Electrotherapy in Pediatric Rehabilitation: A Structured Narrative Review of Clinical Applications, Treatment Parameters, Safety, and Evidence Gaps.

Background/Objectives: Electrotherapy encompasses diverse therapeutic modalities used in Physical and Rehabilitation Medicine, but pediatric evidence varies substantially across modality-indication pairs. This structured narrative review mapped the available pediatric clinical evidence and provided a clinically structured synthesis of clinical applications, treatment parameters, reported therapeutic outcomes, safety, and evidence gaps in pediatric rehabilitation. Methods: PubMed, Scopus, and Web of Science were searched for publications from 1 January 2000 to 17 July 2026. Evidence was synthesized by electrotherapy modality and clinical indication and classified using Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Formal methodological quality and risk-of-bias appraisal using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and Risk of Bias 2 (RoB 2) was performed for the evidence underpinning OCEBM Level 1 classifications; no formal GRADE certainty-of-evidence assessment was performed. Results: A comparatively more developed pediatric evidence base was identified for radial extracorporeal shock wave therapy (rESWT) in cerebral palsy-related spasticity; transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFC) in bladder and bowel dysfunction; and neuromuscular electrical stimulation (NMES)/functional electrical stimulation (FES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) for selected motor rehabilitation outcomes. Photobiomodulation (PBM)/low-level laser therapy (LLLT), pulsed electromagnetic field therapy (PEMF), and high-intensity laser therapy (HILT) showed promising but indication-specific evidence, whereas Transfer of Energy Capacitive and Resistive (TECAR) had preliminary adjunctive evidence. Therapeutic ultrasound and Deep Oscillation Therapy were supported by insufficient pediatric clinical evidence, while several modalities lacked eligible pediatric clinical studies. Short-term tolerability was generally favorable, but long-term safety data remain limited. Conclusions: Electrotherapy has an adjunctive role in selected pediatric rehabilitation indications, but prescription should be based on specific modality-indication pairs. The available evidence does not support comparative effectiveness conclusions between modalities. Standardized multicenter trials and long-term safety studies are required.