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Teachers see children move all day. Lining up, climbing the stairs to the art room, running at recess, sitting at circle time, playing tag in PE. You often see more of how a child moves in a week than a pediatrician sees in a year of checkups.
That puts you in a good spot to notice when a student's body is working harder than it should. Physical therapy (PT) helps children build the strength, balance, and coordination behind everyday movement. Below are 8 signs worth paying attention to, how to describe what you see, and who to share it with.
8 signs a student may benefit from a PT evaluation
1. Trips, falls, or bumps into things more than classmates
Every child stumbles. The pattern to watch for is a student who falls far more often than peers, catches their feet on flat ground, or regularly bumps into desks, doorframes, and other children. Frequent falls can point to challenges with balance, strength, or body awareness.
2. Has trouble with stairs
Watch how a student handles the stairs on the way to lunch or the library. Most children walk up stairs with one foot per step by around 3 years old, and walk down that way by around 4 to 5 years old. A school-age child who still places both feet on every step, grips the railing tightly, or falls behind the line on stairs may need support with strength or coordination.
3. Tires quickly at recess or in PE
Some students sit out of games, lean on the wall, or ask to stop well before their classmates do. Low endurance can come from weakness in the core or legs, and it often looks like a child who "doesn't like" active play.
4. Avoids the playground, climbing, or ball games
Avoidance is easy to read as personality or shyness. Sometimes a student skips the climbing structure or hangs back from ball games because those activities feel hard or unsafe in their body. Notice whether the same child joins in happily when the play is seated or quiet.
5. Slumps or struggles to sit upright
A student who leans on the desk, props their head on a hand, slides down in the chair, or sits with their knees bent and feet out to each side on the rug (often called W-sitting) may be working around weak core muscles. These students often fidget or change position constantly because holding still upright takes extra effort.
6. Walks on their toes or has an unusual walking pattern
Occasional toe walking is common in toddlers. A preschooler or elementary student who walks on their toes most of the time, limps, turns their feet sharply in or out, or has a walk that looks noticeably different from peers is worth mentioning to the family.
7. Has trouble jumping, hopping, or skipping
Many children can hop on one foot by around 4 years old and skip by around 5 to 6 years old. A student who can't get both feet off the ground to jump, can't hop a few times on one foot, or can't keep up with skipping games may have a gross motor delay. Gross motor skills are the large movements that use the whole body.
8. Has poor balance in everyday moments
Balance shows up in small ways: standing in line without leaning on others, standing on one foot to put on a shoe, walking through a busy hallway, or carrying a lunch tray. A student who loses balance in these moments more than peers may benefit from a closer look.
One sign vs. a pattern
Children develop at their own pace, and one of these signs on its own is often nothing to worry about. What's worth sharing is a pattern: several signs together, a sign that shows up every day, or a change from earlier in the year, like a student who used to keep up at recess and no longer does. Pain is also worth sharing right away if a student often complains that their legs, feet, or back hurt.
How to describe what you see
The most helpful thing a teacher can give a family is a clear, specific observation. Skip labels and stick to what happened, when, how often, and how it compares with classmates. For example:
"During recess this week, Sam fell 3 times on the climbing structure and chose to sit out of tag. On the stairs, he places both feet on each step and is usually the last in line."
A note like this gives parents something concrete to bring to their pediatrician, and it helps a physical therapist understand what the child's day looks like at school.
Who to share it with
Start with the family. Many parents are glad to hear what you've noticed, especially when it comes with specific examples and without a label attached. Then follow your school's process, which might include your student support team, school nurse, or a school-based physical therapist if your district has one.
It can help to know that PT for children can happen in more than one place. School-based PT, provided through an IEP or 504 plan, focuses on what a child needs to take part in school. Outside PT, arranged by the family through their pediatrician and insurance, can work on a wider range of goals. Some children have both.
How Coral Care works with schools
Coral Care partners with schools and early childhood programs to run on-site developmental screenings with licensed speech-language pathologists, occupational therapists, and physical therapists. When a screening suggests a child could use support, our care team follows up with the family to help them take the next step. You can learn more about school screenings with Coral Care.
Frequently asked questions
Can a teacher refer a student to physical therapy?
Teachers can share observations with the family and with the school's support team, and that's often how the process starts. A school-based PT evaluation usually goes through the school's referral process with parent consent. Outside PT is arranged by the family, often with a referral or prescription from their pediatrician depending on their insurance.
What's the difference between school PT and outside PT?
School-based PT focuses on what a student needs to access their education, such as moving safely around the building, managing stairs, and taking part in PE and recess. Outside PT can address a broader set of goals, like strength, balance, sports, and daily activities at home and in the community.
What if the family doesn't see the same thing at home?
That's common. School asks a lot of a child's body: long hallways, crowded stairs, recess, and hours of sitting. Share your specific observations, listen to what the family sees, and let them decide on next steps with their pediatrician.
Is it too late if a student is already in elementary school?
No. Physical therapists work with children of all ages, and school-age children can make real progress with strength, balance, and coordination.
Want the parent version of this list? Read Signs Your Child Might Need Physical Therapy, or see what happens at a pediatric physical therapy evaluation.
Frequently Asked Questions
Key signs include: frequent unexplained falls or clumsiness, difficulty keeping up with peers in physical activity, avoiding movement or physical play, significant asymmetry in how they use their body, complaints of pain or fatigue during ordinary activities, toe-walking, and poor core strength evident in posture or sitting endurance. Teachers often notice these signs first because they observe children across many physical contexts throughout the day.
