Independent sitting usually begins around 6 months old.  By sitting independently, I mean being able to sit without anyone supporting them.  So if your baby is able to sit with their hands on the floor holding themselves up around 6 months, then they are on the right track.  

There are a few ways to progress crawling.  

1- Improving sitting balance on an exercise ball- I mentioned this one before, but it is a really great way to start building ab and back strength, as well as improving your baby’s protective reactions to moving in different positions.   You can begin by holding your baby under their arms with your hands around their trunk, and as their balance and strength improves, you can just hold their thighs and move them around and bounce them on a ball.

2- Sitting your baby in free space with a boppy pillow or other large pillow behind them.  This is different from sitting on a ball, because now your baby has the opportunity to try to sit by themselves.  It is okkk to let them fall as long as you have padding all over and are near by.  Each fall will serve as more practice working on those protective reactions and ab and back strength.  You can start with larger supports at first, and gradually move to smaller pillows.  

3- Sitting in a couch corner.  This is a little similar to sitting with a pillow behind them, but the corner allows your baby to fall backwards and try to recover on their own without your assistance.  You can wrap a boppy pillow in front of your baby or put another pillow in front of them to protect them if they fall forward.  This will also provide a support surface for your baby to push off of to try sitting back up again by themselves.  You can make this harder by putting a towel roll or little pillow behind them by their bottoms to prevent them from fully leaning against the couch, so that they have to work harder to sit up. 

not like this haha—> 

more like this—> 

Happy Sitting!

Next on my tips and tricks list is how to progress beyond combat crawling (when a baby drags their body along the floor mostly using their arms).   After combat crawling comes creeping!  Creeping is a funky term, I know, but it actually means crawling on one’s hands and knees.  In PT speak, we call that crawling in quadruped.  

Some babies have a hard time holding themselves up in that hands and knees position:

 sorry couldn’t find a cute kid pic for this position :)

Maintaining this position requires ab strength and arm strength, which can be difficult for a baby that has never tried the position.  There is a way, however, to make it easier for your child if they are having a hard time maintaining quadruped.  

One way to make it easier, is to bring the floor up a bit to help them increase their strength when putting weight on their hands/knees without all that effort.  

As seen in the above picture, you can first work on kneeling a at a support surface.  This helps your child become used to being on their hands and knees and also works on their ab strength/trunk control.  While in this position, you can then work on maintaining this position with just one hand on the support while playing with a toy with the other hand.

You can gradually make this harder by lowering the support surface to eventually being on their hands/knees on the floor.   And then try reaching for a toy while being on hands/knees on the floor.  

A second way to progress combat crawling to creeping on hands/knees is to create obstacles for your child to crawl over so they are forced to push up onto their hands and knees to get over an obstacle.  

Quick sidenote:

The picture I used of the baby kneeling at a support, is from a great blog I found while searching for the appropriate pic.  

Here’s a link to the site, which chronicles a baby with down syndrome’s life from his dad’s point of view.

http://noahsdad.com/

Thought this was a very informative article about strength training in pediatrics.  

When I tore my ACL when I was 14, the pediatric orthopedic surgeon I went to see thought it was only a sprain and told me just to rest.  After doing a lateral run and getting more injured, I went to see an adult surgeon, and then an ACL re-construction followed.  

After that, I was the only 14 year old at a gym working out and most people would ask what I was doing there.  I’m glad to see that strength training is becoming a more common practice especially as kids are entering competitive sports at a younger age.

We also see adolescent patients here in the clinic that have various joint pain with or without participation in sports, and really have to stress to parents how important strengthening is and that they have to follow through with it if they want to see results. 

The article also shows a video from a noted advocate of pediatric strength training, Dr. Metzl.  So go take a look at the article here: http://well.blogs.nytimes.com/2012/07/24/strength-training-as-a-family-affair/

Here are some key paragraphs from the article:

Not long ago, many doctors would have warned parents like Ms. Milano to keep their children out of the weight room, citing the conventional wisdom that young people don’t need muscle enhancement and that pumping iron will only stunt their growth and cause injuries.“We want kids to play sports,” he added, “but we also want to figure out how to make them safer.”

But exactly what constitutes safe and effective strength training for young people? Dr. Metzl says the most important thing to realize is that strength training is not the same as powerlifting. For youngsters, the emphasis should be on low weight and high repetitions. If a child cannot lift a weight for 15 reps, then it’s too heavy, Dr. Metzl says. In fact, many of the most useful strengthening exercises for children are full-body movements that do not involve any weights at all.

But in recent years the medical establishment has changed its tune. The American Academy of Pediatrics says that when done properly, resistance training has no adverse effects on growth in children and can increase strength and bone density without creating bulky muscles, and many studies have found it can be safe and beneficial.

Sorry my TAT-tuesdays is 1 day late already 1 week into it, but here it is!

OK so Tummy TIme Tips! Can you tell I felt like using a little alliteration today? :) 

I see a lot of patients with torticollis as well as patients whose parents say that their children hate tummy time.   There may be a few reasons your child may hate tummy time.

1- they may be teething, and being face down really puts pressure on your head, and I’d rather lie on my back if I had a toothe-ache thank you very much :)

2-they may not be strong enough to hold their heads up so once they feel the burn of those muscles they are over tummy time haha.  

I can’t really help the pain in problem #1, but I can provide an alternative to straight tummy time.  

One way you can ease your child into tummy time is by having them be on their tummy on an exercise ball.  

This can do 2 things:
1- Takes your child’s face higher off the floor so they don’t feel claustrophobic and so they can see more of the world around them if they can’t quite hold their head up all the way.

2- It makes tummy time more fun, since now they are on something shiny, squishy, and bouncy.  Andddd they’re allowed to hit it and it can act like a drum :)

I have parents start with their child slightly tilted backwards on the ball so their more in a nearly standing position.  This way, they are still on their tummy, but don’t have to work so hard to hold their head up.  In this position you can also roll the ball side to side to work on head control.  As your baby gets stronger then you can gradually put them on the top of the ball and tilt in all directions.

I also use the ball for sitting balance and trunk control in the same manner as above.  Bouncing and moving the ball around really helps to improve trunk and head control.

This article was a good read.  Though it discusses families with children with Trisomy 13 and Trisomy 18, thought it could relate to any parents facing a dilemma with the possibility of having a child with special needs.  I rarely see newborns, let alone pregnant mothers, so I don’t ever hear these types of stories.  But I do see patients in physical therapy, whose parents tell me that doctors told them that my patients had little chance of survival or were going to be “vegetables.”  Crazy to think that’s how some of my patients started when, now, I am about to teach some of them how to walk :)  Just shows that sometimes you really never know what can happen…

Here’s a snippet from the article:  

Though many people believe that raising child with severe birth defects would be more than they could bear, many parents of children with severe disabilities say that couldn’t be further from the truth.

In a new study, nearly all — 97 percent — of 332 parents of children with trisomy 13 or trisomy 18, another chromosomal abnormality that can cause similarly severe problems and shortened lifespans, described their child as “happy.” Parents also said that no matter how short their lives, their child enriched their family.

Read the rest here: http://health.usnews.com/health-news/news/articles/2012/07/23/parents-of-severely-disabled-kids-say-they-enrich-their-lives?page=2

I’ve decided to add a weekly blog post with some of the tips and tricks (TAT) I use with my pediatric patients.   For future posts you can always click on the tag on the right: TATtuesdays.

Soooo my first post is for kids who are older than 3 years old.  Around and after 3 years of age, children should start learning how to prepare to catch a ball in standing and gradually improve to catching a ball only using their hands.  

Most kids begin by catching a ball in their arms and bringing it into their chest and then gradually use only their hands.  If your child is having a hard time learning how to catch just using their hands, you can take away a few variables to make it easier for them to learn the skill first.  

One thing you can do is to have your child lay down on their bed with their arms hanging off the edge of the bed.  This takes the body out of the equation so they don’t have to worry about their standing balance and can just focus on catching a ball.  This also makes it harder for your child to cheat by bringing the ball to their chest, because they only have their hands and arms available to catch the  ball.

You can start with a larger ball that has a textured grip like this one:

You can also use an Oball, which has convenient holes to make it easier to grab a ball:

and then gradually go down to a smaller ball like a tennis ball.

Hope this helps anyone who is having trouble catching balls!

Here’s a sample of the position you can have your child lay on their bed.

and hopefully your child will be able to successfully catch a small ball!

Posted this article awhile ago on my pinterest, and just wanted to add it in this blog.  

Good article about different strategies to help children with down syndrome learn to walk.

Here’s a snippet: 

Not every family has access to a treadmill. Luckily a group in Australia demonstrated that these benefits could be obtained with a gait trainer. Willoughby showed that the same goals addressed by treadmill training could be realized with over-ground training and/or a gait trainer.

Read the rest of the article here: http://physical-therapy.advanceweb.com/Features/Articles/Mobility-For-Down-Syndrome-Patients.aspx