When will my child walk?

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Whew! I get this question literally every day in my practice. It is a HUGE concern from parents with a child with developmental delay as well as most parents in general.

Well, let me say that there is absolutely no way that anyone can predict this, however, there are stages and general developmental skills that usually have to be in place.

Not every child has to crawl in order to walk, but I highly recommend that you seek help from a therapist if your child tries to skip this phase or if they only crawl for a few days. Once your child begins to crawl, encourage this and notice that he/she will quickly be pulling to stand.

Once in standing, your child has to develop balance and strength as well as confidence to take a first step.

NEVER back up as your child walks to you. They will be less likely to trust you again if they feel scared during those first trials. 

Look through the Gross Motor pages on my site for ideas on how to accomplish the steps to attain walking. Here is the general order:

Side-lying

Tummy Time

Rolling

Sitting

Crawling

Standing

Walking

There are MANY things in between (like the transition skills), but the general idea is that your child needs to accomplish each skill in order when possible. Trust your therapist to guide you and teach you ways to play to encourage each skill. We generally work on several skills in tandem, so don’t be surprised if we are working on rolling while we address standing. When we see a weak area, we will go back down the skill list to a skill we need to use to build the muscles for upper skill development.

For ideas on ways to interact with your child, see available books HERE

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Tummy Time, Back To Sleep, and Container Babies

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As a pediatric physical therapist that works almost exclusively in the 0 to 3-year-old population, I see a lot of delay that has no underlying reason. Of course, delay is always something to be concerned about and should be monitored to see if there is an underlying reason, but I’m speaking to the undetermined undiagnosed delay today. I believe that much of this delay can be attributed to the Back To Sleep program. Although I do not wish to see this program discontinued because it is saving lives from SIDS (Sudden Infant Death Syndrome), I do feel that there needs to be some clarification and some emphasis given to parents.

Most people understand the importance of tummy time. The problem is, children are almost always on their backs. We put them on their back in a bouncy seat, a swing, a car seat, etc. We have a catch phrase for this: “Container Babies” because they are always in some kind of container. Besides all the container time, now we put them to sleep on their back. That is a majority of their day and night!

After all this time on their backs, many children will cry when placed on their tummies because they may not be able to lift their head or push up enough to feel comfortable. This makes most parents or daycare workers not willing to continue this position because the child is upset.

There are a lot of different ways to accomplish tummy time without directly placing a child on their tummy on the floor. See the posts under the Gross Motor Activities for creative tummy time play. By the way, did you know that the current recommendation for accumulative tummy time is one hour a day? Not all at once–accumulated throughout the entire day, but even still, I doubt most people understand this suggestion and how ot accomplish it. Tummy time skills need to be adhered to for a child to be able to progress through all the developmental skills. It should only be “skipped” or changed under the direction of a therapist and only for specific reasons. Without this position, a child will have difficulty learning to move and transition in and out of different positions, but the biggest problem besides the delay in movement and other skills is the flattening that can occur to the back of the head or to one side (which can lead to terrible neck positions as well). If this flattening continues, the child can have other severe problems, such as facial deformities, that are irreversible. If this is caught soon enough, though, therapy and a helmet can be used to help direct the shape of the head until the skull fuses.

There are different types of flattening that can occur and all can be caused by other things as well, but if your child is not moving well or only likes to lie on his or her back and/or you notice a flattened area on their head or a place where hair is rubbing off, get help! Contact a pediatric physical therapist and let them help you get back on track or you could be facing months of therapy.

And…get your sweet little one out of those “containers” as much as you can!

Click HERE for available books for your child

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Side-Lying Soapbox

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Side-lying Positioning

As a physical therapist with three decades of experience, I’ve seen an increase in the number of problems with development that might be avoided with more emphasis on positioning a baby in side lying.

This position is important for a myriad of reasons.

–First of all it helps shape the head and may avoid helmet use later.

–Second, this position gives your child a way to stabilize and look at a toy when placed between her hands.

–Another reason this position is wonderful is that it helps your child bring a toy into her visual field, even when she may have very little use of her arms.

–Maybe the child will pull the toy or rattle to her mouth to begin exploring, which is another wonderful activity and important for feeding and speech development.

–This position also brings your child’s hands together at midline. This is the magical place where good things happen in the brain. The two sides of the brain can begin to talk to each other and help your child understand the world much better as well as learn to use her hands together to accomplish a task.

NOTE:

If your child uses one arm more than the other (NEVER OKAY BEFORE AGE 4), you can position her with her favorite arm on the bottom and tucked in where she cannot “cheat” and allow her to use the less favorite arm that is on top.

Your child may resist this position, but she must be taught how to stay in this position and learn to play here, even if only for a short time period. Use a toy to bat at or reach for OR put a soft toy or rattle between her hands.

A few therapy tricks:

–Try side lying (always supervised) on a couch where you can tuck her into the soft cushions and sit beside her and talk to her so she can see your face. Never leave a child unattended like this. By using this position and alternating the sides that you let your child lay on, you will be able to help your child develop more effectively. By bringing her hips up slightly you can reduce some of the extensor thrusting that a lot of children have.**

—Roll your child from her back to her side gently. If she resists, you can try laying her on a blanket and helping her roll. She needs to feel safe and happy with this.

—Try 1/4 and 3/4 positioning. This is just like it sounds. You put a small towel roll under one side so that she is only about 1/4 way over OR you can take her almost to her belly but not all the way. Sometimes, a child will not resist this as much. Make sure her face is clear so she can breathe.

—Lay down beside her on the floor and gently roll her toward you. She might even reach for your face!

In Summary

These are only a few simple ideas, but the point is that side lying is VERY important and should be used until a child is smoothly rolling tummy to back to tummy. This is another position to use during the day besides putting her on her back.

**If your child thrusts a lot into extension, she really needs to be checked for this. It could indicate that she is just overusing extension patterns which can be broken with therapy or it could indicate some underlying stomach problems (such as silent or not so silent reflux and trying to stretch out to keep from burning). Just because she doesn’t spit up does not mean that she’s not refluxing.

Other reasons for this could be neurological and all of these things need to be checked and evaluated to make sure that she is going to develop correctly and that she doen’t have a medical problem that needs attention.

A pet peeve of mine is that abnormal movement is not cute. In fact, it can lead to major problems for that child later in life. When you see something that doesn’t look like other children, it needs to be evaluated and addressed. Abnormal movement in early development can be redirected and changed to normalize the movements, but as that pattern stays in place, the motor plan for that is more difficult to break and will be much more difficult for your child to ever learn to move normally. No matter how old the child is, if they have abnormal movement patterns, as a physical therapist, I would want to see them and help them.

Please click HERE for available books by this therapist.

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Thanksgiving Ideas

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Thankful Tree

Materials needed:

Construction Paper

Tape

Picture of a tree

Every year when our kids were little, I would place a picture of a tree on the wall or sometimes I would make a larger laminated version. I would cut out simple “leaves” out of construction paper for every member of our family. Every day, we would each tell something we were thankful for to write on teh leaf and then p;ace that leaf on the tree. Many times, we wouldn’t start this until mid November due to busy schedules, etc. It is not too late to start!!

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Turkey Feather Toss

Materials needed:

Colorful feathers

Hat or bucket

Imagination!

Give each child a different color feather. Have them make up a move to do for their feather, like one child might want to march, another one may chose jump, etc.  Place the feathers in a hat or bucket and toss them into the air. Whoever has the feather that lands last, everyone must do their choice of activity. You can modify this to a race on the ground and have each child blow their feathers across the room to a finish line. Get creative and have fun with this.

For younger children and toddlers, use the feathers for dump and fill (like Easter Egg hunting) with the bucket. Remember that they may try to put this in their mouth, so don’t let them. Follow the recommendations on the label of the feathers you buy as to what is safe.

Turkey Shoot

Ok, when my kids were small, we lived in a warm area. We used the following:

Materials:

Water guns

Picture of a turkey

Sidewalk Chalk

I would tape up a picture of a turkey for each kiddo and use the chalk to draw a line to stand behind. We began by simply shooting at the turkey and this was way too easy. We made it harder by having each child stand on one leg, then shoot under a leg, shoot with eyes closed…you get the idea. Fun and silly!

Inside:

Materials needed:

Laundry basket

Picture of a turkey

Tape

Bean Bags

Here, you could do the same but shoot with bean bags and make the “Turkey” be a picture of a turkey on the inside of a laundry basket turned on its side. Have fun either way and get those kids moving!

Click HERE for available books.

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How to help your baby love tummy time

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Does your baby hate tummy time?

Well, you are not alone!!   It is very common to not enjoy this position.

First, if your baby cannot move out of this position or cannot lift his/her head, then this position is scary.

Also, this may make your baby spit up more. See my tummy time page for more details.

Your baby needs tummy time for muscle development as well as cognitive development. If you notice your baby “swimming” in this position, you need more help than just basic tummy time.  Some new materials are being developed for this and will be posted soon. Please feel free to email me with specific questions about this or any other related issue.

Don’t give up on this. It will get better and you will learn to love playing the games for this. Your baby will soon be rolling to his or her tummy on purpose!

Click HERE for available books for more ideas.

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Cerebral Palsy and D-Day

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Hello all,

I get a LOT of questions about Cerebral Palsy (CP). Most people have an image in their mind about what a CP person is like. I will tell you that there is a WIDE variety of people with this diagnosis. The definition of CP on a simple level is brain damage that occurred either right before, during, or after birth. The cause of the damage can be from any source. So many parents go to the doctor and get this diagnosis and panic. Yes, there is a reason to be concerned; but please do not panic. Get involved with a good set of pediatric therapists who can help you and your child. The initial diagnosis day (I like to call is D-Day) is pretty scary and usually leads to a LOT of sleepless nights. No matter what diagnosis you get from your doctor, let a pediatric therapist guide you through the steps to helping your child with every step of development. I know that you are scared and maybe a little mad. I think you would have to be abnormal not to be a little of both. I think one of the greatest things you can do right now is to try and not google every little thing about CP; but start with working through where your child is now. For instance, did you know that you can now apply for a handicap sticker or tag for your car? Usually, you just go to the local DMV office and get the paperwork to do so. Also, you need to explore what other services are now available to you and your child. Your therapist may be able to help you with some of this or connect you to a social worker in the area who can connect you. There are many doors that open for your child with a CP diagnosis and I don’t want you to miss any of them. Social media sometimes helps as well. There are Facebook groups, etc that have very active and moms with a great understanding of where you are now and how to proceed to find these resources.

The actual treatment for CP will vary immensely, depending on your child’s functional level and abilities. I say ability instead of disability because you need to focus on what he or she can do and work from there. I really hope you have a great journey; but I will tell you that there will be obstacles. Keep digging for information and you will find it. I wish you the best. Please keep the emails coming and I will answer you individually with specific questions.

Click HERE for available books for more ideas and information.

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Does my child need therapy?

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If you are asking this question, you probably need a professional to tell you the answer. Most of the time, go with your gut. Have your child evaluated by a pediatric PT.

Therapy is much easier when it is done sooner. A child left with any type of muscle imbalance or movement problem for a long time will end up with a list of problems later. Scooting to crawl is not cute, a “good baby” who never cries or tries to move is not normal, I could go on and on and on…So many times I hear the woes from parents who thought that their baby would just “grow out of it”. Your child will likely increase his or her skills but the way in which your child performs a skill can greatly affect his or her entire life, including cognitive development and later test scores. I don’t have the research pulled here to reference; but this has been well documented.

Don’t wait until that crack in the dam is a raging flood…seek help now to give your child the best chance that you can.

Click HERE for available books for more ideas.

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Side-lying play for your baby

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Late last night I received a frantic email from a lady in California. She was very concerned about her baby not staying in side-lying position and he has developed a flat head. She was at a loss about how to work with him.  I immediately sent her to my tummy time page and told her to check in tonight as I will post a large section on  side lying and soon will post on torticollis (wry neck) and head flattening (many fancy names but the sort common type that you may hear is plagiocephaly). As always, don’t despair as you are not alone!! These are common problems that I hope to clarify in a simple and easy to follow post. See my Side-Lying page here.

For ideas on how to play with your child, see available books HERE

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What kind of shoes do you recommend?

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Shoes or No Shoes?

I often get asked about what shoes I would recommend for a child and when to start wearing shoes. This is a tricky question. With absolutely no foot abnormalities or tone problems, there are two schools of thought.

The Barefoot Crowd:

Most physical therapists would probably agree to allow a child to stay barefoot until he or she is walking well and it is time to venture outside.

The Shoe Crowd:

Others will argue the need for adequate support to the foot and ankle to help a child attain walking skills. Both would be right. There is a need for both.

I feel that a child staying barefoot inside is the better way to approach this; but it is not always possible to do so. Besides the sensory feedback and advantage of having the small muscles in the feet to get stronger from having to adjust to maintain an upright posture, there is the added benefit of the balance receptors in the feet having direct contact with the ground in order to develop well. All of this is kind of complex and I know you just want an answer. Here are some indoor shoes and first shoes that I do like. If your child attends daycare, for example, he or she may be required to wear shoes. This is another matter altogether. Make sure you purchase a flexible shoe, preferably with some slip resistant sole. There are many types as you see below. There are many conditions that require braces and therefore shoes at an early age. The shoes for this will be addressed later.

Click on the links for each type to see what is available:

1.) Robeez Shoes

2.) Skidders Slipper Shoes

3.) Pediped Shoes

4.) Umi

5.) Stride Rite Prewalkers

6.) Preschoolians

7.) IsaBooties

8.) Jack and Lily

9.) Nike Flyease 

Once your baby is up and walking, you will want to get something more supportive and make sure it is protective as well. It is tempting to get the matching shoes to an outfit or place the cute sandals on your child. It is fine to do this for pictures, etc; but the real goal is to get your child walking. If this is your true desire, then you need to help him or her the best that you can by providing adequate support and protection.

There is no need to spend a fortune to do this.

Most of the above brands and many others provide such options.

 

 

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Discharge from Physical Therapy

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Discharge Day

The smell of flowers blooming filled the air, as I walked to my car. I knew the day that I walked into their home for the first time that this day would come; but that doesn’t make it any easier. For the next several minutes, tears roll down my cheeks, as I try to pull myself together before I reach my next home. That family  needs me too.

The child I just discharged was dear to my heart. I have been going to that house for over two years…laughed with them…cried with them…rejoiced with them. I am a pediatric PT and I work in the early intervention system, where I see the patients in their own homes. They all work their way into my heart and then the rules say that at age three…it all ends.

I feel great about what we have accomplished together. Every milestone was celebrated and enjoyed to the fullest; but the child still needs so much more and I am no longer the one who will be there to help her learn. Thank goodness for the wonderful clinics that I have referred them to; but I don’t want to stop.

There are so many joys in this job; but the sorrows are there too.

As I arrived at the next house, I saw a small child peering out the front door, watching for me–it’s my next patient. The smile on her face makes the sorrow in my heart dim just a little…

Thank goodness I am still needed!

For activities and ways to play with your child, click HERE

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