Common questions about physiotherapy for children

The age varies a lot: some children walk at nine months, and most walk on their own at around eleven to fifteen months. Some are a little later without any problem, especially bottom-shufflers, and late walking can run in families. But if your child is not walking on their own by eighteen months, see a paediatrician, using the corrected age for a baby born early. See a doctor sooner if your child seems very floppy or stiff, always walks on tiptoe, uses one side of the body more than the other, or loses a skill they already had.

Source: Patient.info — Delay in walking (Tidy C, 2023) · Health for Under 5s (NHS-funded) — Learning to walk

Most often it is simply a normal difference in the pace of development, but it can be linked to being born early, very flexible joints or low muscle tone, a hip problem, rickets from a lack of vitamin D, or a nerve or muscle condition. Iron deficiency in early childhood can also affect development, so the doctor may test for it; do not give iron without medical advice. Treatment therefore starts with a paediatrician's check and then depends on the cause; a paediatric physiotherapist can help with play-based practice of standing, balance and stepping. Baby walkers do not help children learn to walk and can cause accidents.

Source: Patient.info — Delay in walking (Tidy C, 2023) · Baker RD, Greer FR (2010). Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics 126(5):1040–1050

There is currently no treatment that removes it, but there are treatments that help a child to be as active and independent as possible. Cerebral palsy is a group of lifelong conditions affecting movement and coordination, caused by a problem in the brain before, during or shortly after birth. It is not a worsening brain atrophy: the brain problem does not get worse over time, although the strain on the body can cause joint problems later. Care includes physiotherapy with exercise and stretching, occupational therapy and speech therapy, and medicines or surgery decided by specialist doctors. Severity varies widely, and many people with cerebral palsy lead independent lives.

Source: NHS — Cerebral palsy

Usually not. Most young children have flat feet, and the inner arch usually develops between the ages of three and ten. If flat feet are not painful and do not affect walking, they need no treatment and should not stop sport, and special shoes do not change the shape of the foot; comfortable, wide shoes and normal activity are usually enough. See a doctor if the feet are painful, stiff or weak, your child keeps spraining an ankle, has problems with walking or balance, or only one foot is flat. At Revibe we examine the foot and the way your child walks when there is pain.

Read more: Children's physiotherapy · Source: NHS — Flat feet

In most cases a rounded back in children and teenagers is postural, the most common type, and linked to sitting and standing habits. Physiotherapy can help improve posture and ease back pain and stiffness, and strengthening the tummy and back muscles helps; at Revibe we start with an assessment with a parent present. Shop-bought posture braces are not among the recommended treatments; a medical brace is used only for certain structural types, under an orthopaedic specialist. In a baby, show any curve that worries you to the paediatrician. See a doctor if the curve does not straighten when your child stands tall, is getting worse, or comes with persistent pain or breathing difficulty.

Read more: Posture and stretching, Children's physiotherapy · Source: NHS — Kyphosis

Look for uneven shoulders, ribs or a shoulder blade sticking out on one side, or the body leaning to one side, especially when your child bends forward. If you notice these, see a doctor, as the size of the curve is measured on an X-ray. Treatment depends on the size of the curve and how much growing is left: monitoring may be enough, a back brace may be used until growth stops, and sometimes surgery is needed; the orthopaedic doctor decides. It is not clear whether specific back exercises or physiotherapy correct the curve, but regular exercise is important: it builds muscle strength and may ease back pain, and a physiotherapist can guide it alongside the doctor's plan.

Read more: Scoliosis · Source: NHS — Scoliosis · NHS — Scoliosis: treatment in children

Most often it is a muscle strain after sleeping in an awkward position, and it usually settles quickly with gentle movement and warmth. In a baby, a head that always tilts to one side may be caused by a tight neck muscle (congenital torticollis): show your baby to the paediatrician, who can rule out other causes and refer you early to a paediatric physiotherapist, who teaches parents stretches and positioning. But a stiff neck with a fever, a severe headache, a rash that does not fade when pressed, unusual sleepiness or dislike of bright light may be meningitis: go to the emergency department straight away or call an ambulance (911 in Jordan or 122 in Iraq and Kurdistan).

Read more: Neck pain · Source: NHS — Meningitis · Sargent B et al. (2024). Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther 36(4):370–421

It can be, so it should not be ignored. Swollen, painful joints lasting more than six weeks may be a type of juvenile arthritis, which a paediatrician and a rheumatologist follow, with physiotherapy supporting movement. Aching in both legs in the evening or at night that is gone by morning, with no limp or swelling, is usually harmless growing pains. See a doctor if the pain is in one leg or one joint, or comes with a limp, swelling, a rash, bruising, weight loss or unusual tiredness. Go to the emergency department straight away (911 in Jordan or 122 in Iraq and Kurdistan) if your child limps and has a fever or seems unwell, or cannot stand on the leg.

Read more: Children's physiotherapy · Source: NHS — Limping in children · NHS — Growing pains

Take your child to a doctor or the emergency department straight away, and do not try to put it back yourself. In young children, a dislocation after being pulled or lifted by the hand or arm is usually at the elbow: the child cries and lets the arm hang without using it. A doctor or nurse can usually put it back quickly, it does not usually cause lasting damage, and the longer it is left the harder it is to fix. Visible deformity or severe pain after a fall needs the emergency department or an ambulance straight away (911 in Jordan or 122 in Iraq and Kurdistan). To prevent it, lift children under the armpits, not by the hands or wrists.

Read more: Children's physiotherapy · Source: The Royal Children's Hospital Melbourne — Pulled elbow (Kids Health Info) · NHS — Joint pain

Most mild sprains get better at home: in the first days protect the ankle and limit walking on it, apply a cold pack wrapped in a cloth for short periods and raise the foot on a pillow, then let your child move it gently as the pain eases. Most feel better within about two weeks; hold off running and hard sport until the ankle is strong again. Graded balance and strengthening exercises help restore ankle stability and a safe return to sport. But if your child cannot stand on it or walk a few steps, you heard a crack, or the ankle has changed shape or colour, go to the emergency department, as an X-ray may be needed.

Read more: Ankle sprain, Sports injuries · Source: NHS — Sprains and strains · Vuurberg G et al. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 52(15):956