Baby Steps Physical Therapy

Concussion Recovery:🧠
When your child is very active in a sport, recovery after a concussion can be challenging. However, it is important to know the steps to safely return to their sport of choice to prevent future injuries and to ensure appropriate healing times.
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Based on Campbell’s: “Specific return-to-activity recommendations are controversial because the progression to activity should be individualized to each patient and focused on symptom and impairment recovery rather than days since the injury occurred. A gradual return to activity program is generally accepted as the safest way to help progress a patient back to preinjury activity levels (Table 15.7). If symptoms arise during this progression, modification should be made to allow the symptoms to resolve.”
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Resource: Campbell’s Pediatric PT book (page 1172 Table 15.7 for reference).
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If you notice any changes in your child’s state after experiencing a concussion be sure to reach out to your primary care provider for further evaluation.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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NEW STUDY ALERT!!
Have you heard the recent news in pediatric development?!
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A new study was release by JAMA Pediatrics on August 21, 2023 by Takahashi et al. discussing the potential harm in excess screen time at young ages and how it may affect age appropriate development.
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So what exactly was the study??
7097 mother-child pairs were included in the analysis. They looked at 4 categories of screen time exposure and varying ages from less than 1 to 4 years old. Of these children 3440 had less than 1 hour/day of screen time, and 290 kids had 4 or more hours of exposure. The outcome measure used was the Ages and stages Questionary 3rd Edition.
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Results found developmental delays in the following domains: communication, problem-solving, fine motor, personal and social skills for children at age 2 years old; and for children at age 4 years old they had delays in communication and problem-solving domains.
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The study states as its conclusion: “In this study, greater screen time for children aged 1 year was associated with developmental delays in communication and problem-solving at ages 2 and 4 years. These findings suggest that domains of developmental delay should be considered separately in future discussions on screen time and child development.”
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I would recommend reading the article in full if you have questions or are interested in learning more! This is NOT meant to shame anyone for allowing their child screen time, totally understandable that some screen time is warranted! In a day & age where screens have become so prominent, it’s important to know the future ramifications, yet more studies need to be conducted.
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Study Citation:
Takahashi I, Obara T, Ishikuro M, et al. Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years. JAMA Pediatr. Published online August 21, 2023. doi:10.1001/jamapediatrics.2023.3057
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!
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Pediatric Pain Scales🩹
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Pain is a subjective matter, and since most babies and kids may have difficulty expressing if they are in pain, it is important as a clinician to be able to understand other cues that could indicate there is discomfort or pain present.
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Here are some of the common pain outcome measures that can be used for varying age ranges, typically through clinical assessment/observations and/or responses, or for older children per their report.
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Comment below if you have any other pain scales that you like to use in a pediatric setting!
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Images from Google. All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: 8 grades of Torticollis👶🏻
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Did you know that in 2018 The Torticollis Clinical Practice Guidelines were updated to now 8 different grades of torticollis? These stages are a helpful indicator of prognosis and realistic outcomes, and if a further referral to a specialist may be indicated.
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Each grade is based on a child’s age, severity of asymmetrical passive range of motion difference between left and right cervical rotation, and whether there is a presence of a mass on the SCM muscle.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Torticollis refresher!🙂
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Torticollis is a very common condition in newborns and infants. It is usually due to a baby’s head position in utero or after birth when they have a preference to tilt their head to one side, rotate to the other, or both a head tilt and turning preference are present.
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The earlier it is noticed and treated, the better the prognosis. Especially with the help of physical therapy for parents to learn proper stretches and positioning. The image above shows the difference between Left and Right side Torticollis head position. So stretching would be in the opposite direction.
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If you have any concerns about your baby’s symmetrical head and neck mobility, please contact your pediatrician to see if physical therapy may be beneficial.

Disclaimer: All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: Equipment Highlight: KidSole!🦶🏼👟
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If you are looking for an inexpensive option to provide more support for your child’s feet while standing or walking, this is a great option to explore!
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KidSole is a company that creates orthotics and insoles just for children in a variety of sizes and styles to fit each individual child’s needs.  If your child has excessively pronated or flat feet with collapsed arches, heel pain, or just discomfort in their shoes, there may be some helpful options with KidSole!
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Their collection includes products is for kids with posture or foot development issues like foot arch problems, over-pronation or ankle disorders (such as hypotonia). Their Heelcup, Heel Pad, & Gel Socks are for kids with heel sensitivity issues (great for kiddo’s with Sever’s!).
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Sizes are based on your child’s shoe size, and you can even trim the edges to adjust as appropriate to fit inside the shoe. If you have further questions, check out their site, ask your child’s doctor, physical therapist, or podiatrist to learn about the best option for your child.
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If you would like more information check out their website: kidsole.com. & you can use ‼️DISCOUNT CODE‼️ for 10% off your first purchase: SP91403
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Arthrogryposis Multiplex Congenita (AMC) quick facts:
- A neuromuscular condition that presents with severe joint contractures.
- Most common type is Amyoplasia
- Common presentations: Jack-knife, or Frog-like
- Common to have hip dislocations & clubfoot
-       PT: stretching program is VERY important, orthotics usually needed, standing program, aquatic therapy helpful, want to enhance independence; choose outcome measure based on ICF model
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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IDEA:💡
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Did you know that your child has rights to receive care that is covered by Federal Laws? IDEA or the Individuals with Disabilities Education Act of 2004 supports early intervention and public education for children. There are two main parts of IDEA, part B & part C.
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Part B: is for children ages 3-21 years old. An Individualized Education Program (IEP) is created by a team of therapists, teachers, and experts to provide appropriate accommodations for a child with disabilities unique needs in school/educational program.
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Part C: is for children ages 0-3 years old. An Individualized Family Service Plan (IFSP) is made by a team of expert clinicians through family centered care to promote a child’s development, learning, and participation in family and community life or natural environments.
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Each team helps create goals for a child, and services provided are almost always cost-free. Some laws may vary based on your state, so it is recommended to seek out further information to see if your child may qualify for services.
All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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DCD – developmental coordination disorder
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DCD is a motor impairment and/or motor skill delay that significantly impacts a child’s ability to perform age-appropriate complex motor activities. Most parents notice difficulty keeping up with peers, difficulty doing tasks such as riding a bicycle, running coordination, frequent falls & more.
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It is typically diagnosed with exclusion criteria by ruling out any other neurological disorders or cognitive impairments by means of differential diagnosis.
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Co-occurring:
* Strong associations have been demonstrated between DCD and:
- attention deficit hyperactivity disorder (ADHD)
- speech/articulation difficulties (specific language impairment)
- language-based learning disabilities, difficulty with reading or poor handwriting
* When a child has any of these conditions, the likelihood that DCD is also present is about 50%.
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Early identification is key:
● Education of teachers and parents about how to make tasks easier and how to ensure that activities are matched to children’s capabilities.
● In this way, children with DCD can be provided with optimally challenging situations that emphasize mastery and avoid multiple failed attempts.
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Credit: Campbell’s Pediatric PT
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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SPASTICITY:
Muscle Spasticity can occur for a number of reasons, typically from neuromuscular conditions such as Cerebral Palsy or other neurological conditions. Spasticity is characterized by an abnormal increase in muscle tone or noted muscle stiffness, that may interfere with movement, speech, and is sometimes painful or uncomfortable.
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Spasticity can be measured using a few outcome measures or assessment tools such as:
 •The Hypertonia Assessment Tool (HAT)
 •The Modified Ashworth Scale (MAS)
 •The Tardiue Scale
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If you notice any changes in your child’s muscle tone be sure to reach out to your primary care provider for further evaluation.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Has your child suddenly started limping?
Are they complaining of hip, knee, or ankle pain?🦵🏼
Here are a few potential reasons for limping based on some orthopedic conditions that commonly occur in young children and teens.
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❗️Note: These are not the ONLY reasons a limp may be occurring. It could even be from growing pains depending on your child’s age. Yet if you notice any changes in your child’s gait that cause you to be concerned, you should always ask your pediatrician to further assess and seek the appropriate next steps.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician. Info from Campbell’s.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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How to know if PT could help your child?!🙌🏼
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For any parents out there who are not sure if physical therapy could be beneficial, here is a general outline of when it might be a good idea to seek out pediatric PT!
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Keep in mind these are not SET timeframes, you can ALWAYS ask your pediatrician SOONER if you feel like your child could use help to achieve their gross motor milestones! I am always encouraging being proactive rather than “waiting and seeing” to assist babies to reach their fullest potential.👍🏼🥰
 
All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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MOBILITY! 💪🏼🤸🏻‍♀️🧘🏽🤸🏻‍♂️
Did you know that children should have MORE mobility than adults when it comes to the normative Range of Motion values?!
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Here are some great tables for reference on values to keep in mind when assessing ROM.
Of course having a younger child sit still while you use a goniometer is almost impossible 😂 so I typically use my “gon-eye” measurements for approximation. However, this is still a helpful tool for reference when assessing each joint for children.
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Source: Medbridge course with David Piskulic
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: Equipment Highlight: Little Steps Gait Plates!👣
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If you are looking for a non-invasive way to try and correct excessive in-toeing or pronation in a kiddo, here is a helpful suggestion!
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Little Steps Gait Plates are a semi-rigid prefabricated orthoses that effectively limit in-toeing caused by rotational deformities of the lower limb, and also can be used to address foot pronation that could be causing gait abnormalities. Some benefits may include: assisting with proper development of the lower limb which could help lead to improved strength, balance, and coordination.🦶🏼🦵🏼
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Sizes range from a Toddler size 5 to a Youth size 8.5, taking children from first steps through teen years. (the oldest kiddo I have trying these out right now is 11 years old, and several younger kiddos too!)👍🏼
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If you would like more info check out their website: nolaro24.com
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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🦴SALTER-HARRIS Fracture Classification:
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I remember learning these in PT school and thought it may be a helpful review for anyone working with a child who experienced a recent fracture.
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The most common fractures to the ankle in the skeletally immature athlete are the Salter-Harris 1 & 2 injuries to the distal fibula. The Ottowa rules & a radiograph or Xray may be needed to rule in/out a fracture.
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Here is a list of the different types:
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Modified Salter Harris Classification of Growth Plate Injuries:
1. Disruption entirely confined to the growth plate; distraction or slip injury.
2. Fracture line runs partially through the growth plate then extends through the metaphysis.
3. Fracture line runs partially through the growth plate then extends through the epiphysis.
4. Combined disruption of metaphysis, growth plate, and epiphysis.
5. Crush or compression injury of growth plate.
6. Abrasion, avulsion, or burn of the perichondrial ring of the
growth plate.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: Swaddling & sleeping protocols for newborns based on the American Academy of Pediatrics:
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I have been getting several questions recently regarding sleeping positions, protocols, and equipment as I’ve been seeing many newborns lately (most recent infant I saw was only 8 days old 🥺) and wanted to review this info!
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As a new parent it is important to understand the “back to sleep” movement that encourages babies to sleep while on their backs to prevent any dangers of SIDS. In the U.S. alone about 3,400 babies die suddenly and unexpectedly each year due to this tragic accident.
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Swipe through above to read about safe sleeping tips for infants. If you have any concerns or questions please contact your Pediatrician, primary care physician, or physical therapist for further assistance.
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Source: Author By: Rachel Y. Moon, MD, FAAP; Last Updated 6/1/2021Source American Academy of Pediatrics (Copyright © 2016)
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: Equipment Highlight: the Upseat!🤗
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If you are looking for a safe and comfortable pediatric chair that will encourage proper sitting position as well as healthy hip alignment for infants, here is a helpful suggestion!🙌🏼
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The Upseat is a multi-function baby booster seat that was professionally designed by physical therapists with a baby’s developmental anatomy in mind. The seat has been made with efforts to support the hips and pelvis by encouraging more anterior pelvic tilt which is required to activate muscles needed for upright sitting and to prevent excessive forward slouching posture. This also helps to properly align the lower extremities for better hip placement in sitting.👍🏼
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Recommended age ranges for use are 4 months - 2 years. This may depend on each child’s unique needs. Accessories included with the Upseat without any additional costs are: a safety harness strap, a large tray, and booster seat conversion straps.
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If you would like more information check out their website: theupseat.com & use our 🚨🚨DISCOUNT CODE: BABYSTEPS10
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Since our last post was on feet, let’s continue the trend! 👣 Does your child ever complain of HEEL PAIN??
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If your child is highly active in sports, or activities of frequently running or jumping, these repetitive movements could potentially cause pain in the heels. 🏀⚽️🏈 This inflammation or traction can occur between the Achilles tendon and the plantar fascia and aponeurosis or bursa (basically fancy words for structures around the heel of the foot!).🦶🏼
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If your child consistently reports this type of pain, seeing your Pediatrician for a Physical Therapy referral may be beneficial to learn ways for pain management!🙌🏼
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Credit: Campbell’s PT for Children p.322
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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Post: Pediatric Foot Development👣
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I recently took a course on this topic and thought I’d share some important takeaways I learned that may be helpful information to know!🙌🏼
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•Ossification of the bones of the foot occur at different ages based on the specific bone
•The calcaneus typically fully ossifies in girls 4-6 years old & boys 5-9 yrs
•The bones change shape by adapting to load and stress (by standing, walking, weightbearing) in the most influential way during the first 4 years of life
•After age 7 years old, bone changes are less likely to occur therefore the use of orthotics may not show as much change (depending on the child)
•Weightbearing load ratio should be as so at around 4 years old: 60%:35% rear:forefoot (Aharonson Z & Cavenaugh PR) – takeaway: very little load should be placed on the midfoot as this area of the foot is not made for shock absorption– therefore increased pronation can cause deformities
•Arches can take up to 6 years to develop of ideal function and walking assuming a child has proper gait mechanics
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Credit: Medbridge – I would highly recommend this course for anyone wanting to learn more!🤗 I do not own the rights to this course.
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All content is for educational purposes, not to diagnose. If you have any concerns, feel free to ask questions or consult your primary care physician.
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Remember: Baby steps daily can lead to big changes overall!👶🏻👣
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