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!

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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.

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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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Leg braces: does my child need these?

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First, let me say that I probably get 50 % of my emails about this and about foot/leg positions of children in general. I am so glad that you are watching and observing your child. Please be patient as your baby learns to stand and walk, as this usually develops over time with a LOT of changes going on in his or her feet and legs. See my page on toeing in and out for some more information.

The good news is that your child will most likely grow out of whatever you are concerned about but you should always as your pediatrician about any suspected problems to get their expertise. Many problems need to be caught early in order to correct for the best results and if your mommy senses are “tingling” that something isn’t right, I would recommend a professional to evaluate your child. Most pediatricians know when to send you to a therapist. If you are not satisfied, please ask again until you get the information you need.

You are always going to be your child’s best advocate!

For information on books that are available, click HERE

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