Developmental Delays Charlotte

According to the Denver II, 25% of children can walk backwards by 12 months, 75% by 15 months, and 90% by 16 months.  Once your child has learned to walk forwards successfully, they will then attempt to take steps backwards.

Walking backwards is a critical skill for children to learn.  This skill is essential for protection from falling backwards.  If a child falls forward they can catch themselves with their hands, but if they are falling backwards they have to be able to take steps to regain their balance to keep from falling on their behind…or worse on their head.

Protective backwards stepping is developed last, after forward and sideways protective stepping.  Similarly, children walk significant distances forward first, then sideways, and then they learn backwards walking for distance. 

How to help:

·        When a child is first learning to walk backwards, stand in front of them and hold onto both of their hands.  Help them take small steps backwards while continuing to hold their hands.  As this becomes easier, try holding just one of their hands while they walk backwards.  I like to make it more fun by saying “beep… beep…beep” like a truck is backing up. 

·        I love playing this game looking at a full length mirror.  Then I can walk forward holding the child’s hand with both of us facing the mirror.  Then, we walk backwards together.  When kids are just learning this, I like having 2 adults, one on each side of the child holding their hand going quickly up to the mirror and then backing up slowly.

·        Give your child a cart or stroller to push.  At first have them push the cart forward, then slowly back up the cart for them for them to recover and step backward.  Silly sounds when going backward make this more fun. 

·        Give your child a pull string toy (like the xylophone, duck or puppy dog toy) or a 1 hand pull toy (such as the classic popcorn popper or a pretend vacuum cleaner) to encourage them to walk backwards.  I like the pull string toys particularly because when you pull the string and walk backward, you can see the toy work!

·        Try playing “I’m going to get you” with your child.  Crouch down with your arms up and in “sneaking up” position and walk toward them to encourage them to step backwards to avoid letting you “get them”.

·        If your child is not bad at backward and you just want more of a challenge, give your child a path to follow.  Place small markers, such as carpet squares, a sidewalk chalk path drawn on the driveway or pieces of paper taped down to the floor.  Tell them to take steps backwards with each foot hitting a marker or staying inside the path.  If this is too hard, start off with 2 hands held, fade to 1 hand, and then work to independently.

Need help?

If you want help with these suggestions or notice developmental warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention.  Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References

"Your Child's Walking Timeline." BabyCenter. Baby Center, Aug. 2011. Web. 21 Mar. 2013. <http://www.babycenter.com/0_your-childs-walking-timeline_10357004.bc>.

"Gross Motor Skills for Toddlers: 12-24 Months." Child Development 12 to 24 Months. Early Intervention Support, n.d. Web. 21 Mar. 2013. <http://www.earlyinterventionsupport.com/development/grossmotor/12-24months.aspx>. 

Is your baby 10 months, 11 months, or 12 months old and not able to get themselves into a sitting position?

According to the Denver II, 25% of babies can get into sitting by 7.5 months, 75% by 9 months, and 90% by 9.5 months. At first, your baby will need your help and support to get into a sitting position, usually when they are between 6 and 7 months old.

There are 3 different positions a child this age will typically get into sitting:

·       Hands/Knees

·       Back Lying

·       Stomach lying

The following lists how to help your child get into sitting from each position:

Hands/Knees:

·        Position your baby on their hands and knees and physically assist them at their hips to drop their hips down and to one side into a sitting position. Practice both sides.

Back Lying:

·        Position your baby on their back with their head away from you and their feet toward you.  Help them pull up by holding their left hand with your right hand and roll to their right side on their right elbow. See how little help you have to give them in pulling up allowing them to push up themselves on their right arm.  To do the other side, just do the opposite.

Stomach Lying:

This is the toughest technique to describe, but try this:

·        Sit on the floor with your legs straight and apart. Place your baby across your right thigh, lying on their stomach with their head to the right and their legs toward the middle. Their armpits should be level with the outside of your thigh. With your right hand grab their left hip and with your left hand grab their right hip. From this position, rotate their left hip up and towards you and their right hip down and away from you to get their legs in a sitting position. Then, roll your baby down into sitting facing away from you. A toy placed in front of them in their final sitting position helps to motivate them. As your baby improves and gets better at getting into sitting from this position, try performing this move at your calf and then eventually on the floor. To do the other side, just do the opposite.

Another general suggestion:

·        I love to use toys that have parts that go together such as a stacking ring, stacking cups, the ball and hammer game or blocks and a bucket. Put the small object progressively further to each side of your child as they sit, so your baby has to lean out and get the toy and return to upright sitting to put the toy on or in a container. This is great practice doing the final steps of getting in to sitting position.

Warning signs:

·        Your baby does not hold up their head when picked up after 2 months.

·        Your baby still feels stiff or floppy after 2 months.

·        Your baby cannot support their head by 3 or 4 months.

·        Your baby cannot sit with help by 6 months.

·        Your baby has poor head control when pulled into a sitting position at 7 months.

·        Your baby is not reaching for objects at 7 months.

If you notice any of these warning signs in your baby, you should contact your pediatrician.  I also generally worry about children who are great when placed in any position, but cannot transition and move in the position, for example, if your baby can not roll or reach and play when stomach lying at 6 months. If your baby is 9 or 10 months and is simply stuck in sitting when you place them there, you might want a consultation with pediatrician or a pediatric physical therapist.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References

"When Should my Baby Start Sitting Up?." Just Mommies. N.p.. Web. 28 Feb 2013. <http://www.justmommies.com/articles/baby-sitting-up.shtml>.

"Warning signs of a physical developmental delay." Baby Center. N.p.. Web. 28 Feb 2013. <http://www.babycenter.com/0_warning-signs-of-a-physical-developmental-delay_6720.bc>.

Hello Bloggers!

I’ve recently moved back to my home state of North Carolina after practicing speech-language pathology in Los Angeles, California for 5 years to work at Child and Family Development in Charlotte.

In my previous settings, I took on a strong interest in verbal motor-planning and motor speech disorders such as childhood apraxia of speech (CAS), dysarthria and verbal dyspraxia. I became PROMPT (Prompts for Restructuring Oral Motor Phonetic Targets) trained 4 years ago and have been practicing the philosophy and techniques of this approach ever since! The PROMPT system has been used with phonological, developmentally delayed, dysarthric, dyspraxic, apraxic, hearing-impaired, autistic spectrum, and fluency disorders. The philosophy behind PROMPT is designed to integrate the most efficacious traditional and/or new approaches that augment, support, and enhance speech production interventions.

In treating children with motor speech disorders, I have also helped parents learn what to expect from their child when it comes to adequate speech production through all phases of treatment. I can imagine how frustrating it may be for a parent to hear a few simple words from their child for the first time only to never hear them again or to see your child struggle to produce new words.

Laura Mize, pediatric speech therapist, has a website with gobs of information for parents on motor speech disorders. Here is a link to one of my favorite articles called “Can’t vs. Won’t” focusing on a child that may demonstrate difficulty with speech production.

 (http://teachmetotalk.com/2011/05/03/cant-vs-wont/) 

Also, it’s a great website to peruse for early developmental milestones of speech and language and communication strategies for your toddlers. It’s also a great website for therapists as well with weekly tips for therapy ideas! Links below.

http://teachmetotalk.com/

http://promptinstitute.com/

http://teachmetotalk.com/2011/05/03/cant-vs-wont/

Is your child 2 years, 3 years, or 4 years old, and having difficulty walking up or down stairs? Watching your toddler master stair climbing can be a nerve wrecking experience. As your child becomes more curious and adventurous, it is critical that they have the proper strength and coordination to safely climb up and come back down stairs. What many parents may not realize is that, for a toddler, going up stairs is much easier than coming back down. Therefore, you may notice your toddler make their way up a staircase, but have no way to get themselves back down. Most toddlers will master walking up the stairs before they can walk back down. Here is a general timeline that most children follow when it comes to stair climbing.

Timeline:

• On average, by 9 - 12 months, children can crawl up stairs.
• On average, by 18 months - 2 years, children can take steps two feet per step, while holding a rail or one hand.
• On average, by 2 years - 2 years 6 months, children can walk up stairs independently, two feet per step, without any support.
• By 2 years 7 months - 3 years, children can walk up and down stairs, one foot per step, while holding a rail.
• On average, by 3 years, children can walk up and down stairs, one foot per step, with no support.

As a general rule, most children should be able to walk up and down stairs independently and alternating feet by the end of their third year. Here are some warning signs that indicate a developmental delay among toddlers relating to stair climbing. 

Learning to climb stairs should be done under the close supervision of an adult. Provide close by assistance as your child climbs up or down stairs. Here are a few ways that you can help your child master stair climbing.

How to help:

• When first learning to climb stairs, children are most supported when both hands are held by an adult. They will then progress to success with one hand held with the other hand holding a rail. Children can then move onto holding only a rail, followed by one hand placed on the wall, and eventually will walk up and down stairs with no support.
• Often children want to keep both of their hands on the rail when they are learning stairs. If you want your child to practice with only one hand on the rail, give them a soft toy to hold in one hand so that only one hand is free to hold the rail.
• Before attempting an entire staircase, practice going up or down the last one or two steps up or down the stairs first. When your child is comfortable walking up or down the last couple of stairs of a staircase, slowly start to add in more stairs.
• When walking up or down stairs, children often arch backwards, relying too heavily on a nearby adult for support. Help them keep their head over their lead foot when walking up and down stairs.
• If your child is practicing hands free stair walking, always stay close below your child as they climb up or descend stairs in case they lose their balance and fall.
• To help your child walk up or down stairs while alternating feet, tap each leg as a physical cue and point to the next step.
• As a general rule, children lead with their stronger leg when walking up stairs and lead with their weaker leg when walking down stairs.
• If you notice that your child always prefers to lead with one particular leg, try placing a sticker on the shoe of the non preferred leg. When it is time to step, tell them it is time for “sticker foot” to take a step.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References

Brown, Stephanie. "When can my child start walking up stairs?." About.com. N.p.. Web. 18 Feb 2013. <http://babyparenting.about.com/od/toddlermilestones/f/When-Can-My-Child-Start-Walking-Up-Stairs.htm>.

Robin, Suzanne. "Helping toddlers with walking up and down stairs." The Bump. Demand Media. Web. 18 Feb 2013. <http://preschooler.thebump.com/helping-toddlers-walking-up-down-stairs-2115.html>.

"Warning signs of a toddler's physical delay." Baby Center. N.p.. Web. 18 Feb 2013. <http://www.babycenter.com/0_warning-signs-of-a-toddlers-physical-delay_12287.bc>.

Is your child 2 years, 3 years, or 4 years old, and having trouble jumping? Jumping can be very difficult for some kids to perform. Jumping and playing is an excellent way for kids to strengthen large muscles that will further contribute to their development and growth. By age 2, most children should be able to jump off the ground with both feet simultaneously.

Here is a general outline for typical toddler development related to jumping:

Timeline

• On average, by 2 years, children can jump up off the ground clearing both feet and jump down from a 7 inch height.
• On average, by 2.5 years, children can jump up to touch an object placed 2 inches above their fingertips.
• On average, by 3 years, children can broad jump a distance of 24 inches and jump over a 2 inch high hurdle.

If your child is behind on some of these developmental bench marks, there are several ways that you can help your child.

How to help

• If your child has no clue how to jump, try this. Sit down on a chair. Face your child away from you and place them in a squat position with their feet on the chair between your thighs. Say, “1, 2, 3, Jump!” Lift them up by their trunk to help them “jump” down to the ground. As your child starts to get the feel for this, help them less and less with each jump.
• Most children first learn to jump from a springy surface, such as a trampoline. To help your child jump on a trampoline, start by providing full trunk support as they jump, next help them by holding 2 hands, and finally hold only one of their hands. After they master jumping on the trampoline, they will begin jumping from the floor.
• Your child can practice their jumping on a trampoline while holding onto hand grips or a bar. Clinically, I have found that purchasing a small trampoline with a hand rail attached for the home, immensely helps children learn how to jump.
• It often helps when children have a start- and end-point to jump to. Place two door mats right beside each other. Have your child jump from mat to mat. You can challenge your child by progressively moving the mats further apart.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation at Child and Family Development. Click here for more information on our services.

References

 "Gross motor skills for toddlers." Early intervention support. N.p.. Web. 18 Feb 2013.

"Learning to Jump." What to expect. N.p.. Web. 18 Feb 2013.

McAfee, O. "Large muscle development and assessment."Education.com. Pearson, n.d. Web. 18 Feb 2013. 

Child and Family Development therapists recently attended a great two-day course called A Dynamic Base of Support --  The Key To Enhancing Function.

The course was sponsored by Neuro-Developmental Treatment Association™ (NDTA) at Integrative Therapy Concepts near Charlotte.

It offered instruction and information about graded handling techniques and pediatric therapy strategies.

Among the therapists who attended:

• Mary Helen Bailey, Occupational Therapist
• Megan Bevington, Occupational Therapist
• Jessica Hoffarth, Occupational Therapist
• Michelle Pentz, Speech Therapist
• Courtney Stanley, Occupational Therapist 

Is your baby 2 months, 3 months, or 4 months old and still not lifting their head? By one-month-old, you should notice your baby turning his/her head from side to side when lying on their stomach. By 4 months, your baby should be able to hold their head up while in a sitting position. Developing strong head control is a gradual process which takes place over the first 6 months of your baby’s life. There are several ways that you as a parent can help your baby strengthen the muscles needed to develop strong head control.

How to help

• Often, I find that children with poor head control keep their shoulders elevated. This is normal development, but muscles must be elongated before they can work properly. If you notice your baby holding their shoulders up high causing wrinkles on their neck:
  •  Press down on their shoulders with a gentle but persistent pressure.
  • It is easier to do this in a sitting position.
  • Sit them in your lap with their back to you and press down on both shoulders simultaneously.
• Help your child learn what it feels like to hold up their head.
  • Sit them in your lap, facing sideways, place one open hand on their upper chest and one open hand at their upper back with your thumb at one shoulder and your fingers at the other shoulder.
  • Gently press in and down. This gives your child stability to work off of.
  • You may need to tilt or rock your child slightly out of midline to find the place where their head is balanced.
  • See how long they can hold up their head. You may be doing most of the work.
  • Once you find their equilibrium point, you may be able to challenge your child by moving them forwards, backwards, left, and right in small ranges to see if they can keep their head up. Return to the start position if they lose it.
• Try reverse pull to sits!
  • Place your child in a sitting position facing towards you.
  • Hold onto their shoulders and slowly start to lay them back.
  • As soon as your child starts to lose head control, pull them back upright.
  • If they need more of a challenge, try holding onto their upper arms instead of their shoulders, progressing to their forearms, and finally their hands.
• When lying on their stomach on the floor, it is very difficult for your child to lift up their head since they are working against gravity. To help with this problem:
  • Sit on the floor with your back to the couch and your feet in front of you. Scoot your behind out from the couch about 9 inches and bend your knees with your feet flat on the floor.
  • Place your child on their stomach on top of your thighs facing away from you.
  • Prop them up on their elbows and use your hands to keep their elbows planted on your knees. You may need a funny sibling, a TV, or a mirror in front of your child as entertainment.
  • You can increase the incline of your legs by bringing your feet in closer towards your hips. The steeper the incline, the easier it will be for your child.
  • From your knees, you can bounce your child, rock them from side to side, or tilt them by lifting up one of your knees.
  • As your child gets better at this, you can challenge them by moving your feet out further away from your hips.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation. 

References

Boyles, Salynn. Infant Head Lag May Signal Autism. WebMD. N.p., 16 May 2012. Web. 16 Feb 2013.

Developmental Milestones: Head Control.  BabyCenter. BabyCenter, n.d. Web. 10 Feb 2013.

Warning Signs of Slow Development. Kids Growth . KG Investments, n.d. Web. 16 Feb 2013.

Is your baby only using one side of their body? On average, favoritism of the left or right hand is established between the ages of 18 and 24 months. Hand preference usually occurs between ages 2 and 4. By kindergarten, most children have established a dominant hand. If your child shows an overwhelming preference to one hand before this specified period, there may be reason for concern.

There are several warning signs for disuse of one side to be aware of:

· If your child has one limb that appears to be dramatically stronger.

· If one hand is fisted or if a thumb is always held in the palm of the hand.

· If there is a significant difference in the skill of grasping between the two hands.

· If your child never reaches with one hand and immediately transfers a toy to the other hand if a toy is placed in the nonpreferred hand.

· If your child always has their weight shifted to one side of the body in sitting and standing positions.

· If your child sits persistently with their knees to one side coupled with scooting in sitting sideways and using only one arm.

·  If you notice that your child appears to neglect one side of the body or does not notice objects placed on the nonpreferred side.

·  If stiffness and floppiness is noted in one arm or leg only.

·  If your child does not bear weight on one arm or leg.

·  If while crawling, one elbow is significantly and persistently more bent than the other elbow when bearing weight.

·  If your child is consistently on the tiptoe of only one foot.

Things to Rule Out:

· Cerebral Palsy:

o  A neurological dysfunction can result from damage to the brain in the areas that control movement.  In cerebral palsy, this damage occurs before, during, or shortly after birth and may cause significant stiffness or floppiness on one side of the body.

· Brachial Plexus injury:

o Injury to the brachial plexus can cause weakness or numbness in one arm.

· Leg length discrepancy:

o When a child has one leg shorter than the other, they can compensate by walking on the tiptoe of the shorter leg.

Physical development is unique to each child. There is a huge variability in the range of which normal gross motor skills are met. However, a significant difference between the use of one side of the body and the other is a definite red flag. If you have any concerns or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child can benefit from intervention.   

Resources:

Developmental Disabilities. American Academy of Pediatrics. Retrieved from www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/pages/Cerebral-Palsy

Is your baby 10 months, 11 months, or 12 months old and still not pulling themselves up to stand? Most parents should expect their baby to be able to pull themselves up into a standing position between 9 and 10 months.

Once your baby progresses through the developmental milestones of head control, sitting, rolling over, and crawling, your baby should begin to attempt grabbing onto furniture or other objects to pull themselves up into a standing position.

Pulling to a stand is a very important milestone in your baby’s development, not just physically, but emotionally. Once your baby can stand upright, they are in a better situation to make eye contact and interact socially with others. 

About pulling up to a stand and tips to help your child:

• When children first start pulling up to a stand, they usually start in a tall kneel position, hold onto furniture in front of them, and rock back pulling themselves up through their feet without bringing a knee up. This will progress quickly to bringing up one knee before pulling up to a stand.  
• Remember, pulling up to a stand from a stable and strong piece of furniture, such as a coffee table or hard chair, is much easier than from a soft structure, such as a couch. Furniture that ends up being mid trunk height is easier to pull up on than furniture that is lower or higher.
• Once children have mastered hard surfaces, such as the coffee table, and soft surfaces, such as the couch, they learn to pull up to a stand on progressively more challenging vertical surfaces. Common vertical surfaces would be: your legs, cabinets with decorative trim, and walls/sliding glass doors.
• Place your child up tall on their knees facing a firm piece of furniture, such as a coffee table or hard chair.
  • Help them lift up one knee while giving them a little boost so they can successfully pull to a stand with support.
• When your baby is sitting with their legs crossed on the floor, take their hands and rotate them to the side and up to transition them to their knees with your hands held.
  • Help them shift their weight over to one knee so that the other knee is free to come up.
  • While holding your child’s hands, help them pull up to a stand.
• Look to make sure that your child is not always bringing up the same leg.
  • Hold down their preferred leg to help them put the other leg up, until it gets easier.
  • You may have to help the non preferred leg get up and into position.
•  If pulling up to a stand seems way too hard for your child, practice pulling up to stand by doing sit to stand transitions.
  • Kneel on the floor behind your child and sit them on your knees facing away from you where they would be in the position to grab the coffee table to pull up.
  • Have them transition from sitting into standing from this position providing the needed support.
  • Put a favorite toy up on the coffee table for motivation.

Need help?

If you want help with these suggestions, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References

Chait, Jennifer. "Baby Milestones: Pulling to a Stand."Hatch. N.p., 24 Oct 2009. Web. 16 Feb 2013.

Fox, Geri. "Is My Baby Developing Normally?" Child Development Media. N.p., n.d. Web. 16 Feb 2013. 

"How Can I Help My Baby Stand Up?" Parents.com. N.p., n.d. Web. 16 Feb 2013.

Does your baby walk on their tiptoes?

Children usually learn to walk at about 1 year of age. In the early developmental stages of walking, children often use different foot positions. Toe walking not uncommonly occurs in the practice stage when your child is walking along furniture but is not ready to walk independently yet.

By the age of 3, the toe walking stage is typically phased out. By 18-23 months, most children have accomplished the skill of walking steadily with feet flat on the ground. However, if your child persistently toe walks and cannot bear weight on flat feet, this should be a concern.

There are a variety of reasons why your child may continue to toe walk:

Cerebral Palsy: Children with this condition may toe walk due to muscle stiffness and poor motor control. Muscle stiffness can cause limitations in range of motion so that their ankle doesn’t move as far as a typical child’s foot moves in the upward direction (dorsiflexion). Cerebral Palsy is caused by damage done to the brain affecting how a child moves. The damage in cerebral palsy occurs before, at the time of birth or shortly after birth.

Leg Length: When one leg is longer than the other, a child may stand on the tiptoe of the shorter leg.

Sensory: Toe walking can be associated with autism and developmental delays.

Factors that may influence toe walking

• Tactile processing (response to touch)
• Proprioceptive processing (sensing our body’s position in space)
• Vestibular processing (maintaining balance)
• Idiopathic Toe Walking: These children toe walk for no clear reason. Often these children can stand or walk on flat feet upon request. However, when left unprompted, the child reverts to toe walking. These children do not have stiffness in there ankle muscles but often have limited range of motion of ankle and knees.
• Genetic History: Research shows that in approximately 50 percent of idiopathic toe walkers, the condition is hereditary and may be more prevalent in males than females.
• Muscle weakness: Children with muscular dystrophy may toe walk due to muscle weakness.

Ways to help

A physical therapy home program is vital in your child’s treatment. The home program would include activities that encourage your child to walk on flat feet as well as improve balance and body control. These activities would be most effectively performed under the direction of a physical therapist.

If you have any concerns or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child can benefit from intervention. Contact us to schedule one today! Let us know that you read about this topic on our blog.

Resources

The Baby Center: "Your Baby is Walking on Her Toes" 

Children's Hospitals and Clinics of Minnesota

Is your baby 14 months, 15 months, or 16 months and still not able to stand up alone?

According to the Denver II, 25% of babies stand alone by 11 months, 50% by 11.5 months, and 90% by 13.5 months. After mastering the art of sitting and crawling, most babies will naturally progress to standing.

In order for your baby to stand alone, they must have sufficient muscle strength present in the legs, hips, and core. If you have noticed your baby struggling with other milestones such as rolling, sitting, and crawling, your baby may not have properly strengthened these muscles over time.

Ways to encourage standing

• Put your baby in your lap with his/her feet on your legs. For more support, face your baby towards you leaning against your chest. For less support, face your baby away from you. Help your baby rock side to side or bounce up and down while supporting their upper trunk.
• Look for opportunities for your child to play with children who are just slightly more developmentally advanced than your child. Watching other children as they figure out how to stand can encourage your child to try as well.
• Help your baby crawl up stairs to strengthen their leg muscles.
• If your baby avoids all contact between their feet and the floor, place them in a sitting or supine position. While in this position, gently pound their feet on the   floor so that they can get used to the feeling. You can also massage their feet using lotion or powder.
• Lay your baby on their back. Grab their feet and gently jostle your baby by pulling and pushing them through their legs to get some “weight bearing” through their legs while laying down.  
• Place your baby on a medicine ball lying on their stomach. Gently roll the ball backwards till their feet touch the floor and they are in a standing position. Repeat this sequence several times.

Normal child development typically follows a predictable pattern. Still, it takes time for babies to develop the necessary skills and muscle strength needed to perform gross motor tasks, such as standing. Certain babies simply take longer progressing through these milestones, especially babies born prematurely. If you are still concerned about your baby’s development, here are some early warning signs that should not be ignored:

Early warning signs

• Not rolling by 7 months of age
• Not pushing up on straight arms, lifting head and shoulders, by 8 months of age
• Not sitting independently by 10 months of age
• Not crawling 10 months of age
• Not pulling to stand by 12 months of age
• Not standing alone by 14 months 
• Not using both sides of body equally
• Not standing when supported by 9 months or later

Need help?

If you want help with these suggestions or notice any of the warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References
Calabrese, Lori. "7 Tips to Get Your Baby Standing Up."Education.com. N.p.. Web. 3 Feb 2013.

Lipka, Mitch. "When Will My Baby Stand without Support." Parents.com. N.p.. Web. 3 Feb 2013.

Is your baby 16 months, 17 months, or 18 months and still not walking? Many parents wonder when they should truly be concerned about their baby’s development. According to the Denver II, 25% of babies walk well by 11 months, 50% by 12 months, and 90% by 15 months.

Many parents eagerly await the day their baby takes his/her first steps towards independence. Each child progresses through the developmental sequence at a different pace. Although, it is still important to closely monitor your child’s progress through each milestone.

Reasons why your baby may not be walking

• Hypotonia – low muscle tone
• Hypertonia – high muscle tone
• Other abnormalities in muscle tone and power
• Baby is carried everywhere and not given the opportunity to try walking
• Stiff limbs or poor balance
• Mental retardation

If your baby is not walking by 16-23 months, a medical examination should be conducted to check muscle strength, range of motion, and joint flexibility. Delayed walking could be an initial warning sign for cerebral palsy, muscular dystrophy, or other genetic conditions. A physician can rule out some of these common disorders.

When to be concerned

• Your baby cannot sit without support by 9 months.
• Your baby is not standing with support by 12 months.
• Your baby is not walking steadily by 16-23 months.
• Your baby consistently walks on toes.
• Your baby is consistently late progressing through common developmental milestones (lifting head, rolling over, sitting up)

How to help your baby to walk

• Limit the use of baby walkers and bouncers which can prevent leg muscles from fully developing.
• Delay introducing shoes until your baby walks well inside. Walking barefoot improves balance and coordination.
• Child proof your home and allow your baby to walk in a safe and familiar environment.
• When your baby is cruising along furniture, challenge them by increasing the distance between each piece of furniture, as possible, to encourage your baby to take small steps.
• When your baby is close to independent walking, walk your child with support everywhere until they can do it on their own. Walking is a mindset for your child.
• When holding your baby’s hand, bring your hand down lower to lessen the support you are providing. This will help build endurance, balance, and confidence in your baby.
• Have your baby stand with their back against a wall. Step away from your baby and call out to them with your arms outstretched. Encourage your baby to take  lunging steps towards you and into your arms.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at (704) 332-4834 ext. 114 to set up an evaluation.

References

BabyCenter Medical Advisory Board. "Developmental Milestones: Walking." BabyCenter. N.p., n.d. Web. 2 Feb 2013. 

Dworkin-McDaniel, Norine. "Ways to Help Baby Learn to Walk." Parents.com. N.p.. Web. 2 Feb 2013. 

Tidy, Dr. Colin. "Delay in Walking." Patient.co.uk. EMIS, 20 Mar 2011. Web. 2 Feb 2013.

Is your baby 6 months, 7 months, or 8 months old and still not rolling over?

Independent rolling is an important gross motor skill that helps strengthen your baby’s core muscles. So when should your baby begin rolling over independently?

According to the Denver II, 25% of babies roll over by 2 months, 50% roll over by 3.5 months, and 90% roll over by 5.5 months. Therefore, a good time frame where you can expect your baby to roll over would be somewhere between 2 to 6 months.

In order to perform this task, your baby must have:

• Head control
• Rotation along the trunk
• Rotation between the hips
• Rotation between the shoulders

Reasons why your baby may not be rolling over:

• Abnormal muscle tone
• Spasticity or stiffness through the trunk
• General weakness or floppiness
• Visual or auditory impairment
• Premature birth

Gross motor skills in infants usually develop in a sequence. Although in order to develop these skills, the baby must first obtain: balance, coordination, and postural control. Without these, the developmental sequence will be delayed.

When should you be concerned?

It is not uncommon for some infants to skip rolling over altogether. The important thing is that your baby continues to progress through milestones such as scooting and crawling. Premature babies also tend to develop these skills later. If your baby has not attempted to flip over to one side by 6 months, the issue should be addressed with your doctor.

What can you do as a parent? There are several ways that you, as a parent, can encourage your baby to roll over:

• Shake a toy off to the side of your baby to encourage head turning.
• Help your baby roll over to get used to the feel of it. Use positive reinforcement when done successfully, such as applause and smiles.
• Lie next to your baby and call out his/her name to encourage reaching and rolling over towards you.
• Sit down with your baby sitting in your lap in front of a mirror while rocking side to side and front to back. This will encourage your baby to hold his/her head in an upright position.
• Encourage “tummy time” to develop head control and strengthen postural muscles.

Want help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. 
Call Amy Sturkey, PT, at Child and Family Development to talk more about it at (704) 332-4834 ext 114.  

References

Snell, Rita. "GROSS MOTOR DEVELOPMENT IN INFANTS WITH MULTIPLE IMPAIRMENTS." Innovations. N.p., n.d. Web. 18 Jan 2013.

BabyCenter Medical Advisory Board. "Developmental Milestones: Rolling Over." BabyCenter. N.p., n.d. Web. 18 Jan 2013. 

Is your baby 11 months, 12 months, or 13 months old and still not crawling?

Crawling is a huge milestone in infant development. Many parents become worried or anxious if their baby is not crawling around the time they expect.

Most babies will attempt some form of locomotion between 7 and 10 months of age. Crawling usually occurs after your baby is able to sit well without support (8 months).  While most babies use crawling as their first form of movement, some babies will employ other forms of movement, such as: bottom shuffling, rolling across floor, or slithering on the their stomach. Some babies may skip crawling all together and go straight to standing and walking.

For many years, some parents and professionals believed that as long as your baby began pulling up on objects, standing, and walking, then it did not matter if they did not crawl. Yet, there is new evidence that suggests that crawling before attempting to walk has many benefits.

Benefits from crawling:

• Improves strength, balance, and spinal alignment
• Crawling works the entire body, strengthening most every muscle
• Helps develop gross motor skills and prepare the small muscles in the arms and hands to perform fine motor skills
• Improves visual skills
• Improves cross lateral integration: right and left side of the brain and body work together to build motor coordination skills

When should you be concerned?

• If your baby is not attempting to wriggle legs by 3 to 6 months
• If your baby does not put feet down on floor when supported in a standing position
• If your baby is not mobile (crawling, scooting, rolling) by 1 year

Possible reasons why your baby is not crawling:

• Your baby is unable to support his/her body weight
• Hypotonia – low muscle tone
• Not enough tummy time given to strengthen neck, back, and arm muscles

Crawling requires a great amount of strength and coordination from your baby. It is suggested that parents encourage their baby to crawl before attempting to walk. By crawling, your baby is working muscles throughout the arms, neck, and back. By skipping this stage, your baby may be missing out on an important opportunity to strengthen these muscles.

Ways to encourage your baby to crawl:

• Do baby “tummy time” for several minutes, a few times a day.
• Demonstrate crawling along side your baby.
• Roll up a towel and place it just under the upper body of your baby. Place the arms out in front and rest the elbows on the carpet. This will slightly raise the upper body and encourage your baby to prop up on elbows.
• Place objects just beyond your baby’s reach for motivation.
• Place obstacles in your baby’s path, such as pillows or cushions, to encourage climbing and increase your baby’s confidence, speed, and agility.

Need help?

If you want help with these suggestions or notice any of the above mentioned warning signs, a Physical Therapy evaluation can determine if your child is simply showing normal variability in gross motor development or if your child can benefit from intervention. Call me today at(704) 332-4834 ext 114 to set up an evaluation.

References

Zachry, Ann. "Why is Crawling Developmentally Important?." Babble. N.p.. Web. 18 Jan 2013. Zachry, A. (n.d.). Why is crawling developmentally important?.

Dworkin-McDaniel, Norine. "Baby Physical Growth: Delayed Crawling." Parents.com. N.p.. Web. 18 Jan 2013.

Have you noticed that your child moves awkwardly, avoids constructional toys such as blocks or legos, is a messy eater, lacks imaginitive play, is more comfortable around adults, and/or takes longer to respond or figure our how to complete tasks?

Developmental Dyspraxia is a neurologically based disorder of praxis. 

Praxis includes:

• the process of ideation - forming an idea of using a known movement to achieve a planned purpose
• motor planning - planning the action needed to achieve the idea
• execution - carrying out the planned movement

Dyspraxia may affect physical, intellectual, emotional, social, language, and/or sensory development and may impair the normal process of learning.  It is inconsistent, in that it may affect the child one day but not the next and it may affect children in different ways at different ages and developmental stages.

Dyspraxia can be considered a "hidden handicap" as many children with dyspraxia may appear no different from their peers until new skills are tried or known skills are taken out of context.

If you are concerned about your child's abilitiy to learn new skills, please schedule an appointment with an occupational therapist at Child and Family Development to assess your child's skills and provide education and support to you and your child.

Information for this blog retrieved from www.dyspraxiausa.org.  Please refer to this website for further information. 

That's me, Maria Morellino-- new to Child and Family Development and to blogging!

I joined the Midtown office in August and have enjoyed working with the kids and multidisciplinary team of pediatric therapists.

I've worked as an Occupational Therapist for more than 7 years. I began my career in inpatient rehab then transitioned to working in pediatric home health, schools and clinics.  I have experience working with children with varying diagnoses such as cerebral palsy, Down syndrome, brain injury, autism, fine motor delays, developmental delays, sensory processing disorders, and visual disorders.  Also, I have additional training in NDT, sensory processing strategies, Therapeutic Listening, and sensory feeding approaches.  It's been great to put that education to work at C&FD.  My goals are to become NDT certified and continue to improve my skills in all areas of practice.

Away from work, my husband and my -year-old son keep me smiling.

The holiday season is upon us! Many families have been asking, “What is fun and educational gift for my child this year?”

During speech therapy sessions, parents ask this question and it is a great opportunity for me to explain the importance of toy selection and why some toys are better than others for facilitating early speech and language development.

More and more every year, I see toys that light up, talk and play music. While these toys are very fun and entertaining for your little ones, there is no better teaching tool than you! If the toy is doing the talking, why do you need to?

Here are 10 toys that will not only help you teach your child, but will give your child a reason to engage with YOU as well as the toy.

1. Play sets! There are all kinds of play sets out there from farm sets to cooking sets, jungles and carwashes. Play sets are great for developing pretend play skills. Some of these sets may encourage cause-effect by making sounds when you push a button or when you put an object in the appropriate place. I love play sets because you have to use speech to animate your play by making people and animals talk to each other.

2. Bubbles, bubbles, bubbles. Parents often don’t realize how many things a child can learn from playing with bubbles. Bubbles are a great communication temptation. This means that your child may not be able to open or blow bubbles independently and will need to request your help to get them. Additionally you can talk about basic concepts such as blowing up/high or down/low (depending on your child’s developmental level), wet and dry, big and little, counting, etc.

3. Stacking or nesting toys (e.g., blocks, cups). Stacking and nesting toys can be used to teach color concepts, shape concepts, counting, problem solving, cause-effect, vocabulary (if there are pictures on them), object permanence, prepositions (e.g., in, out, on, under), sizes (e.g., small, smaller, big, bigger), opposites (e.g., up/down). Stacking is great for developing anticipatory behaviors in younger kiddos. Talk to your speech therapist to find out how.

4. Shape sorters. These toys are good for addressing some of the same concepts as stacking/nesting toys. If your child really enjoys this activity, you may want to try holding all of the shapes in your lap and having your child request them. You can also use shape sorting as a turn taking activity, making it into more of a social interaction.

5. Puzzles. It is very important to consider your child’s developmental level when selecting puzzles. I use puzzles in speech therapy to target object labeling and object identification. You can simplify object identification by giving your child only 2 pieces to choose from as opposed to just putting them all out there.

6. Balls. I use balls to teach verbs (e.g., throw, push, roll, bounce), spatial concepts (e.g., in, out, on, under), turn taking, colors, sizes (e.g., big, little), following directions, and textures (e.g., smooth, bumpy). Especially if your child likes to be very active, playing games with balls is a great way to let them get out some energy while learning.

7. Things that go! Cars, trains, airplanes, fire trucks…oh my! Things that go can be used to target turn taking, colors, numbers, basic concepts (e.g., making cars go under or around), part-whole relationships (e.g., wheels on the car, windows on the car), verbs (e.g., drive, ride, go), and many other early language concepts.

8. Potato head teaches body parts and their function (e.g., What will he see with?), color concepts, describing, requesting or making choices (e.g., Shoes or eyes next?), spatial concepts (e.g., top, bottom, sides), and problem solving (e.g., What else do we need?)

9. Play doh. What cant play doh teach? Play doh board games, cooking sets, counting sets, animal sets, etc. I use play doh to teach vocabulary, commenting, requesting, describing (e.g., big/little, long/short, thick/thin), verbs (e.g., roll, squish, pat, push, squeeze), spatial concepts (e.g., in, out, next to), and many more important language skills!

10. Baby dolls help children (girls and boys!) to develop good pretend play skills. You can feed baby, wash baby, take baby for a walk in the stroller, and make baby go to sleep. Use baby to teach body parts, clothing, object vocabulary (e.g., cup, bowl, spoon, bed, pillow), action words (e.g., sleep, drink, eat, brush, sit, wash), and describing words (e.g., hungry, thirsty, sleepy, sad, happy, wet, dry, hot, cold).

For other ideas, I recommend checking out the website for Beyond Play linked below. They have product categories for many of the items I have suggested here.

http://www.beyondplay.com/

Happy shopping! 

Adults all over the country are struggling with how to explain the recent events at Sandy Hook Elementary School to our young children.

How do you explain the unexplainable? While there are never simple answers to complex questions, here are a few suggestions that may guide your responses to your young children as they ask some very difficult questions.

Our priority at this time must be to make our children feel as safe and secure as possible and to help them to manage their distress. It is important to talk to your children about their feelings. The depth of the conversation will be dependent on your child's age or developmental level and their unique personalities. It is important that they feel comfortable talking about their feelings and fears.  Encourage them to express their ideas and thoughts and validate their feelings, even if there are no answers (e.g., You feel sad for the families affected; You feel scared; Senseless violence is hard for everyone to understand).  Encourage your children to put their feelings into words by talking about them or writing them down. If your child is inclined, encourage them to express their feelings through art. Try to keep your answers to their questions developmentally appropriate. As a general guideline, keep it brief and simple and be sure to include reassurances of their safety.

In our 24 hour news culture, it is hard to keep kids shielded from the news, but try to limit exposure to media to the best of your ability. Turn off the TV, do not leave the scary headlines of the newspaper for all to see, monitor computer usage. These healthy limits may benefit not only the children in the household, but the adults, as well.

We have all heard flight attendants tell us that in the event of an emergency, put on our oxygen masks first.  In a similar vein, it will be important for parents to take care of their own emotional health and well being in light of the recent tragedy. Children are seeking a sense of safety and parents can serve as models for how to cope under times of stress and adversity and be resilient. Be sure to regulate your own emotions and behavior in front of your children. Try to maintain your regular schedules and family routines, as they will provide a sense of comfort and consistency for your child. Keep home a peaceful place and enjoy precious family time during the holiday season.

If your child seems to be emotionally overwhelmed, consider consulting with a professional who may be able to help you and your child to develop coping resources and self soothing strategies to manage anxiety and emotional distress.

Here are some helpful and reputable resources:

• The National Association of School Psychologists -- Talking to Children About Violence: Tips for Parents and Teachers 
•  
• American Psychological Association – Helping Your Children Manage Distress in the Aftermath of a Shooting
•  
• American Academy of Pediatrics – Resources to Help Parents, Children and Others Cope in the Aftermath of School Shootings
•  
• The National Association of School Psychologists -- A National Tragedy: Helping Children Cope
•  
• American Academy of Child & Adolescent Psychiatry – Children and Grief
•  
• Massachusetts General Hospital for Children -- Talking to Children About a Shooting
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• Child Mind Institute – Caring For Kids After A School Shooting