When we think of pelvic floor dysfunction, our minds often go straight to adults. We may even consider toddlers or children struggling with conditions like constipation or bedwetting. A population I frequently find missed is the infant! Many providers don’t realize that the pelvic floor issues that show up in infancy don’t have to be waited out.
As pediatric pelvic health providers, we have a unique and powerful role to play in helping babies who struggle with common challenges like reflux, colic, constipation, feeding difficulties, and even motor delays. At the root of many of these concerns lies the pelvic floor—an area often overlooked in traditional pediatric care. These parents will go to their providers, and they’ll be offered advice like “hold them upright for 20 minutes after feeding” or “try a lactation consultation,” but what happens if these interventions are not enough, OR what happens if a rehab provider wants to provide more support to a struggling family.
You may be thinking, “I don’t do pediatrics.” If that is your stance, I recommend you keep reading. You don’t have to be a dedicated pediatric therapist to provide families struggling with cranky or uncomfortable babies. Even if you don’t want to provide specific recommendations and treatment, you can still screen and offer referrals for support and even this step will create improvement in the quality of life of your families.
Understanding the Infant Pelvic Floor: More Than Just Diaper Changes
The abdominal canister in infants is still developing and is deeply interconnected with multiple systems in the body:
- The digestive system (contributing to reflux, gas, and constipation)
- The nervous system (especially for babies with difficulty calming or regulating)
- The musculoskeletal system (torticollis, body tension, abnormal movement patterns)
- The oral-motor system (especially in cases of tethered oral tissues or poor latch)
When these systems are under stress or not functioning in sync, the baby will likely be showing difficulty in performing regular functions, causing them to be uncomfortable. All babies express their discomfort differently, but this can lead to stressful symptoms such as crying, fussing, gassiness, constipation, reflux, and vomiting, leading to abnormal posturing and gross motor delays due to these adverse symptoms.
What Infant Pelvic Floor Dysfunction Looks Like
Pelvic floor issues in babies don’t always look like they do in adults. Instead, rehab providers may notice:
- Chronic straining to poop or lack of bowel movement coordination
- Irregular bowel habits, bloating, and gas
- Body tension that affects feeding or limits comfortable tummy time
- Shallow or inefficient breathing patterns
- Arching or clenching behaviors in response to gas or discomfort
- Difficulty tolerating changes in position or touch
These signs are often dismissed as “just colic” or “something they’ll grow out of,” but we know that targeted therapy can make a significant difference—not just in comfort, but in functional development.
The Role of Rehab Providers: PTs and OTs Working Together
Both physical therapists and occupational therapists play essential roles in assessing and treating infant pelvic floor dysfunction.
Physical therapists focus on:
- Core and pelvic floor coordination
- Alignment and tension patterns affecting bowel/bladder mechanics
- Breathing mechanics and diaphragm coordination
- Tummy time, head shape, and early motor development
Occupational therapists bring expertise in:
- Feeding and oral-motor function
- Sensory integration, especially around elimination and body awareness
- Nervous system regulation and co-regulation strategies for parents
- Positioning to support optimal arousal and digestion
Together, this integrative approach addresses the whole baby, not just their symptoms.
Why This Matters: Long-Term Impacts Start Early
We’re not just aiming to reduce fussiness or help with pooping (although that’s often where we start!). We’re helping to lay the foundation for:
- Healthy bowel and bladder habits
- Confident motor skill development
- Positive body awareness and sensory processing
- Easier transitions to solids and potty training down the road
Early therapy can prevent compensatory patterns and teach families tools that make everyday care easier and more connected.
A Tool for Your Toolbox: Pediatric Pelvic Floor Play Skills
To help bridge the gap between pelvic health and pediatric development, we offer a class called Pediatric Pelvic Floor Play Skills. It’s designed for rehab professionals to learn specific play skills and actionable treatment techniques for each age group of the pediatric client, from the infant to the teen/tween.
For each age category we cover:
- Age-specific considerations, tips, and tricks
- Play-based strategies to support pelvic floor coordination for each age
- How to support pelvic health treatment
- Case studies and hands-on tools for both PTs and OTs
- Problem solving for more difficult cases and situations
If you're looking to expand your skill set, collaborate across disciplines, or just get more confident in treating your littlest patients - this class is for you. Join me next weekend on May 4th!
AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC
Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating pelvises and ages with a variety of Pelvic Health dysfunctions. There is not much she has not treated since beginning this journey, and she is always happy to further her education to better help her patients meet their goals.
Dr. Pluchino strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at present. In 2020, she opened her own practice called Practically Perfect Physical Therapy to help meet the needs of more clients. She has been a guest lecturer for Rutgers University's Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.