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10 Signs at School Suggesting a Student May Benefit from Physical Therapy

Children develop and improve their gross motor skills significantly during their early school years, between three and ten years of age. A lot of gross motor development occurs at school while playing at recess or doing activities in gym class. School offers the opportunity to recognize if a child needs extra assistance from a physical therapist in expanding or improving their gross motor skills.

Physical therapist treats child

Here are some tips for teachers that will help determine if a child would benefit from physical therapy:

  1. The child prefers to sit and play instead of run or participate in gross motor activities during recess or gym class.
  2. The child has difficulty jumping, skipping, or galloping when compared to their peers.
  3. The child has an atypical gait pattern (for example, they walk on their toes or they are “knock-kneed”)
  4. The child prefers to w-sit (with their knees bent, feet by their bottom, and bottom on the floor) instead of crossed-legged on the floor.
  5. The child frequently trips, falls, or bumps into objects.
  6. When walking up and down the stairs, the child does not alternate their feet, instead placing both feet on each step.
  7. The child is unable to kick a soccer ball.
  8. The child is unable to catch or throw a playground ball.
  9. The child runs significantly slower than his peers or has difficulty running for more than one minute.
  10. The child complains of pain or tightness in their ankles, knees, hips, or back.

If you see any of these characteristics in children at school, they may benefit from a physical therapy evaluation. Without fully developed gross motor skills, a child is going to have difficulties keeping up with their peers during recess or gym class. It will also affect their ability to participate in gross motor games and sports. Also, it is important to note that many children will exhibit the above behaviors and may or may not require physical therapy (PT) intervention therefore it is important to consult with a PT first.

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Is it okay for a Baby to Waddle with Feet Outward? What is “Toeing Out”?

In my continued effort to expedite information for parents, it is ok for your baby to waddle with their feet outwards up to the age of 2, or until the child has been walking for 4-6 months. Toeing out in new walkers is very typical up to the age of about 2, or once they have become proficient walkers.Waddling Baby

And here is why toeing out is normal in toddlers who have been walking for 4-6 months…

Babies walk in this pattern for several reasons, primarily because they are trying to maintain their balance by keeping a wide base of support due to their nervous system and their overall architecture.

New walkers are working with immature nervous systems so they need repetitive practice to build the nerve pathways.  In addition, they are learning what to do with the sensory input that they are receiving from their vestibular system (inner ear), as well as the somatosensory proprioception (feeling where their body is in space).  There are motor development theories that say that children walk not when the stepping pattern is mature, but when the balance control system matures.

Structurally, at the time children begin to walk, their center of mass is around the base of their ribs.  As they grow (and the head to body ratio changes) that center of mass lowers to around their belly button.  This high center of mass early on makes it more difficult to balance, leading to the need for an increased base of support to avoid falling.

New walkers often fire a lot of their hip muscles in order to stabilize themselves as they learn to balance on two feet.  EMG (neuromuscular studies) of children with 6 months of walking experience have also shown that they will fire their outer hip muscles (specifically the muscles that outwardly rotate their legs, and that move their legs apart) for stability.  In doing so, the hip outward rotators over-power the inward rotators, which brings their feet and legs out.

The anatomy of the feet of new walkers also facilitates their out-toeing gait pattern.  Newer walkers have large fat pads on the bottom of their feet and do not have the muscle strength or ligament stability to create a stable structure.  This capability of stabilizing at the foot typically comes with practice and age.

Since new walkers have had little weight-bearing through their legs, the shape of the thigh bone promotes a wide stance.  As the child bears weight on their legs, the shape of the bone begins to more closely resemble the mature alignment.

New walkers will often keep their arms at either chest or shoulder height to help with their balance.  This wide balance reinforces toddlers’ wide stance.  Once these children begin to swing their arms when they walk, then each step begins to promote a more narrow foot placement.

If you ever have concerns about how your child is walking, address it with your pediatrician.  If your child has been walking for 6 months or more and they continue to walk with a wide foot placement and arms at shoulder height, you may have legitimate concerns that could be addressed.

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