Let me make this clear.
Pediatric physiotherapy should broaden its perspective beyond just the musculoskeletal system.
It’s becoming increasingly evident that children’s motor, emotional, and cognitive development cannot be understood without considering their biological, sensory, and environmental context.
Within this integrative framework, the state of the gut emerges as a key piece.
Today, I want to talk to you about gut dysbiosis in children — how this imbalance can profoundly affect their health and development, and specifically, how it connects to fascinating issues like toe-walking.
The Gut: A Key Organ in Child Development
The intestinal microbiota — the collection of microorganisms that inhabit our gut — plays fundamental roles:
it participates in nutrient digestion, regulates the immune system, protects against pathogens, and communicates directly with the brain.
In fact, the gut-brain axis is currently one of the most studied topics in the field of integrative health.
During childhood, especially in the first 1,000 days of life, this intestinal ecosystem is still developing and is highly vulnerable to imbalances.
When the composition of the microbiota is altered, we call it gut dysbiosis.
What Causes Gut Dysbiosis in Children?
Dysbiosis can have multiple origins, including:
- Frequent or prolonged use of antibiotics.
- Cesarean birth (without exposure to the maternal vaginal canal).
- Absence or short duration of breastfeeding.
- Diets low in fiber, fruits, and vegetables, and high in sugars and ultraprocessed foods.
These factors can disrupt the diversity and function of intestinal bacteria, creating a favorable environment for low-grade chronic inflammation.
Note: These factors can even begin prenatally.
I recommend the chapter “Prenatal Factors of Neurodevelopmental Disorders” in the book quickly becoming a bestseller: “Trastornos del neurodesarrollo” (Elsevier, 2025)
Symptoms That May Alert Us to Dysbiosis
Although digestive signs are often the most obvious, dysbiosis can manifest in many varied ways:
- Frequent abdominal pain, gas, bloating, constipation, or diarrhea.
- Atopic skin, allergies, recurrent respiratory infections.
- Irritability, anxiety, sleep disturbances.
- Hypotonia, motor hyperactivity, or difficulties in movement planning.
- Changes in appetite or selective rejection of certain foods.
- And as I mention in my latest masterclass: Toe-walking
As physiotherapists, these symptoms may be present in our patients even if the consultation reason is motor-related.
Connection with Neuromotor and Sensory Development
The gut microbiota produces and modulates key neurotransmitters such as serotonin, GABA, and dopamine,
all essential for emotional and motor regulation.
In children with dysbiosis, you may observe:
- Increased sensory reactivity (hyper- or hyposensitivity).
- Difficulty in self-regulation and attention.
- Problems with balance, coordination, or posture.
- Muscle tone alterations (hypotonia, rigidity).
- Links to conditions such as ADHD, autism, or developmental coordination disorder (DCD).
The gut, therefore, influences not only what the child eats, but how they move, how they perceive, and how they respond to their environment.
What Can a Physiotherapist Do About Dysbiosis?
While we are not the professionals directly responsible for treating dysbiosis,
we do have an essential role in its early detection and in educating families.
Some key actions include:
- Observing digestive, emotional, and motor behavior in an integrated manner.
- Actively asking about the child’s dietary and perinatal history.
- Explaining to families how the gut may be involved in motor symptoms.
- Collaborating with nutritionists, integrative pediatricians, or pediatric gastroenterologists.
- Adjusting our interventions considering the child’s energy level, sensory tolerance, and emotional regulation.
Conclusion: Toward a Physiotherapy More Connected to Global Health
Gut dysbiosis in children is an increasingly frequent phenomenon,
with consequences that extend far beyond the digestive system.
As pediatric physiotherapists, we need to integrate this reality into our assessments and interventions,
understanding that the body is not a collection of isolated systems but an interconnected network.
When we broaden our perspective, we also broaden our therapeutic impact.
And that, without a doubt, makes a meaningful difference in the path of child development.
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