As a pediatric physical therapist (see article on "Baby Walkers..."), I admit to cringing when I see a child in a baby walker! But having been a parent, I know that there are times when you have to put the baby down in a "safe" place so that you can cook, do the laundry, go to the bathroom, etc.!
The best place to put a baby is on its tummy on the floor, and the second best place is on its tummy in a playpen or play yard/playard. (Later you will be able to seat her in a high chair.) But these options are not always available for all parents. So I accept that walkers and bouncers, swings and infant car seats will be used. The key is that they be used in moderation and with some supervision. In a walker or bouncer, watch that your baby is not continually up on her toes, and in a swing or car seat, she should not be asleep. (Babies should sleep in their cribs.)
What's wrong with using a walker? Millions of kids have used walkers and they turned out fine...
In 1993, the American Academy of Pediatrics called for a ban on the manufacture and sale of baby walkers with wheels. Canada has banned wheeled baby walkers since 2004, after 15 years of retailers voluntarily not selling them. The reason for the ban is due to the danger of injury or death from falling down stairs, being able to reach hot drinks or household poisons, running into heaters or hot stoves, grabbing electrical wires or drapery cords, dragging down tablecloths, tipping over after catching on the edge of a rug or running over a toy, or drowning by tipping into the toilet or falling into a swimming pool.
Well, isn't it common sense to put a gate across the stairs, baby-proof the room by removing objects that can burn or poison, etc.? Unfortunately, "common sense" is an endangered commodity. In the U.S., the solution in 1997 was to establish manufacturer guidelines (not laws, but voluntary guidelines that not all manufacturers follow) to make the walkers wider so that they don't fit through doorways and down the stairs (whose stairs?), to have a wider and deeper tray so babies can't reach beyond them, or having a brake system that stops the walker if all four wheels are not on the floor.
The second reason for the ban is that there is no clear benefit from the use of walkers. Studies have been done that indicate that their use actually delays motor and mental development. I have not seen these studies, but can easily see that a child will develop a dependence on the walker and will not be motivated to sit or walk on his own. Also, the posture a child assumes in a walker is usually not good, which can lead to other problems.
From a normal development point of view, babies do not learn to sit by being assisted in sitting, nor do they learn to walk by assisted walking. If a child has any tendency (genetics, atypical muscle tone, atypical bone and joint development, hyper-stretch reflex, etc.), the overuse of a walker can lead to atypical walking, usually toe-walking. (Toe-walking may be seen in a 3-year old, but should no longer be seen in a 5-year old or older. Toe-walking can be caused by other conditions as well.)
Okay, there is nothing wrong with toe-walking. Most toe-walkers turn out within the wide range of "normal." However, all the kids with autism with whom I have worked were toe-walkers. Most of the kids with learning disabilities were either toe-walkers or early walkers.
Normal development follows a progression where motor control and skills build on earlier development. There are so many building blocks needed for the skill of independent walking (see article "On Walking..."), from head and trunk control, core strength and leg muscle strength, grading of movement (controlled movement with controlled speed), flexibility, proprioception (unconscious body awareness), spatial awareness (awareness of body in space), static and dynamic balance, dissociation (ability of parts of the body to move independently of other parts) and rotation along the spine, lateralization (unconscious awareness of two sides of the body) leading to bilateral coordination, to ... integration of infantile reflexes.
So if you really want to help your baby learn to walk, he needs to start with TUMMY TIME!
And make sure he spends a couple months crawling on hands and knees (before and/or after learning to walk)!
Check out the article by Day2Day Parenting on Walkers, Exersaucers, and Jumpers. In summary, avoid walkers, exersaucers, jumpers, and bouncers, and do not keep the baby in a swing or infant car seat all the time! (Common sense, eh?!)
Wednesday, December 7, 2016
Infant & Child Development: Crawling on All-Fours
As a pediatric physical therapist, I have the experience to know the importance of a baby moving through the stage of crawling (or creeping as we like to call it) on all-fours (or quadruped).
The jury is out on this milestone, with studies showing that kids can skip this stage and turn out fine. Fine, I say! Not every kid who skips crawling on all-fours, or every kid who toe-walks, will develop problems later. But almost every kid with dyslexia, with an attention deficit disorder, or with autism, did skip crawling and/or was a toe-walker. Remember that there is a wide range of learning disabilities and of autism, and even "normal" kids may have a touch of a problem. But those with obvious problems missed out on something important. Or is it because of their problems, that they skipped this stage? Either way, we should encourage the crawling experience!
It's been difficult to find an appropriate article, but check out "Crawling and Creeping..."
This is a big deal for pediatric occupational therapists, because they end up treating the kids with learning disabilities and autism.
Crawling on all-fours is an extension of Tummy Time. It further strengthens head and trunk control against gravity (for controlled strength and endurance in sitting, standing, and walking). Weight-bearing through the upper extremities (arms!) improves shoulder girdle strength and control which is essential for fine motor control and visual motor control (eye-hand coordination). Weight-bearing through the arms and legs promotes bone growth and joint development. Weight-bearing on the hands elongates the fingers and stabilizes the wrist, and weight-shifting across the hands leads to dissociation (parts of the body able to function separate from the rest of the body) within the hand and separation of the thumb for finer motor control. Weight-bearing on the hands also normalizes sensory integration (processing and response to sensory input) and provides proprioception (unconscious body awareness). Proprioception is also calming and organizing for the brain. The all-fours position helps to integrate or inhibit the last of the infantile reflexes. It also expands the rib cage for improved respiratory control, leading to speech and language and eating skills!
The position of the head in all-fours stimulates the vestibular system for improved balance and awareness of body in space, and activates the brainstem for self-regulation (you may see greater emotional responses at this time).
The crawling on all-fours movement promotes dissociation within the trunk and lateralization for bilateral integration (awareness and coordination between the two sides of the body) needed for eye tracking left to right, crossing midline (eyes and hands), and hand dominance, which are all skills necessary for reading and writing. Transitioning to and from sit (through rotation) leads to improved grading (controlled movement with controlled speed) and along with bilateral coordination leads to a sense of rhythm, space, and timing. As the baby crawls towards objects and absorbs time and distance, they develop binocular vision and depth perception. Repetition of movement stimulates and organizes the brain for cognitive processes such as comprehension, memory, and concentration/attention.
Crawling on all-fours also develops self-identity and independence, and through exploration of her environment, the baby is learning, learning, learning!
I may have simplified things a bit. Perhaps there are other ways that babies can develop all these "building blocks." But it seems so much simpler to give babies the experience of crawling on all-fours to better prepare them for continued "normal" development.
There are even adult fitness programs that are incorporating crawling, not only for strength and mobility, but to "improve the ability to think, focus, and reason!"
The jury is out on this milestone, with studies showing that kids can skip this stage and turn out fine. Fine, I say! Not every kid who skips crawling on all-fours, or every kid who toe-walks, will develop problems later. But almost every kid with dyslexia, with an attention deficit disorder, or with autism, did skip crawling and/or was a toe-walker. Remember that there is a wide range of learning disabilities and of autism, and even "normal" kids may have a touch of a problem. But those with obvious problems missed out on something important. Or is it because of their problems, that they skipped this stage? Either way, we should encourage the crawling experience!
It's been difficult to find an appropriate article, but check out "Crawling and Creeping..."
This is a big deal for pediatric occupational therapists, because they end up treating the kids with learning disabilities and autism.
Crawling on all-fours is an extension of Tummy Time. It further strengthens head and trunk control against gravity (for controlled strength and endurance in sitting, standing, and walking). Weight-bearing through the upper extremities (arms!) improves shoulder girdle strength and control which is essential for fine motor control and visual motor control (eye-hand coordination). Weight-bearing through the arms and legs promotes bone growth and joint development. Weight-bearing on the hands elongates the fingers and stabilizes the wrist, and weight-shifting across the hands leads to dissociation (parts of the body able to function separate from the rest of the body) within the hand and separation of the thumb for finer motor control. Weight-bearing on the hands also normalizes sensory integration (processing and response to sensory input) and provides proprioception (unconscious body awareness). Proprioception is also calming and organizing for the brain. The all-fours position helps to integrate or inhibit the last of the infantile reflexes. It also expands the rib cage for improved respiratory control, leading to speech and language and eating skills!
The position of the head in all-fours stimulates the vestibular system for improved balance and awareness of body in space, and activates the brainstem for self-regulation (you may see greater emotional responses at this time).
The crawling on all-fours movement promotes dissociation within the trunk and lateralization for bilateral integration (awareness and coordination between the two sides of the body) needed for eye tracking left to right, crossing midline (eyes and hands), and hand dominance, which are all skills necessary for reading and writing. Transitioning to and from sit (through rotation) leads to improved grading (controlled movement with controlled speed) and along with bilateral coordination leads to a sense of rhythm, space, and timing. As the baby crawls towards objects and absorbs time and distance, they develop binocular vision and depth perception. Repetition of movement stimulates and organizes the brain for cognitive processes such as comprehension, memory, and concentration/attention.
Crawling on all-fours also develops self-identity and independence, and through exploration of her environment, the baby is learning, learning, learning!
I may have simplified things a bit. Perhaps there are other ways that babies can develop all these "building blocks." But it seems so much simpler to give babies the experience of crawling on all-fours to better prepare them for continued "normal" development.
There are even adult fitness programs that are incorporating crawling, not only for strength and mobility, but to "improve the ability to think, focus, and reason!"
Tuesday, December 6, 2016
Infant & Child Development: Tummy Time
As a pediatric physical therapist, I cannot emphasize enough the importance of TUMMY TIME!
In 1992 the American Academy of Pediatrics recommended that babies sleep on their backs to reduce the number of sudden infant death syndrome (SIDS) cases, with its "Back to Sleep" campaign. Belatedly, in 2000 they have added "Tummy to Play." So: "Back to Sleep, Tummy to Play."
I won't argue against the recommendation for "back to sleep," but normal infant and child development starts on the tummy; right away. After months of being mostly flexed forward in the womb, the baby needs to work against gravity and develop core strength (head and trunk control). You know the plank position and its importance for core stability? Tummy time is the plank position of babies, and after a while, they will be able to hold the yoga plank position!
There are the standard reasons for tummy time, such as reducing plagiocephaly (skull flattened in the back) and bald spots. But another important reason is to allow normal development through head control against gravity, turning of the head, core strengthening, upper extremity strengthening and control for pushing up, rolling to the side and eventually rolling from back to front (using abdominal strength), lifting the arms to reach for then play with toys, pivoting on the stomach, belly crawling, pushing up into all fours and rocking, crawling/creeping on all fours, transitioning from all fours into side sit and sitting, pulling to kneel, pulling to stand, cruising along the coffee table, and walking with a push toy (or laundry basket!). All of these activities work on the "building blocks" needed for independent walking, as well as for fine motor control, speech and language development, learning skills, binocular vision, visual motor or eye-hand coordination, sensory integration (normalizing the processing and response to sensory input), and even rhythm!
Check out the post on Walkers to read about the building blocks of walking.
There are many websites about tummy time, many with hints to make it easier for babies who fuss. I like the article by The Bump. Note that your goal should be at least 20-30 minutes/day by 3-4 months of age.
In 1992 the American Academy of Pediatrics recommended that babies sleep on their backs to reduce the number of sudden infant death syndrome (SIDS) cases, with its "Back to Sleep" campaign. Belatedly, in 2000 they have added "Tummy to Play." So: "Back to Sleep, Tummy to Play."
I won't argue against the recommendation for "back to sleep," but normal infant and child development starts on the tummy; right away. After months of being mostly flexed forward in the womb, the baby needs to work against gravity and develop core strength (head and trunk control). You know the plank position and its importance for core stability? Tummy time is the plank position of babies, and after a while, they will be able to hold the yoga plank position!
There are the standard reasons for tummy time, such as reducing plagiocephaly (skull flattened in the back) and bald spots. But another important reason is to allow normal development through head control against gravity, turning of the head, core strengthening, upper extremity strengthening and control for pushing up, rolling to the side and eventually rolling from back to front (using abdominal strength), lifting the arms to reach for then play with toys, pivoting on the stomach, belly crawling, pushing up into all fours and rocking, crawling/creeping on all fours, transitioning from all fours into side sit and sitting, pulling to kneel, pulling to stand, cruising along the coffee table, and walking with a push toy (or laundry basket!). All of these activities work on the "building blocks" needed for independent walking, as well as for fine motor control, speech and language development, learning skills, binocular vision, visual motor or eye-hand coordination, sensory integration (normalizing the processing and response to sensory input), and even rhythm!
Check out the post on Walkers to read about the building blocks of walking.
There are many websites about tummy time, many with hints to make it easier for babies who fuss. I like the article by The Bump. Note that your goal should be at least 20-30 minutes/day by 3-4 months of age.
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