Physical Therapist 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>. 

Does your baby’s head seem to be tilted to one side? This may be a result of torticollis, also known as “twisted neck.” This condition occurs in about 1 in 250 babies. Babies with torticollis have their head constantly tilted to one side and typically have their neck rotated to the other side. Most commonly, babies with torticollis will tilt their head to the right and rotate their neck left.  Congenital muscular torticollis can happen before or during childbirth. In the womb, a fetus may become cramped in the uterus. Abnormal positioning of the fetus, such as a breech position, can at times lead to this condition. This type of positioning puts the fetus’s neck muscle, the sternocleidomastoid in a shortened position. After birth, persistently asymmetrical positioning of their head and neck may also encourage the development of acquired torticollis. Either way, the shortened state of their neck muscles causes the muscle to tighten, making it rather difficult for your baby to turn their neck.

There are several warning signs for torticollis to be aware of:

·        If your baby has limited neck movement, caused by muscle stiffness.

·        If your baby has a small bump, on the muscle that runs from the center of the neck to behind the ear.

·        If your baby constantly holds their head tilted and looks at you over one shoulder.

·        If while breastfeeding, it is difficult for them to turn their head to feed on one side.

·        If your baby’s head seems to be flattened or asymmetrical, on one side, due to constantly having their head turned.

Other things to be aware of:

Other disabilities can sometimes be associated with torticollis. Clinically, we find that babies who experience reflux will almost always have their head tilted to the left and only look up and right, to create more space in the esophagus. We also see that language challenges can be associated with babies who have their head tilted to the right and rotated to the left. It is highly likely that if your baby is diagnosed with a plagiocephaly (asymmetrical distortion of the shape of the skull) that your baby will have a torticollis. Klippel-Feil Syndrome is an orthopedic condition in which the cervical bones within the vertebrae are abnormally formed or fused together. This condition can cause congenital torticollis as well.

 It is imperative to understand what exactly is causing your baby’s neck problems due to the disabilities that can be associated with these conditions. About 10-20% of babies born with congenital muscular torticollis, due to abnormal fetal positioning, also have hip dysplasia. Hearing and kidney problems can be associated with Klippel-Feil Syndrome. Although very rare, genetics and underlying conditions such as, a tumor in the brain or spinal cord that has caused damage to muscles, can also cause congenital torticollis.

If you have any concerns or notice any of the above mentioned warning signs, a Physical Therapy evaluation at Child and Family Development can determine if your child can benefit from intervention.   

Resources:

“Torticollis.” BabyCenter. BabyCenter, n.d. Web. 13 Mar. 2013. http://www.babycenter.com/0_torticollis_10912.bc

“KidsHealth.” Infant Torticollis. The Nemours Foundation, n.d. Web. 13 Mar. 2013. http://kidshealth.org/parent/medical/bones/torticollis.html

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>.

On May 2nd, I attended a TalkTools training!  This course was taught by Sara Rosenfeld-Johnson, M.S., CCC-SLP and presented by the Down Syndrome Association of Greater Charlotte.  I left this course with renewed enthusiasm about the field of Speech Language Pathology. 

This course focuses on the fact that there is often a physical reason for articulation issues.  Sara teaches the importance of using touch to teach as well as on the importance of using resistance and repetitions to improve muscle skills (speech/feeding) through Oral Placement Therapy (OPT).

I came back to to my work at Child and Family Development with new ideas, resources, and a desire to learn MORE!  I look foward to attending more TalkTools courses, using my new strategies with my current clients, and educating other professionals and parents about this approach!

To learn more about this approach check out their website at http://www.talktools.com

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>.

An intervention plan for the treatment of Autism Spectrum Disorders requires a multidisciplinary team of professionals to create and tailor a plan to fit a child with ASD. This team approach typically includes speech and language therapy and occupational therapy.

Physical therapy is often a missing piece in a child with ASDs treatment intervention. I believe children are often are not referred to physical therapy because gross motor skills are not uncommonly their highest area of function. However, they cannot perform these skills on request or imitation. This affects their ability to play interactively with other children. Gross motor skills are critical on the “playing ground” of learning socially and interactively with other children. Physical therapy is an excellent option in addressing the core deficits of autism.

These limitations can include:

Sensory processing: These challenges can cause a child to be overly or under sensitive to certain areas of the environment such as light, touch, noise, smell or movement. They may avoid or excessively seek out certain sensations.

Communication: Expressive and Receptive language limitations with both verbal and nonverbal behavior can be associated with a delay or total lack of spoken language, involving initiating or sustaining a conversation with others.

Social interaction: Deficits in nonverbal behavior such as eye to eye contact, referencing, learning imitation skills and turn taking.

Motor planning: Motor planning delays may limit a child’s ability to conceive of movements, retrieve the correct plans for that movement from the brain, perform that movement especially in interaction with others, correct errors in that movement, and remember what worked in the plan so the movement could be more accurately and efficiently performed in the future.

Decreased muscle tone: Decreased or low muscle tone causes poor body mechanics. Low tone or muscle stiffness requires a child to expend more energy to perform movements. This can result in lack of coordination, clumsiness, gross motor skill delays, poor posture, poor walking mechanics, etc.

Physical Therapy Evaluations

When I perform a physical therapy evaluation with an individual on the spectrum, I usually perform a standardized gross motor skills assessment. I pay particular attention to the following:

• How much sensory preparation/heavy work/aerobic activity is required to organize my client to get them to an optimal state for concentrated work? How often do I need to return to sensory work to keep them organized? Do I need to embed the activity itself with sensory input to keep them focused?
• What types of sensory input calms or organizes them and what types of sensory input excites or disorganizes them?  Which type do I need to perform more?  Are they under aroused or over aroused?
• How hard I have to work to gain the child’s attention to give them a meaningful demonstration?
• Do they know to look at the most relevant detail of the demonstration?  For example, if I am walking on my tiptoes, do they look at my feet?
• Can they perform an activity on request? What level of complexity of an activity can they perform?  Bilateral only or unilateral?  Symmetrical only or asymmetrical as well?  Upper body only or lower body as well?  Do the upper and lower body movements need to mirror each other?  How many steps in a sequence can they copy?
• Do they understand movement in relationship to themselves, another person, or things in their environment? For example, can they stand behind a line, behind a person, raise their right hand, or lay on their belly?
• What support do they need to imitate an activity?  Do they need to be physically taken through the activity first? And then support faded? Do they need an immediate model? Can they copy an activity with a previous model? Do they perform better if a familiar caregiver or parent performs the activity first?
• Do they reference me or their caregiver to check in and see if they are doing an activity correctly?
• Do they understand implied cues (including gestural, facial, contextual, postural, tone/inflexion related) that a typical child would understand?  If I say, “Stand over there (while pointing) and catch the ball.”  Do they understand where to stand, what direction to face, and what basic body position to get into, i.e. they don’t face the wrong direction and don’t sit unless I am sitting.
• Do they have a history of interactional play with other children?  If so, what types of play can they engage in?  Parallel? Interactive? Pretend? Flexible? Rule bound games or sports?  

Need help?

If you want help with these suggestions or notice any of the above mentioned difficulties, 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. 

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. 

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.

The Charlotte Observer recently highlighted a new resource for children with sensory processing difficulties.  The United Cerebral Palsy Children's Center is opening a multi-sensory environment room.

The Multi-Sensory Environment Room, on Marsh Road near South End, is the first of its kind on the East Coast to be opened to all disabled children in the community, officials said.

Charlotte’s Easter Seals United Cerebral Palsy Children’s Center, which built the site with donated money, predicts as many as 300 children will be helped in the first year.

“The room is like being in a place where everything is in slow motion,” said Eric Bryant, a physical therapist assistant at the center. “By slowing things down, we let kids step outside the boundaries that restrict them and focus on one thing at a time.”

To find out more about the Easter Seals UCP Multi-Sensory Environment, please call Jeannine Carrington or Lennie Latham at 704-522-9912, or email lennie.latham@eastersealsucp.com. There is a fee for use of the room.

Click here to read the full article or check out The Observer's video below!
(Photos by Todd Sumlin for The Charlotte Observer)

Is the Multi-Sensory Environment Room something that you would like for your child to experience?

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. 

Did you know that Child and Family Development's office in South Charlotte is less than 5 miles from the state line and easily accessible from I-77 and the I-485 loop.

Our multi-disciplinary clinic has been helping children and families since 1980. The team of experienced therapists can assess and treat a wide range of childhood concerns, including autism, ADHD, dyslexia, and other learning disabilities or special needs. We participate in many insurance plans. Also, some of our Occupational Therapy and Physical Therapy providers accept South Carolina Medicaid. 

The Contact Us tab on our website will link you to our address and Mapquest.

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.

Looking for ways to keep your child more active?  

As a pediatric physical therapist, I use many different kinds of scooters to help improve strength, balance, and coordination.  One of the more common scooters is the razor scooter, with one foot pedal and a handle.  While many children would love to ride a razor scooter, their balance may not quite be ready to balance on one foot.  A great alternative option is the Y-Volution Scooter.  It provides a wider base of support for a child to rest 2 feet on after they push off with one foot, and can use lateral weight shifting motion to keep the scooter in motion.  This scooter also has a handle like the razor scooter, and also has a hand brake like on a bike.  

Any dynamic scooter activity can help a child with their balance, coordination, and overall gross motor skills...just remember to always wear a helmet!  

If you have questions about if a Y-Volution scooter is appropriate for your child, please contact a physical therapist at Child and Family Development in Charlotte.

Opportunity knocks at the South Charlotte office of Child and Family Development! 

We are making room for another pediatric Physical Therapist!

Visit the Careers tab on our website, www.childandfamilydevelopment.com, for more information.