Development of the musculoskeletal system in children with cerebral palsy can be very different from development in children without disabilities. Hip and spine problems are common in children who are more severely involved. The purpose of this article is to review the literature related to the development of the hip and spine in children with cerebral palsy and to discuss the clinical implications of this information. According to the literature, primary causes of abnormal development of the hip and spine include muscle imbalances, abnormal positioning, and delayed or insufficient weight-bearing. Secondary complications include contractures, malformation of joints, decreased bone mineral density, and increased incidence of fractures. Development of musculoskeletal deformities is often accompanied by pain, difficulty in maintaining sitting and standing postures, and limited functional abilities. Physical therapy should focus on slowing the progression of deformity, avoiding positioning that contributes to its development, and improving bone modeling by weight-bearing with good alignment.