Cleveland_Clinic_Host: The outpatient therapy program at Cleveland Clinic Children’s Hospital Shaker Campus helps children from birth through young adulthood who are chronically ill or disabled or who are recovering from serious injury. Our goal is to help them become as independent as possible.

After we review your child’s needs, we form a specific, individualized treatment plan. Many children need a combination of therapies, including physical, occupational and/or speech/language therapy. The duration of therapy depends upon the child’s needs. Some children need short-term physical therapy just to build muscle strength following an injury, while others need long-term therapy to cope with a chronic condition.

Please join two of our physical therapists, Merri Jo Somodi, PT and Ann Marie Pace, MS, PT to discuss the concerns of your child. Merri Jo graduated from Ohio University in 1994 with a BS in Physical Therapy. She is certified in Neurodevelopmental Treatment, Neuromuscular Electrical Stimulation and Pediatric Kinesio Taping. Merri Jo has been working for Cleveland Clinic Children's Hospital for Rehabilitation since October of 1994.

Ann Marie Pace has a BA from Denison University and Master's in Physical Therapy from Hahnemann University in Philadelphia, PA. She has over 19 years under her belt as a therapist specializing in pediatrics. Ann Marie has worked in a variety of clinical practices such as: early childhood in Syracuse, NY; Shriner's Orthopedic Hospital in Greenville, SC; private practice and special education in Dallas, Texas. She has a special interest in treatment of infants with torticollis.

Outpatient therapy is valuable for children who:

  • have experienced serious injuries
  • have chronic and acute conditions that limit their development
  • are experiencing developmental delays (e.g., walking or speaking late)
  • have learning difficulties
  • have trouble performing activities of daily living (e.g., bathing or dressing)

Babies who were born prematurely also may benefit from therapy to prevent or minimize developmental delays.

To make an appointment with our physical therapists Ann Marie Pace, MS, PT, Merri Jo Somodi, PT, or any of the other specialists at Cleveland Clinic Children's Hospital for Rehabilitation in the Children's Hospital and Pediatric Institute at Cleveland Clinic, please call 216.636.KIDS (5437) call toll-free at 800.553.5056.  You can also visit us online at

Overview of Pediatric Physical Therapy Services

cellieQ: What is pediatric physical therapy? What type of diagnosis, do you treat?

Merri_Jo_Somodi_PT: Pediatric physical therapy is a service provided to children with a wide variety of special needs. For example, we treat children with Cerebral Palsy, Spina Bifida, Down Syndrome, Autism and Developmental Delay. These are just a few of the special needs our children may present with. We also are seeing more and more children with sports related injuries and obesity.

jpp: What ages do you serve?

Speaker_-_Ann_Marie_Pace_MPT: Cleveland Clinic Therapy Services serves children birth thru twenty one years.

jpp: Is speech language therapy also available?

Merri_Jo_Somodi_PT: We offer Speech Therapy at all of our locations in Cleveland, Westlake, Middleburg Heights and soon to be returning to Beachwood.

cellieQ: Where are services located?

Merri_Jo_Somodi_PT: We offer services at 4 locations; 2801 Martin Luther King Jr. Dr. is our Shaker Campus. Our South campus is located at 7043 Pearl Rd. Suite 200, Middleburg Hts. Our West Campus is 826 Westpoint Parkway, Suite 1200 in Westlake. Our Eastside location will be opening in Beachwood in the beginning of 2010.

hattie: What is the difference between physical and occupational services?

Speaker_-_Ann_Marie_Pace_MPT: Physical Therapy services address gross motor skills as well as balance, coordination and strength.

Occupational Therapy addresses fine motor skills, activities of daily living and handwriting, as well as sensory concerns.

momE: Why is physical activity important?

Merri_Jo_Somodi_PT: Physical activity helps our children by improving their overall health. Promoting an active lifestyle will help children obtain or maintain healthy weight, improve bone and muscle strength, improve endurance and coordination and also plays a big role in alertness and attention in school.

jackb: My son broke a growth plate in his right ankle at 5. He broke the growth plate in his other ankle at age 7. Later that year he fractured the right growth plate again. He is now 9. Would PT or OT be advisable to help strengthen his ankles or legs to prevent further injury? He is very active physically. What implications will these have for him in the future? Can it affect his growth?

Merri_Jo_Somodi_PT: My question to you is what is causing him to fracture? Is it possible that there is an underlying diagnosis? I would recommend you speak to an Orthopaedic Physician. Certainly a Physical Therapist could help with strengthening the muscles that support these bones.

one23: I recently read an article that children who walk consistently on their toes could have a mild form of cerebral palsy. My son has always walked on his toes, or the balls of his feet. He is 12 and has had good yearly checkups. Is this something I should bring up with his doctor, or if the doctor has not seen anything before now, am I making more out of this than I need to?

Merri_Jo_Somodi_PT: Your child could have tightness in his heel cords (Achilles Tendon). A home stretching program daily often helps to resolve this. Toe walking is caused by a variety of reasons. Sometimes it is due to weakness or sensory defensiveness. It would be fair to ask your physician for a referral to PT at his next appt.

relyon: At what age would a child be tested for Cerebral Palsy, at what would be the warning signs that a child could have it?

Speaker_-_Ann_Marie_Pace_MPT: Signs of Cerebral Palsy may include: spasticity "rigid or tight muscles", asymmetry between right and left sides of the body, and/or unsteady gait. I would take concerns to your pediatrician. A neurologist can be further consulted.

frum2: Is there an association between delayed motor skill development, either gross or fine, and autism?

Merri_Jo_Somodi_PT: Not all children with delayed gross motor skills are autistic but clearly children with autism may have gross motor/fine motor delays.

praynow: Are certain children more at risk for motor skill development delays? If so, what are the risk factors?

Merri_Jo_Somodi_PT: Lots of factors affect motor development. Birth order plays a role, environment plays a role. A child's environment should offer safety but also provide visual, cognitive and motor stimulation. Some children are just naturally slower to develop. What is important is that the child is continually changing as they grow.

Gross Motor Skill Development

norris_m: What are the key aspects of Gross Motor development?

Merri_Jo_Somodi_PT: The key aspects of gross motor development are strength, balance and coordination.

clang: What are some of the causes of problems with gross motor skills?

Merri_Jo_Somodi_PT: There are lots of causes of developmental delay in gross motor skills. Your child may have an underlying diagnosis but that is not always the case. Personality, heredity and environment may also play a role. Some children may spend too much time in positioning devices (car seats, swings, play pens) which limits motor development. Parents are also fearful to place their newborn babies on their bellies due to the fear of SIDS. It is very important for development and strengthening that children have belly time every day while alert. This helps to strengthen their much needed core muscles that they will use for standing and walking in the future.

jolie_985: When there are motor skills problem in children, are the problems the problem itself, or are they usually caused by another underlying problem?

Speaker_-_Ann_Marie_Pace_MPT: I would say both. Typically a child who perhaps has poor balance might be caused by low tone, decreased strength or poor attention.

Overall the gross motor deficit is typically the result of underlying diagnosis. It is possible for a child to display weakness but as a physical therapist it is my job to determine the underlying cause.

maryann: What are some things that I can do at home to help my child develop better gross and fine motor skills? How about toys?

Merri_Jo_Somodi_PT: Keep your child physically active. Encourage belly time for your infant, encourage running, jumping and hopping for your toddler. Swimming programs are great for sensory and strengthening. Karate and ballet are great for balance and coordination and core strengthening. Gymnastics/kinder programs are great for core strengthening and coordination.

There are a lot of great toys out there right now that encourage activity. Video games that encourage standing and balance/aerobic activities are great. Don't forget to keep balls, hula hoops and jump ropes around for a child to see and grab whenever. Limit TV time and video games that you sit and stare at.

Gross Motor Milestones

norris_m: What are some gross motor warning signs to look for in the first year of life?

Merri_Jo_Somodi_PT: We look for what refer to as abnormal movement patterns. If your child is not able to hold his/her head erect by the age of 4 months or not sitting by the age of 9 months, you should have us take a look.

turnkey: What can be done to help a child born 3 months premature to help them catch up to other kids their age, with their motor skills? My niece is 1 year old and is quite a bit delayed as compared to when my 2 children were the same age.

Speaker_-_Ann_Marie_Pace_MPT: As a one year old child emerging walking skills, opportunities to climb up on furniture or balance on uneven surfaces such as the backyard grass. By 18 months some children enjoy a ride on toy without pedals.

how2: My child is 15 months and not yet walking, should I be concerned?

Merri_Jo_Somodi_PT: Children walk at a wide variety of ages, from 9 months to 15 months. This is an average, meaning some walk before and some walk much later. If your child is refusing to stand at 15 months, you should have us take a look.

norris_m: My child is 3 and getting ready to start preschool, what are some Gross Motor benchmarks for this age?

Speaker_-_Ann_Marie_Pace_MPT: Some gross motor skills of a three year include: walk up stairs alternating feet, jump, pedal a tricycle a catch a kickball.

pleased2B: My son was very young when he reached some his milestones. He was sitting up at about 4 months, walked at 9 months, and so on. Does this give him any advantages or will have problems later in life? He is really very coordinated for a little kid. Should I restrict some of the things that he does or let him be as long as his is physically able? He is now 4.

Speaker_-_Ann_Marie_Pace_MPT: I would not restrict his physical activity. However, it is important to keep age appropriate physical activity. A four year old child should not be involved in organized sport. A child of this age should enjoy physical activity for fun.

LaikenE: My child is 5 and starting Kindergarten, what are some gross motor benchmarks for a 5 year old?

Merri_Jo_Somodi_PT: By the age of 5, your child should be able to hop on one foot, carry objects while walking, walk on a balance beam, alternate feet when walking up/down stairs without needing the railing, imitate movements, skip, and walk down stairs while carrying an object.

kelnmel: Is there a general timeline that professionals use to gauge a child’s development in regards to motor skills? Can you give us the basics?

Merri_Jo_Somodi_PT: There are several standardized tests that we use to evaluate a child's gross motor development. It is important to remember that all children are different and grow up in different environments. Basically we would look for children to be rolling between 4-6months, sitting up between the age of 6-8months, pushing up on hands and knees between 10-12 and standing to walking between 12-15 months.

kelnmel: In regards to my previous question about the timeline, how long do you give before you start to worry, say 1 month, 6 months, a year? I do understand that every child is different and develop at different speeds.

Merri_Jo_Somodi_PT: I would be concerned if the child is not moving through different areas. Each gross motor skill takes a different amount of time to master. For example, rolling could take several months to master, especially if they are not spending enough time on their bellies. If they are not sitting alone by 9 months, have us take a look.

helenp: With my first child, I spent a lot of time "playing" with him as an infant. We would do what I used to call "exercise," moving his arms and legs as if he were running, clapping, etc. Unfortunately I did not have as much time to spend with my second born son. My first child developed motor skills much more quickly and easily than did my second. Was this because of the time I spent with him at such an early age?

Merri_Jo_Somodi_PT: Children are all different, even within the same family. It is very common for the second/third born, etc. to develop motor skills either slower or quicker. Later born children have the benefit of stimulation from not only their parents but from their siblings. He/She will get visual and verbal stimulation that your first born did not get. It will all work out in the end.

Chronic Pain Program at Cleveland Clinic Children’s

123abc: Can you tell me a little about the chronic pain program?

Speaker_-_Ann_Marie_Pace_MPT: Cleveland Clinic Children's Hospital for Rehabilitation Therapy Services offers a chronic pain program, which typically lasts 3 weeks - two weeks inpatient, one week outpatient. This is a comprehensive program which includes: physical therapy, occupational therapy, psychology and medicine. The total approach addresses: physical and emotional health and return to prior function.

Speech Therapy Services at Cleveland Clinic Children’s

momx2: At what age do you start worrying that your child is not yet speaking or saying only a few words here and there?

Speaker_-_Ann_Marie_Pace_MPT: Although I am not a speech therapist, my colleagues have noted a child should have 50 words by the age of two. Two year olds should be starting to put two words together. Speech therapists can better assess your child’s skill and when in doubt, I would recommend an assessment.

momx2: What about quality of speech?

Speaker_-_Ann_Marie_Pace_MPT: Quality of speech refers to articulation. Again I am not a Speech-Language pathologist. There are age related speech errors. For example, late forming sounds include an "r" or "l".

A 3 and 1/2 year old to four year old child should speak clearly and be understood to strangers.

Childhood Obesity

sally: What about obese children? What types of programs are available?

Speaker_-_Ann_Marie_Pace_MPT: Fit Youth- This is a program available to help overweight kids engage in physical activity, nutritional support and peer group support at several Cleveland Clinic locations. This program is available Cleveland Clinic Main campus and Independence family Health Center. If you are interested and would like more information, please contact Fit Youth at 216.986.4128.


Cleveland_Clinic_Host: I'm sorry to say that our time with physical therapists Ann Marie Pace, MPT and Merri Jo Somodi, PT is now over. Thank you again Ann Marie and Merri Jo for taking the time to answer our questions about infant motor development and milestones.

Merri_Jo_Somodi_PT: Thanks for letting us participate. Hopefully your questions and concerns were addressed.

Speaker_-_Ann_Marie_Pace_MPT: Thanks for the opportunity. If you have any concerns regarding your child's development it is better to seek an assessment.

More Information

  • To make an appointment with our physical therapists Ann Marie Pace, MPT, Merri Jo Somodi, PT, or any of the other specialists at Cleveland Clinic Children's Hospital for Rehabilitation in the Children's Hospital and Pediatric Institute at Cleveland Clinic, please call 216.636.KIDS (5437) call toll-free at 800.553.5056.  You can also visit us online at
  • A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit
  • If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
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This health chat occurred on November 19, 2009.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.