In a national survey of 400 pediatric physical and occupational therapists, two-thirds of those surveyed say they’ve seen an increase in early motor delays in infants who spend too much time on their back while awake. Tummy time is an important and essential activity for infants to develop the strength and musculature they need to achieve their milestones in gross motor development.
What is tummy time?
Supervised time during the day that your baby spends on their tummy while they are awake
Why does my baby need tummy time?
Being on his or her tummy will help develop the muscles of the shoulder, neck, trunk, and back. This, in turn, will allow your child to achieve developmental milestones such as independent sitting, crawling, and standing
Tummy time will help prevent conditions such as torticollis and plagiocephaly (head flattening on portions of their head)
What if my baby doesn’t like tummy time?
The sooner you start tummy time, the sooner your child will get used to it!
If your child cannot keep their head up, use a towel roll, Boppy pillow, or small pillows to help prop them up until they can lift their head on their own
Place a mirror or their favorite toys in front of them to keep them entertained
Put them on your lap on their tummy
How much time do they need on their tummy?
You can start putting them on their tummy from day one for up to 5 minutes, 3-5 times a day. As they get stronger, they will be able to tolerate increased tummy time during the day.
But, always remember – back to sleep and tummy to play!
https://www.nspt4kids.com/wp-content/uploads/2016/12/Blog-Tummy-Time-FeaturedImage.png186183Arielle Ordonezhttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngArielle Ordonez2016-12-14 05:30:052020-02-26 07:30:54Importance of Tummy Time
https://www.nspt4kids.com/wp-content/uploads/2016/12/Baby-on-Tummy.jpg338507North Shore Pediatric Therapyhttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngNorth Shore Pediatric Therapy2016-12-02 15:38:022020-06-29 14:26:37Tummy Time | Facebook Live Video
When I tell people that I am a pediatric physical therapist I am often met with a blank, questioning stare. Why could children possibly need physical therapy? When most people think of physical therapy, they think of recovering from a back injury or shoulder surgery, or maybe they think of someone in a nursing home going through rehab after a stroke. However, children can often benefit from the services of a physical therapist as well, from newborns all the way through adolescents. Pediatric physical therapists focus on the gross motor development of children, and work to address any limitations that may impact that development.
Pediatric physical therapists therefore work with a wide range of diagnoses and conditions including:
Gross motor delay: Development of gross motor skills is an important piece of child development. Since these skills build on one another, a delay with one skill can lead to further delays or difficulty with later skills. Pediatric physical therapists can help your child develop the major gross motor milestones listed below, as well as many more!
Torticollis and plagiocephaly: Torticollis is a condition that occurs when there is asymmetrical muscle length and strength in a baby’s neck muscles, and therefore limits symmetrical neck motion. Plagiocephaly, or asymmetrical head shape, often occurs when a child has torticollis, as a result of frequent pressure being put on only one part of the head. A pediatric physical therapist can help to stretch and strengthen the child’s neck in order to promote symmetrical motion and head shape.
Balance and coordination disorders: Limitations in balance and coordination can have a significant impact on a child’s ability to develop motor skills, as well as to safely negotiate his or her natural environments. A pediatric physical therapist can treat these limitations to allow for improved functioning and safety.
Neurological disorders: A neurological disorder occurs when there is abnormal functioning of the body’s nerves, spinal cord, or brain. These are just a few of the disorders that a pediatric physical therapist can treat.
Orthopedic conditions: Children get hurt too! Even though children tend to be more resilient to injury then adults, children who suffer an injury or require surgery can also benefit from physical therapy services to help restore function to the musculoskeletal system.
Genetic disorders: Genetic mutations may result in impaired development and functioning in children, and can therefore be addressed through intervention with a pediatric physical therapist. While there is a wide range of genetic disorders and their resulting impact on child development, below are a few examples of genetic disorders where a pediatric physical therapist is typically a part of the child’s team of providers.
Gait abnormalities: The way a child’s lower extremity bones and muscles develop have a large impact on the child’s gait mechanics. Abnormalities with gait, such as toe-walking, can be addressed by a pediatric physical therapist.
Many more! If you are unsure of whether your child may benefit from the services of a pediatric physical therapist, speak with your pediatrician or reach out to a pediatric physical therapist near you.
The field of pediatric physical therapy is very different from many other physical therapy settings, which is to be expected since the patients are children who are constantly growing, developing and learning new skills. Parents are therefore often unsure of what their child’s physical therapy session will look like.
While the activities performed will be unique and individualized to your child’s specific needs, there are some common things that all children will experience during a physical therapy session.
Choices-We want physical therapy to be a fun and productive experience for your child, so throughout the session your child will be provided with choices. These choices may include selecting an activity from a few options, or getting to choose what game, puzzle, or toy is played with while working.
Fun-Although your son or daughter will be asked to perform activities to address his or her specific difficulties, we will do our best to make every activity as fun and engaging as possible. The activities we work on are so much more meaningful when your child is having fun and wants to participate.
Work-As mentioned above, your child’s therapy sessions will be as fun and engaging as possible. However, your child will be participating in activities that are physically challenging. Your child will be moving for the majority of the session in order to work towards his or her individual goals.
Encouragement-Your child’s therapist is there to support and encourage your child. We know that your child is working hard to meet his or her goals, and we are there to provide positivity and encouragement with fun and challenging tasks.
Homework-Your child will be working hard during the therapy session, although what is done at home to carryover the new skills learned is just as important. Your child’s therapy session will therefore include homework to help facilitate progress toward his or her specific goals.
Success-While the activities selected for your child’s therapy session will be challenging, your therapist will never ask your child to do something that she won’t be successful at. Working hard and being successful is what the physical therapy session is all about!
https://www.nspt4kids.com/wp-content/uploads/2016/09/Blog-Physical-Therapy-Session-FeaturedImage.png186183Colleen McCloskeyhttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngColleen McCloskey2016-09-26 05:30:342020-06-29 14:35:26What Will My Child Experience in a Physical Therapy Session?
If you have a child who loves that “w” position while sitting on the ground, chances are you’ve either corrected them yourself or heard someone else direct them to sit “criss-cross” or “fix their feet.” The challenge, however, is understanding why there are so many conflicting opinions on the matter. Is it really that bad? There was recently an article on Today.com titled “Why W-sitting is really not so bad for kids, after all.” Two orthopedic surgeons weigh-in on how w-sitting is a position that children sit in because their anatomy allows it, it feels comfortable, and when you should be concerned about it.
I want to acknowledge that, to some extent, I agree with this article. The anatomy, angles, and alignment of a child’s leg bones changes extensively throughout young childhood. Children do have more flexibility which can make w-sitting often a preferred position. And most often, prolonged w-sitting will not progress to the point of being a surgical issue. If your child only sometimes sits in this position and can easily move into and out of it, it is probably not a big deal. (Please note: as with the article above, I am generalizing this blog post. I am just discussing w-sitting and am not going to address the impairments that often result in w-sitting: low muscle tone, decreased core strength, excessive femoral anteversion, etc. Please speak with your pediatrician or see a physical therapist if you have concerns with your child’s development. Sometimes w-sitting is the result of other things going on which can impact their gross motor success.)
So—why do people like myself lovingly attempt to annoy your child out of w-sitting? It is not that physical therapists do not acknowledge the natural development of their anatomy and what feels best. It is that we are bombarded throughout our schooling, clinical experiences, and our entire professional careers of what occurs when muscles are not aligned “within normal limits.” For pediatric therapists, we are given this unique and wonderful opportunity to work with bodies who are just beginning their development, moldable, and are constantly changing to assess and promote optimal alignment- a strong foundation for a strong life. For me, it does not matter if your child is coming to me for shoulder pain- I am going to correct how their legs are positioned while they are sitting; posture is like the “eat your vegetables” and “brush your teeth” of my profession. I want each child’s physical growth and development to occur on top of the best possible foundation. Just as pediatricians and dentists want to establish healthy habits, routines, and lifestyles for short and long term health, physical therapists want to encourage the best posture for your child so that they will not be limited or suffer from the painful conditions or injuries that result from poor alignment and muscle imbalances.
An easy example to compare w-sitting to is poor sitting or standing posture. Almost all adults can relate to the neck and back pain that can occur from poor posture. In addition, poor posture can contribute to nerve impingement, shoulder pain/injury, jaw pain, sciatica, etc. This pain did not happen as your parents/grandparents/teachers/caregivers encouraged you to “sit up straight” or “stop slouching”—it happened later as the bad movement patterns continued and the muscle imbalances grew worse. In my mind, w-sitting is the same. It may resolve and you may never develop pain, or these movement patterns and muscle imbalances may progress; when you look at the alignment and muscle activation that w-sitting encourages, physical therapists think of the following (to name a few): patellofemoral syndrome, hip pain from impingement, flat feet and foot pain, knee osteoarthritis, and increased risk of knee and ankle injuries.
As the parent, how you use information is up to you. As a physical therapist, I will continue to kindly request that each child sits “criss-cross applesauce” for their current AND future development.
https://www.nspt4kids.com/wp-content/uploads/2016/07/Blog-W-Sitting-FeaturedImage.png186183Lauren Beekerhttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLauren Beeker2016-07-15 05:30:482020-06-29 14:33:11W-Sitting: Why There Are Conflicting Opinions and Why Your Child’s Therapist Cares So Much
How is Physical Therapy Included in School Services?
Through the Individuals with Disabilities Education Act (IDEA), public education must be accessible to all children aged 3-21 years old[i]. Physical therapy is a related service used to help implement IDEA. School-based physical therapy must be aimed towards allowing the child to access his educational environment. Some of the things a school-based physical therapist might assess include travel from one area of the school to another, getting onto and off of the bus, safely navigating the bathroom and cafeteria, getting into and out of classroom chairs, and participation in all classes. They will assess independence, safety, and timeliness of the above areas in determining need for physical therapy services.
The Role of the IEP:
If parents, teachers, or students determine a need in the student accessing the school environment, an IEP referral is made. This begins the process for school-based services. A physical therapist employed by the school district or contracted through an outside agency will evaluate the child and determine eligibility. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. However, physical therapy services must be provided at no cost to the family when deemed necessary.
Clinic-Based vs. School-Based Physical Therapy:
Clinic-based physical therapy is aimed at improving quality of movement, return to function, and achieving gross motor milestones in an age-appropriate time frame. Many children who would benefit from physical therapy services, but don’t qualify for school-based services due to the restrictions, attend private clinics for physical therapy services. In these settings, a physical therapist determines need based on standardized assessments, functional assessments, strength and range of motion testing, and compares these scores to age-appropriate norms. Some things that may qualify a child for outpatient physical therapy but not school-based physical therapy include gait abnormalities (including toe-walking and in-toeing), developmental coordination disorder, decreased endurance and overall weakness, hypotonia, foot pain, sports injuries, burns, etc. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. Physical therapy services in an outpatient setting must be covered through insurance or private pay.
Dependent on your child’s needs, physical therapy services may be required in a school setting, in an outpatient setting, or both. If you have any concerns about your child’s gross motor development or access to services in their school district, please contact the professionals at NSPT.
[i] Fact Sheet. Providing Physical Therapy in Schools Under IDEA 2004. www.pediatricapta.org. 2009. Accessed 07/14/2015.
https://www.nspt4kids.com/wp-content/uploads/2015/07/kids-in-line-FeaturedImage.png186183Andrea Ragsdale PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2015-07-28 18:30:112020-06-29 13:59:39How to Qualify for Physical Therapy Services at School
We as physical therapist use functional measures of strength to assess strength in a child. Parents can use these same measures to assess whether their child is on track with gross motor skills, or to see if there is an underlying weakness. I have broken down the milestones for stair ascent and descent during the first 4 years of life, along with possible weaknesses and impairments associated with delayed skill.
Functional Strength Assessment Using a Staircase:
18 months – Children should be able to walk up and down 1 set of stairs in home or at the park, using one railing or one hand held assistance, and demonstrating any type of form. Children will usually place both feet on each step at this phase. Be aware of children who always lead with the same foot; this may be a sign of opposite side weakness. Delays to this milestone may indicate core weakness, lower extremity weakness, or balance impairments.
2 years – As children continue to practice this skill and strengthening their legs, their stair skills dramatically improve. First children will begin testing their stair skills by carrying objects up or down stairs and taking steps without holding onto the railing or holding a hand. Initially, they will place both feet on each step. By 2½ years old, children will begin using a more mature reciprocal form (one foot on each step), when going up stairs while using one handrail. Delays to reciprocal gait while going up stairs usually indicates weakness in the leg that does not step up.
3 years – A 3-year old should be able to ascend 1 set of stairs demonstrating reciprocal gait, without handrail support. This milestone may be delayed due to short stature, and subsequent shortened tibia length (shin bones) which make it harder to reach the stairs, but will be achieved prior to their 4th birthday. Delays to reciprocal gait without handrail support indicates lower extremity weakness in non-leading leg.
<4 years – Prior to their 4th birthday, children should have mastered stairs. This includes walking up a set of stairs using reciprocal stepping, both with and without handrail use, as well as walking down a set of stairs using reciprocal stepping, both with and without handrail use. While handrail use will be dependent on situation, reciprocal gait will be the norm, used regardless. Delays to reciprocal gait while going down stairs may indicate eccentric weakness of quadriceps (inability to control limb with slow descent), impaired single limb balance, or core weakness.
Any child over the age of 4 who is unable to walk up and down 1 set of stairs without support, demonstrating a mature one-foot-one-each –step form, should come into NSPT for a free physical therapy screen to assess leg strength and balance.
https://www.nspt4kids.com/wp-content/uploads/2015/06/stairs-FeaturedImage.png186183Andrea Ragsdale PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2015-06-09 09:34:232020-06-29 14:00:13How to Use a Staricase to Assess Functional Strength
If you have ever thrown out your back helping a friend move or torn your meniscus playing basketball at the gym, chances are you attended physical therapy somewhere on your road to recovery. So when your Pediatrician recommends that your 7 month old attend physical therapy to help with head control, you may ask yourself, “What is physical therapy for infants?”
Physical Therapy for Infants:
First off, your right to assume that physical therapy for infants is going to look at lot different than the physical therapy you received after knee surgery. While all physical therapist must attend accredited Masters and Doctorate of Physical Therapy programs, the areas you can specialize vary greatly, from an outpatient center where people go after surgeries and sport injuries, to a burn unit where physical therapist are helping patients maximize range of motion. A physical therapist who specializes in pediatrics has learned how to achieve similar strength gains, increase range of motion, and functional improvements, with children.
One of the main differences between physical therapy for infants and physical therapy for adults is the idea of parent education. In order to maximize gains, exercises must done multiple times every day. Since it is not feasible for a physical therapist to perform all of these repetitions, they must act as educators to the caregivers, teaching handling techniques and updating exercises as the child progresses. Much of each physical therapy session is spent on updating and educating this home exercise plan.
Now we come to the next major difference between infant and adult physical therapy: exercises. How can an infant exercise?? Are there baby weights they should be using?? Most of the exercises an infant does are going to be greatly different than the ones you or I would perform. Because they are growing everyday, most functional movements are in fact a form of exercise for them, allowing their muscles to get stronger and building the foundation for all gross motor skills. Each home exercise is tailored to the child’s specific needs and growth over time. So depending on what your child was referred to physical therapy for their home exercises could include play time while laying on a specific side, learning to transition into or out of sitting, or stretches while having them turn to the left.
While the differences between infant physical therapy and adult physical therapy are many, the foundations remain the same. The physical therapist is looking for physical deficits in strength, range of motion, balance, etc, that are negatively impacting a person’s performance in a specific activity, whether that be jumping and walking up stairs, or crawling and holding their head up.
Teachers can be wonderful allies to the healthcare field. They spend up to 8 hours a day observing and helping children. Often times, they are the first to notice concerning signs, and when given the right tools, can direct parents where to go to get their children the help they need. Here a few signs teachers can look out for that would warrant a physical therapy screen.
5 Signs at School a Child May Need Physical Therapy:
Unable to keep up with peers during recess or P.E – This may present as a child who doesn’t follow friends onto the jungle gym or pulls themselves out of games of tag. A child would benefit from a physical therapy screen if they are unable to perform a jumping jack or skip forward.
“W”-sits or props onto arm when sitting criss-cross – A child who sits in a “w” position or props onto their arm when sitting on the floor may present with weak core muscles. Weak core muscles result in a poor foundation for other fine motor skills, and may present in sloppy or slow handwriting, poor cutting skills, or decreased independence in self care tasks.
Places both feet onto step when going up and down stairs – A child should be able to go up and down a set of stairs, without holding onto a handrail, by the age of 4. A child who presents difficulty, or immature form, during a stair task, may have lower extremity weakness, impaired balance, or developmental coordination disorder.
Toe-Walking – Toe-walking or early heel rise during gait (which may looking like bouncing while walking) can arise from a multitude of impairments including muscle tightness, core weakness, impaired balance, etc. Prolonged toe-walking may also result in any of the above, excessive falls, or muscle contractures.
Poor sitting posture at desk – Poor posture may be a sign of decreased endurance of trunk muscles. Trunk weakness may also result in a poor foundation for fine motor skills, resulting in poor handwriting, decreased grasping ability, or decreased independence in self care tasks.
https://www.nspt4kids.com/wp-content/uploads/2015/03/slouching-FeaturedImage.png186183Andrea Ragsdale PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2015-03-27 13:51:142020-06-29 14:18:54Signs at School a Child May Need Physical Therapy
Purchasing a baby carrier for your child can be a daunting process. Parents have to take into account a myriad of factors including: safety, price, reviews, materials used. As a physical therapist, I am able to provide a unique perspective to the debate. So I took a look “Best Lists” at parents.com and thebump.com to determine best baby carriers on the market today. Here’s the complied list, ranked based on safety for the child throughout the use of the carrier, ergonomics for the parents, and length of use (without purchasing additional accessories).
The Best Baby Carriers of 2015:
Boba 4G Baby Carrier – This carrier provides great hip positioning for the child from birth to toddler. The optional foot strap to ensure hip flexion and external rotation is what sets this carrier apart from the others. It allows for both front and back child carrying. This carrier also provides great ergonomic support for caregiver in the form of both a waist belt and padded shoulder straps to equally distribute the load.
Baby Bjorn Carrier One – This carrier also provides great hip positioning from birth to toddler. It allows for both front and back child carrying, as well as provides great ergonomic support for the parent. The head support allows for easy adjustments to support the child’s neck from newborn to toddler. This carrier has the added feature of using fabrics that are safe for the child place in their mouth, earning it the number 2 spot on this list.
Becco Gemini – This carrier allows for great hip positioning in 3 different carrying positions: front carrying, back carrying, and over the hip carrying. This carrier also provides easily adjustable head support and caregiver ergonomics.
Tuba Baby Carrier – This carrier requires separately purchased infant insert for use with newborns. However, this insert does provide adequate support for good hip alignment. Can be worn on the back or the front, and provides good ergonomic support for the parent.
Boba Air Baby Carrier – Lightweight alternative to other carriers on this list, but this translates to less ergonomic support for the parent. Designed to be worn on back or front, and promotes hip external rotation and flexion of the child.
Britax Baby Carrier – This carrier requires a separate infacing insert. With infacing insert, child maintain good alignment and is given good support. However, when child is placed in intended out-facing position, excessive pressure is placed on the pelvis and with hips in minimal flexion.
Ergo Baby Original – This carrier requires a separate infant insert, which must be purchased separately. This insert, does not provide the hips to be placed in hip flexion and external rotation (the recommended infant position to limit the development of hip dysplasia – See Judy Wang’s blog on the topic). It should be noted that the insert has a built in “seat” for the child to promote optimal position, the nature of the insert does not ensure it.
https://www.nspt4kids.com/wp-content/uploads/2015/03/baby-carrier-FeaturedImage.png186183Andrea Ragsdale PT, DPThttps://nspt4kids.wpengine.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2015-03-20 05:52:592020-06-29 14:20:10The Best Baby Carriers of 2015: A Physical Therapist’s Take on the Debate