Physical Therapy for Gross Motor Delays in Children

Reviewed by Dr. Eva Lassey, PT, DPT · View full bio → · Last updated August 28, 2026 · How we write and who reviews it

Physical therapy for developmental delays addresses gross motor milestones — head control, rolling, sitting, crawling, standing, and walking — along with the strength, postural control, and coordination underneath them. Milestone ranges are wide, but a missed milestone is not a diagnosis: it is a reason to ask your child’s doctor about developmental screening.⁠^1,2 Two signs warrant particular attention — consistent asymmetry, meaning one side of the body used more than the other, and loss of a skill a child previously had, which requires prompt medical evaluation. For children under three in the US, a parent can refer their child to early intervention directly. The evaluation and the written service plan are free everywhere; for the therapy itself, some states charge families sliding fees based on what they can pay.⁠³

Key takeaways

Physical therapy for developmental delays addresses gross motor milestones in sequence, along with the strength, postural control and coordination underneath them.
Milestone ranges are wide, but a missed milestone is not a diagnosis: it is a reason to ask your child’s doctor about developmental screening.⁠^1,2
The work covers postural control and core strength, symmetry and side preference, muscle tone whether low or high, and positioning or equipment where needed.
Tummy time and floor time is most of the early advice, and it is advice for you rather than for a session.
Sessions are in your home, on the floor, with your child's own toys, and mostly consist of the therapist showing you how to position, encourage and practice between visits.
Goals are concrete: rolls from back to front in both directions, sits unsupported for two minutes, pulls to stand at furniture.

This page covers what physical therapy does for delayed motor milestones. For what the sequence is and when a delay is worth assessing, see Delayed motor milestones.

What PT addresses here

Motor milestones in sequence · postural control and core strength · symmetry and side preference · muscle tone, whether low or high · positioning and equipment where needed · tummy time and floor time, which is most of the early advice · parent coaching

Two flags

Loss of a previously acquired skill warrants prompt medical evaluation — a child who was sitting and no longer sits, or was walking and no longer walks. Investigated differently from delay.

Consistent asymmetry. Hand preference before around 12 months isn't typical and is one of the more useful early signs. → Torticollis · Cerebral palsy

What a session looks like

In your home, on the floor, with your child's own toys. Mostly the therapist showing you how to position, encourage, and practice between visits.

Goals

Rolls from back to front in both directions · Sits unsupported for two minutes · Pulls to stand at furniture

What happens between sessions

A child sees a physical therapist for perhaps an hour a week. The rest of the week is where most of the practice happens, which is why the home program is not an optional extra bolted onto the session — for most families it is the intervention, and the session is where it gets set up and adjusted.

A scoping review in Physical Therapy mapped clinical trials of caregiver-provided home programs aimed at improving motor outcomes in children who have, or are at risk for, motor delay, and examined how the caregiver's own role was described in those trials.⁠⁴

Ask what the home program is at the first session, not the fourth. If there is not one, ask why not.
Ask how long it should take a day. A program that needs an hour will not happen; one that needs ten minutes might.
Ask what it should look like when it is working, so you can tell without waiting for the next appointment.
Say when it is not happening. A therapist can change a plan they know is not being done. They cannot change one they think is working.

Practice does not have to look like exercises. Carrying, positioning, how a child is put down and picked up, where a toy is placed — a good home program is usually built into things that were happening anyway, rather than added to the day as a separate task.

How early is early enough

Earlier is generally better, and the reason is not that a window slams shut. It is that motor skills build on each other: a child who is not yet sitting independently is not yet getting the trunk control that makes reaching, and then crawling, and then pulling to stand possible.

Trials in this area increasingly compare active, family-involved approaches against conventional handling. A randomized controlled trial of infants at risk of cerebral palsy compared the SAFE early intervention approach, which emphasizes infant active participation and family collaboration, against conventional neurodevelopmental treatment, measuring cognitive, language and motor development.⁠⁵

You do not need a diagnosis to start, and you do not need a doctor's referral. In the United States, Part C of the Individuals with Disabilities Education Act is the statutory basis for state early intervention systems serving infants and toddlers with disabilities and developmental delays.⁠⁶ A parent can contact their state program directly. → How to arrange a free evaluation.

Frequently Asked Questions

When should I seek PT for a motor delay?

Whenever you're concerned. Under three you can self-refer to early intervention; the evaluation is free everywhere, and some states charge sliding fees for services.⁠³

Is it a problem if my baby skips crawling?

Not in itself. Movement and steady progress matter more.

My baby uses one hand much more than the other.

Worth raising. Hand preference before around 12 months isn't typical.

My child has stopped doing something they could do.

Contact your doctor promptly — loss of skills is investigated differently from delay.

Will my child catch up?

Many children with a motor delay do reach the usual milestones, later than the average and without lasting difficulty. Some have an underlying condition that changes what progress looks like. Nobody can tell you which at the first appointment, and a therapist who promises either answer that early is guessing. What is knowable early is whether the gap is widening or closing.

Does physical therapy hurt?

It should not. Sessions with young children are built around play, and a child who is distressed is not learning a movement pattern — they are learning that this room is unpleasant. Stretching at end range can be uncomfortable in specific conditions, and that should be explained to you rather than discovered.

Sources

Zubler JM, Wiggins LD, Macias MM, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022;149(3):e2021052138. doi:10.1542/peds.2021-052138 (PMID 35132439). The 2022 CDC checklists use “milestones most children (≥75%) would be expected to achieve” by each age, chosen to discourage a wait-and-see approach; “a child not meeting a milestone should be considered for screening.”
Centers for Disease Control and Prevention. CDC’s Developmental Milestones. “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early”; “Talk with your child’s doctor, share your concerns, and ask about developmental screening.” Checked October 6, 2026.
Individuals with Disabilities Education Act, Part C regulations, 34 CFR Part 303 (eCFR). Parents are primary referral sources: §303.303(c). Checked October 6, 2026.
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Evaluation and assessment, service coordination and the IFSP “must be carried out at public expense, and for which no fees may be charged to parents”; a State may set a “schedule of sliding or cost participation fees that may be charged to the parent for early intervention services,” and a family the State finds unable to pay receives all Part C services at no cost: §303.521.
Gorgon EJR. Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review. Physical Therapy; 2018. doi:10.1093/ptj/pzy009. DOI verified at Crossref; abstract read at Europe PMC.
Yıldız A, Yıldız R, Apaydın U, et al. Long-Term Neurodevelopmental Outcomes of the SAFE Early Intervention in Infants at Risk of Cerebral Palsy. Journal of Paediatrics and Child Health; 2025. doi:10.1111/jpc.70191. DOI verified at Crossref; abstract read at Europe PMC.
Individuals with Disabilities Education Act, Part C — Infants and Toddlers with Disabilities, 20 U.S.C. §1431 et seq. Statutory basis for state early intervention systems. Checked August 20, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.