Guest post by: Nicole M Sergent, MPT
As a new parent, I was there. Giddy excitement over the news of a baby on the way followed by showering love from family and friends in the form of gift, and gifts, and more gifts. At the time I was touched (and am still forever grateful for their generosity) but shortly after the baby came I quickly fell into a routine many new moms do. As a physical therapist, I like to call it, “the container shuffle.”
“The container shuffle” goes something like this. Sleep (crib), eat (highchair), play (exercsaucer), calm down (bouncer seat), sleep (crib), eat (highchair), play (positioning seat), calm down (swing) etc. As a mother, I related to the thoughts many of my patients’ parents have. Everyone buys us all this stuff…and baby likes them and is happy…so why not use them? As a therapist, I’d like to tell you why.
I can’t tell you how many children I have assessed with general motor delays without significant medical histories or orthopedic or neurologic impairments. These babies are very stable in an upright static position. They often even sit really well, without ever rolling, crawling, creeping, kneeling, or standing. After I have carefully assessed to make sure, nothing more significant is going on, I’ll delicately share my diagnosis: CONTAINER SYNDROME.
I realize it is not rocket science but think of it this way. When a baby plays on the floor, he/she has the ability to wiggle, squirm, and move. Each tiny movement that may seem insignificant is actually exercise. They are beautiful diagonally directed movements. And they are needed. Because our moving transitions from one position to another (floor to sit, sit to stand), require that motion. How can we expect a baby to be able to move and explore if we always have them strapped in a container? Research tells us that babies who spend less time on their tummies on the floor, have delayed motor skills in the first year of life.
In addition to the ability to practice motor coordination, allowing a child to play outside of a “container,” has additional benefits. Play on a baby’s tummy, aids in digestion, assists with hand eye coordination, and promotes typical skeletal development. The hips have the ability to develop into a more stable, mature position and the skull, free from pressure from resting against a surface, has freedom to develop typically. Did you know that 20% of all infants now have plagiocephaly (flattened appearance of the head/face)? While free play time may not prevent all of those cases, I believe the increase in “container syndrome,” plays a significant role.
I once attended a continuing education lecture, where the OT speaking suggested that infants should spend 80% of waking hours on the floor. As a therapist, I could see the benefit of this time well spent. As a mother, I felt myself slumping with guilt. My daughters did not spend that much time on their tummies, especially my youngest that had severe acid reflux. A practical balance must exist for families. And while I realize “containers” are helpful with a fussy baby and so that one can actually shower, I recommend promoting floor time throughout the day. I tell the parents of my patients, “If you find yourself going to put your baby down, choose the floor or pack-n-lay first.”
Many of those children I have evaluated that had delays with mobility and transition skills that I felt came from “container syndrome,” ended up catching up to typically expected gross motor milestones in just a few short weeks by allowing more free play time on the floor. It can be argued that it is not rocket science. My mother (and yours) might argue it is common sense and “what we did with you.” But in a commercialized world where more = better, maybe we do need a dash of common sense to help keep our infants happy and healthy as they develop and grow.
Nicole M. Sergent, MPT is a pediatric physical therapist and co-owner of Milestones & Miracles, LLC. She co-authored a unique developmental tool for therapists and parents that pairs detailed development with interactive play skills, called 1-2-3 Just Play With Me. It is available in digital and print and can be found at www.milestonesandmiracles.com, Amazon.com, and select retailers. Follow Milestones and Miracles online for developmental support & fun
The Importance of Tummy Time for Babies – Golden Reflections Blog
Tummy Time & Baby’s First Year – The Recycling 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:
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!
I had the pleasure of hanging out with my friend and her 3 1/2 month old (2 1/2 months corrected) the other day and I just can’t resist the opportunity to check out motor skills. When playing with her son, he is at that stage where his extensors are starting to kick in for short periods. When I give him just a little extra support at his shoulder girdle he is able to lift his head just a little higher and just a little longer. So many times I hear that kids don’t like tummy time, and that can be the case, but when you get down at their level (similar to the picture), it offers a great opportunity for them to engage with you and for you to entertain them! My favorite part of the day was when her husband came home from work and as we were heading out the door for a girls dinner, he asked ‘has he had enough tummy time today?’ And according to my friend, that wasn’t just for my benefit!
Here are some of our past posts on tummy time to give you some inspiration!
Tummy Time: Its a ball! (video link included)
Okay, so I am a big fan of tummy time and I know that people may find it challenging to do with their kiddos so we as therapists are always on the lookout for new ideas to make it easier on parents. One of our PT’s saw the Lamaze Spin and Explore at a kiddo’s home and told us about it so we decided to get it and try it out with a few of our kids who are having challenges with tummy time. We were only able to get pictures for one of the kiddos but the two therapists who are using it both say that it has been helpful.
Here are some of the reasons they like it:
Some of the things to be careful of:
While I am sure there are other things to be careful of, a great way to get the benefit of both is to use the Spin and Explore and then follow up with the child on their tummy on the floor with a toy they really enjoy. Have them start to practice pivoting slightly to the left or right for whatever holds their attention and motivation the most. I think that if you can balance the use of the Spin and Explore so that they are achieving success while building strength and endurance, with the follow up of ‘live’ tummy time on the floor then the draw backs won’t be as apparent.
Has anyone else had success with this tool?
Ok, so I was stuck for an idea for a blog post so I asked one of our regular kiddos what his favorite activity was to do here. After he listed all the apps he likes to play (as motivation) he said flying was his favorite activity. By flying he means the prone swing. When I asked him why he said its because he gets to go in an airplane and visit places like the North Pole, Saturn and New Jersey (very random I know but believe me, imagination is not limited in this kiddo).
We are fortunate to have a Universal Exercise Unit (UEU) that comes with slings for us to set up prone swinging but you can also use other types of swings to create this effect. Swinging in prone is great for eliciting head, neck and trunk extension and can really help a kiddo to work on the endurance of these muscles. We have used bubbles or other interactive toys to keep their eyes and head up as motivation. One of the cool things that we have added is a bungee across the UEU that allows our kids to self propel themselves. This can help with shoulder and shoulder blade muscle strengthening. Its also fun to have the kids realize that they are the ones making themselves go. When they start to do the self propelling its amazing because all of a sudden they can’t hold their head up. Its a coordination challenge that they can’t focus on both at the same time. With lots of cuing and motivation they are eventually able to both self propel and hold their heads up. The more fun they have flying the longer they want to do it and it is a tiring exercise that really works on their endurance while providing vestibular input. If you put a table or hard support surface underneath them you can have them weight bear through their arms and propel themselves by pushing off the table also.
You can also use a platform swing with kids in the prone position to work on some of the same things. With the sturdy surface underneath them they can also work on weight bearing through extended arms or through bent arms. If you want to switch it up you can swing the platform side to side and encourage weight shifting through their shoulders and arms.
The lycra swing also works for the prone position and you can hold the kids hands while swinging them forward and backwards and they have to hold their head up so they don’t topple forward!
Basically we love swings and we love the prone position! What other ways do you use the prone swing?
Muscle tone is the resting state of your muscles. When a child has low muscle tone it means that they need to put a lot more energy into getting their muscles to turn on to do what they want them to do. I often try to explain this to parents by describing that feeling when you finally get to sink into the couch or your favorite arm chair and relax and then someone calls you from the other room and you have to rev up the energy to get up. Think about having to do that every time you move because that’s what it can be like for kiddos who have low tone.
Generally kiddos with low tone seem to be squishable because they melt right into you when you hug or hold them. This is great for cuddling but if you are carrying a baby or kiddo around that is melting into you, it means they aren’t able to help support themselves in your arms so it can seem as if you are carrying a heavy weight around. As their muscles get stronger they get better at activating them so that if you are carrying them, they can hold their own trunk up without having to lean on you. Its amazing how much lighter this can make them feel! (Another way to get the idea is if you are holding a kiddo by their hands to help them stand and they just decide to have spaghetti legs and you weren’t expecting it).
When I talk about strength being a challenge for kids with low tone I am talking about not just their ability to generate enough force to move their arm or their leg, but also their endurance and their ability to switch their muscles on and off. These components all work together to produce movement.
I know that I talk about core strength a lot but for these kiddos its really important. Just think if your trunk (core) was as stable as a slinky. Do you think it would be easy to move your arms and legs, to do fine motor activities, to run and jump or even walk, to keep an upright posture in school to help with learning? It would be challenging to do all of these things and so many more. That’s why when I work with kids with low tone I am often doing activities that will challenge the whole body but also focus on the core. I also work to increase either how long they can do an activity (such as sitting on a ball for trunk control) or how many times they can do something (such as bridging) because this will help to increase the endurance of their muscles so they can stay working as long as they want them to.
Since it is harder to move and to activate their muscles, a lot of times they may need more practice, help and support, not to mention motivation to get moving! When they are little I do lots of tummy time to develop their butt muscles, anti-gravity trunk extensors, their head and neck muscles and their shoulder muscles. The more interesting you can make the activity the longer you can get them to want to play in this position. I do other activities as well, such as pull to sit to work on abs and head control (I make them work both going up and going down). Going down is often easier (until you get close to the ground) because their muscles are already turned on so they just have to keep them on so they don’t ‘crash’ unlike going up where they have to turn their muscles on and its really hard when you are flat on the ground because you are fully working against gravity. I could go on all day and I might have to do another post just on activities!
Since these kiddos have to put out so much more energy to do things than a person with regular muscle tone, and the fact that we are constantly asking them to do more, don’t be surprised if they get tired easily. For instance, it may not seem like it is that hard to sit in a chair to do work but if you think about all the energy they have to expend to keep their body up nice and straight its not surprising that they are tired. When they are little they may need to nap more often, especially if they are doing therapy. If you are in a mommy and me or a gymboree class you may notice that your kiddo needs to take breaks a little more frequently than the other kiddos. This is normal for them. However, you also want to remember the goal of working on their endurance so it doesn’t hurt to challenge them. Just like when I am training for a race, 3 miles may be in my comfort zone but to get to the marathon I will have to challenge myself to run a little bit further than my comfort zone allows each day.
TheraTogs or the Spio suit or even hip helpers are tools that can be helpful for kids with low tone to give them a little extra support in the core so that they can practice the skills they need to practice. I also use a lot of tickling to remind a muscle to turn on and stay on. Sometimes using a slightly unstable surface like a sitting disc or a therapy ball can also be a reminder to keep muscles on. Since it is unstable its a lot harder to sink into the support like they would be able to in a nice firm chair. Also using wedges (although I wish I could find these filled with sand in addition to the air filled ones) in a chair (tilted forward) can help to activate a child’s core for improved sitting as well. What are other tools that have helped either kids you have worked with or your own child – I’m sure I’m leaving out a ton of ones I’ve thought of or used but I always love to hear new ideas!
You can download an informational handout of this information here!
I thought I might stop at Motor Tips for Parents – Part 2 but after hanging out with my friend and her five month old baby the other day I was hit with inspiration (well actually she pointed out that what I told her might be helpful to other parents to know too).
Ok, I am a big proponent of tummy time and I have discussed why I think its important in Tummy Time: The Cornerstone of Movement and Tummy Time: What’s the Big Deal. I have also provided suggestions for ways to incorporate this in Strategies for Tummy Time. I now have a new approach! I am beginning to work on a video series for a set of ‘How To’s’ for parents who are looking for ways to help their kiddos work on their motor skills and milestones. The first video is for tummy time and shows how to use a therapy ball to help your kiddo work on tummy time.
Now, its my first attempt at a video like this and I decided to leave in the natural dialogue between the mom and I because this is the way I talk when I am working with families and kiddos. I added some text at the bottom of the screen to drive home some of the points but I thought I would also outline them here.
Hopefully this video is helpful and my video skills will improve with practice!