If you’ve noticed that your child’s feet look flat when they stand or walk, you’re not alone. Flat feet are one of the most common reasons parents ask pediatricians and physical therapists about their child’s development. The good news is that most children with flat feet have completely normal foot development and will never experience pain or long-term problems.

Knowing the difference between normal development and a condition that deserves further evaluation can help parents make informed decisions and avoid unnecessary worry.

What are Flat Feet?

Flat feet, also called pes planus, occur when the arch on the inside of the foot appears lower than expected or disappears when a child is standing. In many young children, this is a normal part of development.

Babies and toddlers naturally have a layer of fatty tissue on the bottom of their feet that hides the arch. As children grow, their bones, muscles, ligaments, and tendons mature, allowing the arch to gradually develop. Research shows that the arch continues developing throughout childhood, with significant changes occurring during the first decade of life.

Most children are born with flexible flat feet, meaning an arch appears when they sit, stand on their toes, or when the foot is not bearing weight. Flexible flat feet are considered a normal variation of development in most children.

Why Do Some Children Have Flat Feet?

Several factors can contribute to flat feet in children. Normal growth and development are the most common reasons. Family history also plays an important role, as flat feet often run in families.

Some children naturally have looser joints and more flexible ligaments, allowing the arch to flatten more when standing. Tight calf muscles or Achilles tendons can also influence foot position and walking mechanics.

Less commonly, flat feet may be associated with neurological conditions, connective tissue disorders, or structural abnormalities that require medical evaluation.

When Are Flat Feet Normal?

For most young children, flat feet are simply part of growing up. If your child runs, jumps, climbs, and plays without pain, their flat feet are usually nothing to worry about. Many children develop stronger arches as they get older without any treatment.

Current research suggests that treating painless flexible flat feet solely to create an arch is generally unnecessary. Studies have consistently found that shoe inserts and corrective footwear do not permanently change the structure of a child’s foot as it develops. Instead, the arch typically matures naturally over time.

When Should Parents Be Concerned?

Although most cases are harmless, there are situations where an evaluation by a pediatric physical therapist or healthcare provider is recommended.

Signs that deserve attention include foot pain during activity or after walking, frequent complaints of tired feet or legs, difficulty keeping up with other children, frequent tripping or poor balance, one foot looking significantly different from the other, stiffness that prevents the arch from appearing when standing on tiptoes, or swelling and persistent limping.

Children who consistently avoid physical activity because of foot discomfort should also be evaluated. Pain is one of the most important signs that a child’s flat feet may need treatment.

How Can Physical Therapy Help?

Physical therapy focuses on improving how the foot functions rather than simply changing its appearance. A pediatric physical therapist evaluates the entire movement system, including foot posture, strength, balance, flexibility, walking pattern, coordination, and muscle control.

Treatment may include exercises that strengthen the muscles supporting the foot and ankle, balance activities that improve stability, stretching to address tight calf muscles, gait training to improve walking mechanics, and activities that develop overall lower body strength. Therapy also helps children improve confidence during sports, playground activities, and everyday movement.

Do Shoe Inserts or Orthotics Help?

Parents are often surprised to learn that orthotics are not recommended for every child with flat feet. Current evidence suggests that orthotics do not permanently create or restore the arch in children with flexible flat feet. However, they may be helpful for children who have pain, fatigue, or difficulty participating in daily activities.

When prescribed appropriately, orthotics can improve comfort, reduce stress on the feet, and allow children to stay active while other treatments such as strengthening and stretching address the underlying movement issues.

For children without symptoms, supportive shoes and normal physical activity are often all that is needed.

What About Posture?

Flat feet can sometimes contribute to changes higher up the body, including knee valgus, or “knock knees.” When the arch collapses excessively, the foot may roll inward, affecting the alignment of the lower leg and knee during movement. While not every child with flat feet develops these issues, orthotics can help improve foot alignment and reduce stress on the feet and knees in children who have pain or movement difficulties. Current research shows that orthotics improve comfort and movement mechanics but do not permanently correct knee valgus or overall posture. When needed, the best results are typically achieved by combining orthotics with strengthening and balance exercises.

How Parents Can Support Healthy Foot Development

Parents can encourage healthy foot development by allowing children plenty of opportunities for active play. Running, climbing, balancing, hopping, and playing outdoors all help strengthen the muscles that support the feet.

Choosing well-fitting athletic shoes that provide comfort and flexibility is generally more beneficial than purchasing expensive corrective footwear. If your child enjoys safe barefoot play on grass, sand, or other natural surfaces, this can also help strengthen the small muscles within the feet. Most importantly, pay attention to how your child feels rather than how their feet look. Pain, fatigue, or difficulty participating in activities are much more meaningful indicators than the appearance of the arch alone.

References

1. Banwell HA, Paris ME, Mackintosh S, Williams CM. The typically developing paediatric foot: how flat should it be? Journal of Foot and Ankle Research. 2017.
2. Choi JY, Hong WH, Suh JS, et al. The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review. Foot and Ankle Surgery. 2020.
3. Treatment of Pediatric Flatfoot: A Systematic Review-Based Consensus and Guidelines. 2026 Clinical Practice Guideline.
4. Liu Y, Zhang Y, Li Y, et al. The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: A systematic review and meta-analysis. Frontiers in Pediatrics. 2024.
5. Zangi M, Taheri M, Ahmadi O, et al. Biomechanical effects of foot orthoses in children with flexible flat foot: A systematic review. Journal of Rehabilitation and Assistive Technologies Engineering. 2026.

Sensory processing is the way a child’s brain receives, interprets, and responds to information from the world around them. Most kids take in sights, sounds, textures, movement, and internal cues without much effort. But for some children, this process is harder—louder, brighter, more confusing, or not intense enough. When the brain struggles to organize sensory input, everyday experiences can feel overwhelming or unpredictable, leading to behaviors that parents often find confusing.

What Sensory Processing Really is

Children use eight sensory systems—not just the five we typically think of—to understand their environment:

• Sight (visual)
• Sound (auditory)
• Touch (tactile)
• Smell (olfactory)
• Taste (gustatory)
• Balance (vestibular)
• Body awareness (proprioception)
• Internal cues (interoception)

These systems work together to help a child stay regulated, pay attention, move safely, and participate in daily routines. When the brain has difficulty sorting, filtering, or responding to this information, sensory processing disorders can occur.

Why Do Some Kids Struggle More than Others?

Not all children process sensory information the same way. Some are hypersensitive—their nervous system reacts too strongly. Others are hypo sensitive—they don’t register input fully and seek more. Many kids experience a mix of both.

1. Neurological Differences – Some children’s brains interpret sensory signals differently, making ordinary sensations feel overwhelming, dull, or confusing. These differences are real neurological variations—not behavior problems.
2. Co‑Occurring Conditions – Sensory challenges often appear alongside ADHD, autism, anxiety, OCD, and developmental delays. But they can also occur in children with no diagnosis at all.
3. Environmental Demands – Busy classrooms, loud stores, bright lights, scratchy clothing, or unpredictable routines can intensify sensory difficulties. What feels “normal” to adults may feel like a carnival on full blast to a child with sensory sensitivities.
4. Individual Sensory Profiles – Every child has a unique sensory “fingerprint.” One child may avoid loud noises but crave deep pressure. Another may love spinning but gag at certain food textures. These patterns shape how they respond to daily experiences.

Sensory Challenges can Become Barriers

When sensory processing differences go unrecognized, they can affect nearly every part of a child’s day.

• Getting Dressed – Tags, seams, or certain fabrics can feel painful or unbearable, turning a simple routine into a meltdown.
• Eating Meals – Children may avoid foods based on texture, smell, or temperature—not because they’re “picky,” but because their sensory system interprets these sensations differently.
• School Participation – Sensory overload from noise, lights, or movement can make it hard to focus, follow directions, or stay regulated in the classroom. Kids may appear inattentive, anxious, or disruptive when they’re actually overwhelmed.
• Social Interactions – A child who avoids touch, reacts strongly to noise, or seeks intense movement may struggle to join peers in play. Misunderstandings can lead to frustration or isolation.
• Emotional Regulation – When the sensory system is overloaded or under-stimulated, emotional responses can escalate quickly. Meltdowns, shutdowns, or big reactions often reflect sensory stress—not misbehavior.

Why Understanding Sensory Processing Matters

Recognizing sensory processing disorders helps parents and caregivers:

• Reframe behaviors (“won’t” becomes “can’t yet”)
• Reduce frustration for both child and adult
• Modify environments to support regulation
• Choose activities that meet sensory needs
• Seek appropriate support, such as occupational therapy

When we understand the why behind a child’s reactions, we can respond with empathy instead of confusion. Learn more about the role of occupational therapy in helping children participate in everyday activities,

Traveling with children can create lasting memories, but for kids with sensory sensitivities, travel can also feel overwhelming. Crowded airports, long car rides, unfamiliar places, and changes in routine may trigger stress, anxiety, or sensory overload. The good news is that with preparation and the right travel tips for kids with sensory needs, family trips can become smoother, more enjoyable, and less stressful for everyone involved.

Why Travel Can Be Difficult for Kids with Sensory Needs

Many parts of traveling can challenge a child’s sensory system, including:

• Loud noises
• Bright lights
• Crowded spaces
• Unfamiliar smells
• Long periods of waiting
• Changes in routine

Some children become overstimulated and anxious, while others may seek movement or struggle with transitions. Every child responds differently, so individualized strategies are important when planning sensory-friendly travel for kids.

Prepare Your Child Before the Trip

One of the best travel tips for kids is helping them know what to expect ahead of time. Preparation can reduce anxiety and improve transitions during travel. Helpful ways to prepare include:

• Looking at pictures or videos of airports, hotels, or destinations
• Using a simple visual schedule or checklist
• Talking through each step of the trip
• Practicing routines like security lines or boarding a plane
• Creating a countdown calendar before departure

When children understand what is coming next, they often feel more confident and regulated.

Families traveling by air may also benefit from the TSA Cares program, which provides assistance for travelers with disabilities, medical conditions, and sensory needs. Parents can request support before their trip to help make the airport screening process less stressful and more predictable.

Pack a Sensory Travel Kit

A sensory travel kit can help children stay calm and comfortable throughout the trip. Familiar items provide reassurance and support self-regulation during stressful moments. Consider packing:

• Noise-canceling headphones
• Fidget toys
• Favorite snacks
• Sunglasses or hats
• Comfort objects or blankets
• Tablets, books, or calming activities
• Chew tools or sensory supports

Having these items easily accessible can make travel much easier for both children and caregivers. Many of these supports are based on the same sensory regulation principles discussed in our article about sensory play and how children process information through their senses.

Include Movement Breaks During Travel

Movement is one of the most effective ways to help children regulate their sensory systems while traveling. Simple movement activities include:

• Stretching during breaks
• Walking through the airport
• Climbing at rest stops
• Pushing luggage
• Wall pushes or jumping activities

Even short movement breaks can improve attention, reduce stress, and help children feel more regulated during long travel days.

Keep Routines as Consistent as Possible

Changes in routine can be difficult for many children. Keeping familiar routines during travel can provide stability and comfort. Try to maintain:

• Regular mealtimes
• Bedtime routines
• Preferred snacks and foods
• Familiar calming activities

Packing favorite foods is especially important for children with sensory-based feeding challenges or selective eating habits.

Have a Calm-Down Plan

One of the most important travel tips for kids is planning ahead for stressful moments. Meltdowns and dysregulation can happen during travel, and having a calm-down plan in place can make a big difference. Before your trip:

• Identify quiet areas at airports or rest stops
• Plan extra time for transitions
• Build breaks into the schedule
• Discuss calming strategies with your child

Flexibility is essential. Successful family travel may look different for every child and family—and that is perfectly okay.

Traveling with kids who have sensory sensitivities may require extra planning, but meaningful and enjoyable travel experiences are absolutely possible. With preparation, sensory-friendly supports, and realistic expectations, families can create positive travel memories together while reducing stress along the way.

When it comes to infant development, one of the most powerful tools available is also one of the simplest: positioning during play. The way a baby spends their day—on their tummy, side, back, or in supported sitting—directly impacts their strength, coordination, endurance, and motor skill development. While many parents assume babies naturally get stronger as they grow, strength actually develops through movement, practice, and opportunities to explore different positions.

Understanding how positioning supports development can help caregivers feel empowered and give babies the best foundation for reaching important motor milestones like rolling, sitting, crawling, and eventually walking.

Why Positioning for Play Matters for Development

Every position challenges a baby’s muscles in a different way. By experiencing a variety of play positions throughout the day, babies learn how to:

• Build neck, shoulder, and core strength
• Develop balance and coordination
• Improve body awareness
• Practice reaching, rolling, and weight shifting
• Prepare for future milestones like sitting and crawling

Positioning is much more than tummy time—it’s about giving babies opportunities to move, explore, and strengthen their bodies through play.

5 Easy Positioning for Play Ideas to Build Strength

These simple activities require little to no equipment and can easily be incorporated into daily routines.

1. Side-Lying Play

Side-lying is often overlooked but can be extremely beneficial for infants.

Benefits include:

• Reduces the effects of gravity, making movement easier
• Encourages hands to midline play
• Promotes reaching and rolling skills
• Helps babies who tire easily during play

Tip: Place a rolled towel behind your baby’s back for added support.

2. Chest to Chest Tummy Time

For babies who dislike traditional tummy time, chest-to-chest positioning can be a great alternative.

Benefits include:

• Encourages head lifting
• Strengthens neck muscles
• Provides comfort through close contact
• Ideal for newborns and tummy-time-resistant babies

Simply recline and place your baby on your chest while interacting face-to-face. The American Academy of Pediatrics recommends daily tummy time as an important way to support motor development, build strength, and help prevent flat spots on a baby’s head.

3. Inclined Tummy Time

Using a small pillow or rolled blanket under your baby’s chest can make tummy time more manageable.

Benefits include:

• Reduces the challenge of gravity
• Encourages pushing through the arms
• Builds neck, shoulder, and upper body strength
• Increases tummy time tolerance

4. Supported Sitting

Supported sitting helps babies activate important core muscles long before they can sit independently.

Benefits include:

• Strengthens the trunk and core
• Improves balance reactions
• Prepares the body for independent sitting and crawling

Try sitting your baby on your lap and gently shifting their weight side-to-side while providing support at the hips.

5. Purposeful Back Play

Back play remains an important part of healthy infant development.

Try:

• Feet-to-hands play
• Reaching for toys
• Gentle trunk rotations
• Kicking activities

Back play helps babies discover their bodies and develop coordination. The key is ensuring it isn’t the only position they experience throughout the day.

What If My Baby Doesn’t Tolerate These Positions?

Many babies initially struggle with tummy time, side-lying, or supported sitting. This is common and does not necessarily indicate a problem.

However, if your baby consistently avoids movement, becomes extremely upset during positioning activities, or seems unusually weak, a pediatric occupational therapist or physical therapist can help identify underlying challenges and provide individualized strategies. Looking for more ways to encourage movement and exploration? Check out our ideas for infant play activities that support development through fun, engaging experiences.

How Can Occupational and Physical Therapy Help?

Pediatric therapists support babies by:

• Assessing strength, muscle tone, and motor development
• Identifying sensory or movement-related challenges
• Modifying positions to improve comfort and success
• Gradually increasing tolerance for new movements
• Strengthening the neck, shoulders, and core through play
• Supporting milestones such as rolling, sitting, crawling, and walking
• Teaching caregivers simple strategies to use at home

Therapy is not just about exercises—it is about helping babies develop confidence in their bodies while making movement fun and meaningful.

Positioning is about much more than tummy time. By providing opportunities for movement in a variety of positions, caregivers help babies build the strength, coordination, and confidence needed for future milestones. Small moments throughout the day can have a big impact. With consistent play, supportive positioning, and professional guidance when needed, babies can develop the strong foundation they need to thrive.

Reading aloud on a regular basis is one building block in helping a child acquire reading and writing skills. By making a few small changes to your story time routine, you can grow these skills. Making story time interactive is one of the most impactful ways to improve reading and writing.

How to Make Story Time Interactive

• Prediction – Instead of diving right into reading, use clues from the book to predict what the story is about. Use the title, book cover illustration, chapter title(s) and what your child knows about the world to guess what the story might be about. Then as you read along, guess what might happen next. This keeps your child engaged, maintains interest and improves comprehension.
• Vocabulary – Another strategy is to identify new words. When reading, children will be exposed to novel words and concepts. Identify words that your child may not understand and guide them to use story illustrations or sentences in the text to determine the meaning of the word.
• Retell – Encourage your child to retell the story. This can be at the end of the book or the end of a chapter if the story is lengthy. This teaches your child to identify characters in a story, the main idea, key details, setting and plot. It improves their memory by requiring recall of details and sequences. It also improves speech and language skills because they need to articulate their thoughts clearly. Such skills are a prerequisite to writing a story summary, a report or an original story.
• Modify – To further develop your child’s narrative skills, retell the story with different characters, a different setting, a different sequence of events or a different outcome. You might want to create a ‘new book’ to reread at another time. Add a title that represents the story and even draw a book cover. Retelling a story differently requires memory of the story. It also teaches story structure (including sequencing, plot, characters, outcome), improves vocabulary, fosters critical thinking, and facilitates understanding of different perspectives.

Interactive story time is an opportunity to build language, literacy, and critical thinking skills while creating meaningful moments with your child. The simple strategies above turn everyday reading into an engaging learning experience. They will help nurture a lifelong love of books while supporting the early literacy skills your child needs for success in reading, writing, and communication.

Watching a young child walk on their toes can seem harmless — and in many toddlers, it is. During the early stages of learning to walk, children often experiment with different movement patterns, including toe walking. In many cases, this phase resolves naturally as balance, coordination, and strength improve. However, when pediatric toe walking persists beyond the toddler years, it may be a sign that a child’s body is compensating for underlying challenges involving strength, mobility, posture, motor control, or sensory processing. Persistent toe walking should not simply be dismissed as “just a habit.”

What Is Toe Walking?

Toe walking occurs when a child walks primarily on the balls of their feet without consistently placing their heels on the ground. While occasional toe walking can be common in children under age two, ongoing toe walking may warrant further evaluation.

The term idiopathic toe walking is often used when no clear neurological or orthopedic diagnosis is identified. But many pediatric specialists now recognize that toe walking is frequently connected to deeper movement, sensory, or developmental factors — even when no formal diagnosis exists.

Possible Causes of Toe Walking

Toe walking is not always caused by tight calf muscles alone. In fact, it is often a whole-body movement pattern influenced by several systems working together.

Some contributing factors may include:

• Tightness in the Achilles tendon or calf muscles
• Weakness in the core, hips, or lower extremities
• Sensory processing differences
• Vestibular or balance challenges
• Postural instability
• Vision impairments
• Increased muscle tone or neurological conditions
• Motor planning or coordination difficulties

Toe walking has also been associated with conditions such as cerebral palsy, muscular dystrophy, autism spectrum disorder, and developmental delays. Some other risk factors can include frequent heel pricks as an infant. It can also sometimes be connected to broader coordination and motor planning challenges. This is why a thorough evaluation is important when toe walking persists.

Why Early Evaluation Matters

Many children who continue toe walking develop physical adaptations over time. So, as the body grows, persistent toe walking can contribute to:

• Tight calf muscles and limited ankle mobility
• Poor balance and coordination
• Frequent tripping or falling
• Difficulty participating in sports or playground activities
• Foot, knee, hip, or back discomfort
• Changes in posture and walking mechanics
• Difficulty finding shoes that fit
• Social stigma

Early intervention can help prevent these long-term compensations from becoming more difficult to treat later in childhood.

How Pediatric Physical Therapy Can Help

Pediatric physical therapists evaluate much more than the feet and ankles. A comprehensive assessment looks at how the entire body moves and functions together. Treatment plans are specific to each individual and may include:

• Stretching and mobility exercises
• Strengthening for the core and lower body
• Balance and coordination activities
• Gait retraining
• Sensory integration strategies
• Home exercise programs
• Taping techniques
• Orthotics, braces, or night splints

The goal is not simply to “force heels down,” but to improve the child’s overall movement quality, stability, body awareness, and functional mobility.

When Should Parents Seek Help?

Parents should consider an evaluation if their child:

• Continues to toe walks most of the time after about 3 months of walking
• Toe walking is increasing instead of decreasing
• Cannot comfortably place their heels flat on the floor
• Complains of leg or foot pain
• Frequently trips or falls
• Shows stiffness, tightness, or balance concerns
• Has delays in coordination or motor skills
• Recently began toe walking after previously not walking on toes

In many cases, earlier intervention leads to better outcomes and may reduce the need for more aggressive treatment later on.

A Whole-Child Approach

Toe walking is rarely just about the feet. Rather, it is often a reflection of how a child’s muscles, nervous system, posture, sensory processing, and movement patterns work together. By addressing the root causes instead of only the symptom, pediatric therapy can help children move more efficiently, confidently, and comfortably in everyday life.

If you have concerns about your child’s walking pattern, speaking with a pediatric physical therapist can provide clarity, reassurance, and guidance on the next best steps.

References

1. Know to Change. (n.d.). Know to Change. https://www.knowtochange.com/