Purpose: Children with severe disabilities are unable to use handheld walkers because they lack postural and pelvic control. A support walker (SW) provides increased trunk or pelvic support. The purpose of this study was to investigate clinical decision making and use of SWs for children by pediatric physical therapists (PTs). Participants: Twenty-five hundred surveys were mailed randomly selected members of the Section on Pediatrics of the American Physical Therapy Association. Five hundred and thirteen PTs responded. Methods: Using a Likert scale and open ended questions, frequencies were calculated using SPSS. Comments were analyzed descriptively. Results: The Rifton Pacer and Kaye SW are the most commonly used SWs. These SWs are used equally posterior and anterior to the child and usually including trunk and forearm supports. Pediatric PTs report using SWs to address weakness, poor motor control, hip development and respiratory status. SWs are used primarily for children with spastic cerebral palsy, for at least a one month trial before purchase, in at least nine sessions of physical therapy to train a child for use in the school setting. The most common factors considered for SW prescription are participation with peers in school and clinical assessment by the PT. Conclusions: Sws are used in pediatric PT for increasing postural control, mobility and a child’s participation in school. Most clinicians select a SW based on the individual needs and clinical presentation of the child.