals. Three pediatric physical therapists from the Doctor of Physical Therapy (DPT) Programs at Tufts University School of Medicine shared with Tufts Now the things they most want parents, caregivers, and children to know.

1. Physical therapists are movement experts, but parents are experts on their kids.

“Caregivers and parents have an intimate understanding of their child’s development, and physical therapists take seriously the concerns that people caring for children have,” says Jennifer Parent-Nichols, clinical associate professor, associate program director, and director of student affairs in the DPT-Boston program. “A simple screening or conversation with a pediatric physical therapist may be helpful to understand if there's reason to be concerned.”

Early intervention from birth to age 3 has the greatest impact to help correct movement that could be refined or more efficient for the child, Parent-Nichols says, and waiting longer could make recovery more challenging.

“Kids are motivated to move,” says Parent-Nichols. “If we wait to intervene, kids will find a way to move that may interfere with future movement, because they want to explore their environment. Exploring their environment is how they learn.”

In the DPT program, students learn that pediatric physical therapy is family-centered care and an example of a therapeutic alliance, which means listening to parents or guardians (and the child, if they’re old enough to participate) and other caregivers to understand what the challenges are and what success looks like for them. Families are typically present during pediatric PT appointments, which helps them understand the homework or care assignments that a child receives. They are encouraged to be hands-on and mimic what the physical therapist does to try it out and understand what works best.

“We aim to create a significant partnership between physical therapists, families, and children,” says Parent-Nichols. “I could be the best therapist in the whole world, but the few times I see a patient each week isn’t what makes the difference. It’s what happens between those appointments with the family interacting with their child that makes the difference.”

2. With young children, PT sessions look like play, but they are goal oriented.

“The pure joyfulness that comes from being a pediatric physical therapist is the creativity and avenues you can take in order to make it play while still focusing on and harnessing goal-oriented behaviors,” says Wilkinson.

Pediatric physical therapists spend a lot of time thinking about the setup of the physical therapy environment, such as how to keep children engaged, what toys to use, and how to pivot if something isn’t working—something Wilkinson says is both a challenge and an art form.

“We have to develop a sense of how much we can encourage and push a child before we lose their engagement in the session, which can be different week to week with the same child,” Wilkinson says.

Parent-Nichols says it can be hard to prepare for such unpredictability, and that’s why she talks to her students about flexibility and preparing not only plan B but also plans C, D, and E. It’s their responsibility as therapists to meet a child where they are, even if that changes within or between sessions.

Goal writing is a big focus for DPT students. Goals for a patient should be understandable, meaningful, and relatable to everyone at the table. Therapists understand that families have busy lives and therapy needs to fit into that as seamlessly as possible, the Tufts experts agree. They try to leverage what’s already happening in a patient’s day so that therapy feels like a natural occurrence rather than another thing to do.

“We develop strategies with the students around motivational interviewing, which is trying to understand where a person is and what a person needs and how the therapist can be helpful in taking the next step forward,” says Parent-Nichols. “We consistently question ourselves, ‘Am I getting what I want from each intervention?’ And if not, we need to adjust what we’re doing.”

3. Pediatric physical therapists are part of school communities.

Physical therapy at school typically falls under the umbrella of an Individualized Education Program, or IEP, which are created collaboratively by educators and parents. Children with disabilities and special needs can qualify to receive school-based services, such as physical therapy, which are provided by the school district.

“School is being with your peers, learning, having fun, and participating. These services level the playing field,” says Amy Schlessman, assistant professor for the DPT-Phoenix program, who has focused her career on school-based physical therapy. “My goal is to make sure children can play and learn with their friends, and determine what adaptations need to be made in their environment for that to happen.”

For instance, perhaps a child has trouble sitting upright, which prevents them from participating in their educational environment. That child’s IEP may include physical therapy goals that aim to help them achieve their educational goals.

Physical therapists also are proponents of movement for all students, Schlessman says, and they often advocate for physical activity to be embedded in the school day, citing an ever-growing body of research that shows benefits for health and academic aptitude.

“We can combine movement with the academic curriculum,” she says. “For example, in math, roll two dice and have students do addition, subtraction, or multiplication to come up with an answer and do an action that number of times. For language arts, ‘Everybody Wins Musical Chairs’ is great. Give every child a word and write the definitions on cards. When the music stops, the kids have to find the chair with the word’s definition and sit in the seat.”

4. Treating children also means treating the family.

Development is an overlay that doesn’t exist for adults, explains Parent-Nichols. Pediatric physical therapists must understand not only gross motor development, but also cognitive and social emotional development from childhood to adulthood.

As children grow and mature, therapy sessions tend to change in different ways. There may not be as much play, there may be more verbal instructions, and there may be more choices.

“I enjoy giving choices, which allow the child and the parents to maintain some control when they otherwise might feel they have none,” says Wilkinson. “Especially if families are navigating a new norm, such as an incident that caused a dramatic change in their child's development.”

Another overlay that pediatric physical therapists encounter with patients is grief.

“When a child isn’t developing in the way a family was expecting, there’s a level of grief that comes with that,” says Parent-Nichols. “Parents may think their baby's life is going to be certain way, but instead, they’re dealing with significant challenges. It's not just about providing therapy to the child, but also providing support to the family.”

5. They advocate for children and help parents do the same.

For some families, collaboration with a physical therapist can be a lifelong partnership in which the therapist helps families advocate for what their child needs and for who they want to be.

“That's incredibly important, because sometimes children and families feel like they have no voice. They have so many things done to them and told to them,” says Parent-Nichols. “It can be empowering for parents and eventually the children to say, ‘I have a choice in this. Here's what I need, and here's how we're going to go about it.’”

“Advocacy goes hand in hand with empowering families,” says Wilkinson, who spent much of her career in hospital-based and home health-based environments. “There’s a lot to navigate but directing them to available resources can help. I've even attended a physician appointment with a family to demonstrate a higher level of advocacy that could be built upon by the family.”