In a national survey of 400 pediatric physical and occupational therapists, two-thirds of those surveyed say they’ve seen an increase in early motor delays in infants who spend too much time on their back while awake. Tummy time is an important and essential activity for infants to develop the strength and musculature they need to achieve their milestones in gross motor development.
What is tummy time?
Supervised time during the day that your baby spends on their tummy while they are awake
Why does my baby need tummy time?
Being on his or her tummy will help develop the muscles of the shoulder, neck, trunk, and back. This, in turn, will allow your child to achieve developmental milestones such as independent sitting, crawling, and standing
Tummy time will help prevent conditions such as torticollis and plagiocephaly (head flattening on portions of their head)
What if my baby doesn’t like tummy time?
The sooner you start tummy time, the sooner your child will get used to it!
If your child cannot keep their head up, use a towel roll, Boppy pillow, or small pillows to help prop them up until they can lift their head on their own
Place a mirror or their favorite toys in front of them to keep them entertained
Put them on your lap on their tummy
How much time do they need on their tummy?
You can start putting them on their tummy from day one for up to 5 minutes, 3-5 times a day. As they get stronger, they will be able to tolerate increased tummy time during the day.
But, always remember – back to sleep and tummy to play!
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2016/12/Blog-Tummy-Time-FeaturedImage.png?time=1560905331186183Arielle Ordonezhttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngArielle Ordonez2016-12-14 05:30:052016-12-12 14:06:41Importance of Tummy Time
Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 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.
Lifts and maintains head up when on belly
Controls head during pull to sit
Controls head when held at shoulder
Controls head while in supported sitting
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
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2016/03/BlogFirstYearMilestones-FeaturedImage.png?time=1560905331186183Andrea Ragsdale PT, DPThttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2016-03-10 05:30:202016-03-04 14:45:59Gross Motor Milestones in the First Year
First time parents don’t quite know what to look forward to when visiting their pediatricians during their child’s first year. Other than immunizations, growth measurements, and nutritional concerns, what else is there to discuss? Each well-child visit is a brief meet-up to assess the child’s growth and development. A red flag is an early warning sign that something is not developing typically and need to be addressed by a specialist.
Below are some physical development related red flags to discuss with your doctor on each of your child’s well-visits. Any one of them could warrant a follow-up visit to a physical therapist to ensure appropriate gross motor development. Early detection and early intervention is important and many red flags should not be dismissed.
– If your baby prefers to sleep with his or her head turned to one side, be mindful of a flat spot that might start to develop. Switch the side she lies on in her crib and alternate the direction of stimuli.
– Babies at this age should hold their limbs and trunk in some flexion, with random movements here and there. If your baby prefers to lie limply on his back with every limb spread out, pushes into extension with trunk and limbs that seem to stiffen up with every movement, or show difficulties with moving his or her head side to side, bring it up with your pediatrician.
– If you continue to notice a flat spot or a head turn preference when your baby sleeps on her back at month two, it might be good to bring it up with your doctor.
-At this time, babies are gaining more and more strength in their neck muscles. In sitting, their heads are more upright though continues to bob. If you don’t see your baby using his or her neck muscles at all, it may be a sign of slow development.
-This is the month of increased symmetry. If your baby continues to prefer to sleep, sit, and play with head only to one side, try to encourage him or her to play with their head in midline.
-A baby on his tummy at 4 month should be able to push up onto his arms and hold his head up. Red flag behaviors to ask your doctor about include: difficulty lifting head up, stiffening in his legs with little or no movement, pushing back with his head as opposed to lifting it forward when trying to roll, and fisted or lack of arm movements.
-At 6 months, a babies are sitting up and holding themselves up in sitting. They can also roll without help.
-Red flags at this stage are signs that point to difficulties with these tasks, such as: no trunk or head control in supported sitting, increasingly stiff back and legs, or inability to bring arms forward to reach for toys.
-A 9-month-old can sit and reach for toys without falling. He can move easily from lying down on his back or his tummy to sitting on his bottom.
-If your 9-month-old sits with his trunk leaning forward, doesn’t reach out to play with toys, uses one side more than the other, seems to drag one side to move, doesn’t crawl, and cannot take any weight on his feet when you prop him up, please bring it up with your pediatrician at his 9 months well-visit.
– Of course every baby develops differently. But by 12 months, a typically developing baby should be able to pull to stand and cruise along furniture. She might be able to stand alone and take independent steps.
-What we as physical developmental experts look for is fluidity of movement. If a child has difficulty getting to standing because of stiff legs, extended trunk, weakness on one side, or pointed toes, that is cause for a more in-depth look. If your baby only pulls up to stand with his arms instead of using his legs, it is definitely good to make your pediatrician aware.
-If your child sits with weight mostly to one side, needs her hands to maintain sitting, holds any part of her limbs stiffly in extension or flexion, or has difficulty moving between positions by her 12 month visit to her pediatrician, please ask about a physical therapy follow-up.
-A big indicator of need for physical therapy is if a child still cannot stand or take steps independently by 15 months.
-Red flags at the 18 months well-visit include: inability to stand and step independently, frequent falls while standing, poor standing balance, difficulty squatting, or walking predominantly on toes.
The warning signs and red flags mentioned above are meant as a guide to parents. If your child is showing these signs and is not achieving his or her gross motor milestones on time, do not focus so much on a medical diagnosis. What is important during the first year is that your pediatrician is aware of differences in your child’s development and recommend specialist follow-up as needed.
https://secureservercdn.net/22.214.171.124/fnf.6b5.myftpupload.com/wp-content/uploads/2013/07/babyproofing1.jpg?time=1560905331358479Judy Wang, PT, DPThttps://secureservercdn.net/126.96.36.199/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-04-29 13:42:232015-01-08 13:21:59Common Physical Therapy Red Flags at Pediatrician Well-Visits For Baby’s First Year
Many pediatricians refer children to physical therapy around the 15th to 18th month of development. Most of these children are showing a slight delay in their development and pediatricians are hoping that, with the help of physical therapy, they could catch up by their 2nd birthday. Though some of these children have been delayed since their first motor milestones at 6-9 months, some doctors choose the wait-and-see approach before recommending physical therapy. This is an understandable approach. Late term premature babies, for example, are often able to catch up to their peers by the 2nd or 3rd year of development.
There are warning signs and red flags we all look for when we are monitoring children’s development from day one. While there are obvious milestones to be met by a child’s first birthday, every child develops differently. Many factors during the first year of life could influence a baby’s evolution into toddlerhood, from sleep patterns to eating habits, to birth history and home environment. There are, however, some major gross motor milestones a typically growing child should have met by his second birthday. Read over the following and schedule an appointment with your pediatrician or pediatric physical therapist if you still have questions.
Gross Motor Skills at the Beginning of Year 2:
Independent Walking: A typically developing child usually walks independently at 12-15 months of age. This walking is usually unsteady and slow, with frequent stumbles. But within 6 months’ time, a toddler should be able to walk with his arms down, stop, turn, and step onto different terrain easily without losing his balance. He should also be able to walk sideways and backwards, while pulling a toy. Walking alone, squatting to pick up a toy, and then continuing on his way should appear easy and natural to a 2 year old. Push-toys are often part of a 2 year old’s favorite game and he can push/pull them while walking in every direction, without falling.
Running/Balance: With the newfound stability on his feet and all the practice of walking over the past 6-12 months, a two year old should be able to run and walk fast on level surfaces without tumbling, while holding a toy. His movements should be smooth and coordinated, not rigid and timid. Toddlers are so skilled on their feet, in fact, that they can kick a ball and throw a ball without losing their balance. They even can stand on a 2-inch wide line with one foot in front of the other without any assistance. Most two year olds will also attempt to balance on one foot, without holding on.
Jumping: Though I usually tell my clients that jumping is a complex and challenging task, a typical two year old does have the strength and balance to jump with two feet. A typically developing 24 month old is able to jump forward 4 inches, jump up 2 inches, and jump down from a low step, all without help. Sometimes, when prompted to jump forward, a two year old might push off with one foot instead of both. Parents often ask me if this is reason to worry. I suggest they pay attention to what is happening when their child is jumping. Does he always fall after jumping? Does he seem to drag one side? Does he seem to prefer to always push off with only one leg? A hand or leg preference doesn’t come in until year 3, so an obvious disparity between two sides could justify a visit with your doctor.
Stairs: A toddler who has been walking for nearly a year can now safely walk up and down stairs, with or without a rail. He might have to go slowly or put both feet on each step, but the motivation and balance should be there. If your child is still crawling up and down stairs at 2 years or choosing to scoot down on his bottom, there may be weakness in his lower body and trunk muscles. Bring him into baby physical therapy! We’ll take a look and give him some exercises to get him going.
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Judy Wang, PT, DPThttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-02-24 08:48:492014-06-02 22:37:28Gross Motor Developmental Milestones for Two Year Olds
As a follow-up question to the importance of tummy time discussion, most parents want to know what their babies should be doing on their tummies for the first year. Are they still working their muscles if they are just resting their cheek or gnawing on the floor mat? What if he is just kicking and screaming with hands fisted? Is he really doing what he should be doing? When he starts sitting independently, why can’t I just let him sit all the time?
Questioning if your 2 months old should be holding his head up when he is on his tummy? Wondering if your 8 months old should be crawling more? Wonder no more.
Here is a month by month guide on what your child should be doing on his tummy the first year of life.
Month 1: Tummy time can start as early as day 1. By the time a baby is a month old, he can most likely lift his head enough to turn his head and rest his cheek to the other side.
Month 2: After 2 months of spending plenty of time on his tummy, a baby is now not as curled up into the fetal position as before. His hips are a little more stretched out and he has the strength to lift his head even higher. He can put weight on the outer edges of his forearms and his shoulders are strong enough to bring his hands out from underneath his chest.
Month 3: By the 3rd month, a baby can put more and more weight through his elbows when he is on his tummy. Because of increased strength in his neck and trunk muscles, he can now lift up his chest and keep his hips down. Weight-bearing through the forearms is so important because it builds strength and stability in the chest and shoulder muscles and joints.
Month 4: The 4th month is a great month for baby development. This is the month of significantly better head control, muscle control, and symmetry. The 4 month old can now push even higher through his forearms, lift his head up to 90 degrees, and hold his head in midline. His neck now looks longer as his neck muscles develop more strength to hold his head up against gravity.
Month 5: Around the 5th month, a baby starts pushing through his hands with the elbows straight. He is learning to shift his weight from one side to the other. Because of this, he might reach with one arm for a toy or accidentally roll over from tummy to back. He is better at using his back muscles against gravity and may look like he is swimming as he kicks his arms and legs up from the floor.
Month 6: At the halfway point of a baby’s first year, a lot of maturation has occurred (Read more about tummy time at 6 months of age here). The baby is able to perform tasks with much more equilibrium and control. The baby is now constantly on the move and loves tummy time because he can do so much and see so much. If you place him on his back, he will most likely roll himself over to his tummy. Place him on his tummy and he won’t fall over accidentally anymore, because of increased motor control.
Month 7: Between all the swimming and pushing off of the floor in the previous months, the 7 month old has developed a lot of trunk strength and shoulder/hip stability. He can now separate his two sides and pivot himself around in a circle to get to toys. He has the control to shift his weight to one elbow and play with the other hand. Some babies may start pushing themselves back into a bear position (hands and feet) or quadruped position (hands and knees). They may rock back and forth in this position, which strengthens their upper and lower bodies to prepare for crawling and standing and improves their sense of balance.
Month 8: The 7th – 8th month is usually when babies start pulling to stand from a quadruped position. Some babies may skip belly crawling all the together, but most babies creep by the 8th or 9th month. An early crawler will show a low-hanging belly close to the floor, but as he practices crawling more and works on his tummy muscles, he will start creeping with all trunk muscles engaged. The typical 8 months old will no longer need his upper body to lift his trunk. He may be seen more and more in a kneeling position so his hands can be free for play.
Month 9: The typically developing 9 months old is now constantly on the move. Crawling is his main method of locomotion. He has enough trunk and muscle control to transition easily between sitting, quadruped, and tummy time. He may start pulling himself into standing though still needs his arms to do most of the work. One thing he may be able to do better is pulling to stand with one foot in front kneeling (half-kneeling).
Month 10: By month 10, a baby will be transitioning to stand via half-kneeling more often. In standing, a 10 month old will have developed the hip/trunk control to rotate his trunk and weight-shift. This is mostly because of the hard work he did on his tummy before! Not only can he transition well by himself, he does so with more control and is much more safe, steady, and efficient.
Month 11: The 11 months old now has more control of his hips and trunk when on his knees. He may be able to play in tall kneeling and half-kneeling positions without falling. His leg and hip muscles are now strong enough that he doesn’t need his hands as much to pull to stand.
Month 12: By a baby’s first birthday, he will have developed full trunk control and ability to use one side independent of the other. This allows for improved weight shifting during standing, increased use of kneeling and half-kneeling, and stability during standing. The 1 year old is able to transition in and out of quadruped position and is now ready to take some independent steps!
It truly amazes me how many new skills babies can acquire in just the first year. Want to know the key gross motor milestones of a baby’s first year? Click here.
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Judy Wang, PT, DPThttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-01-22 17:38:332014-06-02 22:20:43Tummy Time the First Year: A Month by Month Primer
When parents develop concerns about their child’s speech and language, the first person they typically ask for help is the pediatrician. At the 15 month and 2 year checkups, discussing concerns with your pediatrician is a great way to get more information. Your pediatrician will take a close look at your child’s physical health and the major milestones achieved.
To make this easier, keep track of speech and fine/gross motor milestones and at what age they develop.
As a general rule, here are the ages at which your child should be achieving these steps:
Objects to midline
Gesturing to indicate want
Following 1-step commands
Additionally, it is important to discuss frequent ear infections with your pediatrician. An ear infection is fluid buildup in the middle ear, essentially muffling all speech/language your child is exposed to. If your child cannot hear clearly, he will have difficultly acquiring new language. If your child is prone to chronic ear infections, discussing PE tubes may be the next step to ensuring your child develops speech and language.
https://secureservercdn.net/22.214.171.124/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.png00Kate Connollyhttps://secureservercdn.net/126.96.36.199/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngKate Connolly2013-10-29 17:01:132014-04-20 10:54:20What to Expect from Your Pediatrician during a Speech/Language Checkup
How is Physical Therapy Included in School Services?
Through the Individuals with Disabilities Education Act (IDEA), public education must be accessible to all children aged 3-21 years old[i]. Physical therapy is a related service used to help implement IDEA. School-based physical therapy must be aimed towards allowing the child to access his educational environment. Some of the things a school-based physical therapist might assess include travel from one area of the school to another, getting onto and off of the bus, safely navigating the bathroom and cafeteria, getting into and out of classroom chairs, and participation in all classes. They will assess independence, safety, and timeliness of the above areas in determining need for physical therapy services.
The Role of the IEP:
If parents, teachers, or students determine a need in the student accessing the school environment, an IEP referral is made. This begins the process for school-based services. A physical therapist employed by the school district or contracted through an outside agency will evaluate the child and determine eligibility. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. However, physical therapy services must be provided at no cost to the family when deemed necessary.
Clinic-Based vs. School-Based Physical Therapy:
Clinic-based physical therapy is aimed at improving quality of movement, return to function, and achieving gross motor milestones in an age-appropriate time frame. Many children who would benefit from physical therapy services, but don’t qualify for school-based services due to the restrictions, attend private clinics for physical therapy services. In these settings, a physical therapist determines need based on standardized assessments, functional assessments, strength and range of motion testing, and compares these scores to age-appropriate norms. Some things that may qualify a child for outpatient physical therapy but not school-based physical therapy include gait abnormalities (including toe-walking and in-toeing), developmental coordination disorder, decreased endurance and overall weakness, hypotonia, foot pain, sports injuries, burns, etc. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. Physical therapy services in an outpatient setting must be covered through insurance or private pay.
Dependent on your child’s needs, physical therapy services may be required in a school setting, in an outpatient setting, or both. If you have any concerns about your child’s gross motor development or access to services in their school district, please contact the professionals at NSPT.
[i] Fact Sheet. Providing Physical Therapy in Schools Under IDEA 2004. www.pediatricapta.org. 2009. Accessed 07/14/2015.
https://secureservercdn.net/188.8.131.52/fnf.6b5.myftpupload.com/wp-content/uploads/2015/07/kids-in-line-FeaturedImage.png?time=1560905331186183Andrea Ragsdale PT, DPThttps://secureservercdn.net/184.108.40.206/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2015-07-28 18:30:112019-05-15 20:11:12How to Qualify for Physical Therapy Services at School
In my previous blog about the Alberta Infant Motor Scale, I mentioned that as a baby ages, more age-appropriate developmental motor scales must be used to monitor achievement of skills. The Peabody Developmental Motor Scale is a comprehensive and reliable tool used to measure both fine and gross motor activities early in life. It was designed to assess motor skills in children from birth to 5 years old. A majority of physical therapists use this assessment to monitor toddler and preschooler development.
The PDMS-2 is not just limited to physical therapist use. It can be helpful to occupational therapists, diagnosticians, early intervention specialists, adapted physical education teachers, psychologists, and developmental pediatricians who are monitoring motor abilities of children younger than five. The six subtests that make up the PDMS-2 can be used separately or can be combined to collectively describe a child’s gross motor skills (Gross Motor Quotient), fine motor skills (Fine Motor Quotient), or overall motor skills (Total Motor Quotient).
See below for a description of each subtest:
Reflexes: The 8-item Reflexes subtest measures aspects of a child’s ability to automatically react to environmental events. Because reflexes typically become integrated and less obvious by the time a child is 12 months old, this subtest is given only to children from birth through 11 months of age.
Stationary: The 30-item Stationary subtest measures a child’s ability to control his body within its center of gravity and retain equilibrium. Stationary skills include standing on one leg without falling, or standing on tiptoes.
Locomotion: The 89-item Locomotion subtest measures a child’s ability to move from one place to another. The actions measured include crawling, walking, running, hopping, and jumping forward.
Object Manipulation: The 24-item Object Manipulation subtest measures a child’s ability to manipulate balls. Examples of the actions measured include catching, throwing, and kicking.
Physical therapists mostly focus on the reflex, stationary, locomotion, and object manipulation portions of the PDMS-2. Through these sections of the test, we can better assess 1) the maturation of a baby’s neuromuscular system, 2) his safety and stability when navigating his environment, 3) his ability to support and move his own weight, and 4) his ability to maintain his balance and control his trunk while moving objects outside his center of gravity. Overall, this tells us how well a child can use the large muscles in his body to stabilize and create movement.
The Peabody Developmental Motor Scale has been norm-referenced, and proven to be reliable and valid. It has been used to monitor children with and without developmental difficulties. It is relatively easy to administer and the information it provides can be used by medical professionals to tailor a child’s individualized education program (IEP).
Does your toddler have special needs? Or do you have questions about physical therapy screenings for your preschooler? Come to see one of our specialists!
https://secureservercdn.net/220.127.116.11/fnf.6b5.myftpupload.com/wp-content/uploads/2014/07/laughing-baby-with-ball.jpg?time=1560905331336509Judy Wang, PT, DPThttps://secureservercdn.net/18.104.22.168/fnf.6b5.myftpupload.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngJudy Wang, PT, DPT2014-07-01 12:55:292019-05-15 20:22:37Understanding Physical Therapy Outcome Measurements: The Peabody Developmental Motor Scale, Second Edition (PDMS-II)