Children should first receive clearance from a physician to be sure that there aren't health reasons that preclude hippotherapy. Contraindications may include: seizure disorders, poor head control, allergies, pain, instability of the spine (spinal fusions), skin compromise, osteoporosis, hip subluxation/dislocation. Patients with hydrocephalous may have difficutly fitting a helmet properly. Thereare other risk factors that should be cleared with the physician such as cardiac and respiratory compromise and axial instability in children with Down's Syndrome.
Another consideration is whether or not to avoid the more intense stimuation provided by trotting. This may be contraindicated in children who have spina bifida, risk of detached retina and Down's syndrome (possible axial instabiity).
Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist