Starfish Therapies

August 11, 2014

Tummy Time – More Than Just a Buzz Word (A Blog Hop)

Filed under: Developmental Milestones — Starfish Therapies @ 10:00 am
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Tummy Time Therapy Blogger Blog Hop

Is Tummy Time Important A Therapy Blogger Blog HopBelow you will find all the posts in the Tummy Time therapy blogger blog hop. So many great ideas and thoughts on tummy time from Occupational Therapist and Physical Therapists.

The Importance of Tummy Time for Babies – Golden Reflections Blog

Tummy Time & Baby’s First Year – The Recycling OT

How to Use a Therapy Ball to Make Tummy Time Easier and More Fun for Baby – Mama OT

5 Awesome Toys for Tummy Time! – The Inspired Treehouse

Terrific Tummy Time Positions – Your Kids OT

Tips For Tummy Time From A Physical Therapist – Pink Oatmeal

Tummy Time : The Basics – Therapy Fun Zone

Tummy Time: Developmental Consequences & Future Implications – Tools to Grow, Inc.

Tummy Time Tips – Pedatric OT Tips

Tummy Time Just Isn’t For Babies – Your Therapy Source

Tummy Time – More Than Just A Buzz Word – Starfish Therapies

Tummy Time Never Gets Old – Playapy Platform

Tummy Time has become a common phrase in the last decade or so as a result of the NICHD Back to Sleep Campaign.  Prior to this time most parents put their children to sleep on their stomachs so Tummy Time was never an issue.  Now, with children sleeping on their backs they are spending 12 or more hours a day (if a parent is lucky and their child sleeps that much) on their backs which used to be devoted to time on their stomach.

And, in my opinion, another factor is the rise of innovative baby equipment that has been produced to make some aspects of parenting easier.  I know as a baby sitter I loved having the car seat that clicked into the car and then clicked into the stroller, or even the bouncy seats.  As a therapist I now see how all that equipment was taking away from time the child could have been equipment free, exploring their body and environment.

I’m not saying get rid of all equipment or put your child to sleep on their stomach, but I think its important to make sure you are balancing things out.  For instance, if you went to the gym and lifted weights, and only used your right side, you would be disproportionately strong on one side.  This is the same for infants.  When they are on their back, they are working the muscles on the front side of their body (abs, neck flexors, hip flexors) and learning how to lift them against gravity so that they are getting stronger.  However, the muscles on the back side of their body are getting forgotten about.  Those include their back extensors, neck extensors and gluts (tush muscles).  The muscles on both sides of their body are important to their gross motor development as they learn new skills and move through the developmental milestones.

Some of the benefits of Tummy Time are:

  • Improved head control – ability to hold their head stable so that they can observe the world
  • Improved trunk control – ability to hold their body stable so they can begin to sit on their own and develop balance reactions
  • Stretching – After 9 months in the womb, babies have tight muscles on the front of their body and by being on their stomach they are naturally stretching out so that they can begin to balance out the front and back of their bodies.  In addition, the more time they spend in carriers and other pieces of equipment, it keeps them in a slightly flexed position.
  • Decreased chance of developing plagiocephaly – This is when they develop a flat spot on their head.  Some babies get it in the back or on the side of their head.  This is because the back of their skull is still ‘soft’ and when they have decreased neck strength to move their head, they often lie with their head in one position so it flattens out in that area.  When spending time on their belly, the facial muscles are firm and less likely to flatten out/deform.  It also gives the back of their head a break from constant contact with a surface.
  • Hip development – When babies are born their femurs (thigh bones) are rotated.  Natural development allows a derotation to happen as their gluts get stronger and place a pull on their bones.  While on their belly, they are naturally developing their glut strength by activating their trunk and leg muscles against gravity.  This promotes the natural development that is supposed to occur!
  • Arm strength – While on their tummy, babies begin to experiment with pushing up on their arms which develops their upper extremity strength as well as eventually leads into rolling over and further exploration of their environment and movement.  This is also a precursor to crawling as they learn how to coordinate their arm use.

Tummy Time

These are just a few of the reasons why I like tummy time.  I know it isn’t easy to find time in busy days but I also look at it as ways to get down on the same level as your baby and interact with them.  You can even get some good ‘face time’ in!



January 9, 2012

Motor Tips for Parents – Part 1

Over the last few years many of my friends and relatives have had kids of their own.  As a result I often get questions from them regarding what their baby or child should be doing.  I understand that advice and opinions can be taken with a grain of salt and everybody does things differently but I thought I’d share with you, over several posts, the top pieces of advice I’ve given as a result of all the questions.

  1. Tummy Time, Tummy Time and More Tummy Time:  This is my number one piece of advice to all new parents.  I’ve been to a lot of baby showers and some of them have you offer an anonymous piece of advice to the new mom, well mine’s never anonymous because it usually always reads ‘Lots of Tummy Time!’.  I just think (and research has shown) that this position is the building block of movement.  It helps the baby to begin to develop their head control, strengthen their arms and shoulder girdles, begin activating their gluts which will help to facilitate their hip and femur bony development, and stretch out the front of their body which has been squished into flexion for the last 9 months to name a few.  It also gives them some control of their environment.  If they are lying on their backs they are waiting for toys to be brought to them, on their tummy they can begin to figure out how to move or pivot to get to what they want.  Also, it helps to facilitate them getting into a sidelying position which is really important for trunk development.  With the implementation of the Back to Sleep program and the busier lifestyles of families and the conveniences that have been developed (bouncy chairs, exersaucers, click and go car seats) parents have to make a point of allowing their child to spend time on their belly. (see also ‘Strategies For Tummy Time‘)
  2. Give them motivation and a challenge:  This is in response to how to get their kids to move.  Now some kids may have other challenges going on but the same ideas still apply.  If you want your child to move don’t put everything right in their reach.  I remember going to a family’s house and they were concerned because all their daughter did was sit in one spot and didn’t attempt to move.  When I looked to where she was sitting, she was on her blanket with every toy she could possibly want right in front of her.  She has no reason to move!  Find out what is motivating for your child, let them engage with it and then move it just a little bit out of their reach.  Let them try to struggle and figure out what they need to do to get to it.  The struggle is part of the learning process.  Its when they get to figure out what their body can and can’t do and how to react to any changes.  This is where motor planning is developed.  Now, I don’t torture the kids, I will usually let them try to figure it out and then assist them into having some success so they can play with whatever motivates them and then move it out of reach again and start all over.  Over Christmas my cousin’s little girl really wanted to move but couldn’t figure out what she needed to do.  We put the little baby doll that she wanted a little bit in front of her and then I gave her some assistance at the legs so she could push herself along the floor.  After a few tries she started to grasp that by moving her body she was able to get to her toy.  That awareness helped her to pick up the skill even faster.  (see also ‘Frustration + Problem Solving = Motor Planning and Movement‘)

To be continued…Tune back in for more of my amazing tips!

October 25, 2011








Swaddling is a practice many parents use to help their children sleep better.  It involves wrapping your baby in a blanket with their arms and legs tucked in.  From what I understand there is a specific technique although I have not mastered this technique (generally because I am working with kids and trying to get them to move!).  Many of my friends like to refer to it as the ‘baby burrito’!

I have been asked if swaddling for too long can cause gross motor delay.  There is no research out there on this topic that I was able to find but if anyone has any, please share!

When a few of my friends have asked my thoughts on swaddling I’ve tried to look at it like any other issue.  Many of them wanted to continue this practice so that their child could get enough sleep at night and not wake themselves up with flailing arms and legs.  My only concern was if their mobility was being restricted.  By this I mean were they getting time during the day to figure out movement.  A lot of times when a child goes down for a nap or for bed they use that time before falling asleep or when they wake up to explore their movement and bodies.  A lot of time it can be due to frustration (i.e. they want to get up and so they look for any means to let their parents know this) which can be a key component to movement development.  Many times you will hear a parent say that they first rolled over or pulled to stand in the crib.

For children who are swaddled to prevent excessive movement so that they can get a good night sleep (which is also important to growth and development) its important that they are getting plenty of floor time to move and explore.  This involves tummy time as well as giving them a chance to figure out how to get to the toys or person they want to play with.  Don’t put everything right in their reach, let them figure it out!

If your child is getting plenty of unstructured floor time and tummy time and is hitting their milestones on target then I would use your best judgement as to when you should stop swaddling.

For those of you out there with experience please feel free to share your stories.

January 3, 2011

Top 10 Blog Posts of 2010

Its the end of the year and its time for my Top 10 Blog Posts of 2010.  Based on readership these were the posts that got the most views this past year.  If you want to compare to last year check out Top 10 Blog Posts of 2009!

10.  Repetition and the Beauty of ‘Redo’

9.  Standing Straight and Tall

8.  Climbing:  The Catch-22

7.  Having a Ball With Core Muscle Strength

6.  Why is W-Sitting a Four Letter Word?

5. Buns of Steel

4. Strategies for Tummy Time

3.  Do Video Games Promote of Hinder Child Development?

2.  Glossary of Sitting

1.  Sensory Exploration in Today’s Society

There you have it, the Top 10 for 2010!  If you have any ideas for 2011 please share them, I always look forward to ideas for new posts!  Happy Holiday Season to everyone!

December 8, 2010

Torticollis: What Is It?

I have recently had several friends or friends of friends ask about their child who doesn’t like to look in one direction and is developing a flat spot on the back or side of their head. This is generally a sign of torticollis. Torticollis is when your baby’s neck gets tight (similar to how you get tight hamstrings) and they prefer to look to one side more than the other. In addition they usually like to tilt their head to the opposite side of where they like to look. For instance if they prefer looking to the left they usually like to bend to the right. Generally the muscle that is tight is the sternocleidomastoid and can easily be stretched, especially if you catch it quickly and modify your and your baby’s habits to encourage movement in the opposite direction.

In the past torticollis was generally something a baby got as a result of how they were positioned in the womb. These days I am seeing older babies develop it and there could be a few reasons for that.

I think with the Back to Sleep program babies are spending more and more time on their backs and less time on their tummies.  The back of babies heads are still soft and malleable so if they have a preference for sleeping (i.e. tend to keep their head turned to one side) it can encourage a flatter spot on the back of their head as well as encourage them to keep their head turned only to that side.  On top of that babies are spending more time in car seats and carriers which continues to encourage pressure on the back of their head.  Making sure your child is getting enough Tummy Time can help with this.

Also,  as parents its easy to develop habits such as always carrying your child on the same side, or having a preferential feeding side.  This can all encourage turning their head more to one side.  I know it isn’t easy but break up your habits and carry your child on the opposite side or change where they normally sit when you interact with them.  Maybe even move their crib to the other wall or put them in the crib with their head facing the other way.

If you catch torticollis early and get a referral to a pediatric PT they can show you some simple exercises to do with your child as well as ways to alter your routine to encourage them to actively move their head in the other direction!

You can download an informational handout on this topic here!


October 6, 2010

Tummy Time: The Cornerstone of Movement

Tummy time is the cornerstone of gross motor development in my opinion.  It has become even more critical with the Back to Sleep campaign and the continued development of bouncy chairs and other carriers that increase convenience for busy parents.

In 2006 the Journal of Pediatrics published study looking at the difference between gross motor development of tummy sleepers and back sleepers and there was found to be a delay in those babies that slept on their back.  This delay was eliminated if they received adequate amounts of awake tummy time.  (Please hear me, I am not telling you to put your child to sleep on their tummy, only to make sure they are getting lots of awake  tummy time.)  Pediatrics also published a study looking at the same thing and found that kids who spent more time on their tummy attained gross motor milestones sooner than those who spent less time on their tummy.  They found that there was not a difference in what age the child walked though.  Pediatric Physical Therapy published a similar study showing that increased tummy time demonstrated a significant difference in gross motor skills at 6 months of age.  What is interesting is this report which shows that although a majority of parents are told about positioning their child during sleep, few are told about awake positioning, and if they are, they don’t know why it is important.

These may not seem like a big deal since most of the studies show that children catch up eventually with their gross motor development.  My question is what experiences are the children missing out on by being delayed in their early motor development?  This is  time that they are exploring their environment and their bodies.  They begin to develop motor planning skills which will carry over to higher level skill acquisition.  It helps them to develop their gluts and trunk extensors, as well as upper extremity strengthening that will help with fine motor control as they get older.  Tummy time also decreases the risk of skull deformation or plagiocephaly, as the back of the skull is still forming and is easily influenced by extended pressure due to prolonged time with weight on the back of the head.

Its my personal opinion that more emphasis needs to be placed on educating parents regarding the importance of Tummy Time for their children.  In addition, I think more studies need to look at motor development (fine and gross) of older children and compare it to the amount of time spent on their tummy as an infant.

July 26, 2010

Why Are Babies Getting Flat Heads?

Some babies develop a flat part of their skull after they are born.  This is called plagiocephaly.  Because and infants skull has to grow so rapidly the various bones that make up the skull are not sealed together early on.  This makes them more mobile so if your child spends too much time with pressure on one part of their head, they can develop a flat spot.  This has been a rising trend since the 1990’s.

There are many reasons your child could develop this flat spot. The main non medical reason for the increase in cases of ‘flat head syndrome’ can be linked to the rise of the Back To Sleep campaign to prevent SIDS.  When babies stopped sleeping on their bellies they began spending more time on their back and less time on their tummies.

Unfortunately, technology has improved as well and new and improved gadgets have come out to make parents lives easier such as the 3 in 1 stroller, carrier and car seats and the bouncy chairs to name a few.  These types of equipment also encourage the baby to be on their back and continue to place pressure on the child’s skull.

The easiest way for a parent to prevent their child from getting a flat head is to make sure they are getting plenty of tummy time.

Another reason for your child to develop a flat spot is if your child has a condition called torticollis where they prefer to look to one side only and it is harder to look to the other side, they may be spending too much time lying on one spot of their skull.  Talk to your doctor or your physical therapist about stretches you can do and ways to position your baby to help them move their head in all directions and to prevent skull deformity.

Another reason may be if your child for some reason has difficulty moving or is sick and unable to move it is important to learn various ways to help them with their positioning to prevent them from developing a flat spot.

Craniosynostosis is a medical condition that can also cause plagiocephaly  as a result of the sutures between the bones in the skull closing too early and not allowing the skull mobility that should be there to accommodate for growth and development.  This condition can also cause other changes to the skull besides just a flat spot.

If you know your child has a flattened area of their skull talk to your doctor or physical therapist about what to do and it could be as simple as changing their position or encouraging new positions.  If it is severe it may be necessary for them to wear a special helmet to help reshape their skull.

The take home message is don’t let your child spend to much time on their back and encourage various positions, especially tummy time.

Download an informational handout on this topic here!


March 21, 2010

Rolling, Rolling, Rolling

One of the first milestones parents often notice is their kids rolling over.  As exciting as that is there is usually a little frustration involved also because now they just won’t stay still!  You want them on their stomach for tummy time and they roll onto their back, or you are trying to change their diaper and they are trying to roll onto their stomach.  As frustrating as this can be, this is a period of exploration because they can now move on their own, they don’t have to wait for you to pick them up or reposition them.

Because of the Back to Sleep initiative kids are spending less and less time on their tummies.  As a result often times kids may not roll as early as they used to because they are not spending the time on their belly learning how to push up and eventually topple over (this is before it becomes a nice smooth rolling motion).

Often times I am asked how to encourage rolling for kids.  There are several ways.  I’ll break it down into rolling from their back and rolling from their belly.

Whey they are on their back the easiest way I have found is to find a toy or object that they are really interested in and hold it in front of them so that they notice it.  Slowly start to move it towards the side and above their head keeping it just out of their reach.  As long as they are actively following it and reaching for it I will set it down on the ground just above their head.  For instance if I am trying to get them to roll to the right I will move the toy towards the right side of their head and leave it on the ground just above and to the right of their head.  If they lose interest because they can’t reach it I will pick it up and begin again and maybe hold it up and dangle it to maintain their interest.  If they are actively reaching and trying to get to it I will sometimes give them a little boost/push at their hip to complete the roll and let them get the toy.  Make sure you practice to both sides though.  I always find it amusing my kiddos that can roll in one direction and then get stuck because they run into the wall or a couch or something and don’t know how to roll the other way!

If they are on their belly and they hate tummy time, you first have to work with them on their tummy time skills.  Check out Strategies for Tummy Time for some ideas.  Once you get them pushing up on their arms use the toy trick again.  Have something in front of them that they like and if you want them to roll from their belly to their back over their left side, move the toy towards the right and slowly behind them.   Make sure they are still engaged in they toy because if they stop looking they aren’t going to roll.  This is when toys that make noise can be good because it provides not only a visual but an auditory stimulus.  If they are attempting but can’t quite make it give them a little help at their hip.  Usually the first couple of attempts are crashes onto their back until they begin to learn control.  Make sure that you practice to both sides!

The key is to find something that motivates your child, get them engaged and then if they are working hard to make it happen, give them a little help so that they have some success.  Make sure they get their hands on the toy when they roll over so they see that there was a reason for doing it.  Rolling opens up the possibilities for independent exploration for your kiddos so lets get them rolling, rolling, rolling!

February 28, 2010

Does Gross Motor Development Affect Cognitive Development?

Your Therapy Source recently posted about a press release (Reference: Simple tests in babyhood ‘could point to children who need help with learning’ Retrieved from the web on 2/18/2010 from that may link gross motor delays at 9 months to cognitive delays at 5 years.  I also did a little more searching and found a posting about cognitive and motor delays with the increasing incidence of plagiocephaly (flat head syndrome) in babies.  I’m not posting these to cause alarm among parents but rather because it raised some interesting questions for me.  I started to think about some of the kids I work with and the fact that due to their delays they have a decreased ability to explore and interact with their environment.  This also decreases their chances for problem solving movements and making decisions based on their perception and awareness of the environment.  Could this be a reason for the cognitive delays that may be seen?  Is it a factor of decreased chances for free mobility and interaction so that they can draw conclusions about the world around them?  In addition, looking at plagiocephaly I go back to my stance on the importance of tummy time for infant development and exploration.  I think that we need to increase the opportunities for our kids to explore their world, and look for creative ways for those children who have more significant motor impairments.  Notice in the pictures above that tummy time doesn’t always have to be done on the floor, you can create different environments for it so that the child has something more stimulating to engage with and as a result possibly have more fun playing on their tummy and increase their tolerance!

I love the fact that these postings sparked some questions for me, and I know that more research is needed to really determine if there is a cause and effect relationship.  What do you think?

February 1, 2010

Baby Equipment: Pros and Cons

Baby Equipment

Most people who have had kids have experienced the equipment that they just had to have:  the bouncy chair, or the 3-in1 stroller-carrier-car seat combo, or the Baby Bjorn, or the swing, the list could go on and on!  I’ve been asked a lot about some of this equipment and if it is good or bad for a baby’s development. Unfortunately the answer isn’t cut and dry.  The biggest thing I tell parents is moderation!

Lets look at the 3-in-1 package to start.  I remember babysitting and thinking this was the greatest invention ever.  I mean it didn’t require as many clunky pieces of equipment and if the baby was sleeping it was easy to bring them inside because it just took a little click!  The downside is that it creates a lot less opportunities that your babies are being held and/or touched and increases the time they are on their backs (which is already increased due to ‘back to sleep’).  Basically, its not a bad thing, I love the convenience of it however make sure that you aren’t just carrying your baby in the carrier (in whatever format) all the time.  Your touch is so much better to them than plastic!

Same with the bouncy seats.  Once again, I love these things and they have been my savior many times when I used to babysit.  The downside to this is that your child is losing floor time and exploration time.  They are missing out on opportunities to explore their environment and also to get on their tummy which is key in their gross motor development.  In the bouncy their natural inclination would be to use their abs and the muscles on the front of their bodies when they really need to be working on their back and tush muscles, as well as stretching out the muscles in the front (they were just cooped up for 9 months in the womb and now they need to stretch)!

Baby Bjorns I really like because they baby can be turned in to simulate tummy time and they are experiencing movement in various planes as the person who is holding them moves.  In addition they are feeling the effects of gravity and learning to integrate it.  However, I still feel that they need floor time to develop their back, neck and tush muscles as well as learn to push up and progress their gross motor development.

The Bumbo chair is another one that has been big in recent years.  Once again I feel that it can be good for moderated periods of time.  The important thing is for your child to learn how to get into sitting from lying down and this is how they develop the muscles that will help them to maintain a sitting position.  If they are always placed in sitting they lose that strengthening component as well as the motor planning practice that goes along with it.

I hope you can generalize out to other pieces of equipment and you realize that I am not saying never on these things.  Believe me, I love some of them.  What I am saying that use them in moderation and make sure your child is getting enough floor time and tummy time as well as cuddle time (out of a plastic carrier).  Please feel free to ask if you have any pieces of equipment that you are curious about.

We are frequently asked about Baby Walkers and Jumpers and have an article in one of our old newsletters.  Enjoy.

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