The aim orthotic management for the paraplegic child should be to facilitate and encourage mobility while simultaneously attempting to prevent the progression of deformity. The extent of the paralysis and corresponding deformity is known to depend on the location of the spinal lesion, its severity, and its extent. When considering the orthotic management of the paraplegic child, one should remember that any conceptual distinction that is made between the improvement of function and the prevention of deformity is artificial because both functional and preventative purposes are required simultaneously. Four clinical examples are presented that outline the progression of significant skeletal deformity and joint contracture despite the provision of orthotic management and the adoption of a reciprocal gait pattern. The inability of a particular orthosis to control the rapid progression of deformity is supported by radiographic findings and appropriate clinical review.