Is it okay for a Baby to Waddle with Feet Outward? What is “Toeing Out”?

In my continued effort to expedite information for parents, it is ok for your baby to waddle with their feet outwards up to the age of 2, or until the child has been walking for 4-6 months. Toeing out in new walkers is very typical up to the age of about 2, or once they have become proficient walkers.Waddling Baby

And here is why toeing out is normal in toddlers who have been walking for 4-6 months…

Babies walk in this pattern for several reasons, primarily because they are trying to maintain their balance by keeping a wide base of support due to their nervous system and their overall architecture.

New walkers are working with immature nervous systems so they need repetitive practice to build the nerve pathways.  In addition, they are learning what to do with the sensory input that they are receiving from their vestibular system (inner ear), as well as the somatosensory proprioception (feeling where their body is in space).  There are motor development theories that say that children walk not when the stepping pattern is mature, but when the balance control system matures.

Structurally, at the time children begin to walk, their center of mass is around the base of their ribs.  As they grow (and the head to body ratio changes) that center of mass lowers to around their belly button.  This high center of mass early on makes it more difficult to balance, leading to the need for an increased base of support to avoid falling.

New walkers often fire a lot of their hip muscles in order to stabilize themselves as they learn to balance on two feet.  EMG (neuromuscular studies) of children with 6 months of walking experience have also shown that they will fire their outer hip muscles (specifically the muscles that outwardly rotate their legs, and that move their legs apart) for stability.  In doing so, the hip outward rotators over-power the inward rotators, which brings their feet and legs out.

The anatomy of the feet of new walkers also facilitates their out-toeing gait pattern.  Newer walkers have large fat pads on the bottom of their feet and do not have the muscle strength or ligament stability to create a stable structure.  This capability of stabilizing at the foot typically comes with practice and age.

Since new walkers have had little weight-bearing through their legs, the shape of the thigh bone promotes a wide stance.  As the child bears weight on their legs, the shape of the bone begins to more closely resemble the mature alignment.

New walkers will often keep their arms at either chest or shoulder height to help with their balance.  This wide balance reinforces toddlers’ wide stance.  Once these children begin to swing their arms when they walk, then each step begins to promote a more narrow foot placement.

If you ever have concerns about how your child is walking, address it with your pediatrician.  If your child has been walking for 6 months or more and they continue to walk with a wide foot placement and arms at shoulder height, you may have legitimate concerns that could be addressed.

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Get Cruising! Tips to help your child reach the cruising milestone

A child will typically pull to a stand at 9 months with cruising typically emerging at 10 months when she will use two hands to stabilize herself. At 11 months she should be cruising using one hand to stabilize.

Tips To Help Your Child Start Cruising:

As a parent I know how precious time is, and so I would like to offer you two options, the long-winded version is first; and succinct version is cruising

Long Version:

  • Use a very low bench, booth, or stool that your child can stand at and support themselves with extended arms (modified hands and feet [quadruped] position).
  • Play with your child in half-kneeling (“proposal position”) and allow them to push up to stand.
  • If your child is having difficulty standing at the surface and playing, you may support their balance. The lower you support them, the more difficult for the child.
  • Allow your child to stand on your lap while you are sitting. Like above, give them help for balance, the lower you support them, the more they have to work.
  • While the child is standing a t the surface, offer her a toy so that she needs to take one hand off the support and rotate her trunk.

Be wary of using a push-toy such as a stroller or shopping cart exclusively when your child walks. These types of toys promote a forward shifting of the baby’s center of mass which can lead to sway-back or toe-walking later on. Try these toys as an adjunct, but allow them to cruise around without the push-toy as well.

Short and simple version:

  • Place toys that motivate you child just beyond her reach so that she needs to negotiate her way down along the surface (such as the couch or a low table)
  • Repeat as often as possible.

These strategies may be difficult to initiate, and may not necessarily work at first for every child. Don’t worry if your child becomes fussy upon introduction of these exercises, it is part of her normal development. However, if your child refuses to put weight through her legs at any age, or has not begun to pull to stand by 12 – 14 months of age, we suggest checking with a pediatric physical therapist or occupational therapist to monitor her gross motor development.

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4 Steps To Get Your Baby Rolling

As a pediatric physical therapist, I am often asked “how can I get my child to walk,” “how can I get my child to crawl,” and other such questions. I like to use the same principles that would motivate me, or other adults I rolling

A) Encourage an older child to perform something that is beneficial but difficult by letting her know the alternative is something that is (while still beneficial) either more difficult or outright unpleasant.

B) Observe what the child likes (like a specific toy, not like oxygen) and then remove that item a small distance away from her, and return the object (remember toy, NOT oxygen) when she performs the task that you would like him to perform.

Encouraging A Baby To Roll:

Rolling. I would like to use the words supine (lying on one’s back) and prone (lying on one’s tummy). You can toss these words out at your next pediatrician appointment and impress the doctor. (I think most pediatricians have a deal where you get an extra lollipop if you correctly use medical jargon in a sentence.) Rolling
from back to side typically occurs at about 3 months, with rolling from tummy to back (prone to supine) and from back to tummy (supine to prone) at 4 and 5 months respectively.

4 Steps To Encourage A Baby To Roll:

  1. Break it down. Play with your infant while she is on her tummy, play with her while she is on her back, and play with her while she is laying on her side to make sure she is comfortable in each position.
  2. How can I get my child comfortable laying on her side?  You can place your infant on her side with both arms in front of her and then stabilize her at her hips. Use a toy that she can hold and chew and shake. By supporting at her hips, you promote stabilization through her core.
  3. Work the transitions. Let’s use rolling supine to prone over her right side (see above for definitions) as our example. Using a toy that she can reach for and is interested in reaching for (refer to tip “B” above as needed)…
    1. Brush the toy against her left hand to encourage her to reach with that hand and move the toy so she begins to reach to the right, across her body.
    2. With your hand on her left hip, gently bend her hips to 90 degrees and slowly and gently roll her towards her right.
    3. Move very slowly and allow the child to lead the movement.
  4. Repetition is the key. Repetition is the key. Repetition is the key.  I don’t believe I need to expound upon this point further.

Rolling is a wonderful early milestone for your child. It is one of the first locomotor movements she may learn. If your child is not initiating rolling on her own by the age of 6 months, ask your pediatrician for a referral for a gross motor evaluation by a pediatric physical therapist.

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5 Infant-Friendly Places in the Chicago North Suburbs

As pediatric therapists in Glenview, Highland Park and Bucktown, we are always looking for child friendly places to suggest to our clients.  Below is a list of five infant friendly places for parents to try out with their kids!

Kohl Children’s Museum Kohl Children's Museum

2100 Patriot Blvd, Glenview IL

The Kohl Children’s Museum is the perfect place for children to play, explore, and learn. The museum has 17 exhibits, including exhibits which rotate so that every visit feels brand-new. Kohl is infant and young-toddler friendly as three unique specialized infant-areas are located within the museum exhibits so that parents may stay with their infants and young crawlers while keeping an eye on the older ones. Afternoon hours tend to be quieter, and likely provide an excellent place to bring the littlest of children. Nursing stations are provided to allow nursing Mom’s their privacy. Admission is free for children under 1, $9.50 for older children and adults.  They also do a great job of accommodating children with special needs.  North Shore Pediatric Therapy has worked with the museum in creating a walk-through guide which can be found here: Parent’s Guide 

AMC Sensory Friendly Films

AMC, partnered with the Autism Society has established a nation-wide program for children to experience sensory friendly films. Once monthly, 10am showings of current children’s feature films are screened in a family-friendly atmosphere perfect for small children, or children who find traditional theater experiences to be overwhelming. The lights are left on, the sound is turned down. Getting up, moving around and dancing are all encouraged! Your infant or young toddler will not be required to sit through an feature film, so your whole family can experience movie-magic together, without fear of being “shhhh-ed.” Check the website for local listings.

Nibbles Play Cafe

13 Huntington Lane, Wheeling IL

Nibbles is a café that serves up more than a great cup of coffee. Here you can get your caffeine fix while your child explores indoor play areas specially designed by early childhood professionals. An infant- area allows for early crawlers and walkers to explore in a soft and safe zone separated from older toddlers and children’s imaginative play and art projects. Adults and children under age 1 are invited to enjoy a day at Nibbles free-of-charge while admission for older children is $7.50 each, $3.75 for siblings.

Children’s Museum of Oak Lawn

5100 Museum Drive Oak Lawn, IL

The Children’s Museum of Oak Lawn features many exciting exhibits, and also boasts a Tummy Time exhibit just for infants and young toddlers. “Tummy time” is an important exercise for children’s early motor development (link to one of Bridget’s blogs?) and what better way to encourage your infant, than in a specially designed area for little ones to scoot and explore, belly down! Many children’s museums have rooms or exhibits dedicated to infants and toddlers, look into your local museum to find what they have to offer! Admission is free for children under one year, $6 for older children and adults.

Exploritorium in Skokie

The Exploritorium is a basement-level playground that offers a  infant play areas, a mock theatre, computer stations with educational computer games, water play, a large art area, and a two-and-a-half story climber with slides, tunnels, and swaying bridges.  Perfect for stir crazy children on rainy days. It’s also available for birthday party rentals.  Kids under 1 are free!

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Positioning for Infants 101

Recent statistics show that 1 in 10 babies have plagiocephaly, or flatness to one side of their head. Since 1992 when the American Academy of baby on tummyPediatrics launched the “back to sleep” campaign, cases of SIDS have dramatically decreased. However, cases of plagiocephaly, or flat head, have increased. With babies spending so much of their day on their backs, in swings, car seats and bouncy chairs, babies aren’t given the proper tummy time to let their head naturally round out.

Positioning your infant to switch the direction that they are laying is recommended to prevent flatness to one side of their head. Simple positioning things that parents of little ones can do at home are:

Ways To position Your Infant:

  • Providing ample tummy time daily: start with just a few minutes and work your way up from there. By 5-6 months, aim for ½ of play time to be on the tummy.
  • Alternate the hip or arm where you carry your baby. This way, they have equal opportunity to look both ways and keep their neck muscles flexible.
  • Alternate the end of the crib each night where you place your baby to sleep. This way, if they are always looking at one part of the room, ie a nightlight, window or door, they will have a different part of their head that they are sleeping on each night.
  • Alternate the end of the changing table where you change your baby.
  • Limit use of carseats, swings, bouncy seats or any device where a child is “contained.” Excessive time in these “containers” can cause a flat head on one side and limit gross motor development.
  • When your child is in a car seat, a cushioned head support will help keep some pressure off the back of their head.

It is normal for your babies’ head shape to not be completely round following a vaginal delivery; however, head shapes usually round out from the pressures of delivery within the first 6 weeks of life. It is important to use the positioning techniques above to ensure that your baby has a nice round head shape as they continue to develop.

If you are concerned about your babies’ head shape, talk to a physical therapist or your pediatrician. Physical therapy can help round out your child’s skull and help with gross motor development.

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5 Ways to Know Your Baby is Ready for Solid Food

Since the holidays are just around the corner, you may be wondering if your child is ready to grab a plate and join you at the buffet! While there is no clear-cut age to start introducing solid foods, most young children independently begin to show signs that they’re ready to move past their typical pureed diet around the same time. You may receive the green light from your pediatrician to begin introducing solids, but also but watch for these signs, as these may indicate that your child is ready to move on.

Signs Your Baby Is Ready To Eat Solids:

1. Your child is gaining more gross motor control. When your child is able to demonstrate adequate head baby eating solidscontrol as well as stabilize their trunk when sitting, they are typically ready to tolerate a more complex repertoire of foods. While your child does not have to independently be able to sit on their own, they should be able to maintain an upright position when placed in a highchair without slouching or falling over.

2. Your child begins to show interest in what you are eating. Many young children may begin to watch others intently during meal times, any they may even attempt to grab items off of your plate! Young children may also become more interested in self-feeding, and your child may start to reach for the spoon when hungry, attempt to drink from your cup, bring a cracker or
cookie to their mouth, or place their hands on the bottle when feeding.

3. Your child demonstrates more oral-motor control. The most apparent sign that your child is ready for foods is when they lose the tongue thrust reflex. Rather than immediately pushing foods out of their mouth with their tongue, your child should be better able to manage the foods inside their mouth. Also, when your child begins to present with more tongue movement, such as back-and-forth and up-and-down when a spoon is introduced, they are indicating that they are also ready to move on.

4. Your child is on track for meeting feeding milestones. Observe your child’s behavior at play, as there are many signs to indicate that they are ready for a change in their diet. Some of these behaviors may include: an increase in hand-to-mouth play as demonstrated by orally exploring with objects, anticipation of spoon feedings, the transferring toys from one hand to another, the ability to “rake” toys and foods towards themselves, and the emergence of the pincer grasp.

5. Your child starts to not appear “satisfied” after breast or bottle feeds. During certain ages, children may insist on eating more than they typically would, but note that significant changes in their feeding patterns could also be related to a growth spurt. Some pediatricians will indicate that once children have doubled their birth weight, most children are ready to be introduced to solids.

Even though your child may present with many of the signs, they may still not be ready to tolerate the transition. Just remember to be patient, and speak with your pediatrician about any concerns you may have about moving to solid foods.

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Is Biting Normal?

Parents often ask if it’s normal for their toddler to bite.  It can feel both concerning and upsetting for parents to find out that their child is biting others. If this sounds familiar to you, you’re not alone.  Here are a few guidelines and tips to consider when navigating your toddler’s biting habit.

Consider Your Child’s Age

  1. Biting is more common for children under 3 years of age.  In determining whether or not your child’s biting habits are normal, consider their age and toddler biting another toddlerdevelopmental level.
  2. Under 1 year, mouthing objects is an important part of feeding and speech development.  This is how children develop oral-sensory awareness in their mouth, as they explore various objects.
  3. Between 1 and 1½ years, children may bite others when they are excited.  It’s important to convey to children that biting is not okay
  4. Between 1½ and 3 years, children might bite more out of frustration.  Frustration often arises when children cannot convey their intents, or feel powerless against limits.  It’s still important to convey that biting is not acceptable.
  5. After 3 years, biting is considered to be less typical, and is likely a behavioral response to frustration or fear.  Children might feel frustrated or fearful when they don’t have control over a situation, when they can’t effectively communicate, or when they don’t like the limits set by others.

Consider Possible Triggers:

Understanding why your child bites is a critical step in determining how to intervene.

Here are a few questions parents can ask themselves to identify causes behind their child’s biting habit:

  • Is there a particular environment when biting occurs more frequently?
  • Is there a time of day when biting occurs more frequently?
  • What is your child’s emotional state when they bite?
  • What tends to trigger biting?  For example, does your child bite when you tell them “no”?  Do they bite when they can’t communicate their thought/ideas?
  • Who does your child tend to bite the most?

What Can Parents Do?

  • Respond quickly, and let your child know that biting is not okay.  Use a firm voice, and tell them “No.  It is not okay to bite”.
  • Help your child understand that biting hurts other people.  Believe it or not, this may be a surprise to your child.
  • If your child is struggling to use words, help them by giving them words to express their feelings.  For example, if your child is upset because a peer took their truck, then model “You can say: ‘It’s my turn’ or ‘I want the truck'”.
  • Talk to your child ahead of time about appropriate social rules.  You might say “It’s not okay to bite people” or “You can use words, but you cannot bite.”
  • Talk to your child about things that they can bite.  You might say “We can’t bite people, but we can bite apples!  What else can we bite?”
  • Be proactive about situations that frequently result in biting.  Be ready to intervene and respond, or if necessary, limit situations that result in extreme frustration and biting.

Finally, don’t battle this alone!  Seek help from a licensed professional who can guide you through the process.  Your child’s therapist can help you uncover why your child is biting, and strategies to help your child find better ways to resolve their frustration.

Torticollis: Before And After Physical Therapy

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

Twin Boys With Torticollis

Baby Boys Exibiting Torticollis

What is Torticollis?

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

Physical Therapy Used To Resolve Torticollis

Twin Boys With Torticollis Resolved

After Physical Thereapy, Torticollis Is Resolved

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

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

Developmental Skills While Playing With Dolls

Playing is a child’s primary job, and a beneficial one at that.  Through play, children develop fine and gross motor skills, practice language and develop new vocabulary, and begin to understand new learning concepts. 

Below is a sample of all that is involved and developing when your child plays with dolls.


  •      Develops imaginative play skills as your child cares for her doll.
  •     Teaches different emotions and relationships as child role plays. Read more

Autism Signs Appear in Babies’ First Year: What that means for Parents and Doctors

A Chicago Tribune Article states:

“In its detailed comparison of 50 babies – half of whom would go on to be diagnosed with autism – the researchers in this new study found a steady loss of sociability and responsiveness in the babies who would progress to an autism diagnosis. Those babies’ loss of social skills looked more like regression and less like a slowing of progress that allowed normally developing babies to pull far ahead of them. And that regression was most marked between 6 and 18 months, though it continued more gradually to the 3-year mark, where the study left off. But while the reduced rates of face-gazing, vocalizations and social engagement were evident to researchers who systematically evaluated the babies every six months, 83 percent of the parents did not observe the changes chronicled by researchers – not, at least, in the first year they were happening”.

Autism Checklist

We need to teach parents to look for Sociability and Responsiveness between 6 and 18 months. Pediatricians, you can teach parents to look for these things when the baby is seen at the 6-week check-up!

Here are a few things to start looking out for (feel free to contact us for a more detailed checklist!):

Face gazing

Does he respond to your voice?
Does he smile?
Does she make eye contact?

Does he coo?
Does he make noises?
Does he cry and keep calm at appropriate times?

Social engagement
Does he smile?
Does she enjoy playing games like peek-a-boo?
Does he want mommy at around 9 months and cry with others?
Does he show interest in other children?
Does she use her index finger to point at people or objects?

A few questions can make the difference between early intervention and a quick jump on learning, versus a wider gap in skills as more time passes without proper awareness and attention. You and your pediatrician need to be watching for signs! Don’t forget- family history is a HUGE piece with autism spectrum disorders. If you have any form of social challenges in the family, start looking for signs very early!

Schedule A Visit To Chicago's Autism Clinic

If you are a parent, what advice would you like your pediatrician to give you at your 6 week check up?

If you are a parent of an ASD child, how would an earlier diagnosis have changed where you are today?