Talk Tummy To Me

Our SPROUT babies are the cutest clovers in the patch! 🍀

Happy International Women’s Day!

Check out some of our strong little ladies at our probono clinic working on achieving their functional goals💪

How should a parent encourage positive behaviors? Knowing that behavior has a purpose and is affected by other factors, you can help your child build the necessary skills to communicate more effectively. Here are some strategies to try.

1. Set clear expectations-- Positively state the appropriate behaviors you want to see. Instead of telling your child “Don’t’ stand on the table.” You might say “Please put your feet on the ground.”
2. Provide structure and consistency-- Young children need consistent schedules and ground rules. This helps provide a safe and predictable environment for them to learn appropriate behaviors over time.
3. Collect data-- Keep a log that documents challenging behaviors. Note when the behavior occurs, what your child is doing before and after it happens, and what is going on in their environment when the behavior takes place. If you see a consistent pattern of behavior, think about other ways you can help your child to get what they need.
4. Reinforce and name positive behavior-- Be sure to praise your child when you “catch” them behaving as expected. By naming the appropriate behavior for your child, you are helping them reinforce it.
5. Give words for emotions— teach your child simple phrases such as “I don’t like that!” or “Help me!”

More in the comments!

Our .classof23 did a great job administering the BOT-2 on this unbelievably strong 7 year old girl!

The BOT-2 measures fine and gross motor proficiency, with subtests that focus on stability, mobility, strength, coordination, and object manipulation. The test is tailored to school-aged children and young adults among the ages of 4-21 years.

Roses are red.
Violets are blue.
Our Valentine’s date is cuter than you.
Happy Valentine’s Day! 😍

Winter Car Seat Safety Tips from the AAP:

❄️Bulky clothing such as winter coats and snowsuits should not be worn underneath the harness or a car seat

🧥Add a blanket over the top of the harness straps or put your child’s coat on backwards over the buckled straps after they are buckled up. If you have a coat on, your baby will probably need a coat and blanket!

🤏🏻Use the pinch test— if you can pinch the straps of the car seat harness, then it needs to be tightened!

❄️Use a car seat cover ONLY if it does not have a layer under the baby— nothing bulky should ever go underneath your baby’s body or between their body and the straps.

❌Never use sleeping bag inserts or other stroller accessories in the car seat— if the item did not come with the car seat, it has not been crash tested and may interfere with protection.

To better understand how to address challenging behaviors, you need to understand the four possible functions of behavior.

S- SENSORY: the child finds the behavior self-soothing or satisfying. This might look like flapping their hands or rocking back and forth.

E- ESCAPE: the child wants to get out of their current situation. This might look like running away or destroying property.

A- ATTENTION: the child has a desire for the undivided attention of an adult or other child.

T- TANGIBLE: the child has a desire for attaining a particular object.

Stay tuned for some strategies to encourage positive behaviors!

A behavior is defined as the way a person acts or conducts themselves. Behaviors can be almost anything we can see someone do or say. Behaviors can be desired (things you want the child to do such as asking for help), or not desired (such as tantrums and yelling out).

Challenging behaviors are defined as behaviors that can be threatening to an individual or people around them.

To begin to understand how to treat a problem behavior, the function of the behavior must be determined. This tells you why your child is acting that way. By observing your child and tracking his behaviors, a pattern that tells you why the behaviors happen may emerge.

Creating an ABC Chart is a great strategy! Track behavior using the following:
🅰️Antecedent: What just prompted this behavior? What was happening right before the behavior occurred?
🅱️Behavior: What did the behavior look like? Be as specific as you can – instead of writing “tantrum”, use words like “hitting, kicking, screaming, biting”.
🛑Consequence: How did I (or others) respond to this behavior? What outcome did it have?
🛑Function: Which of the functions of behavior does this fall under?

Reading to your child is an important precursor to language and literacy development. It encourages vocabulary development, positive attitudes to reading, and strengthens emotional ties between the parent and child. In our littlest ones, reading offers opportunities for joint attention, or the sharing of attention by two individuals: parent and child.

Here are some guidelines on how to read to your child:
📕From birth - 6 months of age: begin reading chunky board books, soft fabric books, or vinyl bath books. Babies at this age may come to recognize the book-sharing routine and enjoy your company and the sounds of your voice and words. Babies will primarily explore the books through their senses by grabbing and chewing on the book. They may not pay attention to the whole story, so take breaks when they get bored.
📗From 6 - 9 months of age: begin reading short, simple stories with colorful illustrations, continue reading board books. Babies at this age will continue to explore the books by looking, touching, and mouthing them.
📘From 9 - 18 months of age: Continue offering board books with simple stories. Stories with rhymes and phrases that repeat may catch your toddler’s attention. Around 12 months of age, you can start to ask simple questions about the pictures in the book such as, “where is the dog?” and watch to see if your baby points or gestures.

Prader-Willi Syndrome is a rare genetic disorder that results in a number of physical, mental and behavioral problems. A key feature of Prader-Willi syndrome is a constant sense of hunger that usually begins at about 2 years of age. In Prader-Willi syndrome, a defect on chromosome 15 disrupts the normal functions of a portion of the brain called the hypothalamus, which controls the release of hormones. A hypothalamus that isn't functioning properly can interfere with processes that result in problems with hunger, growth, sexual development, body temperature, mood and sleep.

People with Prader-Willi syndrome typically have mild to moderate intellectual impairment and learning disabilities. Behavioral problems are common, including temper outbursts, stubbornness, and compulsive behavior such as picking at the skin. Sleep abnormalities can also occur. Additional features of this condition include distinctive facial features such as a narrow forehead, almond-shaped eyes, and a triangular mouth; short stature; and small hands and feet. Some people with Prader-Willi syndrome have unusually fair skin and light-colored hair. Both affected males and affected females have underdeveloped ge****ls. Puberty is delayed or incomplete, and most affected individuals are unable to have children (infertile).

In addition to having constant hunger, people with Prader-Willi syndrome have low muscle mass, so they need fewer than average calories, and they may not be physically active. This combination of factors makes them prone to obesity and the medical problems related to obesity, such as diabetes, high blood pressure, heart disease, and sleep apnea.

A multidisciplinary team approach is ideal for the treatment of people with Prader-Willi syndrome. Early diagnosis, early multidisciplinary care, and growth hormone treatment have greatly improved the quality of life of many affected children.

The Soleus muscle is the decelerator of the body; it controls the momentum of the tibia. With decreased soleus activation, there are no brakes! In toe walkers, the soleus activity is decreased by 122%.
Due to an underactive soleus, the quads become more active to slow the tibia, therefore we often see our toe walkers using excessive knee extension during gait.

An efficient gait utilizes 10 degrees of dorsiflexion to facilitate passive force production. Shortening of these muscles during toe walking decreases the strength and contribution of the plantarflexor’s passive force production. Impaired calf muscle function causes an immediate compensatory reaction directed towards maintaining overall stability rather than speed. Therefore we see toe walking expends 53% more energy with the gastrocnemius muscles activated 76% more than in a typical ambulator.

Toe walking is neither an ideal nor efficient mode of human mobility. A child who toe walks is trying to meet a need that is worth the extra effort, dysfunction, and musculoskeletal damage. Our job as physical therapists is to find out what that need the child is trying to meet is. If we try to prevent the toe walking without meeting that need, then we limit our potential for success and invite recurrence of toe walking and its associated consequences.

Nursemaid's elbow is a common injury of early childhood where a child's elbow is pulled and partially dislocates. The medical term for the injury is "radial head subluxation." Because a young child's bones and muscles are still developing, it typically takes very little force to pull the bones of the elbow partially out of place, making this injury very common. It occurs most often in children ages 1 to 4, but can happen any time from birth up to age 6 or 7 years old.

Nursemaid's elbow often occurs when a caregiver holds a child's hand or wrist and pulls suddenly on the arm to avoid a dangerous situation or to help the child onto a step or curb. The injury may also occur during play when an older friend or family member swings a child around holding just the arms or hands. Nursemaid's elbow is rarely caused by a fall. If a child injures the elbow when falling onto an outstretched hand or directly onto the elbow, it may be a broken bone rather than nursemaid's elbow.

Because moving the injured arm may be painful, the primary symptom of nursemaid's elbow is that the child will hold the arm still at his or her side, and refuse to bend or rotate the elbow, or use the arm.

A pediatrician, family medicine physician, emergency room physician or orthopedic surgeon can typically make the diagnosis of nursemaid's elbow based on how the injury occurred and the manner in which the child holds his or her arm. In most cases of nursemaid's elbow, the doctor will gently move the bones back into normal position. The medical term for this procedure is "reduction."

To prevent the occurence of this injury, parents should:
❌Avoid tugging or pulling on a child’s hands or arms
❌Never swing a child by holding the hands or arms
❌Never lift a child by holding the hands or arms

Spending the holidays with your littlest ones can be an exciting, but stressful time of year. Here are some tips from the Journal of Pediatric Health Care that will ensure you have a safe start to the New Year!

🎄Place only nonbreakable ornaments on the lower branches of your Christmas tree and avoid placing ornaments that look edible.
🍿Avoid stringing popcorn or hanging tinsel around your tree; these are choking hazards if eaten.
🎈Avoid giving your child balloons unsupervised; they are the number one cause of toy-related choking deaths
😴Plan quiet breaks away from the action during celebrations; little ones can easily become overwhelmed by the many people, sights, and sounds.

Can you believe Christmas is only 5 days away? Do you need more last minute present ideas?

At this age, your baby should be on the MOVE: pulling to stand, cruising, and taking steps to walk independently! Your baby will display a strong desire for independence; continue introducing toys that provide opportunities for active exploration of their environment!

Christmas is just TEN days away!

Here’s Part 2 of our ❄️Holiday Gift Guide Series❄️

Around this age, your baby will begin rolling around to get places! Your baby should be enjoying tummy time more and begin to be able to lift their head and chest off the ground when placed on their belly. Baby will be working hard on sitting without support and you’ll notice baby is bringing EVERYTHING to their mouth to explore toys and objects.

Swipe for a few of our favorite toys to promote fine motor, gross motor, cognitive, and language skills!

Revisiting our holiday gift guide! 🧸

Part 1 of this series focuses on our littlest ones: 0-3 months old.

At this age, baby is working on head control, tracking objects, and strengthening their muscles through all that tummy time 😉

Swipe to see some of our favorites!

Toe walking is considered a typical part of development up to two years of age. Beyond that, persistent toe walking may be cause for concern, and without treatment can lead to a number of impairments later in life. In some cases, persistent toe walking can be a sign of an underlying medical condition such as muscular dystrophy or cerebral palsy. In most cases, the toe walking is “idiopathic” meaning the exact cause is unknown. Physical therapists can help with both surgical and nonsurgical treatment to help your child learn to walk with a heel-toe pattern!

Achondroplasia is the most common type of dwarfism and is a disorder of
bone growth that prevents the changing of cartilage (particularly in the long bones of the arms and
legs) to bone.

The word achondroplasia literally means "without cartilage formation."

Achondroplasia occurs as a result of a spontaneous genetic mutation in approximately 80 percent of patients; in the remaining 20 percent it is inherited from a parent.
This genetic disorder is characterized by an unusually large head (macrocephaly), short upper arms (rhizomelic dwarfism), and short stature (adult height of approximately 4 feet).

Achondroplasia does not typically cause impairment or deficiencies in mental abilities. People with dwarfism can lead healthy, active lives. In general, with proper medical care, life span is not affected by dwarfism. Parents can help their kids lead the best life possible by building their sense of independence and self-esteem outlined in the slides above!

By age 6 months, significant advances have taken place in the vision centers of the brain, allowing your infant to see more distinctly and move their eyes more quickly and accurately while they follow moving objects.

Visual acuity improves from about 20/400 at birth to roughly 20/25 at 6 months of age. Color vision should be similar to that of an adult as well, enabling your child to see all the colors of the rainbow. 🌈

Babies also have better hand-eye coordination at 4 to 6 months of age, allowing them to quickly locate and pick up objects. That includes accurately directing a bottle — and many other things — toward their mouth.

Six months of age is also an important milestone because it’s when your child should have their first children’s eye exam (unless complications arise before this time).🔎

Even though your baby can’t read the letters on an eye chart, your eye doctor can perform non-verbal testing to assess their visual acuity, detect nearsightedness, farsightedness and astigmatism, and evaluate eye teaming and alignment.

At this exam, your eye care practitioner will also check the health of your baby’s eyes and look for anything that might interfere with normal and continuing vision development.

There are six states of consciousness through which your baby cycles several times a day. Two are sleep states; the others are waking states.

1️⃣State 1 is Quiet Sleep, when the baby lies quietly without moving and is relatively unresponsive. If you shake a rattle loudly in her ear, she may stir a little, but not much.
2️⃣State 2 is Active Sleep, noise will startle your baby and may awaken her. During this light sleep, you also can see the rapid movements of her eyes beneath her closed eyelids.
3️⃣As your baby wakes up or starts to fall asleep, she’ll go through State 3: Drowsy. Her eyes will roll back under drooping eyelids and she may stretch, yawn, or jerk her arms and legs.
4️⃣Once awake, she’ll move into one of the three remaining states. In State 4, Quiet Alert, your baby may be wide awake, happy, and alert with a relaxed body. This is the time when she’ll appear most responsive to you and the activity around her, and be most attentive and involved in play.
5️⃣During this alert, happy state you may notice your baby become more active. This is State 5 or Active Alert. Your baby may become easily overstimulated during this behavioral state.
6️⃣When your baby is overstimulated, they enter State 6 or Crying. Your baby will have a difficult time receiving new information or sensations during this time and need to be comforted.

As your baby’s nervous system becomes more developed, she’ll begin to settle into a pattern of crying, sleeping, eating, and playing that matches your own daily schedule. She still may need to eat every three to four hours, but by the end of the month she’ll be awake for longer periods during the day and be more alert and responsive at those times.

Ideally, pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. An aerobic activity is one in which you move large muscles of the body (like those in the legs and arms) in a rhythmic way. Moderate intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing.
Examples of moderate-intensity aerobic activity include brisk walking and general gardening (raking, weeding, or digging).

You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute workouts throughout each day.

If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.

There are a few precautions that pregnant women should keep in mind during exercise:
💧Drink plenty of water before, during, and after your workout. Signs of dehydration include dizziness, a racing or pounding heart, and urinating only small amounts or having urine that is dark yellow.
🥵Avoid becoming overheated, especially in the first trimester. Drink plenty of water, wear loose-fitting clothing, and exercise in a temperature-controlled room. Do not exercise outside when it is very hot or humid.
❌Avoid standing still or lying flat on your back as much as possible. When you lie on your back, your uterus presses on a large vein that returns blood to the heart. Standing motionless can cause blood to pool in your legs and feet. These positions may cause your blood pressure to decrease for a short time.

To be eligible for EI services, a child must have either (1) a developmental delay consistent with the State definition of developmental delay; or, (2) a diagnosed condition with a high probability of developmental delay. To be eligible for preschool services, children must have a significant developmental delay that adversely affects the child’s ability to learn.

A developmental delay has to be measured by qualified personnel using informed clinical opinion, appropriate diagnostic procedures and/or instruments and documented as:
• a 12 month delay in one functional area, or:
• a 33 percent delay in one functional area or a 25 percent delay in each of two areas, or:
• a score of at least 2 standard deviations below the mean in one functional area or of at least 1.5 standard deviations below the mean in each of two functional areas.

Diagnosed conditions with a high probability of delay are:
• chromosomal abnormalities associated with developmental delay (e.g., Down Syndrome)
• syndromes and conditions associated with delays in development (e.g., fetal alcohol syndrome)
• neuromuscular disorder (e.g., any disorder known to affect the central nervous system, including cerebral palsy, spina bifida, microcephaly or macrocephaly)
• clinical evidence of central nervous system (CNS) abnormality following bacterial/viral infection of the brain or head/spinal trauma
• hearing impairment (a diagnosed hearing loss that cannot be corrected with treatment or surgery)

A preschool child can be classified as a preschool student with a disability if he/she meets the criteria set forth in the current disability classifications in the Part 200 regulations:
• autism
• deafness
• deaf-blindness
• hearing impairment
• orthopedic impairment (caused by congenital anomalies, disease, or impairments from other causes)
• other health impairments (including but not limited to heart condition, tuberculosis, sickle cell anemia, asthma)
• traumatic brain injury (acquired)
• visual impairment

Sickle cell disease is an inherited red blood cell disorder where the red blood cells become hard and sticky, forming a crescent moon shape. 🌙This abnormal shape makes traveling through small blood vessels difficult as they get stuck and clog the blood flow. This can lead to severe pain and other serious problems including infection, stroke, and even death.

Physical therapists play a large role in education, treatment, and prevention of exacerbations. Patients with sickle cell disease may have an intolerance to exercise and may fatigue quickly due to anemia. PT's should be mindful of this and gradually work up to moderate levels of exercise with frequent rest breaks. During painful episodes, therapists should avoid overexerting the patient, and should look out for stressors that may include dehydration or cold.

Check out our probono kids working hard in the with our DPT students!

Between the 4th and 5th month of life, your baby should begin:
🤦🏻‍♀️watching his or her hand movements
🙆‍♀️reach for objects or your face
🤭bring objects to his or her mouth
👀move his or her eyes from person to person or object to object.

👁👁By the 5th month of life, your baby’s eyes should be straight and neither eye should turn up, down, in, or out.

❗️If this is still a concern, you may need to bring your child to a pediatric ophthalmologist or optometrist for further evaluation.

Bottom shuffling is a locomotion strategy that some infants use before independent walking. Bottom shuffling is where an infant moves forward in a sitting position using their buttocks, legs, and/or arms.

Okai et al discovered in a sample of 48 bottom shuffling babies, 42% were later diagnosed with autism (ASD). The rate of poor eye contact and a delay in the first word spoken were also significantly higher in the infants who later were diagnosed with ASD.

The reasons why infants bottom shuffle are still unknown and are likely multifactorial. Interestingly, a family history of bottom shuffling was significantly less frequent in the infants later diagnosed with ASD. Given the high incidence of a family history of bottom shuffling in the non-ASD group suggests there may be a genetic predisposition.

DOI:https://doi.org/10.1016/j.braindev.2020.08.007

Diastasis re**us abdominis is a separation of the left and right sides of the outermost abdominal (stomach) muscle.

It is caused by forces that stretch the connective tissue called the linea alba. This condition most often occurs in pregnancy, but also may occur in infants, older women, and men.

Physical therapists help adults manage their symptoms, improve their strength and stamina, and safely return to their regular activities. In most cases it resolves on its own and does not impair function. Studies show that starting a program to stabilize the core and pelvic-floor muscles in early pregnancy is highly effective.

All physical therapists are prepared through education and experience to identify and treat diastasis re**us abdominis. However, you may want to consider:
✔️A physical therapist who has experience working with people who have diastasis re**us abdominis. Some physical therapists have a practice with a pelvic or women’s health physical therapy focus.
✔️A physical therapist who is a board-certified clinical specialist in women’s health physical therapy (with a WCS credential) or who has completed advanced education in obstetrics physical therapy offered through the Academy of Pelvic Health (CAPP-OB), or who completed a residency or fellowship in women’s health physical therapy. These physical therapists have advanced knowledge, experience, and skills in pregnancy and postpartum rehabilitation and have the training credentials to treat both men and women with DRA.

Baby’s vision makes several important advances during months two and three. Infants develop sharper visual acuity during this period, and their eyes begin to move better as a team. By this point, your baby should be following moving objects with their eyes.

Infants at this stage of development are learning how to shift their gaze from one object to another without having to move their head.

Their eyes are now becoming more sensitive to light. At 3 months, an infant’s light detection threshold is only 10 times that of an adult. You may now want to dim the lights a bit more while they’re sleeping.

Human faces are one of their favorite things to look at, especially their own or a parent's face. Install a baby-safe crib mirror at your baby's eye level and see how your baby watches himself or herself.

Your baby's color vision is also developing, so brightly colored wall hangings or toys will help develop this skill. Soft pastel colors, though, are hard for a baby to see — something to keep in mind when buying toys and books.

There are numerous benefits to standing, some of which have been evaluated scientifically and others that have been noted anecdotally by children and adults using standers. These are just a few of the potential benefits:
⭐️Improve muscle strength in the legs
⭐️Improve endurance and overall cardiovascular health
⭐️Prevent or improve contractures in the legs by providing a gentle stretch
⭐️Improve bone mineral density and strengthen bones
⭐️Prevent or minimize hip dislocation or the development of hip dysplasia
⭐️Prevent pressure sores by offering another position
⭐️Improve circulation
⭐️Improve breathing
⭐️Improve constipation
⭐️Improve urinary function
⭐️Improve sleep
⭐️Improve self-esteem and social interaction by placing the child in a position more typical of his peers

Check out this rockstar working on her standing! 🤩

According to the American Academy of Pediatrics (AAP), almost all children should wear a mask, with the following exceptions:
👶Newborns, babies, and toddlers under age 2 should not wear a mask, because they could suffocate.
If the available mask is a choking or strangulation hazard for a given child, it should not be worn. This is more likely to affect children with behavioral or developmental conditions.
🏥Children with medical conditions, such as those who have difficulty breathing with a mask or those who cannot physically remove a mask, should not wear a mask.
✋🏻Children who are unable to stop touching the mask (or face while wearing a mask) should not wear one, since repeatedly touching the mask or face will increase the risk of infection. Again, this is more likely to affect children with behavioral or developmental conditions, as well as some very young children.

The following recommendations relate to special situations that may require different mask-wearing techniques.
🦻Children with Ear Abnormalities or Hearing Aides-- Children who cannot wear a mask over their ears, whether due to ear abnormalities, hearing aides, or other issues, have many other options. Try a mask with two elastic bands that wraps around the head or use a headband or hat with buttons sewn or pinned on either side to hold the mask. Some children may be able to use an ear saver to secure an ear-loop mask’s elastic behind the head

😷Children with Trachs-- Children with trachs should ideally wear a facemask as well as a secondary cloth covering over their trach, as long as it does not impede their breathing in either location. A bandana-style bib is a good choice for a trach covering. Always monitor with a pulse oximeter to make sure the child is able to breathe properly with the coverings in place

👧Children with Developmental and Intellectual Disabilities-- Children of all ages with developmental disabilities, as well as young children, may benefit from social stories and other targeted information about mask-wearing. Trying multiple different fabric and securement styles may help you find a product that works best.

Lazy eye (amblyopia) is reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward.

Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision among children. Rarely, lazy eye affects both eyes.

Lazy eye develops because of abnormal visual experience early in life that changes the nerve pathways between a thin layer of tissue (retina) at the back of the eye and the brain. The weaker eye receives fewer visual signals. Eventually, the eyes' ability to work together decreases, and the brain suppresses or ignores input from the weaker eye.

Anything that blurs a child's vision or causes the eyes to cross or turn out can result in lazy eye. Common causes of the condition include:
● Muscle imbalance (strabismus amblyopia). The most common cause of lazy eye is an imbalance in the muscles that position the eyes. This imbalance can cause the eyes to cross in or turn out, and prevents them from working together.
● Difference in sharpness of vision between the eyes (refractive amblyopia). A significant difference between the prescriptions in each eye — often due to farsightedness but sometimes to nearsightedness or an uneven surface curve of the eye (astigmatism) — can result in lazy eye.
● Deprivation. A problem with one eye — such as a cloudy area in the lens (cataract) — can prohibit clear vision in that eye. Deprivation amblyopia in infancy requires urgent treatment to prevent permanent vision loss. It's often the most severe type of amblyopia.
Early diagnosis and treatment can help prevent long-term problems with your child's vision. The eye with poorer vision can usually be corrected with glasses or contact lenses, or patching therapy.