what is phonemic awareness

What is Phonemic Awareness?

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Literacy, or the ability to read and write, is paramount to a child’s success in school. Many children struggle with these skills, and this struggle may be due to difficulty with the building blocks of reading and writing, also known as phonological awareness. Phonological awareness can be thought of as one’s ability to identify sounds and letters as they relate to our spoken (and written) language. We all remember playing rhyming games in elementary school, but many people are unaware of their importance!

Children who have an understanding of phonological awareness understand that sentences are made up of words, words are made up parts (syllables), and each syllable has distinctive sounds. One great way to practice phonological awareness is through rhyming games and alliteration. Children will enjoy saying tongue twisters like, “Sally sells sea shells by the sea shore.” and identifying how many /s/ and /sh/ words they can count!

Phonemic awareness, a subset of phonological awareness, allows children to manipulate parts of language. Similar to phonological awareness, phonemic awareness is also comprised of parts including the following:
•    Segmenting: what sounds do we hear in the word “hat?” /h/, /a/, /t/
•    Blending: if you hear the sounds /t/, /o/, /p/, what do we get when we put them together?
•    Deleting: what’s “bat” without the “t?”
•    Substituting: if we change the /h/ in “house” to an /m/, what do we get?
•    Identifying: what’s the first sound in “cat?”

Phonemic awareness is separate from letter identification as it targets individual sounds; however, parents can incorporate letter names when practicing.

Phonological awareness typically begins in preschool and continues through early elementary school to prepare children for reading. These skills serve as the foundation for a child’s ability to read and write. If you suspect your child may be struggling with phonological awareness skills, a licensed speech-language pathologist can help!

Click here to read about 7 Ways to Increase Phonological Awareness.

First Sounds and First Words | What to Expect from Your Baby

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Talking. Some of us don’t like to do it and some of us do it too much. But one of the most exciting things for parents is to witness their child’s first words. Babies learn to talk throughout their first two years of life and believe it or not, there are speech and language milestones that are achieved in the first few months of life. Here is a general outline of the speech and language milestones your child should be achieving from birth to 2 years.

Speech and Language Milestones from Birth to 2 Years:

Birth to 3 months

• Variety of cries to indicate needs – hungry, in need of a diaper change, or upset
• Coos, sighs, gurgles, and makes pleasure sounds
• Recognizes voices
• Localizes to sound by turning head

4 to 6 months

• Uses /p/, /b/, and /m/ to babble
• Vocalizes excitement and displeasure
• Listens to and imitates some sounds
• Responds to changes in your voice

7-12 months

• Babbles using long and short groups of sounds
• Uses a song-like intonation pattern when babbling
• Babbling has both long and  short groups of sounds such as “bababa upup tata”
• Has 1 or two words, though they may not be clear
• Uses communicative gestures such as pointing, pulling, and waving

12-18 months

• Uses nouns almost exclusively
• Uses jargon to fill gaps in fluency
• Combines gestures and vocalization
• Says more words each month, by 18 months child has a vocabulary of approximately 20 words

18 to 24 months

• Uses many different consonant sounds at beginning of words
• Expressive vocabulary of 25-50 words
• Imitates many words
• Uses some 1-2 word questions – “What’s that?” “Mommy?”
• Puts two words together – “more cookie” “no book”
• Language explosion typically occurs around 18-24 months; vocabulary grows to 150-300 words by 24 months

Further Reading

For more on Speech and Language Milestones: Birth to Age 1, click here.
For more on Speech and Language Milestones: Ages 1-2, click here.

Gross Motor Developmental Milestones for Two Year Olds

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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.

The Basics of a Math Disorder

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Mathematics is much more than adding and subtracting.  In reality, there are several factors and components that compose a child’s mathematics achievement.  Children’s mathematics skills are found to develop in a hierarchical fashion.

Stages of mathematics development:

  • The first stage of mathematics development is observed in young children and consists of skills such as understanding of one-to-one correspondence, classification, seriation, and conservation.
  • After theses skills are developed, children are able to learn addition, subtraction, multiplication, and division.
  • Finally, after these skills are developed, advanced skills such as algebra and geometry are able to be learned.

Teachers can watch to see if these skills are developing as they should be.

Once teachers have identified a child as struggling with mathematics, one or more of the following factors would likely need to be addressed:

  • Visualspatial skills
  • Linguistic abilities
  • Working memory

Visualspatial skills are necessary for aligning numerals in columns for calculation problems, understanding the base ten system, interpreting maps, and understanding geometry.  Linguistic skills are needed when performing word problems, following procedures of how to carry out operations, understanding math terminology, and knowledge of math facts.  Working memory capabilities are used for the manipulation of numbers and operations.

From here with a plan from the teacher and/or a neuropsychologist, the student can get back on track with his or her math skills.

Click here for more information on Learning Disorders.

Tips for Buying Tricycles for Toddlers

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An important part of childhood is riding around in your first set of wheels. Between 2 and 3 years of age is a good time to look into tricycles. Tricycles are important for both cognitive and physical development, helping children explore their environment in new ways and develop their confidence and independence. Tricycles are also a great way to build a child’s coordination, endurance, balance, and core strength.

Tricycles are a great transition between scooters and bicycles. Scooters, strider bikes, and seated ride-on toys (learn more about these toys here) don’t have pedals so kids just have to put their feet down on the floor to propel or stop.  Tricycles and bicycles, on the other hand, require some total body coordination to pedal and steer at the same time. Bicycles require more advanced coordination and balance than a starter tricycle.

What to look for in a tricycle:

  1. Safety: A tricycle that is compact, light, and easy to push might not be sturdy enough to support a growing child. Look for a wide base of support and a stable steering wheel (one that does not make hard turns) so the trike isn’t easily flipped over. A decent tricycle does not break easily. Look for a trike that’s made out of sturdy materials (metal as opposed to plastic).
  2. Fit: A tricycle will most likely encourage independence and confidence if the child can actually reach the pedals. There are lots of tricycles out there with adjustable seats, handles, and pedals. Make sure you pick a tricycle that your 1.5 year old can grow into for at least a couple of years. If your child has a hard time keeping his feet on the pedals, there are also Toe Clips available at most toy retailers to help strap their feet in.
  3. Function and Fun: When purchasing a tricycle for your 2 year old, consider if having a push bar would be important. Push bars let parents steer their children around, which could be a good option when trying to navigate busy city sidewalks or if your child has a hard time coordinating the pedals at first. Most push bars are removable for the more advanced tricyclist.  Some tricycles have storage or dump buckets. These are usually big hits with children; they love to cart things around.

Tricycles provide a new level of independence for young children, and promotes emotional and physical growth. As always, children should be supervised and wear protective gear when on any mobile toy.

What Is the Difference Between Occupational and Physical Therapy for Children?

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Many of the parents I meet often ask why very few occupational therapist work with infants, or why an occupational therapist (OT) is seeing their child for toe-walking as opposed to a physical therapist (PT). They often wonder why one child who has balance or coordination issues would see a physical therapist while another with similar limitations would see an occupational therapist instead. Some parents think that occupational therapists only work on fine motor skills while physical therapists only work on gross motor skills.  Physical and occupational therapists work in a variety of settings, including hospitals, neonatal intensive care units, skilled nursing homes, outpatient clinics, schools, rehabilitation centers, and doctor’s offices.  Physical therapist and occupational therapist roles differ depending on the setting they work in and the medical diagnoses they work with.

In the outpatient clinic, some of these roles may overlap.  While there are some similarities between PTs and OTs in each setting, there are a few fundamental differences between OTs and PTs in the pediatric setting.

Pediatric Physical Therapy:

In the pediatric outpatient setting, physical therapists are often musculoskeletal and movement specialists. Parents can seek out evaluations when their babies are as young as 1 month old. Physical therapists have in-depth knowledge about human musculoskeletal, neuromuscular, integumentary, and cardiovascular systems. Based on our background in stages of development and biomechanics, we help children with mobility difficulties; whether they are behind on their gross motor milestones, recovering from injury/surgery, or not keeping up with other children.

Through all kinds of hands-on or play techniques, pediatric physical therapist work with children on the following:

  • Gross motor skills
  • Strength
  • Endurance
  • Balance and coordination
  • Motor control and motor planning
  • Body awareness
  • Pain relief
  • Flexibility
  • Gait mechanics
  • Orthotics training
  • Wound care

Our focus is for children to be as mobile and as independent as possible, while training their caregivers on all aspects of a child’s physical development. This includes anything that may affect a child’s quality of movement, posture, alignment, and safety.

Pediatric Occupational Therapy

Outpatient pediatric occupational therapists are trained to improve the quality of children’s participation in their daily functional tasks.  A child’s job is to play and take part in activities at school and at home. These include important endeavors such as paying attention in class, hand writing, dressing, feeding and grooming themselves, and being able to engage in age-appropriate games. Occupational therapists are also trained to help children organize and interpret information from the environment so that they can just be kids. This may include taste aversions that limit their food intake, or texture aversions that affect their clothing tolerance, or sound aversions that affect their mood.

OTs work with children on the following skills:

  • Sensory integration
  • Cognitive endurance
  • Fine motor skills
  • Hand function
  • Visual-spatial awareness
  • Hand-eye coordination
  • Attention
  • Social skills
  • Body awareness

Occupational therapists often educate parents and teachers on the best techniques to ensure children participate in learning, self-care, and play tasks.

Why do some children need both disciplines and some only need one?

So many factors can affect a child’s ability to participate in her daily life. A child may be experiencing frequent falls or may have trouble jumping due to a number of reasons.  No matter the diagnosis or underlying medical condition, any child who is having a hard time keeping up with his peers can benefit from a comprehensive evaluation by a pediatric specialist.

How to Encourage Baby’s First Steps

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As a physical therapist who works primarily with the 5 and under crowd, I have had the pleasure of witnessing many babies’ very first steps. Some of the proudest moments I’ve experienced on the job have involved children meeting their milestones for the first time.  Watching a child develop the confidence in his abilities to venture onto unfamiliar terrain on his own makes the months leading up to that moment so worthwhile.

I am sure that I do not have to talk about the importance of walking as part of typical development. What parents don’t realize are the components of human ambulation and the importance of each step.   For many new parents, I often reiterate the fact that weight-bearing through their feet is a great way for babies to learn. They learn how their bodies move, strengthen their muscles and bones, and receive the appropriate feedback from their environment to perform more and more challenging tasks, such as jumping, and running, and stairs.

Often, first time parents are unsure how to best encourage their child to take those first steps. So how do we facilitate and not hamper their exploration?

How best to help out a toddler learning to walk:

  1. Cruise is first: About a month after a baby first learns to pull to stand, he will start cruising along furniture.  At this time, he still relies on his hands a lot for standing and doesn’t yet have the full grasp of shifting his weight from foot to foot. Help him cruise along by placing toys just out of reach and he will slowly become more and more stable when all his weight is on one side. Cruising long distances increases baby’s standing stamina and strengthens those important hip and thigh muscles. Place toys on a low surface off to the side and behind him, and he will learn to let go with one hand and rotate in his trunk. Trunk rotation is an essential component of reciprocal walking later on. Click here to read more about cruising.
  2. Where to support: Contrary to popular practice, the best place to support a baby just learning to walk is actually at his trunk.  If you take an early walker (say, 9-10 months old) by both hands and try to lead him, he is most likely going to tilt his body forward and step really quickly to try to catch up with his center of gravity. This will not help him place weight throughout his whole feet. Instead, he may rise up on his toes. Weight-bearing through the heels during early walking is important. That impact from the ground helps build muscles and bones up the chain so babies’ thigh bones and hip joints can become strong and stable enough to support their growth. When assisting babies to walk, stay with them and let them lead, however slow each step may be. For more info about best ways to support a toddler learning to walk, click here.
  3. Slow them down: Children usually start to take steps on their own after they feel safe during independent standing. With each new step, babies will keep their feet wide apart so they can feel balanced.  Many parents I know like to give their babies a push-toy such as a doll stroller or shopping cart so they can speed walk around the house. While these toys may seem like a great way to get babies moving on their feet, if given to a baby in the early stages of walking, they also encourage poor postures and improper weight shifts.  If you have to use push-toys, weigh them down. When a baby takes each step slowly, he can experience the way his center of mass transfers over the entire surface of his feet. His foot muscles and his ankle joints need to experience the hard work required by each step in order to properly respond and develop the balance strategies he needs for later.
  4. No shoes or socks:  While I tell parents from early on that babies should experience their environment with only a diaper on, many parents think shoes are a necessary part of early walking.  Many pediatric therapists will tell you how important it is for babies to learn to walk barefoot. Why? Because babies rely on the feedback they feel from the ground to adjust their standing balance as needed. Standing and learning to walk on plush carpet, grassy terrain, or hardwood floor are all so different and our joints, muscles, and posture have to adjust accordingly. Taking that proprioceptive feedback away from babies just learning to walk by giving them shoes will make them unaware of the differences between surfaces.  Read here for information about the best footwear for babies.
  5. Importance of squatting: Squatting is a key play position for babies. Starting as early as 9-10 months, babies can lower themselves slowly from a standing position while holding onto furniture. So place some toys at his feet and try to get him to pick them up. That up and down motion, supported or unsupported, is great for strengthening hip and thigh muscles. Learning to safely transfer their weight during standing tasks will help them with walking skills. Eventually, around 15 months, a toddler is able to stand unsupported, pick up a toy from the floor, stand back up, and keep walking, all without any help from us. Now that is one independent baby on the move!

The typically developing baby learns to walk around 11-15 months. He might not look stable and he may fall after a few steps, but he is doing what he should. He is trying. Every child is different in how and when he chooses to take that first independent step. Our job is to provide a safe and motivating environment for him.  If your baby is not making any attempts to stand by 12 months, or has been standing for a few months and seems to drag one side and trips often, or still has not walked by 16-18 months, it is a good time to bring up your concerns with your pediatrician and contact a physical therapist for an evaluation.

Tummy Time the First Year: A Month by Month Primer

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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.



The 411 on Infant Rolling

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Around the 4th or 5th month of a baby’s development, he will roll over from being on his tummy to his back. This is often purely accidental; he does not have the ability to control his weight-shifting on his tummy and often tips over as a result.  Around the 5th or 6th month, a baby will have the abdominal strength to lift up his feet and roll over from his back to his tummy. Many of the kids I see are infants and toddlers who somehow missed this important step, or who didn’t start rolling until after the 9th month.  Many of the parents I talk to didn’t give this a second thought until they noticed delays in other skills later on in their children’s growth.

Why is rolling so important?

A healthy, typically developing infant is constantly moving. Like the rest of his body, his musculoskeletal and nervous systems are constantly maturing. As he gains strength in all his big muscle groups, he is also learning how to control his limbs. Motor control is an important aspect of a baby’s neuromuscular growth. Rolling encourages postural muscle recruitment (including the back extensors, hip flexor/extensors, the obliques, and the abdominals). The muscles need to be strong before a baby can learn to crawl, stand, or walk.

The segmental volitional rolling that babies learn to do also encourages trunk dissociation. Through rolling, they learn to separate the movement of their limbs from the movement of their head and trunk. Through these transitional positions, they learn to balance the muscles on the front of their body with the muscles on the back and sides. When they roll to one side of their body, they are elongating that side and contracting the other. It is through this unilateral segmented use that children develop their sequential motor skills – crawling, walking, and most other locomotion skills require the ability to separate one side from the other and separate limb movements from trunk movements.

How can parents help encourage rolling?

  1. Start early. This is similar advice I give to parents about increasing infant tummy time: get down on the floor and play with him. Encourage him and motivate him with toys, sounds, lights, and faces. Start as early as you can. Babies have certain built-in reflexes that help them roll to their side if they just turn their head (the neck-righting reflex).
  2. Ease in.  The more a baby rolls, the more input he receives from his environment to his big muscle groups. Our job is to introduce him to his environment and help him tolerate each new position. His own maturation process will take it from there. Play with him when he is on his tummy or back, then help him to his side and play with him there.
  3. Engage your child, step-by step. With your baby on his back, place a toy just out of reach. Help lift one of his legs and bend his hip to 90 degrees or higher. Slowly cross his leg over the other hip. Wait for him to turn his upper body and kick in his trunk muscles. Your pressure across his hips should be firm, but gentle.
  4. Practice. Practice. Practice. And repeat.

When should I seek a pediatric physical therapy evaluation?

What I often look for is initiation.  The lack of initiation by 6 months is a good indicator that your baby may need a little push from a pediatric physical therapist.  If your baby is not picking up his feet and rolling easily from side to side while on his back by 6 months, bring him in for an evaluation.

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

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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.