I know you probably already did this, but my suggestion is to 1) check vision with a developmental children’s optometrist at Children’s and 2) get an extensive hearing test (not a quick 1 minute one at pediatrician).
Some kids can become really reserved and scared when they have an issue with sight and/or hearing. If the child was born with it, they don’t know it’s not supposed to be a certain way and will try compensate confusing parents.
I have an adult child who had vision problems beyond the normal near sighted/far sighted, and it was very confusing until we found out.

OP, your post sounds like my 3.5 year old. Low tone diagnosis. I could have written your post and his amazing PT told me that low tone/hypotonia can sometimes look like cautiousness. When I described how my son watched other kids play on the apparatuses at the playground instead of going to play himself, she explained that children are excellent at knowing what their bodies are capable of at a very young age. And that maybe he was watching other kids go down the slide and thinking it looked like fun… but realized it wasn’t safe for his body.

She does PT sessions with him at the playground and helps give him confidence, along with building strength. She is such a pro and has been doing this work for a long time.

Here’s his PT’s info, in case you want to discuss this with someone:
Meghan Rosenberg
District Kids PT
https://www.districtkidspt.com

OP, here. Thank you, everyone! I appreciate all of your thoughtful responses. You have given me lots of avenues to explore.

Yes sound like motor planning difficulty or he may be gravitationally insecure. Difficult with discriminating movement or body awareness can lead to him being hesitant. Read up about sensory processing

Sounds a lot like my son (13) with hypotonia and dyspraxia. Both of these conditions just "are." Hypotonia means the muscles are floppy at rest, meaning that it takes more effort for people with hypotonia to move their muscles, and it can affect strength, too. For my son, he gets tired more easily, has no core strength (so even sitting in a desk is hard), and he really struggles with fine motor skills like handwriting.

The dyspraxia is basically a motor planning/coordination issue, but comes along with lots of other sensory things. It's hard for him to figure out how do things, or he doesn't feel safe doing things because he lacks some physical awareness that most people have. He could trip and fall in an empty room! While he learned to ride a bike early on (unusual), he hasn't learned to swim yet and couldn't tie shoelaces if you paid him. It can even be hard for him to organize his thoughts to tell a story coherently. SUPER picky eater all his life.

He was a preemie, so we did a lot of PT for the first 12-18 months. Later on, OT was great for him in many ways--it helped integrate some of the sensory stuff (not eating, sadly) and helped him use his brain in a unified way (for example, learning to jump with both of his feet leaving the ground at the same time), walking up steps one after the other (rather than stopping on each step leading with the same foot).

I think I'd get an OT assessment, but go in with an idea of what you think he needs the most help on, or with a particular goal in mind--working on balance or a particular sensory issue. We started OT later (around age 8), so we did some summer intensives (an hour 5 days a week for 4-5 weeks) which helped a lot.

With that said, OTs shouldn't give you a diagnosis, period, so you may want to seek out a developmental pediatrician. Of course, these are like unicorns in this area, but you might be able to get more traction or help getting an appointment through your regular pediatrician.

I will also say that it has affected him socially, particularly as play got more boisterous--it was harder for him to keep up and fit in, and so he gravitated away from big groups and sports. He does better one on one. For us, it's really about finding supports/modifications and not overscheduling him--he legitimately is more tired at the end of the day.

Sounds similar to my child who has some mild anxiety/OCD. She used to have sensory type stuff. She did a bit of OT but then the pandemic happened so we stopped, so I can't say for sure if that helped but most of her sensory stuff went away. Not sure where you live but MOCO Movement Center sounds like what you might be looking for. If you need a place that takes insurance, Pediatric Development Center in Rockville takes most insurance and the Rockville location has a gym inside (not sure about Silver Spring location). My DD was also shy/timid and I did little exercises, like having her order her own ice cream to help build confidence in speaking.

Anonymous wrote:I had a similar son - he went to Fitness for Health at that age. He definitely had some vestibular and propioceptive issues. That helped a lot. He also ended up getting diagnosed with anxiety and by that time, we had done many things to reinforce the anxiety - talking for him, avoiding difficult situations, etc. I f i could anything over, I would learn more about how to support an anxious child much earlier - it’s very counterintuitive. Find a good anxiety child therapist and have them coach you.

Just to say, I am not sure he is in an aftercare etc, but not all kids at 5 yo are cut out to be out from early AM through aftercare.

I had a similar son - he went to Fitness for Health at that age. He definitely had some vestibular and propioceptive issues. That helped a lot. He also ended up getting diagnosed with anxiety and by that time, we had done many things to reinforce the anxiety - talking for him, avoiding difficult situations, etc. I f i could anything over, I would learn more about how to support an anxious child much earlier - it’s very counterintuitive. Find a good anxiety child therapist and have them coach you.

My picky eater ended up severely anemic. Younger sibling who ate similarly never had a problem. It’s partly a genetic thing (how susceptible to anemia you are). DC has tons of energy now that they are on an iron supplement.

Anonymous wrote:Sounds like hypotonia (low tone). My son sounds like your son. He’s a teenage now. Not super athletic, but very smart.

OP here. Thank you! Did you do anything to address the hypotonia? PT or OT? I’m happy to get him any services that will help, but I have been a bit discouraged by the services we’ve tried so far. I’m sure they’ll take our money, but will it actually benefit him?

Demand an iron and ferritin test from your doctor, for starters.
A celiac test would also put some questions to rest.
Get on the list for genetic testing.
Once you have ruled out metabolism issues/ any deficiency begin athletic training. At his age this should be calisthenics only and small weights as ge gets older.

Sounds like hypotonia (low tone). My son sounds like your son. He’s a teenage now. Not super athletic, but very smart.

Hi all, I’m looking for some wisdom from this group of experienced parents. I am worried about my son, who is turning 5 next month, and I’m not sure what to do. He has always been an exceedingly cautious and risk averse child. He did not walk until 17 months (we started PT at 15 months, but no diagnosis was given and when he started walking at 17 months it really seemed independent of the PT). He is avoidant of most new experiences, especially physical ones. He just recently started riding a scooter (years later than my older son did). He does not like bike riding (he will sit on a bike if we push him, but he struggles with peddling and will not ride a balance bike). He hates swimming and the water. He is a very picky eater and feeding therapy was not helpful. He has some sensory issues — he does not like gels or sticky things. I have a sense that he struggles with either balance or sensing where his body is in space (for example, he really prefers to be bare foot because I think it makes him feel more stable on the ground). He is shy and slow to warm in new social situations (it took months for him to feel comfortable in school this year). When he feels comfortable, he makes friends and is well liked by his peers. Academically, he is normal. His fine motor skills are excellent. None of his teachers have ever expressed concern about him. Up until now, I thought of him as a cautious, reserved kid and have worked on just loving him for who he is and making him feel safe. But last week, he said to me that he is more tired than other kids and I do notice that he often (especially at the end of the day) will be sitting off to the side when I pick him up, saying that he is tired. It made me wonder if I’m missing something here? Or is this just another sign of his introversion and feeling depleted at the end of the day? Do any of you have kids like this? Any advice?