GUIDE
Physical therapy focuses on gross motor skills like crawling, standing, and walking. Occupational therapy addresses fine motor, sensory processing, and daily living skills like feeding and grasping.
Many children receive both. Understanding the difference helps you advocate for the right referral.
Log motor skills as they emerge
“The goals we have for children with disabilities are the same goals we have for all children--for them to be happy, healthy and able to participate fully in life.”
Dr. Amy J. Houtrow, MD, PhD, MPH, FAAP, FAAPMR, American Academy of PediatricsWhen your pediatrician mentions therapy for your baby, you might hear "OT" and "PT" used almost interchangeably. They are not the same thing. Physical therapy (PT) focuses on how your baby moves their body through space — rolling, sitting, crawling, standing, walking. Occupational therapy (OT) focuses on how your baby uses their hands, processes sensory information, and performs functional tasks like feeding and grasping.
Think of it this way: PT helps your baby get to the toy across the room. OT helps your baby pick it up, manipulate it, and not become overwhelmed by its texture or sound. For a deeper look at how these two skill categories develop, see our guide on gross motor vs. fine motor milestones. Both are important, and the distinction matters because the wrong referral wastes time.
For infants specifically, the overlap is real. Torticollis, for example, might be treated by a PT (for neck range of motion and head positioning) and an OT (for feeding difficulties caused by the positioning issue). Low muscle tone might start with PT to build strength and progress to include OT once fine motor skills become relevant. Understanding what each therapy addresses helps you ask the right questions and get the right help.
| Aspect | Occupational Therapy | Physical Therapy |
|---|---|---|
| Primary focus | Fine motor skills, sensory processing, feeding skills, and activities of daily living. | Gross motor skills: rolling, sitting, crawling, standing, walking, and balance. |
| Common referral reasons (infants) | Difficulty grasping or releasing objects, sensory aversions (textures, sounds), feeding difficulties, torticollis affecting function. | Not rolling, sitting, crawling, or walking within expected timeframes. Low muscle tone. Torticollis affecting head/neck positioning. |
| Typical activities (baby) | Grasping exercises, sensory play, feeding practice, hand-eye coordination tasks, texture exposure. | Tummy time positioning, supported sitting, crawling practice, standing exercises, balance challenges. |
| Parent role | Learning sensory strategies and fine motor activities to practice at home. | Practicing positioning, exercises, and movement activities at home daily. |
| Session frequency | Typically 1-2 times per week for infants, depending on severity. | Typically 1-2 times per week for infants, depending on severity. |
| Therapist training | Master's or doctoral degree in occupational therapy. Pediatric specialization through clinical experience. | Doctoral degree in physical therapy (DPT). Pediatric specialization through clinical experience or residency. |
OT is particularly valuable for babies with feeding difficulties, sensory sensitivities, or fine motor delays.
These challenges are systemic, not reflections of OT effectiveness.
PT is often the first therapy recommended for infants because gross motor delays are the most visible early on.
Frustration during sessions is normal — therapists are trained to work within the baby's tolerance.
Tinylog lets you log both gross and fine motor milestones as they happen, giving you and your therapist a clear timeline of progress.
If your concern is primarily about movement — your baby is not rolling, sitting, crawling, or walking when expected — start with a PT referral. If your concern is about how your baby uses their hands, reacts to sensory input (textures, sounds, lights), or feeds — start with an OT referral. If you are unsure or see issues in multiple areas, request an evaluation through your state's early intervention program, which will assess all domains and recommend the appropriate services.
Do not wait for your pediatrician to suggest it. If you are unsure whether to act now or give it time, our guide on early intervention vs. wait and see can help you decide. You can self-refer to early intervention in most US states. The evaluation is free, and there is no downside to getting one. If your baby is developing typically, the evaluation will confirm that and put your mind at ease.
Global developmental delays, prematurity, Down syndrome, cerebral palsy, and other conditions often require both OT and PT. For premature infants, remember to assess progress using corrected age rather than actual age. In these cases, the therapists should communicate with each other to coordinate goals. Ask whether they can schedule back-to-back sessions to reduce your travel burden, and whether they share notes or progress reports. A coordinated approach produces better outcomes than siloed therapy.
A developmental screening at a well-child visit takes 5 minutes and catches major red flags. A full evaluation by a therapist takes 45-90 minutes and provides specific, actionable information about your child's strengths and areas of need.
Therapy sessions typically happen once or twice a week. The other 165+ waking hours are where real progress happens. Ask your therapist for 2-3 specific activities you can do daily at home. Consistent home practice accelerates progress more than adding extra sessions.
Therapists set goals and measure progress at intervals. If you are tracking milestones and daily activities at home, bring that data. It gives your therapist a fuller picture than what they observe in a 45-minute session.
This guide is for informational purposes only and is not a substitute for professional medical advice. Consult your pediatrician for guidance specific to your baby.
