By: Cassidy McCoy PT, DPT and Celine Skertich, PT, MS,PCS
Having an infant born prematurely can be a scary experience. The team of physicians, nurses, and therapists that work with your infant until discharge do their best to assist in whatever your child may need during their stay. But once the baby is discharged, what can you do to continue to promote the appropriate development of your child?
Preemies develop differently, compared to full term infants, so here are a few tips and tricks from what you can do at home.
Head position changes
Typically, the preterm infant’s head size is large compared to their body, and are at a greater risk for developing Torticollis and/or positional plagiocephaly. Frequently changing the position of their head is important to prevent these types of concerns.
Turning their head to the left and right when on their back
Alternating side lying
Reach, Prop and Play
Preemies tend to utilize their shoulder muscles to assist with breathing. It is important to transition them to using their shoulder girdle muscles to reach, prop, and play. Gravity can be your friend as you carry or position your baby in more upright positions to promote flexion and midline.
Low tone is a common disorder that is seen with premature infants due to entering the world before they have had a chance to develop “physiologic flexion.” These positioning ideas help to promote flexion and can aid in normal development for a premature infant
Carrying your baby: be sure your baby’s arms are forward and hips and knees are bent to promote flexion.
Laying on stomach (prone) with arms bent with hand near mouth, head to one side and legs flexed underneath them
Bouncy seat (such as the Baby Bjorn): promotes midline flexion in an upright position to aid in digestion. Gravity will also assist to relax the shoulders.
Promote Symmetry and Midline
Swaddling is important for this
Feeding with baby’s head and hands in midline (center of chest) and hips and knees bent
Playing with toys (on back or on side), to promote swiping their hands towards midline
Prone positioning – Remember back for sleeping, Tummy to play!
Support Social Interaction
Black and white toys
At this point, your child’s vision is continuing to develop. Up until 4 months of age, a child can see black and white toys, or highly contrasted colors, better than distinguishing between colors. Red and Yellow are the first colors they can begin to see.
Present your face at an appropriate distance
For the same reasons as above, present your face or a toy 8-10 inches away from your child when interacting/playing with them.
Know the signs of overload: Infants who are born prematurely can get more easily overloaded compared to an infant born at full term. Signs of overload include:
Visual avoidance or wide eyes
Splaying of the hands
For most children who have undergone a stay in the NICU, it is recommended to have continued care through a NICU Follow-Up clinic. The purpose of the NICU Follow-up Care is to monitor and manage ongoing medical conditions, provide support and guidance to parents and caregivers of the high-risk infant, monitor developmental progress to identify delays, identify need for referrals to other medical professionals a needed.
As a soon to be new mom, sleep is something that is very important to me and something I will soon be getting very little of in my life! I often get questions by parents about sleep and how to better help their little ones develop good sleep habits and routines. There are many great sleep books available to read and review for sleep suggestions. Many are targeted towards babies; however, they still contain useful information about typical sleep patterns as well as some guidelines for establishing sleep routines and how to sleep coach. In order to better prepare myself and my husband, I’ve been reviewing some of my handouts on sleep and wanted to share what I found useful.
My first step with families is to help them understand that sleep is a learned behavior. There are many reasons children have difficulties with sleeping. A child may have difficulty sleeping because:
She hasn’t yet learned to put herself down to sleep
He might have difficulty self-calming and quieting his body and mind for sleep.
She might have separation anxiety
He is testing limits
She might have an overactive imagination
He wants to play longer and will resist going to bed
She is sensitive to noise, textures, or odors which makes it difficult to relax to sleep.
Older children have increasing demands on their time from school, sports, extracurricular activities, and other social activities which can impact sleep. A child might also snore or have noisy breathing during sleep which should be evaluated by their pediatrician with possibly a referral to an ENT to rule out sleep apnea or enlarged adenoids.
Going to sleep and getting enough sleep are skills we need to teach our children. Optimal sleep helps to ensure children are able to play and ready to participate in daily activities. It also promotes brain development and growth.
How many hours does a child need to sleep?
Newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3 months of age; however, this varies considerably and some babies do not sleep through the night until closer to 1 year.
Infants typically sleep 9-12 hours during the night and take half hour to two hour naps, one to four times a day, fewer as they reach age one. Research shows that when infants are put to bed drowsy but not asleep, they are more likely to become self-soothers which allows them to fall asleep independently and put themselves back to sleep when they wake up. Babies need our help to establish their own sleeping and waking patterns. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on their own, and providing the right environment for comfortable and safe sleep. Your baby may show signs of being ready for sleep by rubbing their eyes, yawning, becoming fussier, or looking away.
Toddlers need about 12-14 hours of sleep in a 24 hour period. When they reach about 18 months of age their nap times will typically decrease to one a day lasting one to three hours. Caregivers should try to avoid naps occurring too close to bedtime as this could delay sleep at night.
Preschoolers typically sleep 11-13 hours each night and most do not nap after 5 years of age. It is not uncommon for preschoolers to experience nighttime fears and nightmares in addition to sleepwalking and sleep terrors.
Children ages 5-12 years need 10-11 hours of sleep. Older children may show signs of insufficient sleep by falling sleeping when it is not nap time, frequently waking-up tired and crabbing, seeming irritable or difficulty to please, appearing clingy, or may have a short attention span.
Here are some general tips for all ages.
Routines and consistency is a critical. Parents and caregivers can significantly influence a child’s sleep through scheduling and routines. Some kids do well taking a bath and reading books/telling a story while lying in bed and preparing to sleep. Reading together can be a great way to spend some quality time together and allow the body to relax. Some kids might also need some calming heavy work input prior to bath time or getting into bed for stories. One of the first things new parents learn at the hospital is how to swaddle their newborn because snugly wrapping your baby in a blanket provides calming deep pressure tactile and proprioceptive sensory input allowing the newborn to feel secure and safe. Rocking chairs and baby swings are also some of the most valued and used pieces of baby equipment because of the repetitive movement qualities that provides calming vestibular sensory input.
Some examples of calming heavy work input and movement that might help your child include massage, yoga, pillow squishes, gentle, rhythmical, and linear swinging for at least 15 minutes before bedtime. I would recommend trying simple games that don’t have a competitive nature to them since they are more likely to increase arousal level. We want our children to learn to calm down and be quiet before bedtime.
Darkness is key. Make sure that the bedroom where your child sleeps is as dark as possible and pay special attention to blocking out the early morning sun. Sunlight is a natural wake-up signal; using room-darkening shades and curtains to block out light will help your child sleep. If you are going to use a night light in your child’s room, try to make a compromise and place one right outside your child’s bedroom or opt to turn off the night light after an hour. You can also try a touch operated, battery powered night light with a timer that goes off if your child wakes up in the middle of the night and needs to use the bathroom or hears a noise and needs to be reassured briefly.
Provide some white noise. Parents and caregivers of babies can often be heard making the familiar “shushing” noise or quietly humming to quiet and calm their little ones. These repetitive, quiet sounds mimic the calming, reassuring noises the baby heard when he was in the womb. A sound machine or small fan in your baby’s room will provide a soothing hum of background noise. This has the added benefit of drowning out other noise that might otherwise wake your child
Adjust pajamas. Don’t let your child go to sleep in daytime clothes. Observe your child’s sensory preference for touch. Typically speaking, soft textures are not just comforting but it is also a tactile sign for your body to be calm and quiet down. If you are the parent of a baby, you might want to consider swaddling or using a sleep sack as they grow. Swaddling providers a snug comfort via deep pressure and tactile input that is similar to the womb space.
Look at different blankets and mattresses. Some children, especially children who might have difficulties with sensory processing, are sensitive to the feel of different textures. Blankets of different weights and materials might also be preferred at different times of the year. Weighted blankets or lycra sheets over the mattress may also be helpful options as the provide gentle but sustained deep pressure input which can be calming to the body. Some children like to create a cocoon of several blankets, prefer a sleeping bag, or some have favorite blankets that they use. I was surprised to find many different mattress textures. Try as many mattresses as possible in the store to see which is more comfortable.
Try for natural warmth: Try tossing a blanket in the dryer or cuddling up to a warm scented stuffed animal. Warmth typically sends calming signals to the body to help quiet the mind.
Look at scents: Certain scents can have a calming effect on the nervous system and help to encourage sleep. There are a variety of different scents that can be calming.
Look at nutrition: Proper nutrition throughout the day can also significantly impact the ability to sleep at night. This can be difficult with our picky eaters but being more aware and trying to find a balance can be helpful. The biggest factors to keep in mind include:
Plenty of protein
Limiting carbohydrates and sugars
Limiting preservatives, additives, and dyes,
Having plenty of fruits and vegetables.
Incorporate heavy work during the day: Exercise helps tire our bodies out and make us ready for night. Provide plenty of opportunities throughout the day to engage in heavy work activities (i.e. push, pull, climb, squeeze, gentle rough housing). These activities can include pushing/pulling a laundry basket to the bathroom to complete nighttime routines. Inside the laundry basket include several heavy items as well as pajamas, toothbrush, toothpaste, favorite books to read, etc. The activities can also include wall push-ups to be completed by standing 2-3 ft. from a wall, placing hands on the wall, and slowly lowering body to wall. There are a ton of ideas for heavy work input. Heavy work input involves any type of activity where the person is actively moving their body against resistance.
Limit screen time: No screen time at least one hour prior to bedtime. It has been suggested that longer screen times may be affecting sleep by reducing the time spent doing other activities – such as exercise – that may be beneficial for sleep and sleep regulation. The content on the iPad can also impact sleep. For example, exciting video games, dramatic or scary television shows, or even stimulating phone conversations can engage the brain and lead to the release of hormones such as adrenaline. This can in turn make it more difficult to fall asleep or maintain sleep. Less obvious is the impact that light has on sleep and on our sleep-wake patterns in general.
Try an earlier bedtime: Contrary to popular belief, kids tend to sleep more and longer with an earlier bedtime. Ever heard of the “witching hour”? This is typically when kids are overtired and doing everything in their power to fight off sleep. If a child gets to the point of exhaustion or over tired, it can backfire on the nervous system. Just think of the nights when you pushed past your feeling of exhaustion because you just had to get that one last thing down. How did you feel later that night when trying to fall asleep? It was probably more difficult for you.
This is because when you work past your point of exhaustion it is usually because you are stressed. Stress releases the hormones adrenaline and cortisol. Cortisol normally rises and falls throughout the day and it typically highest at around 8AM and lowest between midnight and 4AM. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increases alertness making it more difficult to relax into sound sleep. Frequent stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state impacting continually restful sleep.
We ALL need sleep, and when there are concerns, it becomes even more important. When we are not getting enough sleep it impacts our mood, behavior, and overall self-regulation.
Torticollis is the third most common congenital anomaly that affects infants. It is defined as a head preference, usually a head tilt with one ear close to the shoulder with head rotation to the opposite direction. This is typically due to a muscular imbalance/tightness through one of the sternocleidomastoids, a muscle that crosses the head and neck, or from positioning in utero.
Torticollis can affect the entire child. It is not just an issue of the head and neck.
Without intervention, an infant with torticollis can lead to multiple sequelae in an infant/child. The head preference can lead to the following, however not limited to:
Plagiocephaly – flattening of one side of the head
Lack of visual tracking to the involved side
Decreased use of the involved sides hand/arm
Shortening through the entire involved side including head, trunk and hips
Decreased midline skills
Decreased sitting balance
Imbalance of muscular strength between right and left sides
The biggest treatment intervention that can assist in “correcting” the affects of torticollis is positioning.
The following examples will be for an infant/child with a tilt to the right (right ear to right shoulder).
Rolling: With a right tilt, your child will more easily roll over their left side to access toys
Place toys or shake a rattle on their right side to encourage them to roll over their right side
Sitting: With a right tilt, your child will sit with more of their weight over the left side of their body.
Place toys over to the left side to encourage the shift their weight over the right hip
Face-Face Play and Crib positioning: Typically with a right tilt, the infant/child will prefer to look to the left.
Position your body to the right side your child’s face to encourage them to look to the right
Position them in their crib so they need to turn their head of the right in order to see the door/your face
Tilted carry: Hold your child facing away from you body, with their back against your chest, tilt them to the right. This will encourage your child to lift their head to the left, increasing strength of the left side and actively stretching the tight right side.
This is an important part of any child’s development, however, for children affected by torticollis, tummy time important for constantly stretching the muscle by lifting and turning their head.
Toy placement in prone with a tilt to the right is the same as in sitting. Place the toys to the left to encourage weight shift over the right side of the body to reach and play with the toys using the left arm.
Babies show a natural tendency to suck on fingers and thumbs from the time they are in utero. Sucking provides comfort and is a natural way for babies to explore the environment. Allowing a baby to suck on a pacifier can have the advantages of helping to sooth a fussy baby, providing a distraction and helping a baby fall asleep. Additionally, pacifiers may help minimize reflux. The Mayo Clinic suggests that a pacifier could help reduce the risk of sudden infant death syndrome when used at nap time and bedtime.
The problem with pacifiers comes when little ones become dependent on them. As a speech-language pathologist, seeing kids more frequently in their toddler years and beyond, I see some of the detrimental effects that persistent pacifier use can cause. The preferred oral rest posture is having the lips closed, tongue placed up against the roof of the mouth, a slight space between the teeth and nasal breathing. This oral rest posture supports dental alignment and wide rounded dental arches. Prolonged pacifier use (or other sucking habits) can cause a child’s teeth to be misaligned or not come in properly.
A study from Van Norman, 2001 found that 60% of dental malocclusions were related to sucking habits. When the shape of the roof of the mouth is changed and dental malocclusions are created, kids can develop articulation errors such as a forward tongue position for production of /s/ (lisping). Obstructing the mouth with a pacifier can negatively impact babbling and imitation of sounds. Additionally, there is a correlation between pacifier use and increased incidence of ear infections. Frequent ear infections are a common cause of speech and language delays.
Guidelines to follow for pacifier use:
The American Academy of Pediatrics recommends waiting to offer a pacifier until a baby is 3-4 weeks old when breast feeding is well established.
Don’t use the pacifier as a first line of defense. Try other strategies such as changing positions or rocking the baby to sooth them.
Use the appropriate size pacifier for your babies age in order to help maintain correct jaw alignment.
Recommendations vary between 6 months and 2 years for when it is appropriate to discontinue pacifier use. It can be easiest to wean the pacifier by the time a baby is 12 months.
Use pacifiers that are rounded on all sides. This allows for a more natural position of the tongue during non-nutritive sucking.
Excellent nutrition is one of the most basic requirements for a child to grow and thrive. A study published by Pediatricsfound that diagnosis-specific, structured approaches to nutrition issues among children with developmental disabilities significantly improved energy consumption and nutritional status. Yet, nutrition disorders and compromised nutritional status are very frequent among children with developmental disabilities.
Research shows that as many as 90% of children with a developmental disorder have at least one nutrition risk indicator. Nutrition problems can include failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders, to name only a few. Individuals with special needs are also more likely to develop co-existing medical conditions that require nutrition interventions.
Thanks to two significant grants from Hanover Township Mental Health Board and Special Kids Foundation, Easter Seals DuPage & Fox Valley can now offer nutrition services for children, regardless of insurance, in areas currently underserved immediately north and west of DuPage County. This includes full financial support for those uninsured, underinsured or on Medicaid; and partial support for those in Early Intervention or with insurance. Children who qualify will receive a nutrition evaluation and follow up nutrition therapy as needed.
Qualifications for children (birth to 21 years of age) to receive this service include:
Eligible medical diagnosis or identified eating concern AND
Easter Seals DuPage & Fox Valley Nutrition Therapy provides care that is difficult to find elsewhere in a community or medical setting. Training and specialties include assisting children with improved oral and digestive tolerance, modifications to help improve growth, adjusting diet for improved variety, volume and complexity of foods and fluids, balancing the diet of those with food allergies or sensitivities, help with transitioning (off of or onto) a tube feeding, and homemade blenderized formula and diet modifications.
Evaluations are performed at the Center, in the family’s home or community setting. Our goal is to provide optimal nutrition care to children with developmental disabilities through an inter-disciplinary approach, addressing their nutrition risks and disorders and helping them to lead healthier lives.
Please refer parents, other specialists or anyone else with questions about the program to our Nutrition Therapy intake coordinator, Christy Stringini, who can be reached at 630-261-6126 and cstringini@EasterSealsDFVR.org.
Learn more about Easter Seals DuPage & Fox Valley nutritional therapy and feeding clinic at www.eastersealsdfvr.org.
Poop. Pooping. Pooped. A word that is usually reserved for little babies, and usually not for anyone older. Though we all do it, discussion after infancy wanes and it is just assumed we do. Terms like ‘bowel movement’, ‘stool’, and ‘number 2’ replace the cute and friendlier term of ‘poop’. However, one of the most common challenges seen in all people, and especially our children, is the ability to produce a stool that is soft, formed, easy to pass, and on a regular basis. Otherwise known as constipation, this quirk in the gastrointestinal system is connected to a myriad of more problems that need to be addressed. Often the underlying root problem of constipation is overlooked, as parents, doctors, therapists all aim to solve the other problems. As a wise doctor once said, “You have to be able to make the package and deliver it”. So let’s look at what contributes to constipation, how this creates further problems, and some ways to make a package and deliver it.
The Gastrointestinal System
In simpler terms, the GI system is a long tube that starts at our mouth and ends at our anus. The process starts when we eat and drink, whatever that might be. Digestion begins in our mouth using our jaw, teeth, lips, cheeks and tongue, and then saliva is released into our mouths to help break the food down. We swallow this food down our throat, through our esophagus and into our stomach. In the stomach churning begins, pushing the food around and breaking it down further, as more secretions from the stomach are released to help water it all down as it makes its way to the end of the stomach, and in a timely fashion, is released into the beginning of the small intestines. At this point more chemicals are released out into the body, sending a message to the brain that nourishment is coming in, and beginning to decrease our hunger, while also telling the GI system to move things along.
In the intestines, more secretions, from the gall bladder and pancreas, are received by the newly arrived stomach contents, which further breaks the particles of food down in this very fluid environment. Muscular contractions, known as peristaltic waves, move the contents along the small intestines, and these minute particles of food and fluid are pulled into our system in the small intestines to provide the nutrition needed for our bodies to function. About two hours after eating, chemicals are released into the body again, telling the brain that it might be getting hungry. Back in the intestines, the peristaltic waves continue to push the mix out of the small intestines and into the large intestines. There a spectrum of bacteria are found to further help the digestive process by feasting on any fiber in the diet creating a small amount of gas, and water begins to be pulled back into the body, thus creating what will become flatulence (gas) and poop. As the formed mass sits in the rectum near the anus, nervous tissue senses the presence and helps further push the contents out of the body.
What causes constipation?
Unfortunately so many things can mess this finely tuned process up, and contribute to constipation. With children, abnormal anatomy function is one, and includes low and high muscle tone, neurologic disorders, Hirschprungs disease, anal atresia or stenosis, lack of activity and immobility. Medications can also mess up the process, and a few known include analgesics, anticholinergics, anticonvulsants, antidepressants or antipsychotics, chemotherapeutics, and long term use of laxatives. Factors such as fatigue, anxiety, changes in routine or lifestyle, lack of routine, negative associations with eating/stooling, improper positioning, behavioral withholding, encopresis and inability of a child to let a parent or caregiver know they need to use a toilet. Diet is most often deemed the culprit, and lack of fiber or fluid is the go to blame. Although these two areas do contribute to constipation, other associated areas of diet include, poorly chewed foods (oral motor delays, low strength and endurance with eating), difficulty swallowing liquids (thickened liquid diet, dysphagia, nipple size, breathing coordination), excessive fluid losses (drooling, vomiting, fevers, renal conditions), and dairy or soy protein sensitivity (IgG, IgE testing, improvement when removed from diet).
What might give one cause to consider if a child has constipation? Frequency of stooling is a clear identifier. But when a parent describes challenges with stools using terms such as rabbit pellets, Snickers bar, little smears, dry rocks, marbles, can pick it off of his diaper, goes into the corner and cries, paces the room first, we know when he’s pooping, and grunts loud and long an intervention should be considered. Other signs that a child is constipated can be very poor eating, small little portions of food or drink, behavioral challenges, vomiting, GE reflux, spit up, aversion to eating, and enlarged abdomen.
Causes of constipation are so many, and the resolution to this is not as simple as giving a child more fluid or fiber. In fact, more fiber with not enough fluid can compound the problem by increasing constipation. So when trying to help find the right solution, a multidisciplinary approach may be the best. Speaking to the child’s pediatrician is the first place to start, and sometimes the solution. Asking to consult with a
gastroenterologist may be the next step, or seeking the help of a registered pediatric dietitian/nutritionist to review the diet and make adjustments where needed. If the child is seen by any therapist, physical, occupational or speech, inquiring about tone, breathing, oral motor skills with eating and drinking can be helpful.
Physicians are often needed initially to help with the immediate concerns of constipation and alleviating the situation. Use of lubricants, bulk producers, stimulants and stool softeners can be very helpful. These include laxatives such as enemas, Senokot, Ex-Lax, Metamucil, Mineral oil, Colace, Miralax, and Lactulose.
Diet changes, assisted by a registered dietitian/nutritionist can include increasing sources of fiber in the diet through grains, fruit and vegetables. Increasing fluid intake through drinkable fluids, or higher watery foods such as fruits and vetetables, or pureed versions of these foods. Trialing off of dairy products, but incorporating other foods to help replace these nutrients. A physical therapist can help if the contributing factor is poor tone, and use of an abdominal binder, SPIO suit, abdominal massage, positioning, breathing coordination have been shown to help in some children. Occupational therapists can help children become more aware of their body, and learn to know when they need to stool if their awareness is poor, or help with managing behaviors that persist once the constipation has been resolved. Speech language pathologists trained in feeding can also ensure the child is managing their eating and drinking well, check respiration as well, and give solid points on positioning with feeding. Bowel management programs do exist, and these programs can help with management of stooling in a broader manner that includes much of what has been listed above, as well as management of timing through the day.
The bottom line (no pun here) is that everyone should be able to stool comfortably and easily on a regular basis. Food and fluid need to go in continually to help with growth and development of all children, and what goes in will ultimately have leftovers that need to come out. With little babies, management is much more controlled, as a parent has access to seeing what has come out in the diaper. But as children age, parents have less access to their child’s bodily functions, children are less vocal about what may or may not be happening, and challenges with pooping can go unnoticed and unresolved. The screaming, crying, pulling, difficulties with eating in infancy are clear signs of constipation that are not going to be seen as children age. But do know that older children who have constipation are going to demonstrate their discomfort somehow. Ensuring an older child is pooping comfortably on a regular basis is a must, and involves a bit more, uncomfortable at times, conversation. But in the end (again, no pun) it can solve a load (really?) of problems.
You probably have seen them on babies in the mall, grocery store and at the park. Baby helmets are everywhere! Helmets have been used for a long time for safety with children that have seizures, but more recently they are also used to help mold babies’ heads that are flat back into a round shape.
Babies can have flat heads from crowding in-utero, which is very common with multiples. However, there is an increasing number of cases of babies with flat head from positioning (or lack there-of) after they are born. In fact, according to an article in the August 2013 issue of Pediatrics , 46.6 % of 440 infants studied from 7 to 12 weeks of age had positional plagiocephaly, or a flat head. Granted 78.3 % of children in the cohort study had a mild form of the condition; it does reveal that positional plagiocephaly is a very common occurrence these days.
When your baby is born, her skull is very soft which has allowed her to travel through the birth canal. They flexibility of the skull also allows for brain growth in the first years of life. Because of this softness, the skull is very moldable. Spending long periods of time in one position can lead to flatness of the side of the head (plagiocephaly) or back of the head (brachycephaly).
The good news is that positional plagiocephaly is preventable. Here are some tips that can help you manage your little ones’ head shape from day one.
Alternate the arm in which you carry your child. If you are right handed, it’s really tempting to just hold your baby in your left arm so it frees up the right hand to grab your cup of coffee or something out of the fridge. However, when you just hold your baby in one arm, they are likely just using their neck muscles to look outward to one side. Alternating which arm you use for carrying your baby encourages them to look both ways often, making their neck muscles strong and less likely to be tight on one side. Tightness on one side of the neck, otherwise known as torticollis, makes it difficult for your child to change their head position, which can lead to flat head. In fact, many babies that have torticollis (tightness on one side of the neck) also have plagiocephaly (flat head).
When placing your baby down to sleep, alternate what side of the crib your baby’s head is on. This way, if baby is looking toward the door of the nursery or at a night light, they are alternating which side they are looking each night (or nap). You can also switch which side of the changing pad you place your babies’ head when changing their diaper so they are looking both ways equally. As a reminder, always place your child on their back to sleep.
Limit the time that your baby is in a container, for example car seats, strollers, bouncy seats and swings. Your baby does not have the ability to move her neck very much when placed in these containers, which can lead to tight neck muscles and flatness of the head. As a mom of an infant myself, I know it is tempting to leave your child in the car seat when they fall asleep after being in the car. Once in a while it is fine, and I am certainly guilty of it myself. However, repeated naps in car seats can quickly become a problem.
Tummy time! I can’t say this enough…start tummy time early and do it often with your baby. Some babies really don’t like it, but stick with it and they will gradually get used to it. If they are really fussy, wait 1 hour after feeding to give their tummies time to settle after a meal. For more tips on how to make tummy time easier for your child (and you!), refer to my previous blog “Yes! We Want Your Baby to Crawl!”
Because of the “back to sleep” program, which started in 1992, babies are not on their tummies as much. The back to sleep program has done an excellent job at reducing SIDS, but the tradeoff is that many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy. This often leads to physical therapy and a possible appointment at your nearest orthotist or baby helmet clinic.
Luckily, there are many clinics in the area that treat children with torticollis and plagiocephaly. There are even specialized clinics that just fit babies for helmets and monitor their progress with head shape. Most children have to wear baby head shaping helmets for a few months before they see good results with their head shape.
Pediatric physical therapy helps with stretching out tight muscles and strengthening weak neck muscles. It also helps your child with their gross motor skills, such as rolling, crawling and standing, which can often be impacted by tight neck muscles and/or a flat head. If your child has a flat head and/or tight neck muscles, schedule a physical therapy evaluation with a pediatric physical therapist at Easter Seals Dupage & Fox Valley by calling 630.261.6287.
During a physical therapy evaluation when I ask parents about their child’s milestones, I sometimes hear a response like “my child didn’t like their tummy so they went straight to walking.” Parents are often so thrilled that their child skipped the crawling milestone (Less babyproofing! Cleaner hands!) However, as a pediatric physical therapist I see on a daily basis what an impact crawling and creeping has on developmental skills later in life. Crawling is also known as army crawling, when tummy is on the ground. Creeping, in the world of development, is when babies’ abdomen is off the ground and they are going places on hands and knees. Crawling and creeping are such important developmental milestones so I want to shed some light on the big benefits of crawling and how you can encourage your little one to do so
Because of the back to sleep program, which started in the early 1990’s, babies are not on their tummies as much. The back to sleep program has done an excellent job at reducing SIDS, but unfortunately, many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy. Without enough tummy time early on, another consequence is that babies can also sometimes go straight to walking without spending time exploring their environment on their hands and knees.
Babies who crawl and creep tend to have improved coordination, improved ability to read and write, improved muscle strength and better speech production when compared to their non-crawling peers. Crawling and creeping puts weight through the hands, arms and shoulders, which provides important strengthening. This position helps with grasp and stability and even strengthens the little muscles in the hand, which assists with fine motor tasks such as handwriting, using scissors and buttoning later in life.
Crawling is also a great core strengthener, which helps with balance and provides stability for speech production. Crawling and creeping provides babies with trunk rotation and repetitive crossing midline, which helps with tasks of using both sides of their bodies that they will need for playground and sports-related activities later in life. Crawling is also a time when the two hemispheres of the brain are communicating with each other, helping with bilateral coordination.
In order to help your child reach the crawling milestone, make sure they get plenty of tummy time from the start. Even when they are newborns, getting into a routine like 3 minutes of supervised tummy time after every (daytime) diaper change will yield great results. This will get them on track early on in life to have strong muscles, good balance and to enjoy tummy time.
When your child is a bit older (7 or 8 months), help your child get up onto their hands and knees by giving them some support under their trunk. This position helps your child gain the muscle strength in their shoulders, core and neck needed for crawling. You can even gently rock them forward and back in order to give them the input into their hands and vestibular movement they will need for crawling.
Here are some of my favorite toys to get little ones motivated to get moving on their tummies:
These colorful play yards are a great way to ‘contain’ your baby without strapping her in to anything. Babies are still able to roll and crawl inside of this playard, so Mom can fold laundry knowing baby won’t be getting into Dad’s briefcase. Bonus: This gate provides a nice barrier between baby and any four-legged furry friends in your home.
Play balls are so under-rated. This simple toy can provide tons of motivation to get your little one moving. Once your baby is able to sit up independently, roll the ball to them. Your baby will learn how to corral the ball and even will start to roll it back by 8-9 months. This is a great way for babies to work on reaching outside of their base of support and eventually learn how to transition from sitting to their hands and knees in order to crawl.
Tunnels can be a great motivator for crawling activities. Place your baby’s favorite toy in the tunnel or play peek-a-boo from the other side. Your baby may love the different sensory experience that crawling through a tunnel allows as an added benefit.
I am a huge fan of this tummy time mirror. Use this right from the start when baby is a newborn to help them to enjoy tummy time. When your baby is older, they will love touching the crinkly butterfly and spinning the wheel on the ladybug. This helps with baby being able to learn how to shift her weight right and left in order to reach forward with one hand. Weight shifting while on their tummy is an important pre-crawling milestone. Also, babies LOVE to look at themselves. Need I say more?
Crawling and creeping on hands and knees is an important developmental milestone and will provide the base of muscular strength and coordination your child will need later in life. Some children do skip crawling and creeping all together, go straight to walking, and turn out just fine. However, if you can encourage your little one to crawl, they will gain some important developmental benefits that will assist them with other fine and gross motor activities later in life. Whether your child is late to achieve milestones, such as crawling, or misses a step all together, it will likely turn out okay. So, keep celebrating all of those milestones and enjoy every step in your little one’s development.
By, Laura Znajda, PT, Manager of Community Based Therapy and Continuing Education
When I went to Physical Therapy school, the entire unit on respiration and the musculature that supports it consisted of a self-study chapter. With so little importance placed on this subject in school, I was surprised to see what an impact treating the rib cage has on my pediatric clients. Learning about the way the rib cage changes in structure and function through normal development, and then what happens when a baby is born prematurely or has poor trunk strength, was a big eye opener for me. Delving into this topic, the most important thing I realized is how rib position could affect not just breathing, but so many other areas of development, including motor skills like sitting, dressing and talking.
If you have put off learning about the rib cage because you think it won’t have a productive impact on your clients’ outcomes, ponder these reasons to add rib cage treatment to your repertoire:
The ribs are connected to the spine and need to move properly in order for the spine to move in all directions—we all know spinal movement is needed for everything from sitting up straight to swinging a baseball bat.
The ribcage needs to move downward, usually between 8 and 24 months of age, in order to gain a more efficient breathing pattern. (the newborn pattern uses the diaphragm only; this normally changes over time to include using muscles all around the trunk to expand the ribcage in 3 directions, which allows the lungs to expand fully. When the lungs can expand fully, the child can take deeper breaths and move air in and out more effectively.)
The rib cage is connected to the shoulder via the collar bones and shoulder blades. The ribs need to move downward after infancy in order to allow the shoulders to work properly for activities such as reaching overhead and dressing.
Normally, a baby or child can change his breathing pattern when the body needs more stability for difficult tasks or when he needs to breathe faster under stress. If the ribs do not move normally or are not in the right position, the child will only have one breathing pattern and might learn to hold his breath to gain stability.
The lower ribs need to move inward when lower trunk musculature contracts to produce an effective cough, which clears secretions from the lungs and upper airway. When mucous is not cleared from the lungs, it can become infected and cause a pneumonia.
When trunk musculature is working properly to contract the rib cage with control, airflow over the vocal folds is controlled in such a way that allows the ability to produce sounds properly for voicing.
Normal development of motor skills that typically occurs from birth until the age of 2 facilitates the muscle lengthening and strengthening that moves the ribcage into its mature position and provides effective breathing patterns for the child. When motor skills develop atypically, muscle lengthening, strengthening, and rib mobility must be provided by a Physical Therapist, Occupational Therapist, or Speech-Language Pathologist trained in this type of therapy. The therapist must also instruct parents in exercises to do at home for the very best result.
The therapy staff at Easter Seals DuPage & Fox Valley are invested in learning more about this frequently overlooked area of treatment and are hosting a continuing education course this month to expand our skill base. Click here to learn more from Rona Alexander, PhD, CCC-SLP, BCS-S, C/NDT.
Seeking the help of a dietitian can be invaluable in helping to determine so many particulars about nutrition, especially if your child has specific needs. A dietitian can help with determining how much nutrition your child actually needs. Typically based on their age, weight, length or stature, sex, and activity, no two children need the same amount of nutrients.
Calories change with weight gain and length growth. They continue to change over time, and what your child needs today will not be the same in a month. Monitoring growth and diet is helpful, especially when your child is not gaining enough weight, or possibly gaining too much. It’s not necessary to count calories, so tools such as SuperTracker are not always necessary.
Using MyPlate Daily Food Plans are an easy way to ensure children are not over or under eating. When in doubt, asking a dietitian for some help can give you the basics on calories so you can monitor them on your own over time.
Protein is similar to calories, and will change with growth and age as well. Most every food contains some protein, and the amount needed is much less than most people would think. If your child is not the best eater, they may be getting enough protein, regardless. A dietitian can help you determine how much is needed, and how much is actually in your child’s diet now. They can also give suggestion on food sources that work for your child.
The government provides guidelines on vitamins and minerals, as well as essential fatty acids, but many conditions can change needs. Some medications interfere with absorption of certain vitamins, while vitamins can interact with some medications. Knowing this information, a dietitian can better guide with changes to help limit the interactions, and allow medications and vitamins do what they do best. Use of a supplement may be needed, and this can be a discussion with the dietitian, about which kind, brand, gummy, liquid, chewable, single nutrient, or multivitamin mineral supplements would be best.
Hydration is the last of the overlooked nutrients in the diet, and although most of us think we drink an adequate amount of fluid in a day, most often this is not the case. With infants most of their hydration comes from breast milk or formula, so no added fluid is necessary. With introduction of baby foods, hydration is still achieved as most baby foods are very watery. But as children reduce and eliminate these primary sources of nutrition, they are replaced with solids. Nearly all foods provide fluid, so we do get fluid from foods, but the body has to work to remove the fluid from the molecules it is bound to when the food is more solid in form. Drinking water is the best way to hydrate a body, and as a rule of thumb, drinking half your body weight in water is an achievable goal.
Easter Seals DuPage & Fox Valley offers exceptional Nutritional Therapy for anyone who feels their child is struggling with nutritional development. Our registered Dietitian/Nutritionist will first asses your child’s nutrition and then provided a individualized plan specific to your child’s needs.
Click here to learn more about this great service, or to schedule an appointment, call our intake coordinator at 630.261.6287.