You suspect your child needs physical therapy…...what next?

By: Nina Berault PT, DPT 

        We have all played the comparison game. Little Susie walked at 10 months- why is my son still crawling at 14 months? My niece is unable to roll over, but my nephew was sitting independently at her age. To add fuel to the fire, it is enticing to google search or scroll through social media to discover what's "typical" in childhood development. Consider the following prior to sounding the alarm. 

1. Has your child had a recent check-up with the pediatrician? If yes, did he/she/they examine motor skills, reflexes and/or muscle tone? If you are unsure, sending a quick email through the patient portal might be to your benefit, making sure the provider speaks to these areas. See the list of skills below for specific areas of concern. 
2. Prior to scheduling a pediatrician appointment, do some research on your physical therapy insurance benefits. Many plans will allow direct access care (without a prescription from your child’s physician) for a finite period of time. If this is the case, call your local physical therapy providers to discuss your concerns and inquire about an evaluation. 
3. Minor discrepancies exist between pediatricians and physical therapists in regards to what warrants immediate intervention. However, if you use the list below as a guide to discuss your concerns, most pediatricians will not hesitate to give a physical therapy referral. 
4. Expect to be moderately-heavily involved in physical therapy once it begins! Your pediatrician and physical therapist will encourage you to facilitate completion of your child’s therapeutic exercise program.
5. Don’t panic. Seeking knowledge to guide your child through their development means you are already on the right path!

SKILLS THAT SHOULD BE OBSERVED...

Birth to 3 months

1. Forearm weight-bearing while laying on belly 
2. Cervical extension (lifting head) ~45 degrees
3. Turning head to clear airway 
4.  Phasic arm batting and kicking in supine 
5. Hands to mouth
6. Reflexive walking (when held up)

4-6 months 

1. ATNR disappears
2. Head righting skills when turned horizontally 
3. Rolling skills back <---> belly 
4. Independent sitting, toys usually held at midline 
5. Prone on extended elbows
6. Hands to midline, then knees, then feet 
7. Feet to mouth 

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7-9 months 

1. Creeping on hands and knees
2. Pull to kneel at support surface
3. Reaching outside of base of support in sitting when playing with toys 
4. Protective reactions- upper extremity extension

10-12 months 

1. Pulls to stand through half kneel 
2. Unsupported standing 
3. Cruising
4. Independent walking EMERGING 

13-24 months 

1. Walking 
2. Ball skills- throwing, kicking, catching 
   1. Increase in height and distance with above skills as we age
3. Begins creeping up the stairs, then walking with assistance 

25-36 months

1. Jumping- up, forward, and down 
2. Single leg balance for several seconds

36-48 months 

1. Running with mature pattern
2. Skipping

 WALKING ABNORMALITIES

1. Toe-walking
2. Pigeon-toe (feet facing inward)
3. Wide base of support 

 GENERAL WARNING SIGNS 

1. Child avoids transitioning between postures- plays in position for long durations 
2. Changes in muscle tone, and/or sudden increase or decrease in joint flexibility
3. “W” sitting
4. Using upper extremities for floor to stand transitions 
5. Low tolerance to physical activities 
6. Asymmetries in gross motor skills
   1. Ex: only leads with R leg up/down the stairs, only swings one arm in walking/running