When do babies start crawling?

As with all baby milestones, there is a range for when a baby is expected to achieve a certain skill. Despite the CDC recently removing crawling from their list of expected infant milestones, it is the opinion of this infant physical therapist (and pretty much every other infant physical therapist) that crawling is one of the most IMPORTANT milestones that your baby can achieve. Your baby needs to move through SO many developmental stages, and put a lot together to achieve crawling on hands and knees. Let’s look deeper into this:

Hopefully, since birth your baby has been working on developing head, neck, and arm strength during tummy time. Over those early months, your baby has learned how to lift their head against gravity, extend their neck and trunk, and eventually push up with their arms. Sustained tummy time while playing with toys and reaching, develops the shoulder stability necessary for crawling.

Hopefully by 6 months your baby has achieved the ability to roll both on and off of their belly. Learning to roll has helped your baby develop core strength and trunk mobility - also necessary components of crawling. Independent sitting is expected by 7 months, where your baby has developed enough core strength to maintain an upright position for play. 

Moving in and out of sitting gives your baby the opportunity to stretch their hips in preparation for crawling. Babies’ hips are used to being open and turned outwards from birth, so it can take some time for their hips to build up strength in positions such as kneeling and “hands and knees.” Lots of time exploring how their body can move in and out of positions is an important developmental stage prior to learning how to crawl.

Finally the answer to today’s question: When do babies start crawling? MOST babies will achieve crawling after a period of “army” or belly crawling, finally moving around well on their hands and knees by 8-10 months of age. 

Crawling on hands and knees, or “creeping” is the culmination of many baby milestones. It requires shoulder strength, single arm stability, core strength, head extension, hip strength, single leg stability, balance, coordination, and reflex integration. It can take some babies extra time to achieve this BIG milestone. If you are looking for guidance, I’m here to help! I’m a big believer that babies should not skip crawling, as it has so many benefits.  

If you are feeling like your baby might need some help, let’s discuss the possibility of working together one-on-one in the comfort of your home. (I have found that this is where babies and their parents learn best!) I offer free consultations over phone or video, so that we can all feel comfortable before I show up at your home to get to work. Reach out today!

Also, I hope that you have already heard about Playful Progress’s Pediatric PT Workshops, but if not, here’s the scoop: Every other Monday, I host playgroups for infants (6 months and up) and their caregivers, so we can learn together about all the milestone magic that happens from sitting to walking. There is a lot for your baby to work on, and I have LOTS of tips to share. I hope you will join me!

Benefits of In-Home Pediatric Physical Therapy

I LOVE providing physical therapy to your babies in your home. I truly believe that it is the best setting for achieving therapy goals and building a relationship with your family. Let’s chat about why your home is the best setting for receiving pediatric physical therapy, especially during your child’s infancy.

It’s convenient!

One of the greatest benefits of in-home pediatric physical therapy is the convenience it offers. Now that you have a newborn, leaving the house for even a simple errand can feel like a monumental task. Packing up all the essentials—diapers, bottles, and a sleepy baby— to head out into the world with it’s unpredictable challenges can be overwhelming. I’m all about less stress, and having me arrive at your doorstep makes things SO much easier.

It’s comfortable

The post-partum period includes physical recovery and emotional adjustment for everyone. I don’t need to tell you about the challenges: fatigue, physical discomfort, and increased stress. I have been there. And even though each family’s journey is different, I DO understand. It’s important to know that I’m here to support your baby and YOU during this very new and very challenging time. I consider it a privilege to be invited into your home during this special time for your family. It is my goal to help ease some of your worries and concerns, as well as provide you with specific play-based activities you can do with your baby to increase your confidence and help meet your goals. In my experience, babies (and their parents) learn best in the comfortable relaxed environment of their home.

The comfort and familiarity of home also help in building a stronger therapist-parent relationship. It is my hope that you will ALWAYS feel comfortable asking me questions and sharing your concerns, but I have found that when I’m in families’ homes, parents are able to engage more in their child’s therapy sessions, perhaps because they are in their most comfortable, relaxed setting.

It’s individualized

In-home therapy allows me to observe and address your baby’s development in their natural setting. This allows me to provide the most personalized and effective treatment plan. We will discuss your family’s daily routine, what equipment to use (and NOT use), and I’ll offer tailored advice that aligns with your family’s specific needs and priorities. I will NEVER recommend an exercise or activity that you do not feel comfortable doing with your baby when I’m not there. When I’m at your home, we are working in your space with your toys, so carryover is that much easier.

Pediatric physical therapy has many benefits for new babies such as getting them more comfortable with movement, decreasing body tension, helping them with breastfeeding efficiency, and achieving symmetrical posture. In my experience, achieving these important goals happens best a home! It is my goal to provide the best pediatric physical therapy experience for your baby and your family which is why I prefer the convenient, comfortable, individualized setting of your home.

What is a Certified Breastfeeding Specialist?

Last month, I completed over 52 hours of online training to become a Certified Breastfeeding Specialist (CBS). I made the choice to invest in this training because I have seen firsthand how motor challenges affect an infant’s ability to successfully breastfeed. In fact, I share the opinion many well-known infant physical therapists that breastfeeding should be considered an infant’s first motor milestone. Most often, if breastfeeding isn’t going well, it will also lead to motor delays in the coming months such as difficulty with tummy time, decreased rolling, etc.

I received my CBS training from Lactation Education Resources, who also certifies lactation consultants. I received education about infant’s oral anatomy, composition of human milk, the normal course of pregnancy and lactation, cultural considerations for breastfeeding, nutrition for breastfeeding, pathologies related to breastfeeding, and the effects of medications.

As a physical therapist, I most enjoyed learning about infant oral motor needs for successful latch and suck, as well as a variety of breastfeeding positions. This training confirmed that successful breastfeeding requires strength, coordination, and functional mobility. This is where physical therapists are experts! Increased body tension that is so common with infants, especially those with tongue ties, affects their ability to latch, suck with coordination, and tolerate positions required for breastfeeding success.

I now feel more confident than ever to support breastfeeding infants and their caregivers, and communicate and collaborate with the amazing lactation consultants we have in southern New Hampshire. If your baby is struggling with breastfeeding, reach out! There is so much I can do to help.

Why do some babies need Physical Therapy?

I have found that most people don’t have ANY idea why a baby would need physical therapy. When I tell people that I’m an infant physical therapist, I’m often looking back at a confused face…so let me take this chance to explain what infant physical therapists like me do, because it is actually quite a lot!

I’m a list maker, so let’s start there. Here is a list of the most common reasons I would work with a baby (not in any particular order):

• torticollis (head turn preference)

• plagiocephaly (flat head syndrome)

• increased body tension or discomfort

• delayed motor milestones

• before and after a baby has a frenectomy (tongue tie release procedure)

• breast or bottle feeding challenges

• developmental education

Torticollis

You can read more about this diagnosis in a previous blog post. Torticollis is a fairly common diagnosis that affects a baby’s posture with a peristent preference to look to one side. This might not seem like a big deal, but for babies that spend a lot of time on their backs, this can make exploring their world, and meeting their next milestone very challenging. Neck tightness is uncomfortable, and can be related to feeding challenges. Untreated torticollis often also results in changes to a baby’s head shape, sometimes leading to plagiocephaly.

Physical therapy helps babies with torticollis by getting them to find midline head position, helping them move their head and body with symmetry, and educating parents.

Plagiocephaly

This is a BIG fancy medical term for “asymmetrical head shape.” I also wrote in-depth about plagiocephaly in a previous blog post. Young babies are at risk for plagiocephaly because their skulls are so soft, and they spend a lot of time lying on their backs. The good news is that physical therapy is super effective in treating plagiocephaly, especially when started early (like, BEFORE 2 months old).

Physical therapy helps babies with plagiocephaly by educating parents about play, teaching symmetrical movement, and strategic positioning to reshape their child’s head.

Increased Body Tension/Discomfort

There are lots of reasons why your baby might seem “uncomfortable.” Often, it is difficult to tease out the root cause, as their can be so many contributing factors, and unfortunately, babies can’t let us know how they are feeling in a straight-forward way. Torticollis or tethered oral tissues (TOTs) are often big culpits when it comes to infant discomfort. Feeding challenges can also cause discomfort, especially if your infant is gassy or demonstrates reflux symptoms.

Physical therapy can help reduce discomfort by addressing range of motion restrictions, assisting your baby in finding movement that feels comfortable, and releasing tension with manual techniques.

Delayed Motor Milestones

Infant physical therapists are skilled at helping babies achieve their next motor milestone. Each important skill builds on the next, so it is always best to address any concerns as soon as possible. Physical therapists assess infants for tightness, weakness, or asymmetry that often contributes to motor delays. Motor challenges are often first noted during tummy time, where your baby might have difficulty picking up their head, or immediately get upset in a belly-down position. Read about ways to make tummy time easier here.

Individualized physical therapy can provide you with specific exercises, positions, and playful activities to get your baby rolling, sitting, crawling, and walking. I love celebrating each of these exciting milestones with the families I work with!

Before and After a Frenectomy (tongue tie release procedure)

A frenectomy, or tethered oral tissue (TOTs) release procedure, is a surgical procedure that is not without risks. It should not be an immediate response to the identification of a tongue, lip, or cheek tie(s). The presence of a frenulum is only one contributing factor in making this big decision. What is most important is how your baby’s tongue is functioning. Physical therapists that are trained in the treatment of tethered oral tissues (TOTs) are uniquely qualified to look at tongue mobility, tongue function, feeding position tolerances, and whole-body movement patterns that all are important for your infant’s feeding success.

Physical therapy for your baby with a possible tongue tie should happen BEFORE you consider a frenectomy. Often, with physical therapy treatment, surgical procedures can be avoided. If it is determined by your team of providers that a frenectomy is the best choice for you baby, you will see the best outcomes when you seek out visits with a physical therapist BEFORE and AFTER the procedure.

Breast and Bottle Feeding Challenges

It is my opinion that your babies first motor milestone is feeding! It requires strength, coordination, and functional mobility to achieve the wide latch and strong suck required for successful feeding at the breast or bottle. Breastfeeding can be especially challenging (and painful for Mom!) if your baby does not have full tongue mobility and/or increased oral tension. Initially, some of the necessary movements for breastfeeding are reflexive, or automatic, but this natural assistance fades with time. If you feel that your infant could use extra help, please reach out. There is so much we can work on, and infants usually make quick progress with focused exercises. Babies that move better, feed better!

Developmental Education

I love educating families about the “magic” of developmental milestones. It is amazing to me how each skill truly builds on the next, and that skipping a skill might not seem like a big deal at the time, but often causes future issues (i’m looking at YOU, crawling). One the best parts of my job is giving parents the tools to help their little one succeed in achieving their next milestone. I do this education in my one-on-one sessions, and in my motor play workshops, which I host weekly on Monday mornings at Wellness Village NH.

Hopefully, (if you made it this far) you are feeling extra educated about what it is that an infant physical therapist does. I would love to answer any additional questions on your mind, and as always, I’m here in southern NH to provide direct services to your babies from birth through walking. Reach out today for a FREE consultation so we can talk specifics about what is going on with your baby.

Understanding Plagiocephaly (Flat Head Syndrome)

What is plagiocephaly?

Plagiocephaly… sounds like a pretty scary word, but honestly, it is just the medical term for an asymmetrical head shape.  The roots “plagio” and “cephal” mean “oblique, slanted” and “relating to the head” respectively.

Asymmetrical head shapes are fairly common these days with some reports that 45% of infants have plagiocephaly in some form. Incidences of plagiocephaly have significantly increased since the “Back to Sleep” campaign of the 80’s where parents were encouraged to keep their babies off of their bellies during sleep. The reasoning behind this is the strong link between SIDS (sudden infant death syndrome) and being positioned belly-down for sleep prior to 6 months of age. This, of course, means that babies started spending a lot more time on their backs. It also means that a lot of parents have more anxiety about positioning their babies on their bellies. But that’s another topic. 

What are the three types of plagiocephaly?

Plagiocephaly, Scaphocephaly, and Brachycephaly. 

Plagiocephaly is the most common type of atypical head shape. The head takes on a “parallelogram-like” shape due to lying down with pressure more on one side of the head  than the other. Babies with general plagiocephaly usually have flattening of the rear of their skulls on one side, not centered. More involved plagiocephaly can include flattening and asymmetry of the baby’s face as well.

Brachycephaly describes a head shape that is wide and flat at the rear. This head shape is common for babies who have had medical issues that have required them to lie flat for extended periods of time, or babies that spend a good amount of their day in car seats, bouncers, and swings.

Lastly, Scaphocephaly describes a narrow, elongated head shape. This shape is more common in babies born prematurely.  This shape poses a unique challenge because babies with scaphocephaly have difficulty keeping their head centered, usually keeping their head turned to either side.

Why does my child have plagiocephaly? 

There are many reasons for why your child may have developed plagiocephaly: 

• In-utero positioning

• postural preferences (possibly caused by torticollis) 

• first born babies due to less uterine capacity

• increased time lying on their backs with head against firm surface in car seats, bouncers, swings

The sutures of infants’ skulls are soft and malleable. This is particularly important when exiting the birth canal. In fact, infants’ skulls collapse slightly when they enter the world through their mother’s vaginal canal. This helpful malleability also means that head shape can change significantly based on the forces that are applied to it. 

If your child is in the same position in-utero for many months, then you can see how a soft malleable skull would come out in an asymmetrical shape. Often times babies enter the world with round heads, but quickly develop plagiocephaly due to postural preferences, such as always keeping their head turned to one side. If your baby prefers to look to the right, and spends a lot of time on their back (as most newborns do), gravity will begin to shape their soft head into more of a parallelogram shape than a circle. The good news is we can use this same malleability to correct their head shape with strategic positioning exercises.

What should I do if my baby has a flat spot?

Infant physical therapists are uniquely qualified to treat plagiocephaly. If your child is seen before 4 months of age, there is an extremely good prognosis. Significant change in head shape can happen with a commitment to repositioning at this young age. Often, a helmet can be completely avoided. If you wait until after 6 months, prognosis goes down significantly. When it comes to plagiocephaly. Early action is more important than ever. As your baby ages, the malleability of their skull  decreases as sutures start to fuse together and form a more solid skull. In order to take advantage of the skull’s ability to reshape, it is important to start treatment prior to four months of age.

Making sure that your baby’s neck can move well in all directions is an important part of treating plagiocephaly.

Need help?

I started my career treating infants with torticollis and plagiocephaly, and have continued to do so throughout my 15+ years working in pediatrics! I have advanced training on how to treat plagiocephaly without a helmet, including strategic positioning and stretching techniques. Do you have a baby with a not-so-round head shape? Reach out today for an evaluation… Don’t wait! I offer free consultations where we can get all of your questions answered prior to beginning treatment. I look forward to hearing from you and answering any additional questions you might have.

Understanding Torticollis

Finding out that your baby has torticollis is scary. It doesn’t help that this diagnosis has such a scary name: torticollis. What is torticollis? How did my baby end up with it? What can I do about it? These are the questions I hope to answer for you today.

Torticollis is the tightening of the sternocleidomastoid muscle (SCM)  in your baby’s neck. This muscle is responsible for both rotating and side bending your baby’s head. When this muscle is tight, your baby most often has a preference to look in one direction and rests with their head tilted to the other side.

The Latin roots for the word “torticollis” mean twisted (“tort”) and neck (“collis”). Because the SCM attaches behind the ear at your baby’s mastoid process and at their sternum, when this muscle is tight, it pulls your baby’s head into a rotated and side bent position. Most parents notice that their child prefers to look only to one side, or they keep their head tipped to one side, or both.

Other signs/symptoms of torticollis may include:

• preference to move one arm more than the other

• leaning to one side when on belly or in sitting

• decreased tolerance to side lying position

• difficulty with tummy time

Almost always, your baby’s torticollis started from their position in the womb. Torticollis is more common in babies of larger size and of multiples where there was likely less space for your baby to stretch out. It is important to understand that your baby’s diagnosis is NOT your fault! Torticollis is very common, but not commonly discussed. You are not alone.

If you are reading this post about torticollis, you are already on your way to helping your child. Understanding the diagnosis of torticollis is one of the most important steps in treatment. When it comes to torticollis, the concept of early intervention, that is, “Earlier action leads to better and faster outcomes,” could not be more true. Studies have shown that starting physical therapy treatment for torticollis prior to 2 months old leads to almost 99% resolution in less than 2 months.

Physical therapy treatment of torticollis includes lots of education, strategic play positions to stretch and strengthen your baby’s muscles, and focus on symmetrical posture and movement. I have helped numerous babies work through their torticollis and successfully meet their milestones.

I would love to help your baby! I offer convenient in-home physical therapy. Reach out today for a free consultation or schedule an evaluation ASAP.

I look forward to meeting you and your sweet baby.

How to Make Tummy Time Easier

As a new parent, I’m sure you have heard about how important it is to do tummy time with your baby. But, has anyone explained WHY it is important?

If you are like me, you like to know the WHY behind things…let me help you with this!

As newcomers to our world, babies “workout” by moving their body against the force of gravity. Since new babies spend a lot of time on their back, this gives them plenty of opportunity to strengthen the muscles on the front of their bodies, mostly the muscles that perform flexion movements, very well.  

When we put our babies on their bellies, we are TOTALLY changing the game. Now your baby has to use the muscles opposite to those they are most used to using, the muscles that perform extension movements. This is HARD work!

Tummy time can be frustrating to babies and their parents because it is so challenging. Have no fear, I’m here to help! There are LOTS of ways to modify tummy time to make it easier for everyone.

Before providing some tips, I have to share my 3 rules of tummy time:

1. QUALITY of  tummy time is much more important than QUANTITY of tummy time

2. If your baby is upset in tummy time, it is time to take a break. Even better if you can read your baby’s cues and take a break BEFORE they are upset.

3. Help your baby feel the transitional movements in and out of tummy time.

Quality tummy time means that your baby is supported with their arms tucked under their shoulders. They are lifting their head and pushing through their arms. It is OK if you need to help them be successful with this…I will share tips for that in a bit. Quality tummy time can be 10-15 seconds at a time. You will quickly notice that your baby can tolerate more, but they need to start somewhere!

Making sure that your baby doesn’t associate being on their belly with being upset is important. Try doing tummy time in front of a mirror, so that you can monitor your baby’s facial expressions and “roll out” before they get upset.  Also listen to your baby. There is a big difference between “hard working” noises, and being upset.

Lastly, learn how to safely roll your baby onto their belly and off. It is important for your baby to begin to get comfortable with movement, especially because we will be expecting them to complete these movements without help in the near future.

Now that we have the RULES out of the way, let me share some tips with you. I suggest trying each of these alone, and pairing some together. It is totally OK to help your baby with their tummy time, especially at first. You will be amazed with how quickly you can peel back some of this help.

Inclines

Placing your baby on an inclined surface with their head/shoulders above their hips, reduces how hard they have to work against gravity (think: doing a plank on the floor is much harder than having your hands up on a bench). Your chest can be an inclined surface if you sit in a reclined position. You can also prop up one end of a couch cushion to make your own inclined surface.

Physical Support

Initially it is helpful to provide physical support at your baby’s shoulders, helping them to position their arms under their shoulders to create a solid base of support. As your baby gets stronger, you can move your hands down their body to support them at their trunk or pelvis. When you provide a point of stability for your baby, they are usually much more successful lifting their heads and pushing with their arms.

You can learn many more Tummy Time tricks and tips at one of my Tummy Time Workshops.. I would LOVE to have you there. You can explore available dates here: Workshop Scheduling