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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!

NSPT is in-network with United Health Care

North Shore Pediatric Therapy is Now In-Network with United Health Care for Speech, Occupational and Physical Therapy Services

North Shore Pediatric Therapy is now in-network with United Health Care for Speech, Occupational and Physical Therapy services in addition to our current in-network offering of Blue Cross and Blue Shield of Illinois. Our goal is to make our services convenient and accessible to all Chicago area families, and this is one more step toward making that a reality.

According to our CEO, Maria Hammer, “We are excited to provide another option for insurance coverage for many of our current NSPT families and we anticipate being able to help more new families as we go in-network with United Health Care.”

Services that are covered by United Health Care:NSPT is in-network with United Health Care

NSPT also offers Neuropsychological Testing, Applied Behavior Analysis, Social Work, Dietetics, and Academic Services.

With 6 locations, North Shore Pediatric Therapy (NSPT) is the only concierge health and wellness center for children and young adults, that combines the power of multiple disciplines, first class service, and inspiring results, that has become the company’s hallmark. Deemed a Thought Leader in pediatric therapy, NSPT brings Peace of Mind to thousands of children and their families with its invigorating blend of positive environment, heroic staff, and blossoming kids.  NSPT provides the ultimate discovery that challenges can be overcome, and happiness restored.  Our team is comprised of Neuropsychology, Occupational Therapy, Physical Therapy, Speech Therapy, Applied Behavior Analysis (ABA), Social Work, Nutrition, and Academic Specialists.  Visit us at www.KidsBlossom.com.

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night splints

The Quick Guide to Night Splints for Children

 

 

 

For many children who are idiopathic toe-walkers, physical therapists often take the conservative approach. We have many things in our arsenal to help children improve without undergoing costly and painful surgery. Outside of stretching and strengthening exercises, we might recommend ankle foot orthoses (AFOs) for day time and/or night time wear. Depending on the child’s range of motion measurements, walking mechanics, and underlying pathology, different types of orthotics might be recommended. We often work closely with orthotists (professionals who design medical supportive devices such as braces) to make sure each child receives the individualized care and equipment he needs to gain full function and optimal alignment.

Here are reasons why your physical therapist might have recommended night splints for your child:

  1. The main goals of physical therapy interventions for toe-walkers are to increase ankle dorsiflexion range of motion and to decrease possible contractures that are associated with the condition. Physical therapy exercise programs include stretching the calf muscles, strengthening the trunk muscles, manual therapy, treadmill training, balance training, and ankle mobility training. Sometimes, in stubborn cases of toe-walking, orthotics are needed to maintain the range of motion gained throughout daily exercise sessions.
  2.  If you’ve ever tried to stretch your pre-schooler’s muscles, you know that children can be active and fidgety. They don’t tolerate passive stretches as well as adults and might complain of boredom, pain, or ticklishness. The most effective stretches are those held for a prolonged period of time at a joint’s end range. Night splints allow for increased stretch time at the ankle joint, because the child is sleeping or resting when they are in place.
  3. The best time to gain range is when a child is relaxed. Since children relax more during sleep, even more range can be gained through passive stretching using a night time AFO.
  4. This is where the night-time splint comes in. While the daytime AFO is a rigid orthosis that keeps your child’s ankles from plantarflexing (pointing down) past neutral while he walks, the night time AFO is a much more dynamic system. Night splints can be adjusted as the ankles gain more range into dorsiflexion. They provide a low-load, prolonged-duration stretch that helps with contracture reduction and counters high tone.
  5. In the literature, night splints have been found to be effective for contractures at a variety of joints, and can be useful in brachial plexus injuries, cerebral palsy, and muscular dystrophy.

As pediatric physical therapists, we rarely recommend over-the-counter orthotics for your child’s orthopedic needs. By consulting with an orthotist, we make sure each child is fitted to the most comfortable and developmentally appropriate custom foot wear for his condition. Usually, children who adhere to a strict physical therapy program and who receive the right orthoses can see a complete change to their posture and gait mechanics in as short as 6 months’ time.

Click here to view our gross motor milestones infographic!

References:
Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for management of idiopathic toe walking in children and young adults ages 2 through 21 years. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2011 Feb 15. 17 p. [49 references]

boy with truck

W-sitting and the Young Child

Chances are, if you know what W-sitting is, you or someone you know sits just like that. Occupational, physical, and developmental therapists often express their disapproval whenever they see a child sit in this position. More and more parents are catching on to the fact that this is a posture to keep their children out of. The most common questions they have are 1) why is it so bad? and 2) what is there to do to help change this habit?

What is W-sitting?

Many children with low muscle tone, decreased core strength, increased joint laxity, or hip instability, will sit and play with their knees together, bottom on the floor, and feet out to both sides.

Why do some children like to sit this way?

Simply put, a young child’s joint and bone structures will allow them to sit in this position. Certain medical diagnoses, such as Down syndrome and femoral anteversion, are often associated with this preferred sitting posture. In this position, children are more comfortable and don’t have to work as hard to hold their trunks upright. Instead, they are spreading their lower limbs out over a wider base of support, thus relying on their joint structures and not their muscles, to hold them up to play.

Why do therapists recommend against it?

While the knees together and feet out position is fine as a transitional position, our hips are not designed to be in the W-sitting position for a long period of time. Prolonged sitting in this position places significant stress on inner hip muscles and joint structures. The young musculoskeletal system will then develop in such a way that just creates more and more instability of the hips. If a child gets used to sitting and playing in this position, weaknesses and orthopedic misalignments will only travel up and down the musculoskeletal chain. Children who W-sit well into their preschool to school years often experience decreased trunk strength, poor attention, in-toeing, poor posture, clumsy coordination, and frequent loss of balance.

How to help a child out of the position?

Many parents would tell me that they are at their wits’ end, constantly instructing their child out of the W-sit position.  While repetition and consistency are key, habits are difficult to change, especially with verbal reprimands alone. Change things up and give your child other sitting postures as options:

1) The most common alternate position is with feet crossed and knees apart. “Criss-cross applesauce” is what we usually tell children when we see them W-sitting. They respond well to this simple cue.

2) Side-sitting is a great alternative if sitting with knees out is too difficult. In side-sitting, both knees are bent, weight is shifted to one hip, and both feet are out to the same side. This takes away stress from the hip joint structures, allowing for easy transitions in and out of sitting.

3) Long sitting with feet forward and back supported is a great way to stretch out those hamstrings and keep hip/knee joints in neutral.

4) If a child has a hard time sitting and playing, I let them kneel with their feet tucked together under their bottom. As long as they don’t slowly shift back into the W-shape, kneeling is a great position to strength their hip and core muscles.

5) Half-kneeling with one foot tucked and the other foot flat on the ground will keep the hips in neutral alignment. In this position, muscles will be active and hip joint structures will not be put under damaging stress.

6) Finally, squatting or sitting on a low chair will also help keep a child out of W-sit during play.

If you are still looking for ways to keep your child out of this injurious habit, talk to a therapist. Physical therapists will come up with ideas and exercises tailored to each individual child and find the best ways to improve his or her posture and alignment.




Dizzy Kids

What Is The Vestibular System

Most kids learn about the 5 basic extrinsic senses of sight, sound, taste, touch, and smell. Many, however, are not as familiar with two hidden intrinsic senses: the vestibular and proprioceptive senses. The vestibular sense is one of the first to develop in a growing fetus and is stimulated by the movement of a carrying mother’s body. By only 5 months in utero, this system is well developed and provides a great deal of sensory information to a growing fetal brain. This system is very important to a child’s early development. Its role is to relay information to the brain as to where a person is in space, as related to gravity; whether they are moving or still, if they are moving how quickly, and in what direction. The vestibular system gathers that information from a set of fluid filled canals and a sac-like structure in the inner ear. These structures respond to movement, change in direction, change of head position, and gravitational pull.

  4 Ways the vestibular system may impact your child:

1. The vestibular system coordinates eye and head movements. Without this coordination, it may be challenging for children to complete everyday activities such as copying from a white board in their classroom, following a moving object such as a softball through the air; or visually scanning across a page to read. The vestibular system helps the brain to register and respond to whether the object the child is looking at is moving or if their head is moving.

2. The vestibular system also helps to develop and maintain normal muscle tone. Muscle tone is the ability of a muscle to sustain a contraction. Without a proper functioning vestibular system, it may be challenging for a child to hold their body in one position. These children may oftentimes prefer laying on the floor instead of sitting up during circle time or leaning on their elbow or hand while seated at their desk.

3. The vestibular system also impacts a child’s balance and equilibrium. As your child moves throughout their environment, so does the fluid in their inner ear canals. As the fluid in their inner ear moves, your child’s brain is receiving information as to the position of their head in space. Depending on that signal, the brain then sends a message to your child’s body signaling it to move in a way that will help them to respond to and compensate for any planned or unplanned movements.  Without efficient vestibular processing, your child may appear to be clumsy and have trouble staying on their feet during routine play.

4. Finally, the vestibular system helps a child to coordinate both sides of their body together for activities including riding a bicycle, catching a ball, zipping a coat, or cutting with scissors.

If you suspect that your child is having difficulty processing sensory information by way of their vestibular system, do your best to be sure that activities including a lot self-propelled movement are incorporated into their day. Activities may include swinging, sliding, or using other equipment at the park. Do your best to avoid activities with excessive spinning or twirling as movement in these planes can have negative effects including over-stimulation, lethargy, or changes in heart rate or breathing. It may also be challenging for your child to pace themselves during these quick paced movement patterns. Encourage activities in which your child lays on their belly to participate in games or play with toys. Throughout your day, take note to see if your child seems better able to focus after completing physical activity or partaking in activities that get them up and moving.

The vestibular system may be less commonly discussed than other sensory tracts, but its impact on your child’s ability to complete day to day activities are vast.





 

Baby crawing

Common Physical Therapy Red Flags at Pediatrician Well-Visits For Baby’s 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.

1 month

– 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.

2 months

– 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.

4 months

-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.

6 months

-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.

9 months

-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.

12 month

– 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.

18 months

-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.

To see what your child should be doing at later stages in life, download our Gross Motor Milestone Checklist here.






 

boy learning to walk

Gait Development In Children

A majority of my clientele are babies just learning to walk, toddlers who are delayed in their walking, or preschoolers who are showing an abnormal gait pattern. Years ago, when I worked in the rehabilitation and hospital settings, most of my patients were trying to regain their ambulatory abilities after an injury. Needless to say, walking is an important part of growth and locomotion. It is a complex task that requires musculoskeletal and neurological system maturation and cohesion.

Development of Gait:

The components of typical adult walking include 1) stability in stance, 2) sufficient foot clearance, 3) appropriate positioning of foot for initial contact of the next step, 4) adequate step length, and 5) energy conservation. Depending on the age or type of injury, a person’s walking ability might be impaired in any of these factors. Physical therapists work to address each component to encourage efficient and safe walking.

At age 1, children are just learning to walk and are still working on their standing stability. When they first start walking, their arms are held up high in protective guard, and they walk really fast so as not to lose their balance.  They rely on a wide base of support to maintain their stability. They often put their feet down flat on the ground and they do not spend as much time on each leg when clearing their feet for the next step.

About 6 months later, children will often start walking with a more natural gait, with arms down in a reciprocal swing, and with heels hitting the ground first.  Because of the structure of toddlers’ bones and joints, they still stand with a wider base of support than adults do, but are in the process of narrowing their stance.

In preparation for running efficiency and coordination, children who are two years old will have better ability to stand on one leg while clearing the other foot, and they are better at lifting their legs up and forward during walking. Base of support will continue to narrow during this stage.

By three years of age, children have gained the strength, upright posture, and limb coordination to walk similarly to adults. They might still stand and walk with different joint motions than adults, but this is more due to structural differences than anything else.  As their muscles and bones mature, children’s ambulatory abilities will improve as the forces of gravity and daily activity slowly elongate and strengthen the structures needed to perform adult walking. Of course someone who is seven years old cannot walk with the same speed and step length that an adult can, but they come pretty close.

The orthopedic and neurological changes that occur in a baby to enable him or her to walk are complicated.  It takes years and lots of practice for a mature walking pattern to develop in a child. Parents often ask whether or not their child is walking “normally.” That analysis depends on the child’s age, medical history, and family history. Studies have shown that adult gait is present in children by 7-8 years of age. A child can come into physical therapy with a variety of deviations (from flat feet, in-toeing, to toe-walking, to frequent falling). It is only through careful observation and assessment of their gait cycles that physical therapists can help these children achieve the optimal pattern.

Reference:

Stout, JL. Gait: Development and Analysis. In: Campbell SK, eds 3. Physical Therapy for Children. Philadelphia, Pa: WB Saunders Co,2004 :161-167.

Keen M. Early development and attainment of normal mature gait. Journal of Prosthetics and Orthotics 1993; Vol 5, Num 2, p 35. Available from: http://www.oandp.org/jpo/library/1993_02_035.asp; 2014 [accessed 31 March 2014]







Arm with kinesiotape

What is Kinesio® Tape and why is it used on children?

Physical therapists and occupational therapists often use Kinesio® Tape on their clients as an adjunct to therapy. So what is Kinesio® Tape? You might have seen this colorful tape on Olympic athletes in various locations and various patterns. It is an elastic tape that has multiple purposes depending on where and how it is applied. It is often used to reduce pain, swelling, improve strength, encourage optimal alignment, and decrease muscle fatigue.  Kinesio® Tape can be used at full tension like regular athletic tape. However, it is the elastic qualities of Kinesio® Tape that make it therapeutic.

Properties of Kinesio® Tape:

-Latex free
-Variable tension depending on function
-Adhesive is medical grade acrylic and heat sensitive
-Allows for free movement instead of restricted movement like regular athletic tape
-Similar elasticity as human skin, so it can stay on for days to maximize its full effect

Purpose of Kinesio® Tape:

-To hold a joint in optimal position to help an overstretched or overworked muscle to rest and return to its most efficient length.
-Keeping a body part in better alignment helps the muscles contract and work in a less stressful fashion during daily activities.
-To increase input to the skin around a specific muscle or joint. With this new proprioceptive input, more awareness of that body part leads to more strength.
-To help relax an overused muscle which helps reduce pain and swelling
-Improve lymphatic flow and reduce edema and bruising, allowing for accelerated healing

Who can benefit:

People with a variety of orthopedic, neuromuscular, or medical conditions, such as:

-Cerebral Palsy
-Conditions with weakness or paralysis of a certain body part
-Down Syndrome
-Gross Motor Developmental Delay
-Children with gait abnormalities such as toe-walking, flat feet, hyperextension, etc.
-Low muscle tone
-Decreased coordination
-Brain injury
-Torticollis
-Lymphedema
-Painful orthopedic injury
-Poor posture
-And many more…

Not only is Kinesio® Tape safe for use on children, I have found Kinesio® Taping to be extremely beneficial and valuable to my clinical practice.  This elastic tape can be left on for 3-4 days after application. Often times, I put it on at the end of a session to help my clients retain the gains we made during the session. In a way, it improves carryover from week to week, and brings the physical effects of therapy home. With babies, this “reminder” is especially important, as they are still working on their neuromuscular control and cannot make a conscious effort to contract a certain muscle or hold a specific position during their play activities. With children, the colorful tape gives them a fun visual cue to increase use of a certain body part and strengthen those all important neuromuscular connections.

Reference:

Kase, K, Martin, P, Yasukawa, A. Kinesio®Taping in Pediatrics. 2006. Kinesio® USA , LLC. 16-19.


Physical Therapy Posts

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.

Preparing for Pediatric Physical Therapy Evaluation

Coming to a physical therapist for your child for the first time can be an overwhelming and confusing experience – but it doesn’t have to be! Here at North Shore Pediatric Therapy we have outlined the most important information to know before you go to the pediatric physical therapist for the first time.Pediatric physical therapist smiling

Paperwork: Although no one enjoys filling out form after form, this information is essential to the therapist and office staff. Please remember to bring the following with you at your first appointment. This information will be emailed to you by the family-child advocate before you come in.

  • Copy of your physician’s prescription for physical therapy. It is imperative that we have this on file before any ongoing treatment sessions.
  • Insurance Card 
  • Your child’s past medical history. We will ask questions concerning his or her gross motor milestones and at what ages these were achieved, as well as birth history, pertinent family health history, educational history and general information about your child’s motor, language and social skills. Also if your child has visited a therapist before and you have documentation from these visits, we would be happy to make a copy of those as well.
  • A clear picture of your availability for future appointments. We will do our very best to make all future treatment appointments at the initial evaluation.

Equipment: It would be helpful to us and your child if you bring a few things along with you.

For infants and younger children:

  • A toy that he or she responds to and enjoys can be used during treatment. This helps us transition the child to the new environment and is good for tracking skills.
  • A onesie to wear during the treatment sessions. At the evaluation we will observe the child moving without clothes on (except for the diaper) to observe his or her muscles and general tone.
  • A blanket can be more comfortable for the children to move around on. If you don’t have one don’t worry, our treatment mat is soft and secure.
  • A pacifier can help to soothe your child
  • A bottle or source of food might help if the child becomes hungry. He or she will be working hard and might become hungrier than normal.
  • A change of diapers is never a bad idea!

For toddlers and older children:

  • Dress your child in comfortable clothes that are easy to climb, jump, roll, crawl and move in.
  • Wear athletic shoes and socks to the appointment. We will complete most exercises without shoes on in order to accurately assess balance and movement skills. However, it is helpful for the therapist to see what footwear the child wears and if additional recommendations are warranted.

What do we do?

  • Strength and range of motion testing.
  • Assess gross motor milestones (i.e. rolling, crawling, running, jumping, skipping)
  • Discuss treatment plan and what you should expect out of therapy.
  • Plan functional short term and long term goals for your child.
  • Standardized testing is usually completed in order to get a baseline measurement for your child. These tests allow us to measure your child against his or her peers, and create realistic projections for what we can expect to achieve through therapy.

The physical therapist working with your child will be able to answer all of your questions pertaining to his or her diagnosis at the first appointment. Any questions that come up after that initial evaluation can be answered before, during or after future appointments via email, phone, or in-person conversations. Thank you for taking the time to read this and be prepared. We look forward to meeting you and your child!

* This article was also written by Adele Nathan, Student Physical Therapist at North Shore Pediatric Therapy

3 At home Exercises For Torticollis | Pediatric Therapy Tv

Here our Pediatric Physical Therapist gives viewers 3 examples of exercises that parents can perform at home with their child who has torticollis.  For more blogs by experts on Torticollis, click here

In This Video You Will Learn:

  • 3 great exercises a parent can do at home with their child who has Torticollis
  • A great alternative to Tummy Time
  • How to get your child to actively move around
  • How to perform an easy pull to sit exercise and why that helps

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now, your host, here’s
Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I am your host,
Robyn Ackerman, and today I am sitting here with Jesse Coffelt,
who is a pediatric physical therapist. Jesse, can you please let
us know three exercises that we can do with a baby who has been
diagnosed with torticollis?

Jesse: Absolutely. There are three great exercises, and obviously
tummy time is going to be hugely important for these kiddos.
This is a great carry I like to do with babies, where my hand is
supporting the baby’s chest here. It can be comfortable. You can
carry the child here. You can put your hand on her, and she’s
always got to lift up her head to be looking around. So she’s
getting that tummy time equivalent.

Another one that’s really good is you can hold the baby up like
this. Again, you can be engaging with your child, and you can
kind of just be tipping her side to side, looking at her, really
getting her to actively move around.

The third one, if I could just place the doll right here, it’s
like a pull-to-sit exercise. What you’re doing is you’re going
to grasp the child by her hands and just gently and slowly lift
her up. What you’re looking for is making sure that she is
lifting her neck up and she’s actively engaging her abdominals.
You can come up here to sitting, and then slowly take her back
down to laying on the ground. The slower you move, the more
she’s got to actively work and strengthen those muscles.

Robyn: All right, great. Thank you so much, Jesse, and thank you to
our viewers. And remember, keep on blossoming.

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mind to your family with the best in educational programming. To
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How to get your Child to do PT Exercise without Feeling like “The Bad Guy”

Wow, you are sitting down to read this. You are lucky to take the minute between gift shopping, cleaning for your relatives to girl doing physical therapyvisit, packing for your own vacation to get away from your relatives, and the 13th version of the Nutcracker ballet that you have seen since January. I say that you are in luck, as I have hidden the winning lottery numbers in the text of this blog.

With the excitement of the holidays, and the variety of directions that children and parents are pulled these days, I have a lot of parents looking to advocate for their children and wanting strategies on how to best support their child’s growth towards his physical therapy goals. In that vein, I reached out to Beth Chung, MSMFT, AMFT, one of North Shore Pediatric Therapy’s brilliant Marriage
and Family Therapists. I asked her several of the questions I am frequently asked:

“My child won’t do their PT ‘homework'”

“Work towards a goal.”  Beth answers.  You can help motivate your child by creating a star chart. These charts work for behavior as well as exercises. This chart can track your child’s progress with his/her exercises, and gives you something physical you can use to motivate him/her throughout the week (“Let’s look at your star chart. Look! You did such a wonderful job yesterday of doing all your leg exercises. I know you can do it again today!”). It can also allow your child to work toward a goal (ex. 5 days of completed exercises can lead to a reward.) Some of the best rewards for this can involve spending time with the family, and possibly something physically active. You can find active family-friendly places here. But don’t forget that walking through the Lincoln Park Zoo, the Chicago Botanical Gardens, any of these museums, or even through a park near home can be just as entertaining.

“Break it down.” You utilize immediate rewards. This works great for privileges the kids already get, such as time on the computer (for non-homework activities) or time with video games. For example, 15 minutes of a PT exercise can correlate to a certain amount of time with electronics.

“Dive in with them.” Most of the exercises you can do right along-side them. [Quick note, as long as you do not have a condition that would worsen if you performed them.]

“My child doesn’t believe me when I say that it’s important”

“Go to the source.” Set up a meeting with your child and the clinician she is working with. That clinician has experience, education, and research to back-up the activities she suggests. When the child can see that her parents and PT or OT are a team, it reinforces what they each say.

“Encourage your child’s questions.” Getting your child to “buy-in” to her exercise routine is essential, or it will be a struggle every day. Use what you know is important to your child (ex. Playing on the soccer team next year or feeling physically strong). Explain to your child how engaging in homework exercises can meet these goals, and praise your child throughout the process (ex. “I noticed that you ran faster today than I’ve ever seen you run! Those exercises must really be helping!”).

“Can’t we just take a couple of weeks off of exercise?”

“No.” This time of year is stressful for almost everyone. Finding creative ways to incorporate exercises into your routine is the key to success. Taking just a few days off of exercises can be a big set-back, and slow progress towards your goals. Here is a link to some fun movement activities.

“Explore your own feelings and thoughts as parents.” It may feel tempting to allow your child to take time off from the exercise, especially during the busy holiday season. Something to keep in mind, however, is that PT or OT occurs one hour out of your week and that, as clinicians, we rely on parents to continue to encourage your children to practice various exercises during the week. One way to think about it is that your PT or OT is your consultant, who can give you strategies and exercises, and that you are the coach to empower your child in his daily life!

To reiterate Beth’s point, we as clinicians see your kids for 1/168th of the week, or approximately 0.6% of the week. You are the expert on your child, and you are her primary influence. So it is essential that parents and clinicians work together to fully facilitate the homework program and maintain consistency with the exercises.

Enjoy your time with your kids and, when you win the lottery, remember who provided you with those numbers.

Torticollis: Before And After Physical Therapy

What do you notice in the picture of two babies lying down? That they are two adorable boys?…Well of course!! They are my sons so I can’t help but agree. You may or may not also notice how both of their heads are tilted to the left. This is because they both had a condition called torticollis.

Twin Boys With Torticollis

Baby Boys Exibiting Torticollis

What is Torticollis?

Torticollis is derived from the Latin language for twisted neck, which makes sense but sounds pretty awful! As a parent it can be even more awful to find out that there is something wrong with your child. For me, even as a clinician who works along side children with torticollis, it was hard to believe that my young sons had a condition that required therapeutic intervention.

Physical Therapy Used To Resolve Torticollis

Twin Boys With Torticollis Resolved

After Physical Thereapy, Torticollis Is Resolved

Both of my sons received physical therapy under the care of a physical therapist at North Shore Pediatric Therapy for a few months, and the torticollis is now resolved. Overall, the process of receiving physical therapy was a great experience.

First and foremost, if torticollis is not treated and resolved there are several issues that can result, including issues with development of gross and fine motor skills, visual perceptual difficulties, and even facial and jaw asymmetries can present. Also, from a parent of small infant’s perspective, it was really helpful for me to have some structure to my week that included an “outing” (therapy) with my boys to force me to get dressed and leave the house Finally going to the appointments weekly and hearing about progress that an experienced clinician was observing every visit was helpful and encouraging!