When Should My Child See a Pediatric Physical Therapist? Signs Parents Often Miss

Parent Education, Physical Therapy

The Signs Most Parents Already Know to Watch For

Missed or significantly delayed gross motor milestones are the most commonly recognized reason to seek a physical therapy evaluation, and for good reason. Limited head control by 3 months, difficulty rolling over or sitting with support by 6 months, an inability to sit independently or bear weight on the legs by 8 to 10 months, and not walking independently by around 18 months are all considered meaningful red flags worth raising with your pediatrician¹. These milestone-based signs are well documented and widely discussed, which is exactly why they tend to get caught. The subtler signs below are the ones that more often slip past unnoticed.

Keep an eye out for patterns like these:

• Consistently sitting in a W position rather than other floor-sitting postures
• Frequent tripping or falling well past the toddler years
• Favoring one side of the body, or a persistent limp
• Avoiding activities like jumping, climbing, or running that peers enjoy
• Tiring noticeably faster than same-age peers during physical play

Sign One: Consistent W-Sitting

Many parents notice their child sitting on the floor with knees bent and feet splayed out to the sides, forming a W shape, and assume it’s simply a comfortable, harmless position.While occasional W-sitting is not highly concerning, children who consistently default to this position, especially when other sitting options are available, may be compensating for core weakness or tightness in their hips. Over time, this can cause postural and alignment issues, which can lead to other concerns as they develop². A physical therapist can assess whether this pattern reflects an underlying strength or stability issue worth addressing directly.

Sign Two: Frequent Tripping or Falling Past Toddlerhood

Young toddlers fall constantly as a normal part of learning to walk, which is exactly why this sign gets dismissed for longer than it should. But a child well past the toddler stage who continues tripping or falling significantly more than same-age peers, particularly on flat, unobstructed ground, may be showing a coordination or balance difficulty rather than simple clumsiness³. This distinction, ordinary toddler stumbles versus a persistent pattern in an older child, is exactly what a physical therapy evaluation is built to clarify.

• Consistently sitting in a W position rather than other floor-sitting postures
• Frequent tripping or falling well past the toddler years
• Favoring one side of the body, or a persistent limp
• Avoiding activities like jumping, climbing, or running that peers enjoy
• Tiring noticeably faster than same-age peers during physical play

Sign Three: Favoring One Side or a Persistent Limp

A child who consistently favors one side of their body, whether that shows up as a limp, reluctance to bear weight evenly, or one arm used far more than the other, is showing a pattern worth a closer look rather than something to wait out⁴. This sign is easy to miss because it often develops gradually, and a child may adapt their movement patterns in ways that make the underlying asymmetry less obvious day to day, especially to someone who sees them constantly and adjusts to the pattern without noticing it as unusual.

Sign Four: Avoiding Physical Play or Tiring Unusually Fast

Children who struggle with coordination or motor planning sometimes respond by avoiding the physical activities that would otherwise reveal the difficulty, opting out of jumping, climbing, or running games rather than participating and struggling visibly. This avoidance can look like a personality trait, a quiet or cautious kid, rather than a physical sign, which is part of why it’s so commonly missed. Similarly, a child who tires noticeably faster than peers during active play, needing more breaks or seeming physically wiped out sooner than expected, may be showing reduced strength or endurance rather than simply having lower energy in general.

Frequently Asked Questions

Is W-sitting always a sign my child needs physical therapy?

No. Occasional W-sitting is common and not automatically concerning. A consistent, default pattern, especially when other seated positions are available, is the more meaningful signal worth evaluating.

How do I know if my child’s falls are normal toddler clumsiness or something more?

Frequency and age both matter. Frequent falling on flat ground well past the toddler years, more often than same-age peers, is the pattern worth raising with a physical therapist.

Does my child need a diagnosis before seeing a pediatric physical therapist?

No. A physical therapy evaluation is appropriate any time you’re noticing a concerning pattern, regardless of whether a diagnosis is involved.

What if my pediatrician doesn’t seem concerned about what I’m noticing?

You can pursue a physical therapy evaluation directly. Consistent observations from a parent carry real clinical weight, even without a physician’s referral in many cases.

Can these subtle signs resolve on their own without therapy?

Some mild, occasional instances can be typical variation. Persistent, consistent patterns are less likely to resolve without support, which is exactly what an evaluation is designed to clarify.

Trusting the Pattern, Not Just the Milestone Chart

Missed milestones are only part of the picture. Consistent W-sitting, frequent falls, favoring one side, or avoiding physical play are worth just as much attention, even when a milestone checklist looks fine on paper.

Learn more about our pediatric physical therapy program, or reach out with your questions. Call us at 815-783-2544 or submit a contact form.

Know a parent who’s been quietly noticing something but wasn’t sure if it was worth mentioning? Share this with them. It might be exactly what they needed today.

Clinically verified by Caitlin O’Dowd, PT, MPT, Westside Children’s Therapy

Where to Go Next

• What Does a Pediatric Physical Therapy Session Look Like?
• Physical Therapy at Westside Children’s Therapy
• Contact Westside Children’s Therapy

1. Gross Motor Delays and Pediatric Interventions. PedsTeam.
2. Signs Your Child Could Benefit from Pediatric Physical Therapy. Southern Pediatric Therapy.
3. 7 Early Intervention Physical Therapy Goals. Care Options for Kids.
4. Signs Your Child May Need Developmental Physical Therapy. GenCare Kids.

Authored By

Caitlin O’Dowd

PT, MPT

Caitlin O’Dowd, PT, MPT earned a Masters in Physical Therapy from University College Dublin in Ireland after completing her Bachelors of Science in Kinesiology with a minor in Nutrition from the University of Illinois at Chicago. She is also a Certified Schroth Scoliosis Therapist, a certified Pediatric Pelvic Floor Therapist, and a Certified Emergency Medical Technician. Caitlin has been with Westside for her entire PT career, starting in 2015 and having served as Director of Physical Therapy since 2022.

Her clinical interests include working with patients of all ages, abilities, and diagnoses. She specializes in working with infants and patients with torticollis, developmental delays, scoliosis, pelvic floor concerns (constipation, incontinence, etc), and supporting children with neurological and genetic diagnoses. She also brings a strong movement and performance background from coaching figure skating since 2009 and providing off-ice strength and conditioning to athletes since 2015.

Outside of the clinic, Caitlin is a mom of four (one boy and three girls) and a figure skating coach. She enjoys spending time with her family, exploring new places with her kids, and traveling.