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Background: Congenital limb deficiencies are a relatively rare but measurable occurrence, with a portion of them resulting in the child being born with two affected limbs. Limb deficiency has important implications for gross motor development in childhood. Thus, the purpose of this case report is to highlight the rehabilitation management of gross motor skill development for a pediatric client with bilateral lower limb agenesis. Case Description: The patient is a 2-year-old male with a prenatal diagnosis of bilateral tibial agenesis. Their development through gross motor milestones was influenced by absence of lower limbs and use of different motor strategies to promote functional mobility. Activity and participation limitations related to decreased level of independence with gross motor skills and functional mobility with bilateral above knee prostheses donned. Intervention: Outpatient physical therapy focused on care coordination with prosthetist to ensure appropriate fit and function of lower extremity prostheses. Each session served to promote increased level of independence with floor mobility, transfers, transitions, stairs, and gait with use of prostheses. Outcome Measures:The primary measures considered for this patient were level of assist with gross motor skills and Pediatric Evaluation of Disability Index (PEDI). Discussion: This case report demonstrates intervention strategies that can be considered to progress independence with gross motor skills and use of bilateral above knee prostheses for functional mobility.