Play is an active process by which an individual is intrinsically motivated to explore the self, the environment, and/or interactions with another person. For infants and toddlers, engaging in play is essential to support development across multiple domains. Infants and toddlers with or at risk of motor delays may demonstrate differences in play or challenges with engaging in play activities compared to typically developing peers. Pediatric physical therapists often use play as a modality to engage children in therapeutic assessment and interventions. Careful consideration of the design and use of physical therapy that embeds play is needed. Following a 3-day consensus conference and review of the literature, we propose physical therapy that embeds play should consider three components; the child, the environment, and the family. First, engage the child by respecting the child’s behavioral state and following the child’s lead during play, respect the child’s autonomous play initiatives and engagements, use activities across developmental domains, and adapt to the individual child’s needs. Second, structure the environment including the toy selection to support using independent movements as a means to engage in play. Allow the child to initiate and sustain play activities. Third, engage families in play by respecting individual family cultures related to play, while also providing information on the value of play as a tool for learning. Partner with families to design an individualized physical therapy routine that scaffolds or advances play using newly emerging motor skills.

Introduction: In pediatric physical therapy, there is an ongoing debate about the use of therapeutic handling and its potential effects on motor learning. In this study, we build on enactive theoretical perspectives to explore the role of therapeutic handling in connection to children's sensory-motor play, engagement, and performance during a single physical therapy session.Material and methods: This is a qualitative study based on video observations of therapy sessions and interviews with 15 physical therapists (PTs) each treating two different children aged 0–3. The authors utilized a framework of co-reviewing, discussing, and reflecting on the sessions. Themes were identified and used to describe the ways by which PTs’ therapeutic handling unfolds, with connections to theories on sensory-motor play and learning, along with enactive perspectives on embodiment, experience, mutual incorporation, and sense-of-agency.Results: The characteristics and purposes of therapeutic handling are presented in two main themes: (1) position and support, and (2) directing movement. We found that position and support promoted sensory-motor improvement when the PTs’ handling aligned with the child's play interests and engagements. As part of play, the children used new and additional support surfaces to self-initiate better posture and movement solutions and reach play goals. The PTs’ ways of directing movements varied. To awaken curiosity and induce a child's self-driven motor exploration the PT needs to be subtle, flexible, and precise in the directing of movement. This entails responsiveness to the child's signals and bodily know-how in the placing of hands and direction of pressure to enable the child to actively participate in and eventually self-drive movement.Discussion: Therapeutic handling that is mutually incorporated between PT and child can enrich the child's playing-to-learn-to-move process by providing novelty and facilitating the child's sense-of-agency in the self-initiated exploration and refinement of movement possibilities. In the PTs’ effort to merge therapeutic handling with children's play, the momentum of interaction can open new therapeutic windows of movement experience and learning opportunities.

Having a preterm infant is a life-altering event for parents. The use of interventions intended to support the parents is recommended. In this study, we investigated how parents’ perceptions of physiotherapy in primary health care influenced their adaptation to caring for a preterm child. We conducted 17 interviews involving parents of seven infants, at infants’ corrected age (CA) 3, 6, and 12 months. The analysis was a systematic text condensation, connecting to theory of participatory sense-making. The parents described a progression toward a new normalcy in the setting of persistent uncertainty. Physiotherapists can ameliorate this uncertainty and support the parents’ progression toward normalization, by providing knowledge and acknowledging both the child as subject and the parent–child relationship. Via embodied interaction and the exploration of their child’s capacity, the parents learn about their children’s individuality and gain the confidence necessary to support and care for their children in everyday life.

Background: Physiotherapists (PTs) in primary health care provide services to preterm infants and their parents after hospital discharge. The service should be collaborative and individualized to meet the family’s needs. In this study, we analyze pediatric PTs’ collaborative work in the clinical setting and investigate the PTs’ emerging clinical reasoning (CR) in interaction with the infant and parent(s). Methods: The study is based on observations of 20 physical therapy sessions and 20 interviews with PTs. We performed a systematic content analysis informed by enactive theory regarding the interactions and co-creation of meaning. Results and Discussion: CR emerged in reciprocity with the PTs’ interaction with the infant and parent(s). Based on the sensitivity to the infant’s motor abilities and signs of engagement as well as the parents’ need of support and education, the PTs individualized and reasoned about their therapeutic approach. This interactional CR was vulnerable: infant disengagement, parent expectations, and PT preoccupations could obfuscate interactions and hamper CR. Conclusion: Through mutuality and engagement with the infant and parent(s), the PTs allow the autonomy of interaction to emerge and shape the translation of CR into successful therapeutic actions and learning together with the infant and parent(s).

Introduction: Play is a way for children to develop and learn about themselves in conjunction with the world. Using play as part of pediatric physical therapy is broadly recommended. This study investigates this integration of play and seeks to answer the research question: How do pediatric physical therapists (PPT) understand and manage embedding play in pediatric physical therapy with children aged 0–3?Methods: This is a qualitative study in which we connect to an enactive theoretical framework. We interviewed 14 PPTs about their use of play, including video-elicited questions while viewing recordings of their therapy sessions. Our results were developed through an abductive thematic analysis.Results: The PPTs acknowledge play as a foundation of children’s learning and a vital component of physical therapy. They explain that play and therapy often co-exist and intertwine, but they also experience tensions when they strive to make play therapeutic. The PPTs find it taxing to engage in play with children who present with limited interaction and play skills, and voice concern for children who struggle to engage in interactional play.Discussion: Trusting play and letting play emerge through shared sense-making can resolve challenges and enable PPTs to discover new therapeutic opportunities. A child’s striving and overcoming of resistance can be infused with playfulness and make play thrive. We invite PPTs to experiment with the emerging opportunities and boundaries between therapy and play during treatment sessions. Respect for the child’s autonomy, attention to the child’s play experience, and repairs of interactional mismatches are crucial in this process. Therapeutic guidance and mutuality in interactions can empower children to learn to play to learn new skills and experience mastery as they explore and venture beyond what they already know.