If your pediatrician suggests physical therapy for your baby, it’s normal to be worried. You might even think you did something wrong. But babies can need PT for a lot of reasons, including some that happen before they are born.
Physical therapy is gentle for babies. It may seem like a therapist is playing with the baby, but they work toward specific goals. They will also teach you activities and exercises you can do at home to help your baby.
Maure Schuhardt, a specialist in pediatric physical therapy with Banner Physical Therapy, shared more about what to expect from infant physical therapy.
Why your baby might need physical therapy
Babies can need physical therapy to help correct:
- Torticollis (tight neck muscles)
- Favoring one side, or a strong preference for looking in one direction
- Positional plagiocephaly (flat head syndrome or flat spots on the head)
- A developmental delay, like rolling, sitting, crawling or walking later than expected
- Being born prematurely
- Spending time in the NICU
- Low muscle tone or high muscle tone
- Feeding or positioning challenges connected to posture
- Recovery after injury, surgery or a medical condition
What happens at the first infant PT visit?
“The first visit is about getting to know the parents and the babies, figuring out routines that are challenging and learning about the areas of concern,” Schuhardt said.
Here’s what to expect:
- The therapist will ask about pregnancy, birth, medical history, feeding, sleep positioning, tummy time and key infant milestones.
- They will watch how the baby moves during age-appropriate play.
- They may check head shape, neck motion, posture, strength, reflexes and how the baby uses both sides of the body.
- They may look at rolling, reaching, sitting, crawling or standing, depending on age.
- The visit should be gentle and baby-led, when possible.
- Crying can happen because babies get tired, hungry or dislike certain positions but those positions can give the therapist important information about how to help.
What do infant PT sessions look like?
“I try and engage with the babies first so they are comfortable. There is a lot of bonding that happens initially with babies,” Schuhardt said. Parents are usually involved in the session and the therapist explains why each activity helps.
Therapy may look like guided play, with activities on a mat, caregiver’s lap or therapy ball. “It may just look like we play with babies all day but we have specific goals in mind,” Schuhardt said. Those goals support your baby’s motor development, movement, strength, flexibility and coordination.
Sessions may include:
- Stretching
- Strengthening
- Tummy time
- Rolling practice
- Reaching
- Sitting
- Balance
- Crawling skills
The therapist may use toys, mirrors, sounds and positioning to encourage your baby to move. They may teach you how to use purposeful play at home to help your baby progress.
Physical therapy for torticollis or head preference
With torticollis, your baby may tilt their head or turn more easily to one side. This can lead to flat spots on the head.
PT may include gentle stretching, strengthening and positioning strategies. The physical therapist may teach you ways to encourage your baby to look in both directions during feeding, play and diaper changes.
Always place babies on their backs for sleep, even if they have a flat spot or head preference.
How parents can support progress at home
Home practice is often the most important part of infant PT. “The more you do at home, the better outcomes you will have,” Schuhardt said.
Your baby’s therapist may give you short activities to do during your normal routines, like:
- Supervised tummy time while awake while awake
- Changing which side you offer toys
- Encouraging the baby to turn both directions
- Alternating feeding or carrying positions
- Floor play instead of long stretches in seats or swings
- Practicing rolling, reaching or sitting
Activities should be safe, short and realistic. Stop and ask your therapist if an exercise seems painful or confusing.
How long will a baby need physical therapy?
Some babies only need a few visits, while others need therapy for months or longer, especially with complex medical or developmental needs. Schuhardt said she assesses progress toward goals at every visit, with a more formal evaluation at every sixth visit.
As babies make progress, they may only see the physical therapist every other week or once a month. In that case, re-evaluations will happen more often, since babies may be moving toward their goals at home.
Progress may not be perfectly steady. You may notice changes during growth spurts, illness and new milestones.
When to ask your baby’s doctor about PT
“Trust your gut. If something feels off, get it checked,” Schuhardt said.
Ask your pediatrician if your baby:
- Always looks or turns to one side
- Has a noticeable head tilt
- Has a flat spot on the head
- Seems stiff or unusually floppy
- Uses one side much more than the other
- Is not meeting movement milestones
- Has trouble with tummy time
- Has feeding or positioning trouble connected to posture
- Had a NICU stay, injury, surgery or medical condition that affects movement
- Loses skills they previously had
Your pediatrician can help decide whether PT, imaging or a specialist referral might help.
When symptoms need urgent care
Get urgent care for:
- Sudden weakness or loss of movement
- Seizure-like activity
- Trouble breathing
- Poor feeding with dehydration signs
- Fever in a young infant
- A swollen, painful or injured limb
- A baby who is very hard to wake
- Sudden loss of skills
- Signs of pain that do not improve
Bottom line
A recommendation for baby physical therapy does not mean you did anything wrong. There are many reasons a baby may need PT, including how they are positioned before they are born.
Infant PT is gentle, play-based and focused on helping your baby move, grow and meet goals. A therapist can check your baby’s movement, teach you how to do safe activities and show you how to support progress during everyday routines at home.
If you are worried about your baby’s movement, head position or milestones, a Banner Health provider can help evaluate your baby and offer guidance.
FAQs about physical therapy for babies
Is physical therapy for babies painful?
Infant PT should be gentle. Some babies cry because they are tired, hungry or in an unfamiliar position but therapy should not be harsh or forceful.
What is baby PT for?
Baby PT can help with torticollis, flat spots, delayed milestones, muscle tone concerns, prematurity or movement challenges.
Will my baby need to do exercises at home?
Usually, yes. The therapist will show you gentle physical therapy exercises for babies that you can practice during daily routines, such as tummy time, positioning or guided play.
Can PT help with a baby’s flat spot?
PT may help when a flat spot is related to head preference or tight neck muscles. Your pediatrician can also advise whether other treatment is needed.
When should I worry about my baby’s development?
Talk with your pediatrician if your baby misses milestones, uses one side more than the other, seems very stiff or floppy, has a head tilt or loses skills.
