Motor Development and Pediatric Physical Therapy

Pediatric Physical Therapy is an active, parent-involved, evidence-based approach to physical and sensory challenges in children. A pediatric physical therapist uses science and a thorough functional analysis to determine the cause of a child’s motor challenges. Once the cause is identified, it can be targeted with individualized exercises until the child’s body and nervous system adapt. The goal of pediatric physical therapy is to increase the child’s enjoyment and freedom of movement. Joy of movement is built when a child can freely use his or her body and participate in activities on an equal basis with other children.

Pediatric Physical Therapy is obviously not a quick fix, but it has a lasting effect as the muscles and nervous system (re)learn optimal movement patterns. Babies are born on a “motor track” that takes them through a series of motor development milestones. However, some babies are “derailed” from this motor development track due to things like preferred side, back dominance, tension, prematurity, low muscle tone, or other issues. Pediatric Physical Therapy is all about helping the child get back on track so that subsequent milestones are met and the child regains a strong foundation for further motor development. To that end, I have developed specific exercise programs that include simple, everyday exercises to help your child back on the motor development track. And when the body is functioning as it should, enjoyment of movement, social participation and health are positively affected.

motor development, Pediatric Physical Therapy
Sensory Integration

Sensory Integration is an important part of Pediatric Physical Therapy. I have a special interest in this topic, both as a mother of a child with sensory integration challenges and as a Pediatric Physical Therapist. As a mother, I have used Sensory Integration exercises on a daily basis with my son for years, and as a Pediatric Physical Therapist, I have taught countless parents how to implement sensory integration exercises in their daily lives. Sensory Integration training is very important for children with ADHD, ADD, anxiety, autism or other diagnoses if the child is sensory seeking or -avoiding. (often as part of a multidisciplinary approach)

Injuries

Prior to training as a Pediatric Physical Therapist, I was a general Clinical Physical Therapist for 15 years. During these years I received extensive training in sports injuries, functional analysis, dynamic stability, neck and back problems and differential diagnosis. Therefore, I have a relevant educational profile to help children with various injuries.

Sensory Integration
Examples where Pediatric Physical Therapy is relevant:
  • Flat head (brachycephaly)
  • Asymmetrical head shape / One-sided flat head (plagiocephaly)
  • Preferred side / side preference
  • Back-arching /back dominance
  • C-shape / banana shape (body bent sideways like a C)
  • Tummy time challenges
  • Twisted neck (congenital muscular torticollis)
  • Premature birth
  • Low muscle tone / floppy baby (hypotonia)
  • Delayed motor development
  • Asymmetrical motor development
  • Fussiness / colic
  • Motor restlessness
  • Congenital clubfoot
  • Impaired balance
  • Clumsiness / motor insecurity
  • Hypermobility
  • Growing pains
  • Toe / ball walking
  • Sports injuries
  • Neck or back pain
  • Sensory Integration / Sensory Processing Disorder
  • Highly sensitive kids (e.g. with ADHD, ADD, Autism)
  • Rehabilitation after injury or surgery

The latest on Instagram

Follow me on Instagram @develobaby, where I share evidence based motor development knowledge and fun! ❤

About me

My name is Maria Schultz Appelt and I was born in 1981 in West Denmark. I am married to my German husband, Uwe, and together we have two beautiful children, Oscar (August 2014) and Isabella (January 2017). I am a Physical Therapist at heart and love working with children’s Motor Development for Joy of Movement!

Maria Schultz Appelt
Educational background

I graduated as a Pphysical Therapist from the University of Aarhus in Denmark in January 2007. During my first 10 years as a Clinical Physical Therapist, I have completed a number of courses in manual therapy, sports Physical Therapy, dynamic stability and MDT (Mckenzie neck and back method).

Since 2016, I have focused on national and international courses in Pediatric Physical Therapy. I have completed courses offered by the Danish Pediatric Society for Physical Therapy, including diagnostics courses and various courses in Manual Therapy for infants and children. I also completed a course in Pediatric Dynamic Neuromuscular Stabilization (DNS), which provided a valuable link between dynamic stability for adults and its application to babies and children.

Much of my education was and is self-study, as I find it difficult to find advanced level Pediatric Physical Therapy courses. In fact, I have found a very effective way to use my Instagram profile for this self-study. I posted my first modest update in March 2020, during the first days of COVID-19. As my number of followers grew, so did the number of questions in my inbox. My followers were generous with the topics they wanted me to cover, and when in doubt, I turned to search engines and found top-notch research that could give me the answers I needed.

Maria Schultz Appelt
Evidence-based Physical Therapy

To me, evidence-based treatment means that the treatment your child receives from me is consistent with the treatment provided by the public health system. (Note that Denmark has arguably one of the best health care systems in the world, and it is government-run). It is very important to me that my professionalism and the advice I give to parents is evidence based and in line with best practice in Denmark. You will not find alternative treatments. This may have its justification, but it is not my practice, as I believe that I have a responsibility as a licensed Physical Therapist to be able to substantiate my practice professionally.

The same applies to my Instagram. I promised myself that before posting anything and before answering my followers’ questions, I would dig deep into the research and find evidence-based approaches and only share knowledge that is in line with what is considered best practice in Denmark and always in accordance with the recommendations of the Danish Health Authority.

To accomplish both, I keep myself up to date with the latest evidence and participate in the annual meetings and various professional forums of the Danish Society for Pediatric Physical Therapy.

Maria Schultz Appelt

Frequently Asked Questions

Flat head and one-sided flat head are common symptoms in babies with a preferred side and back-arching babies. See a practitioner who will use traditional physical therapy methods and give you exercises to work at home with your baby’s preferred side. Manual therapy can also be very important, but should not be used alone. It is important to work on strengthening, mobilizing, and stretching the right muscles. It is also important for the child’s motor development that the therapist makes sure that both sides of the body are working symmetrically and provides appropriate exercises if this is not the case.

Craniosynostosis is a deformity of the skull in which one or more sutures fuse together prematurely. Craniosynostosis can be an isolated deformity, or it can be part of a syndrome in which the child has deformities in other organs, although this is extremely rare.

I have seen many children and with different types of craniosynostosis. The most common is scaphocephaly, where the sutures along the mid-line of the skull fuse too early, preventing the skull from growing sideways. As a result, the skull only grows forward and backward, resulting in an elongated and narrow head. Craniosynostosis can also occur as coronal synostosis or lambdoid synostosis, which can cause an asymmetrical or deformed skull. In most cases, the condition is purely cosmetic. However, it’s important to monitor the development of craniosynostosis by seeing a pediatrician who can measure and evaluate the development on a regular basis.

Torticollis is a congenital contraction of a muscle called the sternocleidomastoid muscle. It is located on the side of the neck and its function is to rotate the neck to the opposite side and tilt the neck (ear-to-shoulder) to the same side. For example, if a child is born with a tight muscle on the right side, the child’s head will tilt to the right and rotate to the left. Torticollis is a muscle problem that must be treated by stretching the tight muscle and strengthening the muscle on the opposite side until symmetry is restored. Research shows that a combination of parental guidance and exercises has the best effect on torticollis. Evidence for manual therapy is limited.

Sensory Integration is the ability of the brain / nervous system to sort, organize and process sensory information so that we can respond appropriately.

Yes, it is. Not life threatening important, but important for motor development. Each milestone your child achieves is a prerequisite for the quality of development of the next milestone.

No. Typically my role is consultative, so you can do the training with your child at home. In the spirit of physical therapy, what we do every day, what we take ownership of, what we understand and see the meaning in, creates long term engagement. So my most important role is to share knowledge, connect the dots with you and give you the appropriate tools (exercises) to motivate you to do the exercises with your child at home.

However, I am very realistic about what is possible in a busy family with children. I’ve been training my own son with sensorimotor exercises at home for several years now, and I don’t set aside specific training time. Rather, I incorporate the exercises into our play time. I also involve him in everyday activities that fit into the training framework, and I have established rules and routines for motor activity. In the beginning he needed a lot of training and now he needs much less. Of course, it requires motivation from both you and your child, and it may take some adjustment at first, but eventually it will become an ingrained part of your daily routine.

I’m convinced that this approach will yield much better results than having your child train once a week in an unfamiliar environment with equipment not available at home. I have a strong interest in motivational psychology and one of my strengths is motivating my clients to make a difference for their children.

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There will always be someone to help you up the two steps to enter the clinic. You can also choose to use rear entrance of the building, where we have a wheelchair entrance at street level. Other than that, you can always ask at the reception if you are unsure about anything.

No, it won’t. Any exercises you receive from a pediatric physical therapist will be adapted to your baby’s muscle pattern. The worst thing that can happen by doing exercises with your baby, even if they could do them on their own, is that they’ll get stronger in the right places for future milestones. That’s why many parents use my exercise programs as regular playtime inspiration during the long days of maternity leave. The motor restlessness and sensory integration exercises are also good for all children as they provide general calming sensory stimulation for better physical and mental calm. The specific balance exercises can be overdone, so be aware of your child’s signs of discomfort. Everything else is just nice and beneficial for your little one.

If your child generally has a strong need for sensory stimulation to fall asleep, it’s often a sign that he or she can benefit from exercises that stimulate these “hungry” senses, making it easier for the body to find rest. It’s important to note that motor restlessness is completely normal and is NOT a diagnosis. However, we do know today that restless sleep is not just a very long phase that parents must endure, but that we can work with this restlessness to return to a good night’s sleep.

I usually say that you should think of the exercises as a powerful tool in your toolbox, but don’t forget to consider if there are other more serious and treatable reasons why a baby or toddler is sleeping poorly. These may include stomach or ear problems, night terrors, melatonin deficiency, or other discomfort for the child. In these cases, the exercises are still very important, but they are only part of the solution. As a starting point, the exercises will be relevant to all children who are premature, have experienced birth trauma, or have been hospitalized for illness.