a guide to buying baby shoes

A Guide to Buying Baby’s First Shoes

The seemingly exponential growth of the children’s shoe industry can overwhelm the even the most expert buyer. A quick search on Google for “Buying Baby Shoes” reveals over 40,000,000 hits. In this blog I’ve broken down the shoes requirements for each stage of walking to guide the consumer.

A Guide to Buying Baby’s First Shoes:

  • Pre-Walking – Shoes for children in this stage are used for protection from the elements. Due toA Guide to Buying Baby's First Shoes increase of floor time, shoes should be flexible enough to allow for ease of movement in this position. It should be noted that the best footwear for children in this motor phase is no-shoes at all.
  • New Walkers – As a child begins pulling up to stand and taking her first steps, her shoes should change to meet the increased demand. Shoes should continue to remain flexible, allowing for ease of transition between crawling and walking. It is also important that these shoes have some sort of grip associated with them to limit slipping.
  • Expert Walkers – These children use walking as the main, and usually only, means of locomotion. Crawling is no longer functional for them, but may be used in play. As children transition into this phase of walking, their shoe needs change as well. The shoe should have a semi-rigid sole, meaning the sole is made of hard plastic, but it can twist with a moderate amount of effort.

If your child has demonstrates any sort of gait abnormality (single foot turned out, walking on toes, excessive falls) or has not begun walking by 18 months, please come into NSPT for a free physical therapy screen.

north shore pediatric therapy physical therapy

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!

12-Month Doctor Visit Checklist

12-Month Doctor Visit Checklist

Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have a about your child’s development. While Pediatricians have their own set of developmental red flags, these only hit the “big-12-Month Doctor Visit Checklistbad-uglys” as we like to call them, including the following:

  • Is your child rolling by 6 months?
  • Is your child sitting independently by 8 months?
  • Is your child crawling by 12 months?
  • Is your child 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 Pediatricians red flags, I have put together a checklist of things to discuss with your Pediatrician at your child’s 12 month check-up.

Checklist for your child’s 12-month doctor visit:

Gross Motor Skills

  • Independently transitions into and out of sitting
  • Rolling independently from back to belly, and belly to back, with ease
  • Crawling on hands and knees with reciprocal form
  • Pulls to stand at stable surface
  • Cruises along furniture

Fine Motor Skills

  • Begins using pincher grasp (thumb and single finger)
  • Transfers objects from one hand to the other
  • Places toys into large container, and takes toys out
  • Begins holding spoon during feeding

Speech Skills

  • At least 1-2 words
  • Babbling with constant – vowel combination, ie. ba-ba, ma-ma, da-da
  • Labeling object with consistent sounds, ie. ball is always “ba”
  • Pays attention to speech around them
  • Follows simple commands, ie. “go get the ball”

Take this checklist with you to your 12-month visit. If you have further concerns, schedule a pediatric physical therapy evaluation.

north shore pediatric therapy physical therapy

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!

Why Isn’t My Child Walking Yet?

As a follow up to last week’s blog, Signs that My Child Will Walk Soon, I present the next topic in my walking series, Why Isn’t My Child Walking?. As first birthdays come around, many anxious parents wonder, “why hasn’t my child taken his first steps?” First off, let me dispel the myth that babies will begin taking their first steps by their first birthday. The normal range for independent walking is 10-18 months, however most children begin walking around 14-15 months. Delayed walking skills may be due to decreased muscle strength, decreased confidence, or impaired balance. Read below for a description of signs of each and tips to help improve them.

 Reasons Your Child May Not Be Walking Yet:

  • Decreased Muscle Strength: Walking is a major milestone for children and requires a lot of lower extremitywhen will my child walk strength. This is why there are so many important precursors to walking, such as cruising and creeping on hands and knees. Children typically spend 1-4 months in each of these precursory milestones in order to build the strength necessary for walking. Encouraging your child to spend time in these gravity dependent positions will help build lower extremity strength.
  • Decreased Confidence: Often times children who have been cruising for significant periods of time without making the transition to independent stepping may have decreased confidence in their walking skills. Employing a towel or blanket that is held as a link between parent and child, can help build their confidence.
  • Impaired Balance: A child who shows difficulty with independent standing may have impaired balance and proprioception. Using heavier shoes that help give feet to the child that let them know where they are in space.
  • Other Medical Reasons: There may be an underlying medical condition preventing your achieving his gross motor milestones in an appropriate time frame If your child is not demonstrating signs that he will walk soon by 12 months of age, please contact your physician or come into North Shore Pediatric Therapy for a free physical therapy screen.

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!

signs my child will walk soon

When Will My Child Start Walking? 5 Signs That Your Child Will Be Walking Soon

All children develop and grow and their own rates. Current research gives a range where typically developing children achieve their gross motor milestones. But when the baby books and Pediatricians tell you that your baby will probably be walking independently somewhere between 10-15 months, with some children even walking at 18 months and still falling within normal ranges, parents want more answers. A great way to see if your child is on the right track is to check for these 5 signs that walking may be in their imminent future.

5 signs your child will be walking soon:

  1. Pull to Stand – When a child begins pulling up into standing using hands or stablesigns my child will walk furniture, he is strengthening his legs to prepare them for walking. The mature form of pulling to stand is to perform through a half-kneeling position.
  2. Cruising – Cruising is defined as walking while holding onto furniture. Cruising allows your child to practice weight shifting and forward progression in a safe environment.
  3. Crawling onto and over Furniture – As a child becomes stronger throughout his core and extremities, you may find him starting to climb onto furniture or crawl over obstacles. These are all signs that your child is developing the muscle strength and balance needed to walk independently.
  4. Walks with Push-Toy/Handheld Assistance – The added stability of walking while holding onto a push-toy or a parent’s hands helps children develop the confidence needed to take those first independent steps. Some children may use this as a crutch, so be sure to provide as little support as needed (2 handheld assistance>1 handheld assistance> holding onto sleeve of shirt>holding blanket between child and parent).
  5. Standing Independently – Children begin to let go of objects while standing when they feel confident and stable. The longer the child is able to stand, the greater his confidence is.  Bonus if the child is able to get into or out-of this position with control by himself.

If your child has not begun demonstrating the above skills by 12 months of age, he may benefit from a physical therapy evaluation.

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!

Help! My Child Won’t Exercise

 As a pediatric physical therapist, I often prescribe home exercises for my patients. When parents follow through with these exercises on a regular basis, the potential benefits exponentially increase. The problem arises when a child begins to view these exercises as a chore and parents receive push-back. Here are a couple of tricks I’ve learned along the way to help motivate your kids to exercise.

Use a Reward SystemHelp! I can't get my child to exercise

            Creating a simple star chart will help keep your child motivated throughout multiple exercises. Using small rewards once the chart is complete will also help your child develop a sense of pride in his/her work. These rewards do not need to be material- or food-focused; rather a reward can be as simple and gratifying as having a special Friday movie night. Try and develop a reward system that supports your child’s hobbies/interests. This may be a great jumping off point for instilling a healthy relationship with physical activity.

Change up your Routine

            Just as your personal exercise routine can grow monotonous over time, the same may hold true for your child’s home exercises. Asking your therapist to update your child’s exercise regimen is a great way to boost enthusiasm for home exercises. Home exercises should be updated regularly as your child strengthens and improves his/her skills in order to effectively challenge your child. Once a goal is met, work with the physical therapist to develop new exercises that will keep your child on the path to success.

Turn it into a Game

            A large part of my job as a pediatric physical therapist is figuring out novel ways to motivate children to partake in therapy sessions. I have seen that the best way to ensure enthusiastic participation is to re-tool something that may seem like a “chore” and transform it into a fun game. Instead of a mind-numbing walk on the treadmill, why not consider creating a fun obstacle course around the backyard? Or use a high energy scavenger hunt in which your child has to complete various physical feats before proceeding to the next level? Re-imagining a traditionally dull exercise into something fun can be a deeply rewarding experience!

NSPT offers physical therapy 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!

Hypotonia

What is Hypotonia?

Low muscle tone, also called Hypotonia, is a term used to describe the resting length of a muscle before it is activated for purposeful movement. If a muscle’s resting length is greater than average, a child may present with hyperextenion of the joints. In addition, hypotonia refers to the speed of a muscle contraction, difficulty in maintaining a static pose and difficulty in completing dynamic movements. This is not to mean that a child has no muscle tone, but rather that a lower muscle tone makes it more strenuous to complete age-appropriate tasks.Hypotonia

Hypotonia is often identified at birth or during infancy. You may see low tone as a child ages as well. A common indicator of hypotonia is delayed motor skills. It can be associated with certain medical diagnoses, including Down syndrome or Prader-Willi syndrome, or can be independent diagnoses.

Other common signs of Hypotonia

  1. Open mouth posture
  2. Difficulty in initiating a suck or swallow reflex
  3. Breathing difficulty   (could be shallow or labored)
  4. Slow reaction times to stimuli, including pain, surprise or humor
  5. Difficulty in flexing arms and legs in infancy
  6. Delayed motor skills
  7. Difficulty in maintaining a seated posture
  8. W-sitting
  9. Inability to lift or carry body weight
  10. Clumsiness
  11. Low foot arches

Hypotonia cannot be cured, however, with consistent physical or occupational therapy, low muscle tone can be managed and treated. A therapist will complete standardized testing and clinical observations to determine how a child is performing certain tasks and what aspects of the task are proving difficult. Therapy will focus on providing multisensory and motor experiences to improve muscle tone, responses to sensory input and body awareness.

NSPT offers physical or occupational therapy 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!

Exersaucers

The Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

I recently read an article posted on parents.com about baby development that touted the benefits of exersaucers and Jonny Jumps. Let me put an end to that notion right now. While I understand the necessity of such devices for small periods of time (meal preps and bathroom breaks can be near impossible without them), these devices should in no way substitute free play on the ground or be used as a way to “strengthen” young children’s legs.

For the remainder of this article I am discussing  devices that support the pelvis while the legs are in a weight-bearing to semi-weight-bearing position, including but not limited to: jumpers, exersaucers, sit-and play walkers.

The Dangers of Jumpers, Exersaucers,
and Sit-and-Play WalkersThe Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

Places Children in Weight-Bearing Position before Muscles are Ready
When a child is not physically strong enough to support their body weight in a standing position, they will assume a position of flexion (knees bent, hips and trunk bent forward). If the child is pulling to stand at a stable surface, this weakness may result in a collapse at the knees or a fall backward. However, when a child is strapped into a device supporting their pelvis and trunk, they are unable to drop to the floor. Instead the child assumes a semi-weight bearing flexed position. Many advertisements for such devices depict the child in this flexed semi-weight bearing position.

Teaches Weight-Bearing through Balls of Feet (rather than heels)
Many times children will bear weight through the balls of their feet while in these devices. Usually because the device is not adjusted to the appropriate height and the child is trying to reach the ground, or the child is not strong enough and is in a flexed position while trying to reach the ground. Repetitive weight bearing through the forefoot creates a motor learning pattern that can be continued on into regular gait. We call this types of walking, through the forefoot, toe-walking.

Poor Alignment of Lower Extremity
The semi-weight bearing flexed position that children may assume when placed in sustained weight bearing before their muscles are mature enough for standing has already been described above. This position can result in: 1) excessive stain and force through the pelvis to support the trunk, or 2) excessive hip external rotation, excessive knee flexion and weight bearing through lateral knee, and/or excessive weight bearing with ankles in maximum plantar flexion(toes pointed down). Excessive time in these abnormal positions can lead to a multitude of musculoskeletal problems later on, including: toe-walking, hip stabilizer weakness, increased falls, knee pain, out-toeing.

To limit the negative effects of jumpers, it is recommended that children spend no more than 20 minutes a day in them. In fact, time spent in all positioning devices should be limited to a total of 30 minutes per day to allow for optimal gross motor development.

NPST offers physical therapy services in Bucktown, Evanston, Highland Park, Lincolnwood (coming soon), Glenview and the Neuropsychology Diagnostic and Testing Center in 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!




bowleg child when to worry

Bowleg (Genu Varum) in Children: When to Worry

Genu Varum, or bowleg, is defined as an outward bowing of the knee in relation to the thigh. This results in one or both of the knees being more lateral than the hips and ankles. A parent may first notice this abnormal posturing at birth or when the child begins walking. This can be a scary time for most parents.

It is important to first note that the most common cause of bowleg is idiopathic physiologic genu varum. While this long and confusing name may sound scary, it simply means that the cause is due to normal genetic variations and nothing more serious. Many children grow out of this type of genu varum by the age of 2 without treatment. In cases where the genu varum angles worsen over time or persist after the age of 2, treatment options include bracing, orthoses, or surgical correction.

When a child presents with severe genu varum presentation, genu varum worsening over time, or genu varum persisting past 4 years of age, more serious causes of genu varum must be ruled out. Below is a brief description of several of these causes of genu varum.

Causes of Genu Varum (Bowleg)[1]:bowleg child when to worry

  • Blount’s Disease: This disease is manifested by failure of inner part of tibia (shin bone) to develop, resulting in progressive deformity without treatment. Diagnosis is made through physical exam and x-rays.
  • Rickets: Rickets is caused by insufficient vitamin D, leading to softened bones. Posture and gait abnormalities may be most pronounced following growth spurts or during winter months, when sunlight is low. Diagnosis is made through physical exam, x-rays, and blood work.
  • Osteochondroma: Benign bone tumor found usually near the growth plates of long bones. Mass grows with skeletal growth. Increased pressure and mass on lateral part of knee result in appearance of genu varum. Diagnosis is made through physical exam, x-rays, and biopsy.
  • Osteogensis Imperfecta: Abnormal Collagen, in amount or quality, result in easily fractured bones and shorted stature. Genu varum results from repeated trauma to inner part of tibia restricting growth. Diagnosis is made through x-ray and genetic testing.
  • Pathologic Anterolateral Bow of the Tibia: Results from failure of tibia and fibula to unite. This places the limb at a greater risk for fracture during the first year of life. Diagnosis is made through x-ray.

Consult a physical therapist or orthotist if you have concerns about bowleg in your child.

[1] Leach, J. (2006). Orthopedic Conditions. In Campbell, SK, Vander Linden DW, and Palisano RJ (Eds.), Physical Therapy for Children (481-515). St. Louis: Saunders Elsevier.

 

3 Tips for Raising a Good Sport

This past month, the 2014 MLB season came to a close with the wild card San Francisco Giants winning the World Series against the Kansas City Royals. The season was exciting, filled with historic pitching feats. The most memorable moment of MLB 2014, however, was Derek Jeter’s farewell tour.

Derek Jeter, legendary shortstop for the New York Yankees, led an impressive 20 year career: he helped carry his team to 5 World Series Championships, was nominated to play on the American League All-Star team 14 times, and held numerous records for the Yankee organization. Jeter was respected not only amongst opposing managers and players, but also amongst the umpire staff. During an era when it is commonplace for managers to storm onto home plate and argue calls, Jeter stayed classy. He was never one to throw a bat out of rage or turn and yell at the umpire when things did not go his way. He often demonstrated his reputation as one of the few good role models in professional sports. Thus, when Jeter finally made the decision to hang up his jersey, Major League Baseball gave him a farewell tour.

So in honor of Derek Jeter’s retirement, I give you three tips for raising a good sport of your own:

  1. Model good sportsmanship, in both wins and in losses. You are your child’s first and most formative 200211664-001teacher, so exhibit good behavior in front of them in all competitive/leisure activities, from board games to sporting events. Make it a habit to say, “Good game,” to your opponent in wins or losses, and compliment your opponents often for the things they do well. Make sure to thank coaches and referees who volunteer their time each week. And, most importantly, have fun! When your child sees you having fun regardless of the outcome, it will reinforce the belief that winning is not everything.
  2. Place emphasis on having fun, improving skills, and making friends during games and sports. It is important to recognize that there is so much more to participating in sports than winning. Sports are a great avenue for learning discipline, setting personal goals for lifelong self-improvement, making friends, and instilling a love of exercise and healthy, balanced living.
  3. What do you do when your child loses? Losing can be very tough on young egos. It’s important to not let a loss deter your child from enjoying the game. Use a loss as an opportunity to sit down and have a heart to heart conversation with your child. Be available when your child needs you and provide support and guidance. This will help you to develop a trusting relationship with your child. Looking back on my youth sports career, my fondest memories are sitting down with my dad after the game over a milkshake recapping the things I did well and things I could work on. I don’t remember how many games I won or lost, but I’ll always remember those milkshakes! (Click here on more tips on what to do when your child loses a game.)


when to specialize in a sport

Should Your Child Specialize in a Sport?

In a push to help their children become the best – insert sport here – player, many parents are quick to sign them up for year round travel teams and private training sessions. The question is, what is the best age to begin this specialization and professionalization of sport? If we were to ask world-renowned sports orthopedic surgeon Dr. James Andrews, I bet he would say much later than we currently are.

Why shouldn’t young children specialize in a sport?when to specialize in a sport

Dr. James Andrews is a strong proponent of giving young athletes time off to recover, stating “their kid needs at least two months off each year to recover from a specific sport. Preferably, three to four months.” Dr. Andrews goes on to state that there is an epidemic of adult-type overuse injuries, such as rotator cuff injuries and UCL tears (the injury that requires Tommy John surgery) in youth athletes across America, with children as young as 12 years old comprising almost half his patients. So while parents and coaches are pushing for younger and younger sport specialization, I’m here to ask you to please diversify your children’s after school activities and allow for proper rest.

How do you allow your child ample time to recover from sports?

While this can mean allowing a 2-4 month break from all sports, the emphasis here is on taking a break from each type of sport. For example, sports that focus on repetitive overhead movements include baseball and swimming, ones that require short bursts of explosive energy include basketball and football, and those that involve a combination of endurance and explosive bursts include sports such as soccer and hockey. Each of these types of sports has their own overuse injuries associated with them, so it is important to take a break from the whole sport subset rather than going from, say swimming to baseball. A great way to limit overuse injuries is to follow the seasonal sports, allowing for adequate time to rest between each sport and also during one season.

Won’t a break hinder my child’s progress in his/her chosen sport?

You may be worried that the lack of practice may hinder your child’s skill set, but many dual sport athletes have gone on to say that aspects of one sport-specific training have had a significant impact on their performance in an entirely different sport. For example, a football wide receiver may be able to draw from footwork gained during a previous soccer season. We can look to the NFL for living proof of this. Russell Wilson of the Seattle Seahawks was a dual sport athlete at North Carolina State, playing football and baseball, even signing to a minor league contract prior to the NFL. Brandon Weedon of the Dallas Cowboys pursued a career in baseball, prior to enrolling at Oklahoma State and leading the Sooners to the 2012 Fiesta Bowl. Even LeBron James was a two-sport athlete prior to signing with the Cleveland Cavaliers the first time. So let’s stopping training our kids to become the next Tiger Woods, only to have them become one of Dr. Andrews’ statistics, and allow their growing bodies to rest as needed and diversify their skill sets along the way.

As a parent, you are your child’s biggest advocate. Now that you know the true dangers of early sport specialization please educate coaches and give your children the rest they need. For further information on overuse injury prevention in children, please contact our Pediatric Physical Therapists at North Shore Pediatric Therapy.