Why are milestones so important in the first year?

Most kids end up walking - eventually.. So, why does the doctor even bother with a questionnaire to check on development?

We know that most kids will eventually walk.  I hear from parents all the time, "they will walk when they are ready." 

There are a few major shifts in behavior in kids in their first year of life.  The first comes along when you see that they are starting to get motivated to move by any means possible.  They are exerting their independence and showing a desire to move and explore, which is one of the ways babies learn.

The second shift comes along when babies learn how to move fast, by crawling (some by scooting).  They have just opened their world and can access a much broader range of the environment to learn from.  Their learning opportunities increase exponentially.

The third shift comes when they get upright and mobile - meaning walking!  Their world suddenly shifts from being 1 foot off the ground to a couple feet.  They can see whole rooms better than before, they can get to things faster than before and once again their learning opportunities increase exponentially.

When a child is delayed in walking (or crawling) it isn't often that we worry that the child will never walk, it's more that we worry about all of the learning opportunities the child is missing out on.  Learning is exponential in many ways as babies.  Once they learn one thing about the world they then learn 10 more things from that one thing, then they learn 10 more things from each of the prior 10 things, and on and on. 

When a child is stuck on the floor for too long they miss out on many of these learning opportunities.  Studies have shown that if a child is behind it's really hard for them to catch up in learning (not learning to move but learning about the environment, life, etc.).  I would give you links to research articles, but this blog isn't really about quoting research, its about life as a mom and my experience as a PT.

So, what should you do if your child isn't crawling or walking on time? 

1. The first thing is to call your Early Intervention office and get an evaluation scheduled (I know I sound like a broken record with this, but it is the easiest, best support you are going to get for FREE).
2. Secondly, make sure your child has access to as much of the world as possible.  Don't leave them sitting in one place all day - move them around the house so they can see different rooms, hallways, everywhere.  Make sure you aren't using too many "contraptions" or containers (pack and plays, chairs of any sort, bouncers, etc).  The best way for your child to learn is to get out there on the floor moving!  Not be stuck in some sort of contraption.
3. Third, talk, talk, talk.  Talk to them about everything and anything!  This is great to do even if they are on schedule with movement.
4. Talk to your doctor about resources to help you and your child and to ensure there is no medical reason your child isn't moving.

When should you get worried?  Try not to worry, all kids are so different but use these loose guidelines:

1. Not moving in circles or backwards on their stomach by 7 months
2. Not crawling (or sometimes scooting) by 11 months
3. Not walking by 15-18 months

Happy learning for you and your child!

The difference between a mom and a physical therapist for kids

As a  PT for kids you would assume that I know what to do with kids, I have built my career on it after all!  But being a mother I have found basically erases any and all knowledge of what I know I SHOULD do...

There is a sympathy factor that I lack as a PT, I am fine with kids whining and whining doesn't stop an activity, but tears do.  As a mother I give in to the whine way too much!  It just tugs at my heartstrings when my kids whine or cry!  I know that when Jemma takes a toy from Charlie for the 20th time I should probably take it from her and give it back to Charlie, but both Charlie and I have a soft spot and dread of Jemma crying - so I don't.  Charlie will usually let his sister take his toys, tug on his ears, pull his hair without even a whimper (unless I haven't cut her fingernails for awhile)!  In Jemma's world what's hers is hers and what's yours is hers!  As a PT I would likely counsel a mom on just what to do in this situation (likely the advice would have something to do with just ignoring the tantrum that just occurred because a toy was given back to Charlie) but as a mom I find myself coaching Charlie how to keep his toys instead.  I know I'm just trying to avoid a Jemma tantrum (I'm sure I will live through plenty of them but at 8 months it seems a little early for her and I to go to battle over anything).

As a PT I would be very bold and give Jemma's beloved bath toy (a sand sifter $0.50 at Target, I'll never understand why this became her beloved toy, but if I would let her she would take it to bed with her) to Charlie at least once to explore it and see what he's missing - but as a mom tonight I was totally chicken and just hid the bath toy and didn't even bring that one out!  Jemma throws herself into a tantrum every time I take it from her even when bath time is over and it's time for a bottle!!

It's the same with nighttime.  As a PT I wouldn't bat an eye at letting a baby of 8 months cry for at least 10 minutes in the middle of the night before going in to give them a bottle, but as a mother, of Charlie, I find myself in their room with a bottle before I can even fully open my eyes because I hear his cry.

There is another factor I have as a PT that I don't seem to have as a mom and that is creativity for new activities, games, and songs to get kids to do what I want and need them to do in PT to progress in their development.  At home as a mom I find all three of us are bored more than I care to mention and I am truly embarrassed by this fact! 

My babies are generally very happy and really don't cry very often unless they are hungry or tired, but who knows what the future will bring!  Every day that goes by they get easier and harder at the same time!  I never expected to have this shift with my own kids!  Just goes to show you - or show me!!!!

Flooring - Could this be why your child isn't walking or crawling yet?

I don't know about where you live but in Colorado there seems to be an ever increasing amount of tile floors.  Whether it's being put in because it's cheap or easy to clean in rental homes I'm not sure, it certainly isn't to keep the house cooler here in Colorado!

For ages babies have been learning to crawl and walk on all types of flooring - even dirt floors!  So the likely culprit behind a baby not crawling or walking on time isn't the floor itself.

It seems that parents are more reluctant to put a child down on a floor that is tile or wood.  On carpet parents seem fine putting a baby down on their stomachs, but on wood or tile they try to lay a blanket down or they put them on the bed or couch instead.  Tummy time is still important no matter what kind of floor you have, but it does seem more difficult or scary on tile.  Wood floors are surprisingly soft, heads will still "bonk" on it causing crying with crashes, but wood is a lot softer than tile.

So, if you have tile floors you can scour second hand stores and get rugs or foam play mats to cover them up or if you can afford them just go get a rug or foam play mat.  But a rug or mat will limit the amount of space your baby can explore.  You can also head to the dollar store and get a non-slip mat that usually goes under rugs but will provide a little bit of cushion itself or a roll of non-slip drawer liner for a couple dollars that you can lay down for a little bit of cushion. 

If you child is learning to walk on a tile floor it can be scary for parents.  By the time a child learns to walk they have hopefully learned how to protect their head but it is important to be near and avoid major crashes while they are learning.

If your child is having trouble learning to crawl it likely isn't the floor itself, but if they have any weakness in their muscles it will exacerbate the issue.  So, the first thing to do is ask yourself if they have been on the floor enough?  They should be on their tummies on the floor each time they are awake for at least a couple of minutes - as they near 6 months they will hopefully be playing on the floor on their tummies for 5-10 minutes at a time.  They should be pushing up high enough with their arms to get their tummies off the ground by 6-8 months or so, if they aren't pushing up high enough to get their tummies off the ground try giving them some more time to practice during the day on their tummies.  You may have to entertain them more than normal to keep them on their tummies longer than they are used to.


If your child is having trouble learning to walk it also isn't likely the floor itself.  Try having them play in standing at a couch or table longer by putting their toys up on the furniture.  You can stay close and guard them if you are worried they will fall and hit their head on a hard floor but try to let them play without holding onto them the whole time.  Sometimes just a little more time in standing will increase their balance and strength enough to have the confidence to try a first step.

As always - it's a great idea if you feel your child is delayed in any movements to call and get an evaluation for Early Intervention services and talk to your doctor.  Sometimes a little support is all you and your child need!  If nothing else from the evaluation you will like pick up some great tips to get your child moving better and faster!

Tummy Time - They hate it! Now what?

So, you've tried tummy time and your baby doesn't like it!  What next?

First, take a good look at tummy time.  Is your baby crying after 30-60 seconds of being there or are they starting to cry even as you start putting them down on their tummy or is your baby just fussing but not really crying?  Is your child consolable or distractible while they are on their tummy, can you play or sing with them to get them to stop crying?

If your child is just fussing but not really crying, persist, persist, persist!  They are telling you they don't really like it but will tolerate it.  Try to bring out a special toy only when they are on their tummy, when they are not on their tummy the special toy goes away.  This will make tummy time a little bit special and hopefully you will be able to build time when they are happy there and not fussing or crying.

If your child is starting to cry after a short time (30-60 seconds) congratulations!  You have a starting point to work from.  After you put your child on their tummy try to play or sing with them to extend the time by about 30 seconds every day.  Before you know it they will be spending 5 minutes or so on their tummy.

If your child is starting to cry right when you put them down and they are inconsolable until you pick them up try the following:

1. Call your Early Intervention provider and schedule an evaluation.  A little help from a physical therapist might be just the trick.  Even if your child doesn't quality for Early Intervention services at this time you will pick up some good hints and tricks to try from the therapists that do the evaluation.

In Colorado this is the link to contact Early Intervention:  http://www.eicolorado.org/

In other states if you Google the term "Early Intervention" and your state name the contact information should come up easily.

2. Call your doctor and see if you can schedule an appointment to talk about anything medical that might be making tummy time uncomfortable or difficult for your baby.

3. Pull out the bubbles!! 

I don't know why but bubbles are a magic and babies will tolerate positions when you are blowing bubbles that they won't otherwise.  Flashlights are another good, novel trick to get them to stay on their tummy longer.

4. Try changing locations to anther room to see if a different spot on the floor is more comfortable.

5. Pull out a special toy, possibly the babies favorite toy at the time, and use it only when your baby is on their tummy.  This will keep the toy special and exciting and may help distract your baby while they are on their tummy.

Whatever you do continue to persist! 

Early Intervention - Most of the time it's better not to "wait and see"

Early Intervention services are an amazing tool that is FREE to any child under the age of 3 that qualifies.  In order to qualify for Early Intervention services a child has to undergo an evaluation, usually by a team of therapists (Physical Therapist, Occupational Therapist, Speech and Language Pathologist, Early Childhood Special Educator), and show some kind of delay in their development.  The delays can be very minimal to qualify when children/babies are really young.  Early Intervention services are usually carried out in the child's home, which is a great benefit to parents in that the therapists come to you!

The whole idea behind Early Intervention is:
1. For children with disabilities that will be lifelong - to start making the most of the body they have at a young age so that they can keep up with their peers to the best of their ability.

2. For children who don't have disabilities but are showing delays at an early age - to address the delays early so they don't spiral into bigger issues for the child.

An example of a child referred to Early Intervention:
A 10 month old girl who throws a tantrum every time she is placed on her stomach.  The little girl can sit but won't reach for a toy that she drops and just cries until someone picks it up for her and gives it back.  The little girl is happy to lie on her back but also cries if she drops her toy and won't try to reach for it.

This little girl probably should have been referred to Early Intervention around 3 months old if she was crying when placed on her stomach.  At 3 months tummy time could have been addressed and the little girl would likely be much further along in her movement.

When should a child be referred to Early Intervention from a Physical Therapist's point of view?  Any time a child refuses or just cries when they are put on their tummy after they are a month or two old, any time a child is not pretty actively moving backwards or in circles on the floor on their tummy by the time they are 6 months old, any time a child is not sitting independently by about 8 months old, any time a child doesn't seem like they want to move from one position to another by the time they are 9 months old.

It seems doctors in Colorado are very much in the "wait and see" frame of mind instead of making early referrals to Early Intervention.  One of the best things about Early Intervention is that parents can make the referral for their own children!  And then at the evaluation usually the therapists will give the parent some hints and tips to start working on even if the child doesn't qualify for services.

In Colorado you can go to: http://www.eicolorado.org/ to find contact information.  If you Google the term Early Intervention for your state you should easily find contact information.

So, what kind of tips can you try yourself that therapists are likely to try?  With at home therapy with children PLAY is really the method of delivery.  Therapists mix in therapy techniques and trying to get children to participate through play.  So....

1. Play play play with your babies!
2. Try bubbles!  There is no other magic wand that I know of besides the wand in the bottle of bubbles and this wand is pretty magical!  Bubbles can get most kids to stop crying and do many things (such as being put on their tummy) that they won't tolerate otherwise.

3. If tummy time is the issue try rolling up a blanket and putting under the babies chest.  Also try building up from REALLY short tummy sessions (starting with around 5 seconds) to longer sessions very slowly.
4. Talk to your doctor!!  If a child is crying on their tummy - is their head all stuffy all the time?  Does there seem to be something odd about their eyes?  Have the doctor check over your baby for any and every possible reason the baby can't tolerate tummy time.

Tummy Time - It really is as important as the doctor says!

Let's talk tummy time!  Everyone says you should do it, my doctor even recommended more tummy time when Charlie had really bad gas, but when and how?

Tummy time is possibly the single most important thing to practice when your baby is awake!  Tummy time helps trunk muscles strengthen, hands strengthen and even is the first time a baby scans the environment with their eyes (the same way we read) without rotating their head side to side.  But many small babies don't like it, even older ones often don't like it, so what to do?

The first step in my book for successful tummy time is to find a good place on the floor (RIGHT NOW!  Go find a place on the floor) that is in a room where you are a lot but out of the way so you could leave a blanket on the floor all the time.  If you have to get out and put down a blanket every time you go to do tummy time you are likely to give up on it or forget, but if a blanket is already on the floor just waiting for a tummy to land on it you are likely to remember and follow through.  If you don't have a space you can designate for tummy time then try to leave a blanket somewhere close so that it's always there and accessible.

A lot of people will tell you with tiny babies you can do tummy time on your chest, but I would tell you instead of your chest or the couch or your bed the floor is the best place to get used to doing tummy time.  If you start doing it on the floor you will know that your baby is safe there, once they start rolling if they are on the floor they are safe from rolling off a bed or a couch.

The second step in my book for successful tummy time is to make a habit of putting your baby down on their tummy every time they are awake, even if it's for 30 seconds.  When they are really small you can lay down on the floor with them and sing or talk to them.  When they get a little bit older you can lay down and play and show them how to play with toys.  Once they are old enough you can "play and walk away" - meaning play for a couple of minutes and then walk away and let them play on their own. 

If after a couple of weeks your baby is really unhappy every time you put them on their tummy and just cries even if you are down talking, singing or playing I would advise you call your doctor and get a referral for Early Intervention services.  Having a PT support tummy time early on can save a lot of headaches and delayed development later.  

When a baby just cries during tummy time parents are likely to give up and then you end up with a baby with a.) a flat head in back b.) delayed  rolling and crawling and sometimes even walking c.) can have other difficulties further down the road with reading and writing.  Early Intervention is a great resource to help address issues early so that they don't compound into other issues.

The third step in my book for successful tummy time is to leave them on their tummies until they are ready to change positions.  You will know they are ready to change positions when they start fussing or getting cranky.  But until they do start fussing there is no reason to move them from their tummy (when they are awake) until they need a position change.  They will hopefully build up in time starting with 30 or so seconds when they are really little to by the time they are 6 months or so to 10-15 minutes at a time or more.

Happy Tummying!!!

Introduction - about me and my little ones

Greetings!  A little introduction about me.  I am a physical therapist working in pediatrics.  I have worked in Early Intervention going to families homes, schools, and hospitals.  My blog is geared towards parents (real parents - not the ones who post all the clever stuff on Pinterest, they don't need any help :)). 

I am also the mother of twins and most of the time I am a single mom, I would explain further about that, but that is a whole other blog in itself!  My twins have very different personalities and it wasn't until I had them that I REALLY understood how hard it is just to get through every day, let alone do all the things that are supposed to be so good for our kids.  My twins are almost 8 months old and I wonder every night how we did it, got through the day, without all three completely and utterly breaking down into tears.   A disclaimer - I am not a super mom, I am just normal like most other moms.  I am a fairly good PT I think, and I believe others would agree. 

Jemma and Charlie will likely be examples and stars of this blog, so I should introduce them.  Jemma is VERY stong willed and beautiful.  She takes care of her brother already (she is older by 1 minute).  Charlie is a ham, he loves to giggle and flirt (but doesn't seem to have a taste for dyed blondes).  He usually starts something new first before Jemma, getting up on his hands and knees, saying "dadadada" and "bobobobob", and then Jemma picks up what he's doing and tries it out herself.

I am back to work after taking 5 months off after the twins were born, I am lucky in that I only have to work two days a week, but at the same time - we are pretty tight on money, so none of the information or suggestions I post here will be based on having tons of money, who really has tons anyway!!  After being back to work I realized every day that with just a couple of tips and hints, changes of schedules, changes of habits most families could have avoided needing a PT for their kids.  Most of the kids I work with don't have any kind of disability they just need a little adjustment in their environment to thrive.

I hope you enjoy this blog!