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Moving Away from Positioning Devices in 2017

Obviously, no baby is going to spend 100% of their time playing on the floor or a mat/blanket. At some point you need to cook or shower and you need a place for the baby where they’re safe Blog-Positioning Devices-Main-Landscapefrom the toddler, the dog, or somewhere you know they won’t roll away. This is the time to use the exersaucer, sling seat, or bumbo seat; but try to limit the time spent in these devices to 20-30 minutes per day, collectively.

Here’s why you should consider moving away from positioning devices…

The biggest problem with these devices is children are placed in them well before they have the proper trunk and/or head control to really utilize them properly. With an exersaucer, most babies are also unable to place their feet flat on the bottom but are still pushing up into standing. This can increase extension tone, decrease ankle range of motion/muscle shortening, and can possibly be linked to future toe walking.

With a bumbo or sling seat, the baby is not placed in optimal sitting alignment causing poor sitting posture. While these appear to provide great support and make 4 month old babies look like they can sit independently, the truth is the device isn’t allowing your baby to utilize their core muscles to actively sit.

The bottom line is, if the positioning device is doing all the work, what is your child learning to do?

The best place for your child to play and spend the majority of their time is on the floor or on a blanket/mat. This allows them the opportunity to properly explore their environments and practice typical movement patterns like reaching for their feet, rolling to their side, rolling over, spending time in prone, pivoting, and creeping/crawling.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Everything Tummy Time

Parents of infants all know that they should be working on tummy time every day from an early age. However, most parents also experience difficulty consistently working on tummy time, since babies are often initially resistant to this position.Blog-Tummy Time-Main-Landscape

Below is a list of reasons why tummy time is so important, even if your child does not initially enjoy the position:

  1. Strength: When a baby is placed on her stomach, she actively works against gravity to lift her head, arms, legs and trunk up from the ground. Activating the muscle groups that control these motions and control the motor skills that your child will learn in tummy time allows for important strengthening of these muscle groups that your baby won’t be able to achieve lying on her back.
  1. Sensory development: Your child will experience different sensory input through the hands, stomach, and face when she is lying on her stomach, which is an integral part of her sensory development. When your baby is on her stomach her head is a different position than she experiences when on her back or sitting up, which helps further develop her vestibular system.
  1. Motor skill acquisition: There are a lot of motor skills that your child will learn by spending time on her stomach. Rolling, pivoting, belly crawling, and creeping (crawling on hands and knees) are just a few of many important motor skills that your child will only learn by spending time on her stomach. Along with being able to explore her environment by learning these new skills, your baby will also create important pathways in the brain to develop her motor planning and coordination that impact development of later motor skills, such as standing and walking.
  1. Head shape: Infants who spend a lot of time on their backs are at risk for developing areas of flattening along the back of the skull. It is recommended that babies sleep on their backs to decrease the risk of sudden infant death syndrome, and since babies spend a lot of time sleeping, they are also already spending a lot of time lying flat on the back. Spending time on the tummy when awake therefore allows for more time with pressure removed from the back of the head, and also helps to develop the neck muscles to be able to independently re-position the head more frequently while lying on the back.

It is important to remember that your child should only spend time on his or her stomach when awake and supervised. Many infants are initially resistant to tummy time because it is a new and challenging position at first. However, by starting with just a few minutes per day at a young age and gradually increasing your child’s amount of tummy time, your child’s tolerance for the position will also improve.

For more tips on how to improve your child’s tummy time, watch our video!

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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Importance of Tummy Time

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 onblog-importance-of-tummy-time-main-landscape 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!

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!

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Encouraging Muscle Development in the Infant Stage

Importance of Tummy Time for Muscle Development

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

Jumpers, Swings, and Exersaucers

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

Developmental Red Flags to Be Aware of

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

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

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

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the development of play

From Stacking Blocks to Tea Parties: The Development of Play

At each stage of our lives we have certain responsibilities; as adults we work, as highschoolers we went to school, as kids we played. Playing is a fundamental skill for children, and often acts as an avenue for other skills to develop. While playing, kids explore the world; they learn how things work, they arethe development of play exposed to new vocabulary and they learn to interact with other kids.

Play mirrors language development. As a child ages, their language skills develop, progressing from one word utterances to 3 – 4 word phrases and ultimately reaching conversational level skills. Along with this improvement and development of language abilities, a child’s play skills will also progress through a developmental hierarchy. Therefore, just as there are developmental steps with language development, there are certain play milestones that a child will progress through.

Use the table below as a reference to determine appropriate play skills for your own child for his or her age.

The Development of Play:

Age Play Skills
0-6 Months – Demonstrates reaching and banging behaviors for toys- Starts to momentarily look at items and smile in a mirror

– Rattles and Tummy Time mats are very popular at this age

6-12 Months – Begins to participate in adult-led routine games(e.g., Peek-a-boo).

Functional play skills are emerging at this age (i.e., playing with a toy as it is meant to be used). Examples of functional play are pushing a car or stirring with a spoon.

– Demonstrates smiling and laughing during games

 

12-18 Months – Consistently demonstrates functional use of toys- Emerging symbolic play skills were be observed at this age (i.e., the use of an object to represent something else). For example, pretending a banana is a telephone or pretending to brush a doll’s hair with an imaginary brush

– A child will also ask for help from a caregiver or adult if his or her toy is not working

 

18-24 Months – Pretend/symbolic play will become more advanced with the use of multiple toys in one play situation (e.g., playing kitchen or house)- There is much more manipulation of toys at this age – grouping of like items and assembling a complex situation

– Children will also become more independent in putting toys away or repairing broken pieces

 

24-30 Months – At this age children will begin to demonstrate parallel play. In other words, children will engage in the same play activity with the absence of interacting with each other- Although at this age, children are not yet interacting together directly, they will begin to verbalize more around children as well as share toys with other peers

 

30-36 Months – Children at this age are becoming expert playmates – long play sequences will be carried out. Typically, children will begin by playing out familiar routines, such as a parent’s dinner routine. As children age, new endings to play sequences will emerge- Dolls or other play animals may become active participants in a play sequence.

 

Rossetti, L. (2006). The Rossetti Infant-Toddler Language Scale. Linguisystems, Inc.

Encourage your child to explore and interact with new toys. Try sabotaging a play sequence (e.g., putting a block on your head rather than on the floor) to add extra fun or laughs to an afternoon. While playing with your child, also encourage and add language to the situation. You can do this by asking the child, “What should the horse do next?” or even just narrating what you are doing, e.g., “First I’m going to stir my pot, then…”.

Playing is meant to be fun and enjoyable for parents and their kids. Enjoy the warm weather, encourage language and play development and go outside to play!

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

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.







torticollis and car seats

Torticollis, Plagiocephaly and Car Seats

 

 

Many times, babies with torticollis will develop plagiocephaly, or misshapen head. Babies develop these flat spots on one or more parts of their heads because they often sleep in the same position for prolonged period of time. Quite a few parents I know like to keep their children in car seats because they sleep better in that cradled position. If you are worried about your baby’s head shape, or if he starts to show a preference for the way he holds his head in the car seat, read on for three tips to help decrease the likelihood of plagiocephaly and improve his torticollis.

3 Tips for Reducing Plagiocephaly and Improving Torticollis in the Car Seat:

  1. Get him out of the car seat as much as possible. It may sound obvious, but car seats are really only to be used in cars. I know it’s easier to carry a sleeping infant in and out of places while they are in a car seat, but the best position for a baby is still on his tummy. Babies with torticollis are going to hate tummy time at first, but they eventually learn to like it (click here for some easy alternatives for tummy time). Even just doing tummy time over a boppy or a towel roll will help get them off their flat spot, strengthen their neck muscles, and help round out their head. Just remember, all tummy time should be supervised, whether the child is asleep or not.
  2. Place objects on the opposite side. If your baby likes to look out the window he’s next to when he’s in the car seat, switch things up and put him near the other window instead. If he likes to look to the right side all the time in the car seat, put dangling toys to the left side. Young infants are attracted to bright lights, yellow or red colors, faces, and rattle sounds. Use toys and mirrors to get him looking the other way.
  3. Try props. Props such as towel rolls and little foam cushions should only be used if they can be separated from the baby by a barrier that prevent babies from wiggling into the towels. Some infant car seats have a little shield between the baby and the soft padding of the carrier. I always recommend propping the towel rolls behind the shield and underneath the side of the head they prefer to lie on. This gets them to turn their head more to the other side. It does the same job as the Tortle hat, and babies tolerate it much better than wearing a beanie.

If you are still having trouble keeping your little one off his flat spot while he is in the car seat, or if you are noticing a head shape change, bring him (and the car seat) in to one of our physical therapy specialists, and we will help turn things around.

Click here to read more about plagiocephaly helmets from a therapist’s perspective!

Tummy Time the First Year: A Month by Month Primer

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.



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.

Holiday Toy-Gifting Guide to Promote Gross Motor Skills

It’s the holiday season yet again. In this time of family, friends, foods, and traditions, many little minds are thinking about new toys.   This is the perfect opportunity for parents and family members to stock up on games and toys to facilitate their children’s development.  While some older children might have wish-lists to be fulfilled, there are plenty of toys outside of the latest trend that will help promote growth in children of all ages. As any therapist knows, a toy can be a powerful tool to promote developmental gains, particularly in children who are a little behind their peers.  Below are some toys that help kids strengthen their big muscle groups and attain gross motor skills, without making play seem like work.

Learning Tables

A learning table is a great investment if you have an infant. It will grow alongside your baby and help her attain valuable gross motor skills such as body control in tummy time, cross-body reaching, independent sitting, cruising, standing, and weight-shifting, all while promoting her upper body and cognitive growth.  Early learners can keep busy with the lights, sounds, and activities; the height of the tables adjusts so that babies from 6 to 36 months can play in various positions. Babies will be challenged throughout each step of their development and learn about cause and effect. Read more

Physical Therapy Posts

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Tummy Time | Facebook Live Video

Join our physical therapist, Leida, for the basics on Tummy Time!

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