Participation of children with physical disabilities is critical to optimizing their life roles and lived experiences. This perspective explores the complex and multidimensional construct of participation and presents recommendations for practice, education, and research to transform pediatric physical therapy service delivery. Two models are reviewed of participation-based service delivery grounded in client-centered care and the principles of coaching to engage clients in their rehabilitation. The roles and responsibilities of the physical therapist and the importance of team collaboration are emphasized. Considerations are presented for ecological measurements and interventions to support client participation goals for children of all ages in home and community settings. Practitioners, educators, and researchers are encouraged to be advocates and change agents to ensure that services support meaningful participation for children in real-life contexts.