Pediatric Physical Therapy at Home in New York City

What is Pediatric Physical Therapy?

Movement is important at all stages of life; and individuals may have challenges with this at any of these different stages. However, newborns, infants, children and teenagers are not just little adults. Their body’s structure, and how their body responds to interventions are different, and treating a child similarly to an adult can result in injury. When a newborn, infant, child or teenager has challenges with posture, alignment, developmental skills, balance, coordination, strength and stability, flexibility, pain, or performing functional/ play/ sports related skills, a pediatric physical therapist can help.

Palmer Concierge Physical Therapy has therapists that specialize in various areas of pediatric physical therapy including: Developmental PT, Vestibular PT, and Sports Performance, Sports Injury Prevention and Sports Injury Rehabilitation; as well as Pediatric Rehabilitation due to injury or illness. This differs from clinic, hospital, school based and Early Intervention physical therapy in that it is provided at a time and place of your choice, focuses on more than just minimal functional standards, is able to be initiated in a timely manner (rather than waiting on a wait list, or in terms of early intervention – until your child is 2 standard deviations behind their same aged peers to then begin therapy). In addition, babies who are medically fragile, might not yet be fully vaccinated, are possibly immunocompromised due to prematurity or other reasons, or are at higher risk of illness during “respiratory season” can have this risk decreased by not having to navigate crowded areas like public transit and waiting rooms.”

Could Pediatric Physical Therapy At Home Benefit Your Child?

Our physical therapists provide developmental therapy and specialized support for preemies or infants with extended NICU stays, serving patients from newborns to teenagers, including:

Infants with:

• Torticollis
• Club Feet
• Calcaneovalgus
• Cranial malformations
• Chronic lung disease or heart disease affecting your baby’s posture and/or function
• Gastrointestinal dysfunction (sometimes requiring abdominal surgeries, and
• delaying tummy time as well as resulting in bound down abdominal scarring)

Infants who experienced the following at birth or before birth:

• Exposure to toxins (at times prescribed medications that pose challenges to newborns, or accidental non-prescribed substances)
• Loss of oxygen
• Shoulder dystocia

Infants, toddlers, children and teenagers with:

• Developmental Delays
• Challenges of balance, stability and coordination
• Congenital or Genetic Disorders
• Autism Spectrum Disorder
• Cerebral Palsy
• Altered muscle tone – low, high, ataxic, athetoid
• Sensory Challenges
• Deficits resulting from accidental or non-accidental trauma
• Deficits resulting from prolonged illness, surgeries or hospitalization

Especially when working with young clients, PT Krissy finds it most beneficial to work with the client, but also spend time teaching the client’s caregivers how to carry over what is done within the session, between sessions. (This may be the parent, grandparent, daycare provider, nanny or other individual designated by the client’s caregiver.)

Pediatric Physical Therapy At Home: What Parents Can Expect in their First Session? 

The first step in the pediatric physical therapy journey is a thorough baseline evaluation: observation of any positioning or mobility equipment that your baby or child is using.

The evaluation is a time for the parent to voice questions and concerns about pediatric physical therapy.  We review all information and then collaborate with parents, where appropriate the child, and in some cases other professionals involved to determine objectives, aligned to and targeting the child’s functional deficits, delays, injuries or recovery goals.

Your child’s physical therapy treatment plan may include different therapeutic modalities, including:

• Positioning and handling (that the PT will perform and also teach you) to help facilitate developmental milestone progression.
• Education regarding barriers to progression, and different activities and toys to help progress toward the next stages; or in the case of premature babies, identifying and limiting stimulation that may be too much for them.
• Scar massage to help loosen bound down surgical scars that may be limiting movement.
• Strategies for helping babies who can’t regulate their state (are either asleep or awake and crying) improve their transitions and ‘quiet and active alert periods’ so that they can be awake, happy, exploring their environment and playing.
• For children with ASD, sensory and movement strategies that can be integrated into your child’s day to help them function more easily and comfortably throughout the day.
• Activities for increasing: strength, balance, stability, coordination, motor planning, body awareness, muscular length, endurance and postural alignment.
• Play that incorporates breath work, calming the nervous system, and grounding.

Our objective is that through working with your child and yourself; that we can help make movement, play, and exploration easier, safer and more enjoyable; so your child can grow, develop and more easily participate in activities they enjoy, including those with their peers.

Key Benefits of Pediatric Physical Therapy for Babies & Toddlers

• Helps in the transition between a prolonged NICU stay and independent care of a preemie or medically fragile baby.

• Improves asymmetries, so that equipment such as helmets can be avoided, alignment is improved to preserve joint development, and developmental milestones can more easily be achieved.

• Addresses developmental challenges and delays early so that they have less of a chance of progressing as far, can be addressed more easily, and decreases frustration of a baby who wants to play, but motorically is challenged to.

• Increases your child’s sense of confidence and independence.

• Increases a child’s ability to participate with their peers and in a larger variety of activities, both through improving their skills, and helping to modify equipment needed to do so.

Signs Your Baby Might Need Physical Therapy

• Your baby is either asleep, or awake and crying; without any intermediate states.
• Your baby demonstrates a neck preference and/ or has flattening on part of their head that makes it hard for them to keep their head in the middle.
• Your baby doesn’t tolerate tummy time and/ or can’t lift and turn their head when on their belly by 3 months.
• Your baby keeps their thumb(s) in the palm of their hand, unable to bring them out (as is needed for grasping), past __ months.
• Your baby isn’t bringing their hands to their mouth or together by 3 months.
• Your baby isn’t accepting weight through their legs when supported by 6 months.
• Your baby can’t sit unsupported by 8 months.
• Your baby isn’t pulling to stand, standing at a support surface and starting to cruise by 12 months.
• Your baby is showing a hand, arm or leg preference before 3 – 4 years old.

Signs Your Child Might Need Physical Therapy

• Your child trips and falls a lot, bumps into others when walking, or tends to walk with one side of the body touching a wall.
• Your child tends to slouch or lean to one side.
• Your child repeatedly gets picked last for teams, or can’t keep up with his peers.
• Your child wears out the toes of their shoes before the rest of the shoes are worn in; or walks on their toes/ forefeet.
• Your child tires out before their peers walking through the halls, going up stairs, or playing outside.
• Your child isn’t able to sit still in class, at the table for meals or for any activity long enough to finish; needing to get up and move, fidget, or demonstrating challenging behaviors

Pediatric Physical Therapy for Sports Injuries

Participating in sports is an excellent way for children and teens to enjoy regular exercise while learning all about teamwork, perseverance, and leadership.  Unfortunately a side effect of youth sports is the occasional injury that requires pediatric physical therapy to properly heal. 

The bones, muscles and joints of children and teens require special care. Growth plates—tissues at the ends of bones in children and teens that influence the future shape and length of the bone once mature —are still open and vulnerable to damage.  Should growth plates become injured, and not diagnosed or treated correctly, it can lead to long term debilitation leaving children and teens permanently sidelined from the activities they enjoy.  

Some of the most common sports injuries that children and teens experience are due to impact (with other players or objects like balls) and repetitive motions or overuse and include:

• Ankle injuries
• Pulled muscles
• Shin splints
• Knee injuries
• Tennis elbow (tendinitis)
• Hip flexor injuries

While children and teens do recover faster than adults from injury, they should still be treated and as soon as possible once suffering an injury.  Beginning therapy early enables the young athlete to benefit from joint mobilization and manual soft tissue massage to decrease any inflammation and initial pain resulting from an injury. Treating sports injuries purely with rest and medication does not target the movements,  skills, and strength demands for your child to safely return to a sport with a reduced risk of re-injury.   In rehabilitating your child, we will have them safely perform exercises that mimic the specific motions and stressors they will experience when they return to their sport.   Upon completion of a tailored treatment both you and your child should feel confident that they can return to their sport without fear of injury.

Why Early Intervention Matters: A Guide to In-Home Pediatric Physical Therapy in NYC

Before diving into specific conditions, be mindful when you have concerns over possibly development delays with your baby, the  “wait and see” approach, once common, is now discouraged by the CDC and developmental experts because it often delays supportive care and possibly any necessary referrals, leaving children further behind their peers (1, 2).

The Problem: Delays in the first year can create a domino effect. A child who cannot sit independently may struggle to free their hands to explore toys, which can subsequently delay cognitive development and fine motor skills. Furthermore, compensatory habits—like scooting instead of crawling—can reinforce abnormal movement patterns that are harder to break later.

The Concierge Pediatric Physical Therapy Solution: Concierge pediatric physical therapy is an immediate intervention in your baby’s “natural environment.” Research shows that infants learn best through exploring their actual surroundings—your rugs, your hardwood floors, and your furniture (3, 4) . By integrating physical therapy into your baby’s daily life, we leverage your baby’s natural adaptability to correct delays and prevent secondary issues, all without the stress of having to get packed up and navigate through New York City.

(1) https://pmc.ncbi.nlm.nih.gov/articles/PMC9680195/ Scholarly Source: Zubler, J. M., et al. (2022). “Evidence-Informed Milestones for Developmental Surveillance Tools.” Pediatrics, 149(3).

(2) https://publications.aap.org/pediatrics/article/145/1/e20193449/36971/Promoting-Optimal-Development-Identifying-Infants?autologincheck=redirected Lipkin, P. H., & Macias, M. M. (2020). “Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.” This clinical report emphasizes that waiting often leads to missed opportunities for Early Intervention (EI), which is most effective when the brain is most plastic (birth to age 3).

(3)  https://pubmed.ncbi.nlm.nih.gov/23085640/ Adolph, K. E., et al. (2012). “How Do You Learn to Walk? Thousands of Steps and Dozens of Falls per Day.” Psychological Science, 23(11), 1387–1394.  Infants take thousands of steps per day and fall dozens of times. Adolph’s data shows that this immense amount of practice is most effective when it happens on variable terrain—switching from a grippy rug to a slippery hardwood floor, or cruising along a soft couch versus a hard coffee table. This forces the infant to constantly adjust their balance, which “teaches” the brain how to coordinate the body.

(4) EverydayActSett-2006.pdf Dunst, C. J., et al. (2001). “Natural Learning Environments and Asset-Based Orientations.” Topics in Early Childhood Special Education. This research supports the idea that using “your rugs and your furniture” is not just convenient—it is actually clinically superior to a clinical gym because it helps the child master the environment they actually live in.

Treating Torticollis and Plagiocephaly at Home: A Guide to In-Home Pediatric Physical Therapy in NYC

One of the most common reasons NYC parents seek pediatric physical therapy in the first few months is a noticeable head tilt or a flat spot on the baby’s head.

The Problem: Asymmetry and Tightness: Torticollis is a tightness in the neck muscles (specifically the sternocleidomastoid) that causes a baby to persistently tilt their head to one side or turn it in only one direction. You might notice your baby struggles to breastfeed on one side or only looks at you when you stand to their right.  Torticollis is often accompanied by Plagiocephaly, or “flat head syndrome.” Because the baby consistently rests their head in the same position due to the neck tightness, a flat spot develops on the back or side of the skull. In the first month, if you notice your baby prefers to sleep with their head turned to one side, this is a red flag that warrants monitoring.

The Concierge Solution – Positioning and Environment: In a clinic, a therapist stretches the neck. In your home, a physical therapist acts as an ergonomic consultant for your baby’s entire world.

1. Strategic Stretching: Typically we will use gentle, play-based positioning to stretch the tight muscles and guide your baby through symmetrical movements, encouraging them to look and turn toward their non-preferred side.
2. Environmental Adaptation: This is the concierge advantage as we will assess your specific crib placement, changing table, and play area. We might suggest rotating the crib so that when your baby looks out to see you enter the room, they are forced to turn their head to the “tight” side, providing a natural, frequent stretch throughout the day.
3. Preventing the “Container” Effect: New York City living often relies on strollers and carriers.  We will teach you how to minimize time in “containers” (swings, car seats) which can exacerbate flat spots, and introduce alternative holding positions that relieve pressure on the skull while you move about your home.

Overcoming Tummy Time Intolerance:  A Guide to In-Home Pediatric Physical Therapy in NYC

The “Back to Sleep” campaign was a landmark public health initiative aimed at educating parents and caregivers to place babies on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome, but it has led to a generation of babies who spend little time on their stomachs while awake, leading to motor delays in neck and trunk strength (5, 6) .

The Problem:  Tummy time intolerance is characterized by extreme distress or an inability to lift the head during tummy time past the age of 3-4 months. If your baby persistently cries, keeps their face pressed into the mat, or cannot push up on their forearms, they are missing out on the essential strengthening required for rolling and crawling.

The Concierge Solution – Comfort and Props: A clinical gym can be overstimulating and frightening for a distressed infant. At home, we turn tummy time into a bonding activity.

1. Graded Exposure: We will help your baby tolerate their position by using props you already own, such as a rolled-up towel or a pillow placed under the chest. This leverage makes lifting the head mechanically easier, reducing frustration.
2. Sensory Engagement: Using your baby’s favorite toys or a mirror placed on the floor, we’ll distract and motivate your baby to lift their head. This builds neck and back strength—the precursors to all future movement.

Parent Coaching: At the end of the day you – (the parents) are the primary changemakers.  We will teach you how to integrate short bursts of tummy time into every diaper change. Because you are at home, you can practice these techniques immediately in the environment where they will be used daily.

(5) https://pubmed.ncbi.nlm.nih.gov/9794945/ Davis, B. E., Moon, R. Y., Sachs, H. C., & Ottolini, M. C. (1998). “Effects of sleep position on infant motor development.” Pediatrics, 102(5), 1135–1140.The study found that while all babies eventually caught up, “prone sleepers acquired motor milestones at an earlier age than supine sleepers.” Specifically, back-sleepers were slower to roll over, sit up, and crawl because they had less opportunity to develop upper body strength.

(6)  https://pubmed.ncbi.nlm.nih.gov/9086895/ Argenta, L., et al. (1996). “The Increase in Infant Plagiocephaly with the ‘Back to Sleep’ Campaign.” Journal of Craniofacial Surgery. This early study noted the rapid rise in flat spots on the back of the head (plagiocephaly) and tight neck muscles (torticollis) immediately following the 1994 campaign launch, directly linking the two phenomena.

Managing Low Muscle Tone (Hypotonia): A Guide to In-Home Pediatric Physical Therapy in NYC

Some parents describe their baby as feeling “floppy” or like a “rag doll.” This can be a sign of hypotonia, a condition that makes it harder for infants to move against gravity.

The Problem:  Hypotonia involves low resting muscle tension. These babies may appear to have a “frog-leg” posture when lying down, or they may slip through your hands when you lift them under the armpits. At 4 months of age, an indicator of low muscle tone is difficulty lifting the head, often visible as a significant “head lag” when the baby is pulled up from a lying position. By 6 months, this may present as an inability to sit upright without slumping forward or rounding the back excessively. Consequently, this forces the baby to work twice as hard to achieve the same movements as their peers, which often leads to rapid fatigue and a lack of motivation to move.

The Concierge PT Solution – Activation and Stability:  Treating hypotonia requires “waking up” the muscles and building core stability (7) and here’s how we will go about it.

Home Integration:  Here in New York City we have small living spaces and that’s okay, you don’t need bulky equipment. We will show you how to use your couch cushions to create support for sitting practice, allowing your baby to work on trunk control while you read a book together.

Handling Techniques: We will use specific handling techniques to stimulate postural reactions. For example, we might gently bounce your baby on a therapy ball (or your own exercise ball) to trigger the core muscles to contract and stabilize the body.

Core Strengthening: We’ll focus on building endurance with supported sitting activities that encourage your baby to right themselves when tilted, or “superman” poses that strengthen the back extensors.

(7) https://books.google.com/books/about/Motor_Control.html?id=BJcL3enz3xMC Shumway-Cook, A., & Woollacott, M. H. (2017). Motor Control: Translating Research into Clinical Practice. (5th ed.). Wolters Kluwer. In the chapters on “Physiological Basis of Motor Learning and Recovery,” they explain how “sensory facilitation techniques” are used to increase the recruitment of motor units in patients with hypotonia or weakness.

Managing High Muscle Tone (Hypertonia): A Guide to In-Home Pediatric Physical Therapy in NYC

Conversely, some infants feel unusually stiff or rigid. This is known as hypertonia and presents a different set of challenges for movement.

The Problem: Babies with hypertonia often keep their hands constantly fisted or hold their legs stiffly extended, creating noticeable resistance that makes routine tasks like diaper changes difficult.  You might also spot potential red flags, such as the baby pushing back with their head instead of lifting it, or their legs stiffening and crossing in a scissoring motion when they are picked up. This excessive muscle tone creates a significant barrier to development because it blocks fluid (8), coordinated movement; consequently, a baby who cannot bend their legs easily will struggle to roll over or successfully transition into a crawl (9).

The Concierge Solution: Relaxation and Range of Motion.  The goal here is to reduce stiffness to allow for functional movement.

1. Therapeutic Handling: We utilize rotation and gentle rocking techniques to decrease muscle tone and help the baby’s body relax.
2. Stretching: Targeted stretching exercises increase the range of motion in stiff limbs. For example, gently bending the legs and rotating the hips to prepare the body for the movements required in crawling.
3. Nap-Friendly Scheduling: Babies with high tone often fatigue easily or become overstimulated. A major benefit of concierge care is scheduling sessions around your baby’s sleep needs. A well-rested baby is more pliable and receptive to therapy, whereas a clinic visit scheduled during a nap time can result in a rigid, crying infant who cannot benefit from the session.

(8) https://www.amazon.com/Abnormal-Postural-Reflex-Activity-Lesions/dp/0871890917  *Bobath, B. (1971). Abnormal Postural Reflex Activity Caused by Brain Lesions.

(9) https://www.amazon.com/Campbells-Physical-Therapy-Children-Consult/dp/0323390188 Palisano, R. J., et al. (2023). Campbell’s Physical Therapy for Children Expert Consult. (Elsevier Health Sciences). Validates the specific link between stiffness and the inability to crawl.

Mastering Mobility: Rolling & Sitting (6-9 Months): A Guide to In-Home Pediatric Physical Therapy in NYC

As your baby approaches the half-year mark, mobility becomes the primary goal, as delays at this stage can significantly impact a child’s ability to interact with their world.

The Problem: By 6 months, most babies can sit with support and are beginning to roll, progressing to independent sitting and transitioning between positions by 9 months. Significant red flags during this period include a 6-month-old lacking trunk control in supported sitting or a nine-month-old unable to reach for a toy without toppling over. This stability is critical because if a child cannot sit securely, they cannot easily free their hands to manipulate toys, creating a domino effect that hinders fine motor and cognitive development.

The Concierge Solution: In-home therapy focuses on functional independence and dynamic stability using your floor plan as follows:

1. Breaking Down the Movement:  Your baby is taught to reach across their body—crossing the midline—and to shift their weight, mastering the two essential components of a roll.
2. Protective Reactions: To sit safely, your baby must learn to catch themselves. We use play—like placing toys just out of reach—to encourage your baby to lean and right themselves, building the “protective extension” reflexes needed to prevent falls.
3. The “Safety” of Home: Practicing sitting balance involves inevitable tumbles. Doing this on your own soft rugs or play mats, rather than a clinical surface, keeps the baby confident and secure. We will also show you how to position pillows to create a “crash zone” for safe practice when they aren’t there.

The Pre-Walking Phase: Crawling and Pulling to Stand (9-12 Months): A Guide to In-Home Pediatric Physical Therapy in NYC

The final push of the first year involves verticality—getting up and moving.

The Problem: Although the CDC recently removed crawling from its standardized milestone checklists to focus on clearer benchmarks like walking, physical therapists maintain that crawling remains a critical developmental phase for building core strength, shoulder stability, and bilateral coordination—the vital neurological bridge connecting the left and right hemispheres of the brain (10). Because of its foundational importance, we look beyond simple checklists to monitor the quality of movement, identifying red flags such as a baby who relies solely on “army crawling” past typical timelines or a 12-month-old unable to pull to stand. Most critically, any sign of asymmetry, such as a baby dragging one leg or consistently using only one side of their body to pull up, warrants an immediate evaluation to rule out underlying neurological or orthopedic issues.

The Concierge Solution: Obstacle Courses & Cruising where your home becomes the gym.

1. Facilitating Transitions: If a baby isn’t crawling, we work on the “quadruped” position (hands and knees), using rocking and weight-shifting exercises to build the confidence to move a hand forward.
2. Furniture Cruising: We will identify the perfect furniture in your home—a low coffee table or a sturdy sofa—that is the right height for your baby to pull up on. They teach the baby how to shift weight to take lateral steps (“cruising”) along these surfaces.
3. Toe Walking Correction: If your baby stands on tiptoes (toe walking), which can be related to sensory processing or tightness, we can address this immediately with footwear recommendations and weight-bearing exercises on your specific flooring types.

(10) https://pubmed.ncbi.nlm.nih.gov/2038537/ McEwan, M. H., Dihoff, R. E., & Brosvic, G. M. (1991). “Early Infant Crawling Experience Is Reflected in Later Motor Skill Development.” Perceptual and Motor Skills, 72(1), 75–79.This study found that children who had a solid foundation of crawling performed significantly better on later motor skills requiring bilateral coordination than those who did not.