What Will My Child Experience in a Physical Therapy Session?

The field of pediatric physical therapy is very different from many other physical therapy settings, which is to be expected since the patients are children who are constantly growing, developing and learning new skills. Parents are therefore often unsure of what their child’s physical therapy session will look like. blog-physical therapy-session-main-landscape

While the activities performed will be unique and individualized to your child’s specific needs, there are some common things that all children will experience during a physical therapy session.

  • Choices-We want physical therapy to be a fun and productive experience for your child, so throughout the session your child will be provided with choices. These choices may include selecting an activity from a few options, or getting to choose what game, puzzle, or toy is played with while working.
  • Fun-Although your son or daughter will be asked to perform activities to address his or her specific difficulties, we will do our best to make every activity as fun and engaging as possible. The activities we work on are so much more meaningful when your child is having fun and wants to participate.
  • Work-As mentioned above, your child’s therapy sessions will be as fun and engaging as possible. However, your child will be participating in activities that are physically challenging. Your child will be moving for the majority of the session in order to work towards his or her individual goals.
  • Encouragement-Your child’s therapist is there to support and encourage your child. We know that your child is working hard to meet his or her goals, and we are there to provide positivity and encouragement with fun and challenging tasks.
  • Homework-Your child will be working hard during the therapy session, although what is done at home to carryover the new skills learned is just as important. Your child’s therapy session will therefore include homework to help facilitate progress toward his or her specific goals.
  • Success-While the activities selected for your child’s therapy session will be challenging, your therapist will never ask your child to do something that she won’t be successful at. Working hard and being successful is what the physical therapy session is all about!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, and Hinsdale! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

W-Sitting: Why There Are Conflicting Opinions and Why Your Child’s Therapist Cares So Much

If you have a child who loves that “w” position while sitting on the ground, chances are you’ve either W-Sittingcorrected them yourself or heard someone else direct them to sit “criss-cross” or “fix their feet.” The challenge, however, is understanding why there are so many conflicting opinions on the matter. Is it really that bad? There was recently an article on Today.com titled “Why W-sitting is really not so bad for kids, after all.” Two orthopedic surgeons weigh-in on how w-sitting is a position that children sit in because their anatomy allows it, it feels comfortable, and when you should be concerned about it.

As a physical therapist, I felt it was important to address this article in a way other than pointing out our profession’s fears of w-sitting, which can be found in “What’s Wrong With W-Sitting?” and “W-Sitting and Your Child’s Growth.

I want to acknowledge that, to some extent, I agree with this article. The anatomy, angles, and alignment of a child’s leg bones changes extensively throughout young childhood. Children do have more flexibility which can make w-sitting often a preferred position. And most often, prolonged w-sitting will not progress to the point of being a surgical issue. If your child only sometimes sits in this position and can easily move into and out of it, it is probably not a big deal. (Please note: as with the article above, I am generalizing this blog post. I am just discussing w-sitting and am not going to address the impairments that often result in w-sitting: low muscle tone, decreased core strength, excessive femoral anteversion, etc. Please speak with your pediatrician or see a physical therapist if you have concerns with your child’s development. Sometimes w-sitting is the result of other things going on which can impact their gross motor success.)

So—why do people like myself lovingly attempt to annoy your child out of w-sitting? It is not that physical therapists do not acknowledge the natural development of their anatomy and what feels best. It is that we are bombarded throughout our schooling, clinical experiences, and our entire professional careers of what occurs when muscles are not aligned “within normal limits.” For pediatric therapists, we are given this unique and wonderful opportunity to work with bodies who are just beginning their development, moldable, and are constantly changing to assess and promote optimal alignment- a strong foundation for a strong life. For me, it does not matter if your child is coming to me for shoulder pain- I am going to correct how their legs are positioned while they are sitting; posture is like the “eat your vegetables” and “brush your teeth” of my profession. I want each child’s physical growth and development to occur on top of the best possible foundation. Just as pediatricians and dentists want to establish healthy habits, routines, and lifestyles for short and long term health, physical therapists want to encourage the best posture for your child so that they will not be limited or suffer from the painful conditions or injuries that result from poor alignment and muscle imbalances.

An easy example to compare w-sitting to is poor sitting or standing posture. Almost all adults can relate to the neck and back pain that can occur from poor posture. In addition, poor posture can contribute to nerve impingement, shoulder pain/injury, jaw pain, sciatica, etc. This pain did not happen as your parents/grandparents/teachers/caregivers encouraged you to “sit up straight” or “stop slouching”—it happened later as the bad movement patterns continued and the muscle imbalances grew worse. In my mind, w-sitting is the same. It may resolve and you may never develop pain, or these movement patterns and muscle imbalances may progress; when you look at the alignment and muscle activation that w-sitting encourages, physical therapists think of the following (to name a few): patellofemoral syndrome, hip pain from impingement, flat feet and foot pain, knee osteoarthritis, and increased risk of knee and ankle injuries.

As the parent, how you use information is up to you. As a physical therapist, I will continue to kindly request that each child sits “criss-cross applesauce” for their current AND future development.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, and Hinsdale. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Encouraging Muscle Development in the Infant Stage

Importance of Tummy Time for Muscle Development

Tummy time is a great way for infants to strengthen their muscles and develop age appropriate motor Muscle Developmentskills. When a baby is born they are in a position referred to as physiological flexion which simply means they are in a “curled up” position. All their back muscles are stretched and their core muscles are tight. By incorporating as much tummy time as possible, babies are allowed to strengthen their back by extending and stretch their tummy and core muscles at the same time. Encouraging floor time is key to developing motor skills such as rolling, sitting, crawling, and eventually walking.

Jumpers, Swings, and Exersaucers

Devices that aid in childcare can be lifesavers, such as when you are taking a shower or cooking, however, they should never replace the benefit that a child receives from floor time. When a baby plays on the floor they are using their entire body to explore their space. On the contrary, when they are in a swing or jumper, something is not being utilized. Excessive use of swings can result in flattening of the skull or a preference to tilt their head to one direction which can then lead to muscle shortening that requires intervention. Jumpers, exersaucers, and bumbo seats can also result in muscle disuse since the hips are frequently placed in unnatural positions and the core is not allowed to rotate as much as when a child is working to navigate the floor. When using devices such as the ones mentioned above, be mindful to limit their use in order to maximize muscle development.

Developmental Red Flags to Be Aware of

Sometimes babies will discover a pattern that is different than what we typically expect. Below are some movement patterns to be aware of and mention to your pediatrician should you notice them.

  • Scooting on their bottom to get around rather than crawling. This does not allow for the proper leg strengthening and cross lateral movement that crawling incorporates.
  • Pulling up to stable surfaces using only hands and not adjusting legs in order to push themselves up.
  • Stiffness in the legs or trunk that is constant and impacting movement; may first become evident with a lack of voluntary rolling.
  • Head position that is not in line with the body or a preference to only look in one direction, roll in one direction, or reach with only one hand.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood,Glenview, Lake BluffDes Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Meet-With-A-Physical-Therapist

Video Games That Get You Moving

Getting your child off the couch and active can be challenging. With video games and iPads, it can be hard to pry your child away from the screens. But what if the screens can work for you? There are many video games on various systems that get your body moving, heart rate up, and can be a lot of fun!

Here are a few games on different systems that will surely make your child break a sweat while having a great time!Blog-Video-Games-Main-Portrait

  1. Xbox – Kinect Sports

Kinect Sports uses a sensor to track your body movements while playing fun sports games including soccer, volleyball, baseball and more. Unlike other systems that only track your upper body, Kinect Sports also tracks your legs for a full body workout!

If you are looking for more intense activities, try Track and Field. Go for the gold in sprints, hurdles, the long jump, and discus – you’ll feel like you’re in the Olympics!

  1. Wii Sports

Wii Sports uses a wand controller to simulate the real game. This systems features games like baseball, golf, tennis, boxing and bowling. The greatest part: you can play against a friend!

  1. PlayStation Move + Eye

The PlayStation Move is a wand controller that works with the PlayStation Eye camera to track the player’s movements. Because some of the games use both the wand and the Eye, you will be put into the game, literally! The PlayStation Move features games such as soccer, tennis, bowling, golf, dancing, and more.

  1. Just Dance – Xbox 360, Wii and PlayStation

Just Dance is compatible with many systems that use a camera to track your movements. You can dance with three of your friends to today’s top hits and yesterday’s classics. This is my personal favorite to have fun and exercise in a creative way.

Now that you have a list of some awesome, fun games for your home system, it’s time to get active and move your body!

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Get Your Baby to Start Cruising

Cruising is an important gross motor milestone that occurs when a baby steps sideways Blog-Baby-Cruising-Main-Landscapewhile holding on to a safe and stable piece of furniture. Cruising facilitates core, hip and leg muscle development, standing balance, and is a crucial stepping stone (no pun intended!) to independent standing and walking.

This is a milestone that is typically reached around 10 months of age. Before your baby can cruise, he or she needs to be able to stand, accepting weight evenly through both legs, with 1 or 2 hands supported at a safe and stable piece of furniture, such as a couch or ottoman. Many babies are excited once they can start standing on their own at a piece of large furniture, although they often do not know how to move around.

Here are a few useful tips to help your baby learn how to cruise:

  1. Place toys a few steps away in either direction. If your child has the toy she is interested in playing with right in front of her while she is standing at the couch, there will be little motivation to move. However, if you place the toy just a few steps away, your baby will be highly motivated to try and get to the toy. Make sure you don’t place the toy too far away though, as that might encourage your child to crawl to the toy instead, or your child may lose motivation due to feeling that the toy is completely out of reach.
  1. Show your baby how to cruise. Since the cruising motion is most likely different from any other movements your child has performed, he may not know that he can step sideways or how to activate the muscles required to do so. When your baby has both hands supported on the stable piece of furniture, slowly and gently elevate the lead leg off the ground, move it a small distance to the side, and then bring the other leg to meet it.
  1. Practice! Learning new gross motor skills takes lots and lots of practice. Babies learn through trial and error, so the more that they work on a new skill the better at it they will become. Give your child frequent, supervised opportunities to practice cruising.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Meet-With-A-Physical-Therapist

Gross Motor Milestones in the First Year

Developmental check-ups with a Pediatrician throughout your child’s first year of life (atBlog-First-Year-Milestones-Main-Landscape 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have about your child’s development. While pediatricians have their own set of developmental red flags, these only hit the “big-bad-uglys” as we like to call them, including: is your child rolling by 6 months, sitting independently by 8 months, crawling by 12 months, and walking by 18 months.

These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. I have seen many children referred to physical therapy for delayed walking skills, who are not standing independently or didn’t roll consistently until 8 months.

To help these children who are being missed by the pediatrician’s red flags, I have put together a list of gross motor skills to discuss with your pediatrician at your child’s check-ups throughout their first year.

2 Months:

  • Lifts and maintains head up when on belly

4 Months:

  • Controls head during pull to sit
  • Controls head when held at shoulder
  • Controls head while in supported sitting

6 Months:

  • Sits independently for 1 minute
  • Rolls from belly to back
  • Rolls from back to belly
  • Lifts chest off ground when on belly, pushing onto extended arms
  • Grabs feet or knees when on back
  • Bears weight through legs in supported standing

9 Months:

  • Gets into and out of sitting independently
  • Army crawls or crawls on hands and knees

12 Months:

  • Pulls to stand at stable surface
  • Cruises along furniture
  • Stands independently for 5 seconds
  • Walks forward with hands held

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Meet-With-A-Physical-Therapist

How is Torticollis Diagnosed?

Congenital muscular Torticollis should be a suspected diagnosis if your infant demonstrates a preferred head position or posture. Infants will present with reduced cervical range of motion, a potential palpable mass in the sternocleidomasoid muscle and/or craniofacial asymmetry.BlogTorticollisDiagnosis-Main-Landscape

A diagnosis is made by your pediatrician and can usually be done based on a simple history and physical examination. Physical examination findings may include:

  • Head tilt to one side
  • Reduced range of motion
  • Palpable SCM tightness
  • Absence of findings associated with non-muscular causes of congenital Torticollis

[1] Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants–a study of 1,086 cases. J Pediatric Surg 2000; 35:1091.

[2] Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Meet-With-A-Physical-Therapist

fitness goals for kids

Fitness Goals For Elementary Aged Children

Parents often wonder if their children are happy and healthy. While most children will let you know if they are happy or not, determining a child’s health may require some more investigative work. A child’s innate athleticism, or lack thereof, may make a child appear more or less fit than they actually are. Here are some fitness standards pulled from standardized gross motor tests, the Presidential FitnessGram, and endurance norms for 6-12 year old children.

Fitness Standards for Children:Fitness Standards for Elementary Aged Children

6 Year Old

  • Completes 5 sit-ups Independently
  • Completes 8 push-ups with good form, given 1 demonstration
  • Skips forward 10 feet
  • Completes half mile run in 6 minutes

8 Year Old

  • Completes 6 sit-ups Independently
  • Completes 8 push-ups with good form
  • Completes 4 pull-ups
  • Rides a bike 20 feet independently
  • Completes half mile run in 6 minutes

10 Year Old

  • Completes 12 sit-ups Independently
  • Completes 10 push-ups with good form
  • Completes 4 pull-ups
  • Completes mile run in 12 minutes

12 Year Old

  • Completes 18 sit-ups Independently
  • Completes 10 push-ups with good form
  • Completes 4 pull-ups
  • Completes mile run in 9 minutes for boys and 11 minutes for girls

If you feel your child isn’t meeting the above fitness goals, please see the pediatric experts at North Shore Pediatric Therapy for a free physical therapy screening.

north shore pediatric therapy physical therapy

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

too much exercise

The Dangers of Too Much Exercise in Kids

Childhood obesity is an epidemic in the United States. According the CDC, 18% of 6-11 year olds and 21% of 12-19 year olds were obese in 2012,[1] with poor nutrition, defunding of physical education and city-wide park programs, and an increase in sedentary lifestyle to blame. It is interesting to ask then, “Can kids exercise too much?”

As with all things, too much of a good thing can be injurious to a person. I will discuss 3 risks of excessive exercise in children: mental health disorders, overuse injuries, and risk of quitting exercise all together.

The Risks of Too Much Exercise in Kids:

  • Compulsive Exercise, also known as obligatory exercise and anorexia athletica,[2] is a compulsion toThe Effects of Too Much Exercise on Kids exercise or practice that outweighs injuries, illnesses, homework, other activities, even friends and family. The exercise or practice no longer brings joy to the child, but they feel compelled to perform, feeling guilt or anxiety when unable to exercise.
  • Overuse injuries in the young athlete is a phenomenon of the 21st Early specialization in sports in children as young as 6 years old has created a culture of overuse injuries (see blog on sport specialization). The American Academy of Pediatrics, Council on Sports Medicine and Fitness recommends 2-3 months off between same sport season and at least 1 day off a week of organized activity. They recommend limiting “sporting activity to a maximum of 5 days per week with at least 1 day off from any organized physical activity. In addition, athletes should have at least 2 to 3 months off per year from their particular sport during which they can let injuries heal, refresh the mind, and work on strength, conditioning, and proprioception in hopes of reducing injury risk.” [3]
  • “Burn-out” from a particular sport, from running, or from exercise all together is a major risk of too much exercise as child, regardless of whether the child is forced into the activity or freely chooses it. The goal of a healthy childhood is to build a foundation for a healthy lifestyle as an adult. When a child exercises too much, they risk burn-out from a couple of areas, specifically, injuries that lead to inability to continue performing preferred activity and inability to rest mind and body sufficiently.

While exercise is an important part of living a healthy lifestyle, it is important to always make sure to monitor the frequency of exercise.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Resources:

[1] http://www.cdc.gov/healthyschools/obesity/facts.htm

[2] http://kidshealth.org/parent/emotions/behavior/compulsive_exercise.html

[3] “Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes.” Brenner, Joel S. Pediatrics, Vol. 119; 1242-1245. 2007.

w sitting

What’s Wrong With W-Sitting?

Parents bring their kids in for a physical therapy evaluation for many different reasons, from toe-walking to neuromuscular conditions to decreased ability to keep up with peers. Regardless of the diagnosis, about 25% of my clients under 5 also present with w-sitting. When brought to the attention of the parents, typical responses range from, “I’ve never noticed that before; is that bad?” to“I w-sat as a child, and I turned out fine.” Physical therapists will most always work to correct this sitting posture and some of the underlying impairments. Here are some of the reasons w-sitting is not healthy for children.

What’s wrong with w-sitting?

  • Decreased Core Activation – Due to the wide base of support afforded with w-sitting, less coreWhat's Wrong With W-Sitting? muscle (trunk extensors and abdominals) activation is required to maintain position. This wide base of support also limits the child’s need to weight shift from side to side during play, resulting in decreased use of lateral and posterior balance reactions.
  • Poor Posture – “W”-sitting encourages excessive posterior pelvic tilt, which can result in slouching. Excessive hunching over results in minimal trunk extensor activation. This creates a cycle of poor sitting posture due to muscle weakness, resulting in poor sitting posture.
  • Pigeon-Toed (In-Toeing) Walking Pattern – Increased hip internal range of motion, decreased hip external range of motion, and hip abductor weakness can contribute to an in-toeing gait pattern. It should be noted, however, that some in-toeing gait can be attributed to femoral anteversion.
  • Decreased Trunk Rotation – Poor trunk extension due to posterior pelvic tilt can limit ability to turn trunk from side to side. This is important because decreased trunk rotation during play can impair the body’s ability to integrate left and right sides of the body, leading to decreased coordination
  • Delayed or Impaired Fine Motor Development – This delay is usually due to a combination of the impairments already mentioned above, such as decreased trunk rotation and poor core strength. These impairments can lead to decreased play involving midline crossing and poor development of bilateral coordination. High level fine motor tasks, such as fastening a button, requires a coordinated effort between left and right hands.

Click here to read more about w-sitting and the young child.

To help your child who ”w”-sits, please contact one of our physical therapists at North Shore Pediatric Therapy for a free screen.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!