Child & Family Development Child & Family Development

January 7, 2021

Pediatric Aquatic Therapy

By: Sam Develli, OTR/L

What is Aquatic Therapy?

Aquatic Therapy is the provision of therapeutic activities and exercises in the aquatic environment in order to promote functional improvements on land. In the adult population, this might include exercises after hip or knee replacements or pain reduction/muscular relaxation for back or shoulder pain. In the pediatric population, our focus shifts to a focus on achievement of developmental milestones and fostering age-appropriate skill acquisition.

For our pediatric clients, we focus on the utilization of the affordances offered by the pool (i.e. gravity reduction, enhanced sensory input, etc) to promote the skills mentioned above. The aquatic environment is a naturally motivating and rewarding environment with its typical association with ‘fun’ and ‘play’. Additionally, it provides a good break from the typical clinic environment by moving intervention to a community-based site, therefore providing intervention in a child’s natural environment.

In the realm of aquatic therapy, physical therapy is the more commonly discussed and understood intervention. Aquatic physical therapy utilizes the physical properties of water to promote gait, improve balance, address myofascial restrictions provide muscular strengthening and endurance. Physical therapists are experts in movement, with great knowledge of  the muscular and neurologic systems, and take advantage of the affordances offered by buoyancy and surface tension to decrease weight-bearing and therefore ease movement to provide the just-right level of challenge.  They can also adjust the levels of resistance to activities with movements in the aquatic medium.  The hydrostatic pressure aids in balance and providing a delayed requirement in righting reactions, giving longer time for learning.  The aquatic environment also allows for positioning and movement of children that is not possible on land, leading to a variety of manual practices that can ONLY be accomplished in the water.  As movement is possible in many planes, not just upright, many of our clients can move independently in the water in ways not possible on land.

As additional research is released demonstrating the overarching benefits of the aquatic environment on occupational achievements, occupational therapy has embraced the use of the aquatic environment to deliver holistic, evidence-based interventions in a child’s natural environment in order to enhance skill development and advancement on land. Aquatic occupational therapy also utilizes the physical properties of water to provide a just-right level of challenge, but approaches skills through a very different lens. Occupational therapists are experts in daily occupations, the sensory system, and task analysis to promote achievement of valued activities (i.e. occupations). Therefore, we utilize the affordances of the aquatic environment to develop the motor patterns required to achieve valued occupations and to reduce symptoms which interfere with occupational achievement (i.e. tactile sensitivity, behaviors, hyperactivity, etc).

A few of the models of practice that we pull from include Halliwick, task-based, motor learning, Ai Chi, and reflex integration.

Why is it special?

For children with reduced movement abilities, perceptual development is significantly impacted, which contributes to difficulties in accomplishing motor skills and developing independence in daily living skills, play, and school participation. Even in the presence of passive movement, normal perceptual and visuomotor development will not be obtained without active motion of the body.

The aquatic environment provides a beneficial environment that allows for greater freedom of movement, and the development of active motion that is so vital to development of underlying skills that contribute to occupational independence. Hydrodynamic principles such as buoyancy and turbulence help increase reaction time to more adequately actively move the body and develop these core skills.

Additionally, the properties of the water provide a number of benefits on symptom reduction, allowing for far more sustained independence and growth in everyday life skills as compared to land-based therapy alone. The support provided from buoyancy helps relieve pain and tension, and offsets the effect of gravity on the body. Further, the aquatic environment reduces spasticity, improves head control, strengthens weak muscles, increases joint range of motion, improves balance and coordination, and encourages participation in functional activities.

The activities that can be attained in the aquatic environment that are unable to attain at present on land help complement our land-based goals and contributes to overall developmental skill training as it relates to our functional land-based goals. According to physicians Andrew Cole and Bruce Becker, “the gravity-friendly aquatic environment promotes enhanced opportunities for movement activity, enabling children to learn desired motor skills with increased range of motion, fluidity, and motor control. Children often experience success with motor skills in the water first and then later generalize those skills to land” (Comprehensive Aquatic Therapy, 2004).

Who can it help?

Pediatric aquatic therapy, whether delivered through physical or occupational therapy, is beneficial for a wide variety of children across developmental and skill levels. Pediatric physical therapists often see individuals with musculoskeletal or neurologic conditions such as cerebral palsy, hypotonia, muscular dystrophy, scoliosis, spina bifidia, spinal muscular atrophy, concussions/traumatic brain injuries, and spinal cord injuries. Pediatric occupational therapists also commonly see individuals with cerebral palsy and hypotonia in the aquatic environment. Additional common diagnoses seen include autism spectrum disorders, attention deficit hyperactivity disorders, fine motor coordination difficulties, upper limb/bilateral coordination difficulties, visual-motor deficits, behavioral or mental health conditions (i.e. anxiety), and developmental delays.

However, this is not an exhaustive list of conditions that we have worked with in the aquatic environment or that would benefit from aquatic interventions. If you believe your child or client would benefit from the addition of aquatic therapy, please reach out to our aquatic therapists!

Who to contact


  • Client Services- Pineville
    • 704-541-9080
  • Client Services- Midtown (Park Rd)
    • 704-332-4834

Aquatic Occupational Therapy

Aquatic Physical Therapy