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Why Isn’t My Baby Walking?

The walking stage is a huge milestone for every child. It’s an exciting new time when your baby officially becomes a toddler. Most babies learn to walk between 12 and 15 months. A baby isBlog-Walking-Main-Landscape considered delayed in walking once they turn 18 months old. When a child is delayed in a certain gross motor skill, parents are always curious why this delay is happening.

Here are some reasons that your baby may be delayed in walking:

  • Muscle weakness and/or low muscle tone. This is the most common reason. A child who has weakness or low tone in their core and hip muscles may have difficulty with walking. Sometimes this weakness affects the earlier milestones such as crawling, pulling up to stand, and cruising. If your baby had difficulty learning early milestones, they are more likely to have difficulty with walking. A physical therapist can do exercises with your child to strengthen their muscles and help them learn to walk.
  • Orthopedic concerns. This involves the bones and joints in a child’s legs and how they are aligned. An example is hip dysplasia. These concerns are diagnosed by an orthopedic surgeon and are treated in a variety of ways.
  • Neurological concerns. This involves the nerves, muscle fibers, and nervous system of the body. An example is diplegic cerebral palsy. These types of concerns are diagnosed by a neurologist.

Orthopedic and neurologic concerns can be very scary to parents. It is important to understand that a delay in walking does not automatically mean that your child has an orthopedic or neurological disability. If you think your child is delayed in walking, speak to your pediatrician. A pediatric physical therapist can evaluate red flags for causes of delayed walking, as well as help your child to learn this skill.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des 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.

Meet-With-A-Physical-Therapist

How to Get Your Baby Talking

A baby typically starts babbling, using speech-like sounds, between four to six months of age. Usually, the sounds p, b, and m are the first to develop. Additionally, in this age range, a baby is more Blog-Baby-Talking-Main-Landscapeinteractive with the parent or caregiver, laughing and vocalizing displeasure or excitement. Between seven months to a year of age, communication will expand and most babies are producing repetitive consonant-vowel combinations such as baba or dada, using gestures for communication, using vocalization to gain and maintain attention, and by one year of age a baby typically has one or two words or word approximations.

A parent or caregiver can support their baby’s language development or “talking” by encouraging all communication, interacting on their baby’s level, and making communication opportunities.

  • Match your child’s communications and interaction attempts, including repeating his/her vocalizations and gestures. By matching your baby’s vocalizations, you are communicating on a level that allows them to maintain communication turn-taking. Additionally target speech games and songs such as itsy-bitsy spider, peek-a-boo, and gestures such as clapping, blowing kisses, and waving hi/bye.
  • Talk through daily routines such as bath time, bedtime, get dressed, and feedings. You are providing your baby with the associated language during these daily routines. Talk through the plan for the day, what will you be doing, where you are going, who are they seeing, etc.
  • Teach your child gestures and signs to support language development.
  • Teach your child animal sounds (e.g., moo, baa) and environmental sounds (e.g., vroom, beep).
  • Spend time reading to your child and labeling pictures in books.
  • Reinforce your baby’s communication attempts by giving them eye contact and interacting with him or her.
  • Simplify your language during communication interactions with your baby.
  • Make communication opportunities within routines and daily activities.
  • Limit your baby’s exposure to television and/or videos. A 1:1 interaction between a parent and child is preferable to support turn-taking communication.

Remember there is a range of typical development. Not all babies will have their first words around one year of age!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des 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!

Exersaucers

The Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

I recently read an article posted on parents.com about baby development that touted the benefits of exersaucers and Jonny Jumps. Let me put an end to that notion right now. While I understand the necessity of such devices for small periods of time (meal preps and bathroom breaks can be near impossible without them), these devices should in no way substitute free play on the ground or be used as a way to “strengthen” young children’s legs.

For the remainder of this article I am discussing  devices that support the pelvis while the legs are in a weight-bearing to semi-weight-bearing position, including but not limited to: jumpers, exersaucers, sit-and play walkers.

The Dangers of Jumpers, Exersaucers,
and Sit-and-Play WalkersThe Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

Places Children in Weight-Bearing Position before Muscles are Ready
When a child is not physically strong enough to support their body weight in a standing position, they will assume a position of flexion (knees bent, hips and trunk bent forward). If the child is pulling to stand at a stable surface, this weakness may result in a collapse at the knees or a fall backward. However, when a child is strapped into a device supporting their pelvis and trunk, they are unable to drop to the floor. Instead the child assumes a semi-weight bearing flexed position. Many advertisements for such devices depict the child in this flexed semi-weight bearing position.

Teaches Weight-Bearing through Balls of Feet (rather than heels)
Many times children will bear weight through the balls of their feet while in these devices. Usually because the device is not adjusted to the appropriate height and the child is trying to reach the ground, or the child is not strong enough and is in a flexed position while trying to reach the ground. Repetitive weight bearing through the forefoot creates a motor learning pattern that can be continued on into regular gait. We call this types of walking, through the forefoot, toe-walking.

Poor Alignment of Lower Extremity
The semi-weight bearing flexed position that children may assume when placed in sustained weight bearing before their muscles are mature enough for standing has already been described above. This position can result in: 1) excessive stain and force through the pelvis to support the trunk, or 2) excessive hip external rotation, excessive knee flexion and weight bearing through lateral knee, and/or excessive weight bearing with ankles in maximum plantar flexion(toes pointed down). Excessive time in these abnormal positions can lead to a multitude of musculoskeletal problems later on, including: toe-walking, hip stabilizer weakness, increased falls, knee pain, out-toeing.

To limit the negative effects of jumpers, it is recommended that children spend no more than 20 minutes a day in them. In fact, time spent in all positioning devices should be limited to a total of 30 minutes per day to allow for optimal gross motor development.

NPST offers physical therapy services in Bucktown, Evanston, Highland Park, Lincolnwood (coming soon), Glenview and the Neuropsychology Diagnostic and Testing Center in 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!






Boppy Pillow

Boppy Pillows: Multifunctional Uses

When living in the city, maximizing what space you have and minimizing purchasing frivolous things is the difference between living in a cluttered mess and having an organized abode. Throw a new baby into the mix and their accompanying lists of “must-haves,”  your home can easily change into a cluttered nightmare! To avoid this as much as possible, it is ideal to purchase things with multiple uses.

The boppy pillow is a device that takes up minimal space, but allows for maximal use throughout your child’s first year of life.

Uses for a Boppy Pillow:Boppy Pillow

Shoulder Support for Caregiver During Bottle or Breast- feeding: The boppy pillow, and other nursing pillows, was designed to make newborn feeding an easier process for the caregiver. The device fits around the trunk of the caregiver just above the naval to allow for support of the baby, without causing stress to the shoulder joint.

Introduction to Tummy TimeIt has been well documented that by 3 months of age, infants should be spending about 1 hour of total time on their stomachs each day. For an infant who initially is resistant to tummy time, propping them over a boppy  pillow allows them to build up neck strength while gradually increasing tolerance to tummy time.

Independent Sitting Assistance: The boppy pillow can be used several different ways to aid in independent sitting. Once a child has adequate head control to begin sitting exercises, the boppy pillow can be placed around the child’s trunk to give the child some support at the base, while still allowing the core muscles to develop.

Protective Environment when Learning Protective Responses in Sitting: This can be progressed to having the only the ends of the boppy pillow touching the child at the hips, providing increased degrees of freedom at the trunk while creating a protective environment in case of falls. Falls are in important part of the learning process for something called protective responses. A child who has mastered protective responses will outstretch an arm sideways, forwards, or backwards when exhibiting a loss of balance, in order to slow down their body and protect their head.







What Should My Baby Be Doing on Her Tummy by 6 Months?

Many first-time parents are not told about the importance of tummy time for newborns until their children become toddlers with atypical movement patterns, clumsy gait, or motor delay.  With our hectic schedules and fast-paced lifestyle, sometimes it is just easier to pick our children up and get going. But, pediatricians and physical therapists will agree, tummy time is an important aspect of infancy to develop the motor skills children need to actively engage in their environment.

How do you know if your baby is spending enough time on her tummy?

By 6 months, these are the things your growing explorer should be able to do:

Reach for nearby toy while on tummy:

Her gradually improved trunk stability, shoulder girdle mobility, and emergent interest in her surroundings allow your baby to briefly prop on one hand and reach with the other for toys.

Raise entire chest:

Now that your child can props on her hands with arms straight, elbow in front of shoulders, she not only can lift her head up, but her trunk as well.

Extend arms and legs (alternately or together) off a surface, and lift head up against gravity with neck elongated:

At 6 months, a baby’s back muscles are strong, but that strength is also balanced by her chest muscles. Because of this, a baby at 6 months can lift up her head against gravity but also tuck her chin. She may be able to perform swimming motions that eventually lead to belly crawling.

Equilibrium reactions in prone:

What this means is that the muscles on the front and back of her trunk can now adapt to changes in her center of gravity. The equilibrium reactions return her to her tummy when she shifts her weight and prevents her from falling over. The more controlled her movements become, the better equipped she is to start scooting after toys.

To Summarize:

For a typically developing child, tummy time should be her most preferred position because of the mobility and freedom she experiences in that position. Tummy time is where a child learns to separate her two sides and use them independently of each other. It is an important place to encourage the initiation of belly crawling and eventually crawling.

Red flags – Signs that warrant a physical therapist evaluation:

Remember, every child develops differently. The tummy time skills listed above are the skills pediatricians and physical therapists look for to make sure a child is on track.  If your baby isn’t consistently showing these skills by 6 months, keep putting her on her tummy, play with her, and give her a couple weeks’ time. Some babies just need more input to their hands and abdominals before they build up the strength to do all of the above.

However, consider an evaluation if you still notice the following by the 7th month:

  • Difficulty lifting her head
  • Stiffens her legs with little or no movement
  • Does not roll over
  • Arches body backwards stiffly in an attempt to roll over, instead of using the abdominals.
  • Does not sit independently
  • Does not play with her feet when lying on her back

If your baby gets really fussy during any time spent on her stomach, read here for great alternatives to tummy time.

Encouraging Crawling in Babies

There is nothing as heart warming as watching your child crawl across the room to try to pull your grandparents wedding china onto the floor.

baby crawling

Crawling is an important form of movement for infants.  It helps to build a stronger core and begins to introduce weight through the bones of the upper leg to increase bone density.  Crawling is singular in its ability to promote strength and stability of the shoulder and the surrounding muscles (which become important postural muscles once the child is standing) using the child’s own weight.  From a visual standpoint, they begin to hone their ability to maintain a smooth visual field while the head is in motion as well as work on their objects per minutes. Reciprocal crawling also develops the ability to coordinate their right and left sides (bilateral integration).

It is typical for babies to progress from scooting backwards on their belly, “swimming ” (where arms and legs are both moving up off the floor), belly crawling (“army/military crawling”), and then reciprocally crawling on hands and knees.  This sequence cannot begin if they are never on their tummies to play, so the foundation is tons and tons and tons of tummy time.

Attempting to change the movement habits that you little one has, or challenging them to build new habits is not easy.  Yeah, very not easy.  I would encourage you to understand their frustration, empathize with them, but stay the course.  Remind yourself of your own tears every time you try to give up coffee.  Remember how tough it was to begin something you wanted to challenge yourself with, but how rewarding it was when you accomplished your goal.  So there may be some tears (some from the baby), but there should also be plenty of cheers and hugs and kisses.

Try these activities at home to encourage crawling:

1. Strong foundations – Tummy time, tummy time, tummy time. I know I said this above, but it is worth  repeating.
2. Get down and get busy – Lay, roll, and crawl around with your child.  You can make a lot of eye contact, and if you are on the floor your face can still be seen if they need to put their head down to rest, so they may enjoy being on their tummy longer.
3. Get low – If laying next to them is not enough, lay on your back, and place your child on your chest.  This is great for bonding and
4. Born free– Take them out of the exerscaucer or bouncy seat – When children do not have to move to get a toy or look at something new they won’t, which leads me to……
5. Move a toy just out of their reach – Yes, I said that you needed to be mean, and this may lead to screaming. They may just surprise you and themselves by moving towards it.
6. Try a different toy- perhaps with lights and/or music.
7. Try using your phone to motivate them -I have seen this work, just don’t let them put it in their mouth.  Ew!
8. Try changing what they are wearing- Layers of clothing can impede sensory input and get in the way of movement.
9. You are the local expert – If these things do not work, you know what motivates your child, mix it up, and then let me know, I’m running out of ideas.
10. Tummy time -which means getting them out of the bouncy chair/bumbo seat.  Learn more about the importance of Tummy Time from this 2 minute video