Wednesday, December 7, 2016

Infant & Child Development: Walkers

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?!)

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!"

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.

Friday, March 30, 2012

Last Wishes

One of the risks of any surgery is death. This makes one think. One is rarely prepared for death, but we can make some plans.

I want to make some requests beyond that of my Living Will. There is no need to prolong my life at the risk of my becoming a burden to you, the family. I will die happy, having lived a full life, much of it thanks to you, my family.

Remember that if I die at home, the first thing you must do is call the police/coroner. Yes, we live in a sort of a "police state," and if you don't get that official piece of paper, the death certificate, things can get very difficult. If I die in a hospital, the doctor can take care of that. If I am in the hospital, you can have my organs harvested.

Upon my death, please have my remains immediately cremated. You will need to contact a funeral director to do that. Do not bother with any special container, a brown paper bag will do. It doesn’t matter where you spread my ashes, as long as they go back into the earth. Just dig a hole and bury them! Do not place a plaque at any site.

Inform my mother, and ask if she wants to inform the rest of my family. Inform your own family as you wish. Inform Marylee Lewis, and she will spread the word! Inform Karen Carr Hopkins and she can spread the word. Make a note on my Facebook page.

I do not wish to have any memorial service, but here it is more important that the survivors have what they/you need and would prefer. Instead, if an obituary is printed in the newspaper, it will also be online and have a place for comments. (If you want to have a service, I suggest going to St. Paul’s Catholic Church in Jacksonville Beach, FL. I have continued to send offerings there, so they should provide the service. No longer applies!)

You already know NOT to have the hymn “Amazing Grace” played at my service. Here are some suggestions.

Entrance Song: “Here I Am Lord”

1st Reading: Ecclesiastes 3:1-11

2nd Reading: Second Letter of Saint Paul to Timothy 4:6-8

Gospel: Matthew 25:31-46

Liturgy of the Word Responsorial: “Create in Me a Clean Heart”

Eucharist Song: “Let There Be Peace on Earth” (my favorite hymn)

and “Joyful, Joyful, We Adore Thee”

Closing Song: “On Eagle’s Wings”


In lieu of flowers: spend time with family, enjoy nature, donate to your own preferred charity or cause.

I have collected a lot of "collectibles," but nothing of any great value. If you will not derive any enjoyment from them, give them away. Someone else can enjoy them.

http://www.unclefed.com/AuthorsRow/Newland/pass_on.html

Thursday, March 29, 2012

Marriage 101

Ha, I am no expert. But I do have some experience. And I have listened to countless complaints from others.

I want to insert here my theory on the continuum of humanity. If you look at DNA and genomes, there are nearly an infinite variety of combinations. Thus, while hair color can come in so many variations, so can one’s sexual orientation. There may be an ideal “Man” and an ideal “Woman,” but more likely there is an average “Man” and an average “Woman.” The rest of us fit somewhere on this infinite continuum. Most of us have some female and some male traits. Some of us may have enough of the opposite sex traits that we are termed homosexual. But even among homosexuals, there is a great variation.

So there is my biological explanation of homosexuality and here is my caution that you cannot compare yourself easily with other people. Each of us is unique, and our relationships are unique.

Marriage Myth? Each partner must put 50% into the relationship.

No, ideally, each person should put in 100%. Of course, things not being perfect, neither partner is usually able to put in 100%. And since things are not black & white, there is an ebb and flow to the relationship where the percentages are constantly changing. So you must accept that there are times when one partner is “giving” more than the other.

Marriage Myth? Men are from Mars and women are from Venus.

Actually, there is a lot of truth in this statement. But again we must look at the continuum of humanity, and that some of us have traits from the opposite sex. So there are females who like to solve problems and males who like to nurture. However, there will be differences in communication. For some reason, this has not become common knowledge and remains in the field of psycho-babble. So it takes a good counselor to sort things out if a couple can’t figure it out on their own time.

*Communication:

A common complaint is that a woman will say her husband doesn’t support her. Make her be more specific, and she will say he does not hug her when she is sad and he does not listen when she is angry. Actually you need to make her be even more specific, because…

When the husband hears he doesn’t support his wife, he says that hey, he does support her - he goes to work and brings home the income to pay for things she wants, to raise the kids, etc. His definition of support is totally different than hers. Then tell him he doesn’t hug her when she is sad or listen when she is angry, and he will respond that he has no idea when she is sad or angry. So whichever partner this may be, you have to be very specific in communicating your wants and needs. You need to say you are feeling sad today and need a hug. Then hubby can solve the problem and give you the hug. Say you have something to vent and will he just sit and listen while you get it off your chest? The husband now needs to learn to sit and listen, without judging and sometimes without giving a solution to the problem (which he may be wont to do). The husband may be surprised that after you have talked out your anger, the problem is gone! You didn’t need money or an answer, just someone to listen! Hopefully husbands will learn how easy it is to “support” his partner, by just listening and doling out hugs. Okay, maybe some partners will want more than that, and maybe some wives do want just the money, but they need to communicate that. Also, guys, when you are listening to your spouse, try to maintain some eye contact with her. Girls, if it appears that he is not paying attention, and is doodling, drumming his fingers, or staring off into space, he may really be listening. Learn how he listens.

A common complaint is that a man will say his wife doesn’t support him... What?! says the wife, I cook his meals and clean the house, take care of the kids; I’m always supporting him. I listen to his complaints about work and hug him when he is sad. Women tend to give a lot. But that is not what the man wants. His idea of support is for his wife to leave him alone in his cave to stew over and solve his own problems. Oh, in today’s world, that means allow him to “veg” in front of the TV. Once women understand why men sit in front of TVs, they will allow them to do so more often. As long as women think men are ignoring their wives by sitting in front of the TV, they will resist the whole TV idea. And by resisting the TV idea, they may be sabotaging the relationship.

The above examples have the average women and men roles being played, but the roles are likely to be different in your individual relationships. That is why clear communication is important. Assume nothing. You cannot assume your partner knows what to do, even though it seems so obvious in your own mind. He/she cannot read your mind. You have to be very specific about your wants and needs. You can’t use general words like love and support.

Marriage/relationships require a lot of work and communication. Can I throw in a monkey wrench? Don’t think that because today you learned to give a hug, or to give space by allowing TV watching, that the same technique will work in the future! Relationships ebb and flow, and who knows, the person may change and require something different. But if he is specific in his communication, then there should be little problem.

However, there are certain things that are not acceptable in relationships. If your spouse specifies he wants to whip you with a belt, or that she needs more cocaine, perhaps it is time to end the relationship. Only you can decide the limits you will put on a relationship.

Above all else, it is said you cannot change another person, you can only change your reaction/toleration/acceptance of that person. If you do not like your partner’s drug or alcohol problem, you are not going to change it. Only that person can change it. If he/she is not making the effort, then you have all rights to leave the relationship. Some people can change themselves to accept a drug addict or alcoholic (they must be extremely nurturing), but most of us cannot.

One more kicker: mood (or affective) disorders. I do not know the answer as to why there are so many people with mood disorders in today’s world. Yes, they did occur before the world became industrialized, but not in the numbers we see today. I also cannot understand why mood disorders have not become common knowledge, but also hide in the world of psycho-babble. On the continuum of humanity, we all have a little mood disorder in us! In the normal world, we can get depressed, and after a couple days we get over it and carry on. That means that some episode sent some of our neurotransmitters in our brain out of whack. Normally our body can restore the balance and restore our normal mood. However, if our body cannot restore the balance, then we have an illness. If your body cannot maintain an insulin balance, then you have the illness of diabetes. If your body cannot maintain a neurotransmitter balance, then you have a mood illness. This should be treated medically.

You can have a hereditary tendency towards a mood disorder. Again, the variation in disorders or the relative stress-level in your life can decide the severity of your disorder. I am not going to assume you need treatment. But if your persistent mood is affecting your quality of life, perhaps it is time to seek help. I, nor your spouse, can make you seek treatment. This has to be your decision.

Would you believe many marriages could have been saved if the antidepressant Prozac was easily available? We tend to get irritated by little things our partners do, and if that persists, it leads to divorce. But a little antidepressant helps balance our mood, meaning we aren’t so easily irritated and all is okay. Don’t you ever wonder why something that never used to bother you about your partner, now bothers you terribly? Why the change? Why do we now remember the 100 times in the past that this something occurred and we are now bothered by it? Or are more irritated by it? It’s our brain that is different - those neurotransmitters are in a different balance and setting us off. What do you want your normal to be? Easily irritated or go with the flow? Seeking medical treatment helps you to cope and go with the flow. There is so much stress in our lives today, some of us need some help.

In conclusion, marriage takes a lot of work. Communication is key, and you can never assume your partner knows what you are thinking. If you need some extra help, get it.

Why do so many arranged marriages work? The individuals come to the relationship expecting to have to work at it and expecting that they will have to tolerate some quirks. Often these couples have so much in common (culture, for example) that it is easier when the situation is the couple versus the world. When does it not work? Usually when one of the partnership is inherently evil! (Okay, maybe that is a bit extreme...)

Tuesday, September 6, 2011

Laundry - Stains

Ball point ink stains:
Pour rubbing alcohol on the stain, then scrub.

Blood stains:
With fresh blood stains, immediately put in cold water and scrub. If that doesn't do the trick, or the stain is old, pour hydrogen peroxide on the stain to cover it and let it bubble. Scrub and rinse, then wash in the laundry after the stain is gone.

Vacuuming

A lesson in using a vacuum cleaner?

1) Vacuuming posture; just like throwing a ball, you should have one foot in front of the other! If you push the vacuum forward and back with your right hand, place your left foot forward and rock back and forth from forward to back foot. Tighten your tummy muscles, but keep breathing!

2) Vacuuming carpets: it is said you need to vacuum 3-5 times over the same area of the carpet to get it clean. Think of the first run for loosening dirt, the second to suck up the dirt and loosen some more, and the third to get more dirt. Obviously the more times the better, but who has time? Also, like mowing the lawn, you need to overlap runs, to make sure you are reaching all areas. So what I do is to overlap half the run. That way each section gets double coverage and if I do only two runs per section, that means each area gets four runs of vacuuming. If I have time, I will do three or four runs for more thorough cleaning.

3) I just cleaned an apartment that had a one-inch wide swath of dirt around all edges of the room. You have to use the proper tool to get the edges of a room, the vacuum head won't reach.

4) After vacuuming, you have to clean the vacuum! Check the bottom of the brushes and rollers, and pick out all the dust and hair that you can see. Vacuum the brushes and rollers. Dust and lint on the brushes will decrease the amount they can pick up. Hair and pieces of string wound up in the rollers will decrease efficiency of the vacuum. If the bottom of the vacuum cleaner is full of dust, get a damp cloth and wipe it off. Why spread around more dust?

5) Vacuum cleaner bags. Of course, when they are full you need to replace them. Otherwise you are not only no longer collecting dirt, you are more likely to be spreading dirt. HEPA bags or not? Unless you truly have allergies, don't waste your money on the special bags. Just get the regular kind and change them as needed. Also, whenever changing the vacuum cleaner bag, you should probably wipe out the canister with a damp cloth.