Pediatric Play Therapy in Action: Case Study Spotlight

When Play Becomes Therapy - and Therapy Becomes Play
Pediatric pelvic floor therapy can sound intimidating to parents at first. They often imagine sterile clinics, complicated equipment, or uncomfortable exercises. But in reality, the best therapy for children often looks a lot like play. When we engage children in fun, creative, and developmentally appropriate activities, we not only help their bodies heal. We also help them gain confidence, resilience, and joy. Let’s dive into an example of a patient named “Alex.”

“Alex” is a 5-year-old who came to therapy with a history of chronic constipation, including hard, infrequent stools and painful bowel movements. Part of his assessment reveals that he has weak core strength, exhibited by his slouched posture, trouble sitting upright for long periods, and fatigue during physical play. His parents also describe “play aversion,” including avoidance of playground activities, reluctance to join peers, and resistance to movement-based games. His therapist determines that these issues didn’t just affect Alex’s health; they impacted his daily life. Alex’s family wanted their child to feel comfortable in his body, develop healthier bathroom habits, and learn to enjoy playing.

Step 1: Building a Sensory-Friendly Toilet Routine
For many children with constipation, the bathroom itself can feel overwhelming. Bright lights, cold seats, or long, uncomfortable waits can add to anxiety and resistance. For “Alex,” we started with sensory-friendly toilet sits. His family learned how to use a child-sized seat insert and footstool to support proper posture (knees slightly higher than hips, feet flat for stability). As a team, we talked with “Alex” about softening the bathroom environment with warm lighting, gentle music, or a favorite stuffed toy. In addition, we implemented keeping sessions short and predictable (e.g., sitting after breakfast for 2–3 minutes rather than forcing long waits). The focus of this stage was on making the bathroom feel safe and manageable, turning it into a place for success rather than stress.

Step 2: Motivation Through Playful Rewards
After talking with “Alex” and his parents, it was determined that he responded well to positive reinforcement in other home scenarios, so we created a sticker reward system for his pelvic floor routine. Each successful bathroom attempt earned “Alex” a sticker for their chart.

Accumulating stickers led to small, non-food rewards, such as extra story time, a favorite game, or a family activity. His parents were coached to keep rewards playful and encouraging, avoiding any hint of punishment or shame. This shifted the focus from “bathroom battles” to celebrating little wins. Over time, Alex began to approach toilet time with more confidence.

Step 3: Nutrition Meets Fun
Constipation often has dietary roots, but telling a 5-year-old to “eat more fiber” rarely works. Instead, we worked with the family to integrate preferred foods with fiber-rich options. We talked about what Alex liked about foods and eating and established a few ideas, including adding blueberries to Alex’s morning yogurt, mixing finely shredded carrots into favorite muffins, offering crunchy veggie straws alongside a sandwich, and greeting sing silly names like “super-poop power berries” to make healthy foods exciting. This helped the family gradually expand Alex’s diet while keeping mealtime fun. We also coordinated with a feeding therapist to ensure that food exploration remained safe and developmentally appropriate.

Step 4: Strengthening Core Through Play
One of Alex’s biggest barriers was weak core strength and all the symptoms that came with it. His parents described trying to perform traditional exercises felt like a punishment. Instead, we incorporated playful, functional movement. We created a therapy plan full of animal walks (bear crawls, crab walks, frog hops), obstacle courses with tunnels, balance beams, and climbing cushions, balloon volleyball to engage posture and coordination, and some yoga-style poses like “starfish stretch” or “superhero pose.” By getting creative with strengthening work as games, Alex gradually built endurance and stability without ever feeling like therapy was “work.”

Step 5: Parent Coaching Through Playful Routines
Parents play the biggest role in pediatric therapy success. We coached Alex’s caregivers to weave therapeutic play into daily routines. Their home program was intended to create a group bonding, playful experience, versus feeling forced or boring. This made therapy a natural part of life, not an extra burden.

Example of activities:

• Brushing teeth on one foot to sneak in balance training
• “Dance breaks” between TV shows or homework
• Storytime stretches (sitting crisscross on the floor while reading)
• Turning cleanup into a game (squats and reaches while picking up toys)

Step 6: Coordinating the Care Team
Finally, we worked with other professionals on Alex’s team. Pelvic floor therapists may need more players on the team than just the child and their parents. We included consultation with a feeding therapist who supported food variety and mealtime success. We coordinated with the child’s pediatrician, who monitored constipation and overall health. His teachers were also asked if they could incorporate movement breaks during school to support posture and core strength (which they reported benefited the whole class). In this case, when therapists, parents, and teachers collaborated, “Alex” was able to progress more quickly and successfully.

Results: Progress Through Play
Within a few months of this collaborative approach, Alex showed remarkable improvements, including more regular and less painful bowel movements, improved sitting posture in class and at meals, greater willingness to participate in play with peers, and reduced stress for the entire family around bathroom routines. Most importantly, Alex rediscovered the joy of moving their body in fun, functional ways. Therapy became a source of empowerment rather than resistance.

Key Takeaways for Parents and Providers

• Make it playful: kids learn best through fun, not force!
• Start small: short, predictable routines build trust and consistency.
• Celebrate wins: stickers and smiles go a long way in creating positive habits.
• Integrate therapy into daily life: little moments add up to big change.
• Collaborate: a team approach ensures the child gets well-rounded support

Pediatric pelvic floor therapy is not just about addressing bowel and bladder concerns; it’s about helping kids feel confident, capable, and playful in their own bodies. By blending functional exercises, sensory strategies, parent coaching, and team collaboration, we can transform challenges like constipation and play aversion into opportunities for growth.

And the best part? For children like Alex, therapy doesn’t feel like therapy at all. It feels like play.

If you would like to learn more about these strategies or bring Pediatric Pelvic Floor Play Skills into your clinical practice, check out the course at Herman & Wallace. Pediatric Pelvic Floor Play Skills is scheduled for November 1, 2025.

AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC

I am a graduate from Stockton University with my BS in Biology (2007) and Doctorate of Physical Therapy (2009). I have experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. I began treating Pelvic Health patients in 2016 and now have experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much I have not treated since beginning this journey, and I am always happy to further my education to better help my patients meet their goals.

I strive to help all of my 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 the present time. In 2020, I opened my own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. I have been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. I have also been a TA with Herman and Wallace since 2020 and have over 150 hours of lab instruction experience.