Hand and Foot Play

Hand and foot play is an important part of a child’s development.  So is bringing the feet to their mouth (unfortunately I didn’t get a good picture of that!).  So what are some of the reasons it is so important?

1. Hamstring stretches – They just spent 9 months cramped up in the ‘fetal’ position. This means their knees were flexed and in close to the body. By reaching for their feet they are beginning to perform hamstring stretches that will help to lengthen the muscle.
2. Core strength – By lifting their feet up and reaching with their hands, they are working their abdominal muscles which will help to develop their core strength. You try lifting both your feet up and reaching with your hands. Its not easy work on those abs!
3. Midline – You can see in the pictures that they can bring their hands and/or feet to midline which helps to increase their awareness of where midline is.
4. Body awareness – Hand and foot play allows your baby to explore their body and the various parts of their body. They begin to realize that their feet are attached to them and that their hands and feet can work together.
5. Exploration – Once they are participating in hand and foot play, you will probably see them putting their feet in their mouth. This is how babies explore. They put everything in their mouth, including their own toes!
6. Movement – As you can also see in the photos lots of movement is happening. He isn’t just lying flat on his back holding his feet. He is rocking back and forth, dropping one foot, picking it back up again, etc. This helps to create building blocks for movement and cause and effect. If they end up on their side, what do they have to do next?
7. Self-soothing – When they are engaged in play with their feet, or putting their toes in their mouth, they are also able to self-soothe. This can help with sensory regulation.

If your child isn’t doing this, you can help to encourage them.  Gently bring their feet up towards their hands. Maybe help them to put their hands on their feet and try to grasp them. You can make a game out of it by playing peek-a-boo behind their feet so that their feet are in midline when you are ‘hiding’. You could also do ‘This little piggy’ while you have their feet up in the air and count each toe. You can play ‘patty-cake’ while holding their hand and feet together and bringing them to midline for each ‘clap’.

What are other ways you have encouraged hand and foot play?

Foot in Mouth – Sometimes its a Good Thing!

As babies develop they will often engage in hand and foot play, even bringing their feet to their mouth.  This may seem odd to parents but it actually serves a purpose and has several benefits for your child.  Some of these benefits/purposes are:

• Bringing their feet up to their hands and even their mouth allows the child to start stretching out their hamstrings.  After approximately nine months in the womb they have really tight hamstrings from being in the ‘fetal’ position.
• By lifting their feet up in the air and attempting to get them with their hands they are working on their core strength as well as developing anti gravity strength in their flexor muscles in both their abs and their head and neck.
• Grasping their feet allows them to develop their grasping skills which can carryover into fine motor tasks.
• Reaching for their feet encourages reaching with both hands as well as one hand.  It also can work on reaching to the same side of the body as well as to the opposite side of the body.
• Assymetric reaching can also lead to the development of skills such as rolling.
• The practice of attempting to grab their feet in either one or both hands, and either one or both feet allows them to develop motor learning and motor exploration so they can figure out what their bodies and muscles do.
• Also, hand and foot play, as well as putting their feet in their mouth shows they are developing body awareness as well as gives them opportunities to continue to develop this.

You can encourage hand and foot play as well as foot to mouth by gently bringing their feet up to where they can reach them.  Never force this motion because some kids may be tighter than others.  By exposing them to their feet, they will begin to be interested and attempt to reach for their feet to explore and play.

Top 10 Blog Posts of 2011

I love Top 10 lists!  Here is this years list of Top 10 Blog Posts:

10.  Core Muscles:  Building a Solid Foundation

9.  No Kid Left Inside – Benefits of Outdoor Play

8.  Having a Ball With Core Muscle Strength

7.  Gross Motor Development vs. Fine Motor Development

6.  Standing Straight and Tall

5.  A Glossary of Sitting

4.  Let’s Play!

3.  What is Protective Extension?

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

And the most read blog post by a landslide:

1.  Torticollis:  What Is It?

Thanks for everyone who reads and I look forward to the next year!

Posture and Knee Hyper-extension

We have several kids who have varying degrees of knee hyper-extension when they stand.  Knee hyper-extension is when their knee bends backwards past zero degrees of extension.  This can happen for many reasons and many children and young adults do this without having any predisposing factors.  In fact it can be common in gymnasts and adolescent girls.  For kids with neuromuscular disorders such as cerebral palsy, knee hyper-extension in standing can be common in one or both legs.  One of the ways to correct for this is to use a brace called an AFO (ankle foot orthosis).  If it is set so that the child can’t point their toe, it can prevent them from going into knee hyper-extension.  Many families go back and forth on the debate of whether their child should wear AFO’s or be allowed to wear a less restrictive brace.  I myself go back and forth as well and try to help the families see the pros and cons of both choices.  As I have been observing some of our kids recently I have noticed some of the side effects of increased knee hyper-extension.

First, there is always the potential damage that is being done to the child’s joints and ligaments due to the repetitive stress of going into hyper-extension with every step.

Second, when a child’s knees are hyper-extending they need to make other postural compensations to keep their body balanced over their base of support.  To do this the tend to arch their low back more (increase their lumbar lordosis) causing their hips to flex more.  This over time (not even a very long time) can cause their hip flexors to get tight.  Specifically their ilopsoas which causes hips to flex and low backs to extend (arch).

Third, with the flexed hips and increase arch in the low back it causes their stomach and behinds to stick out further making it a challenge for them to activate their gluteal (butt) muscles or their abdominal (stomach) muscles.  These are two important sets of muscles for maintaining balance and posture.

In addition to this there are down sides to wearing the AFO’s.  If the child has decreased strength, they have trouble lifting their foot up when they are walking so they tend to turn their feet in (internally rotate their hips) more.

Also, with decreased strength they may not be able to overcome the tension on the AFO to achieve more ankle bending (dorsiflexion) so they can lose more strength in their calves.

I think the whole process is a balance that needs to take into consideration the goals of the family and child as well as the pros and cons.  I’m sure there are plenty that I have not mentioned but I wanted to start to point out some postural challenges created by knee hyper-extension.  As always, I think working towards a balance with the family and child can be effective.

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!

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!

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Animals Galore!

 

Snake

Frog

So, to go along with my post from last week I was looking at other imaginative ways to encourage play and gross motor skills (oral motor as well if you throw in the animal sounds!).  Well, one of my favorite is to pretend to be animals.  You can do animal parades, animal races, animal charades, Simon Says animals, etc.  Here are some of the animals I use and I will do my best to list some of the gross motor benefits for each animal.

Bear: Have your child walk on their hands and feet so they are bent in the middle.   Walking this way helps to stretch out hamstrings and calf muscles.  It also helps with balance, upper extremity weight bearing, total body coordination, core strength and leg strength.

Rabbit/Kangaroo: Have your child hop on two feet, for added effect you can have them hold their hands up in front of their chest since both animals have tiny arms.  This works on jumping, endurance, and leg strength.

Dog/Cat: Crawling on hands and knees (although they could also be mouse or hamster, etc).  This works upper extremity weight bearing, total body coordination with reciprocal movement, core strength, weight shifting, leg strength, and head and neck strength.

Lizard: Have your child ‘commando’ crawl on their belly.  This works on reciprocal total body coordination, weight and pelvis shifting, upper and lower extremity strengthening, and core strength.

Crab: Have you child sit on their bottom and put their hands behind their tush, then lift their tush off the ground by pushing through their arms and legs.  Basically they will be making a table with their body.  This one is really challenging because of the motor planning so don’t let your child get discouraged.  Even if they start out scooting along and dropping their bottom keep encouraging them over time to use their arms and legs to walk with, without their bottom hitting the floor! This really works their coordination, reciprocal movement, core strength, upper extremity weight bearing and leg strength.

Snake: Have your child lie on their belly and and use their arms to push up their chest and then pull themselves along.  It can look like the old break dancing move ‘The Worm’ but even the lift and pull will work to start.  This works on upper extremity weight bearing, coordination and core strength.

Duck: Have your child squat down so that their feet are flat on the floor but their bottoms are not on the floor.  Have them walk in this position (and add in arm flapping for good measure).  This really works on balance as well as stretching calf muscles, coordination, endurance, core muscle strength and leg strength.

Frog: Have your child squat down so their hands and feet are touching the floor with their knees bent.  Have them hop forward (use circles for lily pads if you can).  This works on leg and core strength, and jumping.

Bird: Have your child lie on their stomach and lift their head, arms and legs up in the air.  If they can flap their arms also that’s an added bonus!  This works on coordination, and total body strength.

Flamingo: Have your child stand on one foot.  Make sure you take turns between feet.  This works on balance, core strength, endurance.

These are just a few.  Please feel free to add your own if I have forgotten some animals and variations that you and your children use!

Growth Spurt

Since Spring is a time of growing I thought I’d talk a little bit about kids and growth spurts.  Many of you may remember your adolescent years when all of a sudden you seemed to be all arms and legs and were tripping over your own feet.  Well that was because your body grew a lot in a short amount of time and it hadn’t caught up to where everything was again.  We take in information all the time that tells us where our body is so that we can move through the world.  Three ways we take in information is through our vision, our vestibular system and proprioception.  The quick version of vestibular is our inner ear that keeps track of where our head is and sends messages to the brain.  When you go on spinning rides or spin yourself around until you are dizzy that is the system that you are sending information to.  Proprioception is information that comes through our joints and muscle attachments that tell about where parts of your body are at any given time.

When a child grows they need to adapt to their new size and this involves recalibrating the information receptors that are passing signals on to the brain.  Generally this happens in a fairly short amount of time and doesn’t cause too many problems.  For kids who are already having challenges moving it  is important to keep them moving and practicing skills (even if they already know how to do them) so that their body can begin to make the adaptions to their new size.  Without practice they run the risk of regressing and having difficulty with a skill (such as walking) that they may have already mastered.

In addition to having trouble with proprioceptive information you may see some more tight muscles.  When they grow the muscles stretch and if they have a tendency to be tight or had been tight in the past then they may get tight again.  Although stretching is important all the time it can become even more critical during periods of growth so that they don’t lose range of motion.  You may want to consider talking to your physical or occupational therapist about ways to help maintain range of motion during these times of growth so that you aren’t spending your whole day stretching.  Maybe its using a stander or getting creative with sitting options so that your child doesn’t even realize they are being stretched!

Lastly, for kids who have underlying weakness or who have to work to maintain strength, its critical to work with them during their growth spurts because they will appear weaker due to the new length of their muscles and they bodies.  For kids who are working and ‘strengthening’ on a regular basis they can generally prevent major losses in strength or get the strength back much quicker than kids who have not been receiving active therapy or doing a regular home exercise program.

Basically, the take away is to pay attention to if your child is growing because you may see some changes in their abilities to perform skills and movements that you thought they had already achieved!

Baby Equipment: Pros and Cons

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.

Toe Walking: Is it a Big Deal?

What is toe walking?  Toe walking in kids is when they either drastically walk on their tip toes or they don’t hit the ground with their heel first.  Walking is broken up into two phases, swing phase (when your foot is off the ground) and stance phase (when your foot is on the ground).  Toe walking would be noticed in stance phase because when their foot should be flat on the ground, it isn’t!

Walking develops with the child and when they first start walking they hit the floor with their foot flat and don’t rely on their calves and ankles much for walking.  As they develop a more mature gait (usually between 3-5) they hit the floor with their heel first and travel over their foot until they push off with their toes.  With toe walking the child will either hit the floor with their toes first or the ball of their foot and almost ‘bounce’ onto their toes.  With some kids this is only noticed when they are running and may not be as apparent when they are walking.

Some toe walking is caused by cerebral palsy as a result of the shortening of the calf muscles.  This can be corrected by bracing and/or stretching along with other exercises.  Some kids just walk on their toes for no reason and this is called idiopathic toe walking.

I have found that for the kids that are idiopathic toe walkers they generally outgrow it however some of them don’t.  The biggest concerns I see are that they can develop tightness in their calves (although maybe it was the tightness that was there first).  They also have weaker calves.  We use our calf muscles to keep us from falling as we move our body over our foot while walking.  If our calves are weak and our body doesn’t think it can effectively keep us upright its reaction, in some cases, is to pop up onto our toes.  This isn’t something we think about, it just happens.  Also, you may notice some clumsiness in your child’s running and jumping because they are losing the benefit of the push off that they would get from hitting with their heel, then crossing over their flat foot and then using their calf muscle to push off with their toes to propel them forward.  If they are already on their toes they have no momentum to gain. It would be like trying to get a spring to go that never got compressed.

So, I hope you hear me that idiopathic toe walking is not a big problem unless they are having trouble with clumsiness or running or jumping or other activities that kids like to do!