When Your Child's Therapy Isn't Working
Your child has been in occupational or physical therapy for months. You're driving to appointments, doing the home exercises, and you're not sure anything is changing. That's an exhausting place to be, and it's a common one. Sometimes the therapy genuinely isn't working. Sometimes it is working and nobody has shown you the evidence. Sometimes something else is in the way entirely. This page walks through how to tell the difference and what to do about each.
Is the therapy failing, or are the expectations wrong?
Start here, because it's the most common answer and the easiest to fix.
Motor development in children with delays or disabilities is slow and uneven, and progress often arrives in steps rather than a steady climb. A child with Down syndrome typically walks between 23 and 32 months, compared with around 18 months for other children. A child tracking to that timeline is not behind, they're on a different curve. A baby born at 28 weeks should be measured from their due date, not their birth date, until about age two.
Ask your therapist directly: compared to what? If a timeline you've been given assumes a typical developmental curve, it's the wrong yardstick.
Just starting out instead? See what happens after a therapy referral.
How long should it take to see progress from pediatric therapy?
There's no universal answer, which is exactly why you should have been given a specific one for your child.
A good therapist can tell you what skill they're working toward, roughly when they'd expect to see it, and what they'd change if it doesn't appear. If you've never been given that, you have no way to judge whether therapy is working. And neither do they.
Ask for goals in writing, with target dates. This is a normal request and it is the single most useful thing you can do.
Has anyone actually measured your child's progress?
Impressions are unreliable, in both directions. Standardized measures exist for exactly this reason. The Gross Motor Function Measure (GMFM-88) is widely used in pediatric therapy, and there are others suited to different ages and conditions.
Ask when your child was last formally assessed and whether you can see the scores compared with the previous assessment. If nothing has been measured in a year, that's worth raising.
Two things you can do yourself:
- Film short videos at home every few weeks. Motor progress is often too gradual to notice day to day, and video is the most honest record you'll have.
- Track function rather than exercises. Is dressing easier? Can they hold a position longer? Do they attempt more on their own?
Could your child be getting the wrong kind of therapy?
Occupational therapy, physical therapy, and speech-language therapy overlap but target different things. Broadly, PT tends to focus on gross motor skills, mobility, and strength; OT on fine motor skills, sensory processing, and daily living tasks; speech on communication, and often feeding and swallowing.
If your child's biggest barrier is gross motor and they're only receiving OT, or their real difficulty is feeding and nobody has assessed it, more of the same therapy won't close the gap. Ask whether an evaluation from a different discipline is warranted.
Is your child getting enough therapy to make a difference?
Frequency matters, and for some goals a 30-minute weekly session is simply not enough repetition to drive change.
Ask your therapist whether they believe the current frequency is sufficient for the goals you've set, and what they'd recommend without insurance constraints. That answer is often different from what's being delivered, and knowing the gap tells you whether to push for more visits, seek additional services, or look at an intensive model.
Does your child have a diagnosis?
If nobody has explained why your child's development is delayed, that's worth pursuing alongside therapy rather than after it.
A cause can change what your child needs, identify treatable conditions, and connect you to condition-specific support. Some causes are time-sensitive. Ask your pediatrician for a referral to pediatric neurology, genetics, or developmental pediatrics if no workup has been done.
Is it a fit problem?
Therapy depends on a child engaging, and some children simply don't connect with a particular therapist or setting. A dysregulated child in a loud clinic will not perform, and that isn't a measure of their potential.
It is reasonable to ask for a different therapist, a quieter room, a different time of day, or a home-based session. Asking is not an insult to the therapist; it's information they need.
What other approaches could we ask about?
If you've addressed the above and progress has genuinely stalled, there are other approaches used in pediatric therapy. None of them is a cure, and none has an evidence base that justifies dropping what's working.
Intensive models — the same therapy delivered daily or twice daily over one to two weeks instead of weekly, on the reasoning that concentrated repetition drives faster motor learning
Dynamic Movement Intervention (DMI) — a structured, therapist-directed approach that provokes active postural responses against gravity
Cuevas Medek Exercises (CME) — the approach DMI evolved from
NDT / Bobath — a long-established neurodevelopmental approach many pediatric therapists are trained in
Aquatic therapy — water reduces the effect of gravity, which can allow movement a child can't yet produce on land
Be direct with any provider about what evidence supports what they offer. For DMI specifically, there is no published outcome research yet, and a January 2026 paper in Pediatric Physical Therapy argues it should not be presented to families as established treatment. A randomized trial comparing DMI to the Bobath approach completed in June 2026 with results not yet published.
Read our full summary of DMI and what the evidence shows
How do I get a second opinion?
Ask your pediatrician for a referral to a different clinic for an evaluation only. You are not obligated to switch providers, and a fresh set of eyes with standardized testing often clarifies whether progress is real.
In Idaho, children under three can be evaluated at no cost through the Idaho Infant Toddler Program, independent of any private clinic. School-age children can request an evaluation through their district.
What if the honest answer is that progress will be slow?
Sometimes everything is being done well and progress is still slow. That is a real outcome and it is not a failure. Not yours, not your child's, and not necessarily your therapist's.
What changes in that situation is the goal. Gains in comfort, ease of caregiving, tolerance of positioning, and participation are real gains even when milestones stay out of reach. A therapist who can talk honestly with you about that is worth more than one who keeps promising the milestone.