Dear Melissa,
I have a student in my preschool classroom who I think would benefit from physical therapy. How do I know when a child needs a PT referral?
As a mama who still has a youngster in preschool, I frequently get pulled aside by preschool teachers or fellow parents to be asked if what a child is doing is “normal."
First of all, any concerns about child development should always be discussed with the child’s pediatrician. In addition, I highly value the opinion of preschool teachers, Sunday School teachers, and any other adult who is both actively involved in the child’s life AND has frequent experience with typically developing children as well.
This blog is actually the conclusion of a 3 part series on “How do I know if my child would benefit from therapy?” If you have questions for speech, refer back to the speech blog. If you have questions for occupational therapy, look back at the OT blog. Over the years, I have found that oftentimes, therapists just know when a child would benefit from therapy, and often these “red flags” don’t necessarily match up with what is on common developmental milestone lists.
When is Physical Therapy needed? For the question of gross motor development, I compiled a list of gross motor developmental milestones from reputable sources located in the resource section listed below. However, the resource lists are long, and some valid concerns seem to not make their way into those developmental milestones lists. Therefore, I interviewed TEAM physical therapists Holly Hill and Wade Cunningham to learn what red flags make them question whether a child might benefit from further, formal gross motor evaluation. Once again, I broke these concerns up into rough stages to help with your scanning needs.
Birth to 2 years:
- An infant who greatly prefers looking to one side or the other, or consistently tilts his/her head to one side (as in the ear of one side generally stays closer to the shoulder of that side)
- Flat head - where the skull does not have a round shape
- Not crawling by 10 months – as an OT, I echo the importance of crawling!
- Preferring to stay in one place once he/she has the skills to be mobile
- Not walking by 15-16 months
- Consistent toe walking
- Consistent “pigeon toe-ing” where the toes point toward each other
- Chronic “W” sitting where the knees face forward and the ankles/feet face backward
- Not jumping with both feet off of the ground at the same time (by 2 years)
- Unable to walk up stairs without holding onto the hand rail at 3 years
- Unalble to walk down the stairs without holding onto the hand rail by 4 years
- Overly fearful of catching a playground ball by 3 years
- Frequent tripping and falling, especially when the child does not “catch himself” with his hands when falling, and frequently bumps his face/head
- Appearing to fatigue more easily than peers
- Appearing weaker than peers
- Collapsed foot arches “flat feet”
- Not able to stand on one foot
- Incoordinated running pattern
- Not able to keep up with peers on playground
Move Forward – A Physical Therapist’s Guide to Developmental Delay, American Physical Therapy Association, Accessed March 2016
Developmental Milestones, CDC, Accessed March 2016
Ages & Stages, American Academy of Pediatrics, Accessed March 2016
About the Author:
Melissa Foster is the leading contributor to Children's Therapy TEAM's Weekly Blog. She is a Pediatric Occupational Therapist with over a decade of experience in the field. An active public advocate in the NWA community, Melissa addresses topics related to Autism, Sensory Processing Disorder and general health and child development.
