Licensed Physical Therapist FAQs

As a child, my sister had her legs broken and straightened. My toddler’s legs are bowed. Does this mean he will need the same thing or would physical therapy help?

A certain amount of bowing in the lower legs in children is normal when they’re learning to walk. Many children have bowed legs because of the positioning in utero.  As the child develops better muscles in their legs and becomes more competent in standing and walking, their legs straighten out. If your child’s legs don’t straighten out even after toddlerhood, you may want to consult with a pediatric orthopedic doctor especially when the following issues are present:

  • Awkward walking pattern (i.e. not direct or forward).There may be either in-toeing or out-toeing. The feet may point inward instead of pointing straight while walking or running or the feet may curve outward instead of pointing straight.
  • Lack of coordination in movement
  • Pain or discomfort

It is important to remember that most young children will outgrow the condition. Thank you for your question.

What should I do to encourage babies to crawl?

The following is a list of things you can try to help babies learn to crawl:

  1. Make sure the baby gets plenty of tummy time
  2. Place toys out of reach or to the sides so baby can pivot while on tummy to reach for toys
  3. Help the baby to kneel with hands forward on a Boppy pillow or other low firm raised surface
  4. Place the baby tummy down over your legs as you sit on the floor. You can place toys that the baby can reach for but the most important part is to get the baby to place weight on extended arms.
  5. Help the baby to do pushups by giving baby a lift under ribs while baby is tummy down making sure to let baby keep arms extended, pushing against the floor
  6. Put the baby on all fours with your support and help the baby rock back and forth.

Below is a good YouTube video that will give you a visual of these activities. Have fun with these activities while watching the babies develop these skills! 

My 12-month old is not walking or pulling up to stand, should I be worried?

The window for walking is typically between 12 and 16 months. Walking can happen for some children earlier and some a little later. If your baby is not walking by 18 months, you should consult with your pediatrician. Your twelve month old baby should able to support his/her weight when you place the baby on his/her feet. Can you baby stand holding your hands? This would be a good activity to practice. You should also offer your baby opportunities to pull to standing holding your hands. When your baby is standing with your help, you can try to get the baby to take steps holding your hands. Offer your baby a push toy to hold onto and with your help push while taking steps. These activities will help your baby develop independent walking. Have fun playing these games with your baby.

My baby’s head is not round, and the grandparents recommend rubbing down the misshapen areas daily. Is this something that physical therapy can help?

It sounds like your baby has plagiocephaly or a flat shape of the head. This is something a pediatrician needs to diagnose. Here is some information about plagiocephaly and what you can do to help your baby’s head reshape.

Babies’ heads are soft and malleable and even gentle external forces, whether met in the womb or in baby’s daily routine, can cause misshaping. The good news is, babies with plagiocephaly typically respond very well to noninvasive treatments, such as repositioning techniques, which parents can practice at home.

Back-Sleeping

The relationship between back-sleeping and plagiocephaly in infants is well-documented. While the American Academy of Pediatrics still recommends back-sleeping to prevent Sudden Infant Death Syndrome, they also recommend frequent rotation of baby’s head when they are on their back, as well as supervised tummy time. The baby will need to have a least 60 minutes total each day of tummy time in order to reshape the head.

Carriers & Convenience Devices

While in car seats, bouncy seats and swings, baby’s soft head is often placed against a rigid, unyielding surface. Though normal use is not a concern, extended use—and allowing an infant to sleep in such devices, in particular—increases the risk of plagiocephaly. This includes the rocking device known as a mamaroo.

How Can I Prevent or Correct Flat Spots?

Simple at-home practices, including supervised tummy time and repositioning techniques, are known to effectively prevent and improve abnormal head shapes. In addition to tummy time, placing the baby on his or her side to play for 15 minute intervals is another way to help. Make sure you switch sides the next time you use this position. When your baby learns to sit and move this will also help reduce pressure on the head where the flat spot might be. Lastly, as mentioned above, do not let your baby sleep in car seats or other carrier/convenience devices. Car seats should only be used for travel and the baby should be removed from the seat when not in the car.

Rubbing the baby’s head may be enjoyable for you, the grandparents and the baby but, unfortunately, it will not help reshape the baby’s head.

Our toddler fell and broke her arm near a growth plate at 30 months. Will she need physical therapy?

Treatment depends on which bone is broken and the pattern of the injury. If your child was or is in a cast, it will also depend on what joints are casted. The length of time the cast is worn will vary depending on the severity of the fracture. A stable fracture may require 3 to 4 weeks in a cast. A more serious injury may need to be immobilized for 6 to 10 weeks. When the cast is removed, the wrist and elbow joints may be stiff for 2 to 3 weeks. Young children are very resilient and tend to recover much more quickly than adults. This stiffness will go away on its own, usually without the need for physical therapy. Your orthopedic doctor will determine what steps need to be taken when the cast is removed. 

Our daughter is 16 months. She leans a little to the left and uses her left hand when reaching for things. Is this a problem or will she be a “leftie”?

If your daughter has been walking for a few months, she should look pretty even on both sides when she takes steps or stands still. When sitting, she should be centered without leaning to one side or the other. Hand preference is generally not established until about 2 years of age and is usually well established by age 5. You can encourage your baby to use both hands during play by offering her toys on her right side.  This can also be done with food or snacks. In terms of the leaning when standing, you have noted, you can play games where she needs to take steps on her right leg to get toys, climbing up steps with the right leg leading, or marching games having her stomp around.   I have included some areas for you to consider at below. If they apply to your daughter, you should have a discussion with your pediatrician: 

  • Favoring one hand, leaving the other hand in a fist or reaching across their body to grab objects, or not bringing both hands together during play
  • Delays in early motor milestones – rolling, sitting, pulling to stand, crawling, and walking
  • Stiffness or weakness in muscles on one side of the body
  • Difficulty with the early development of walking and balance
  • Asymmetrical movement and posture
My child walks on tip toes and falls a lot when playing. Is this normal?

Toe walking isn’t something to be concerned about for most children under the age of two. More than half of young children who toe walk will stop doing so on their own by about age 5. Most children toe walk occasionally when they’re cruising around a room (holding on to furniture), especially if they’re on a bare floor. Some kids keep toe walking, off and on, just for fun. If your child is developing in all areas like other children, toe walking is usually nothing to worry about.  You could try sneakers or shoes to see if that makes a difference.

In terms of falling, that would be one of the reasons to check in with the pediatrician when combined with toe walking. However, at certain ages when children are developing higher level gross motor skills like running, jumping and climbing they do fall more frequently. For instance the average two year old falls 38 times per day.

You should consult with your pediatrician in the following cases:

  • Walks on toes most of the time
  • Has stiff muscles
  • Seems uncoordinated
  • Walks awkwardly and stumbles all the time
  • When fine motor skills do not seem to be developing normally
  • If the child can’t bear weight on a flat foot
  • Loses motor skills already developed
  • Has other medical problems
  • Has a family history of muscular dystrophy or autism
  • Was born prematurely
  • Has previously walked flat-footed and only recently began to toe walk
Hi! I’m the Head of School in a program in Charlottesville. I have an 18 month old child with pigeon toed feet. Mom said her doctor told her she would grow out of it. But they’re so severe that I’m concerned. An infant and toddler specialist is also concerned. Is there a person I can have Mom call for a second opinion? Thanks.

Thank you for your inquiry. I can understand how concerned you might be about the child in your program that is in-toeing (pigeon toe). What I would suggest first is that the pediatrician may be right to tell the parent to wait as the vast majority of children that in-toe do outgrow it as they grow and their legs below their knees tend to become straighter. One question I would ask is does the child seem clumsy or does the child stumble frequently? That would be a concern that you could approach the parent with and possibly suggest a visit to a pediatric orthopedist. An orthopedist can make a better evaluation of the source of the in-toeing and if a specific treatment is necessary.

In-toeing can be developmental due to the natural bowing of the infant lower leg before he or she learns to walk. It can also be the result of other orthopedic issues that may require some form of medical intervention whether it is shoes, orthotics or simple stretching activities. Keep in mind doctors rarely treat pigeon-toed feet because it may just be something the child will outgrow. Special shoes and braces commonly used in the past were never proved to speed up the natural slow improvement of this condition. In-toeing usually doesn’t interfere with walking, running, or sports, and ends on its own as kids grow into teens and develop better muscle control and coordination.

I hope this answers your question. Please do not hesitate to let us know if you have any other questions.

Warmest Regards, Marion J. Addis, PT

My daughter has plagiocephaly and is being treated with a DOC band. We were never diagnosed with Tortocollis by our pediatrician. We just finished our first DOC band and didn’t see good results so we are getting a second one. Do you think PT will help? She didn’t roll until 7 months and isn’t walking yet at 14 months. Can you please show us PT exercises and work with us to help her?

It sounds like you are not sure if your daughter has torticollis. Perhaps the orthotist that worked with you for the DOC Band mentioned it. In any case I would look for a pediatric physical therapist in your location that can assess for torticollis which is a head tilt toward one side usually due to tightness in muscles on that side but may also be contributed too by weaker muscles on the other side of the neck. Since the stretching/strengthening program is dependent on which of these factors are contributing you will need to have at least one visit with a physical therapist to make that determination. Once you have done that the therapist will give you a home exercise program that is tailored to your baby’s needs.

Fourteen months may or may not be a delay for walking depending on whether your baby is standing without supports, walking with one hand held, stepping sideways holding onto furniture, smoothly lowering to the floor through squatting and trying to take a step or two on her own. Again a pediatric physical therapist can help you strategize how to get her to move in that direction.

As for the DOC Band, it is a proven Plagiocephaly treatment for babies ages 3 to 18 months of age. Because the DOC Band relies on natural brain growth—which is rapid during the first 6 months of life, steady from 6 to 18 months, then slows through 24 months of age—starting treatment early has been shown to reduce overall treatment time. How long treatment lasts will depend on your baby’s age and the severity of your baby’s condition. Starting treatment between the ages of 4 and 6 months, a period of rapid head growth, has been shown to reduce overall treatment time, though noticeable improvement can be achieved using the band between 3 and 18 months of age. Most treatment times are between 5 weeks and 4 months. Although I have seen babies who need to be in the band longer and also have good end results. I hope this is helpful to you and good luck to your and your little one.

Marion Addis,  PT

My son was born prematurely. Should I still use the developmental milestones chart that was in my new parent information packet?

That’s a good question – most people look at development based on the child’s actual age, but you need to consider what’s known as your child’s adjusted (or corrected) age until they are 18 months old.  By that time, most children have caught up with their development.  The easiest way to figure this out is to just think about how old they would be from their due date – that would be their adjusted age.  Health professionals such as pediatricians, therapists, and educators have a more precise way to figure this out, but this easy way should work just fine.  Remember that keeping your child’s adjusted age in mind when thinking about milestones such as rolling over, sitting up, first words, and even starting baby foods can make a big difference in how well they do!

Do all children crawl before they walk?

Most children go through a phase of crawling, either on their stomachs (known as army crawling) or on their hands and knees prior to pulling up to standing and walking.  Some children even do both!  Either one is fine, but crawling is a necessary step that is vital to strengthening the trunk, arms, and hips prior to walking and later developmental tasks.  Research has shown that children who do not crawl miss out on the stability needed in their arms for later tasks such as writing and other fine motor tasks.

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This project was supported by the Virginia Department of Education (VDOE) Grant #93.575, with funds made available to Virginia from the U.S. Department of Health and Human Services. Points of view or opinions contained within this document are those of the author and do not necessarily represent the official position or policies of VDOE or the U.S. Department of Health and Human Services.