A Therapists Guide to Fix the Developmental Delay of Baby Milestones

Posts Tagged ‘Trunk control’

side sitting and trunk controlBaby development can be encouraged with a baby who might be delayed.

It is not necessary to take a “wait and see” attitude if you notice that your baby is not achieving all her milestones on time. The longer you wait, the stronger the possibility that your child won’t reach her potential.

I am going to describe an exercise today which is fantastic and appropriate for almost all babies and toddlers.

It is especially beneficial for children with cerebral palsy (awesome for hemiplegia), Down syndrome, Spina Bifida, torticollis and more. If your child w-sits, or your baby can’t sit straight in the high chair, or she flops over when she attempts to sit independently, then this exercise will really help.

This activity is most demanding when it is done on a therapy ball, but you can start with your baby on the floor.

I normally start this exercise when the baby is trying to sit independently. It is possible to try earlier, but the baby will probably fall to the side and it’s not worth the effort. You would be giving too much support to make it effective.

Place your child on the floor in a sitting position. Next, take both her legs and bend them so that both knees face the same direction. At the same time, move them so that both feet end up near the right hip or the left hip. Be sure to support your baby at the trunk while you are doing this. The position she will end up in is called side sitting. If she has a weak trunk, or has spasticity (cerebral palsy) there is a tendency to fall to the opposite side of where the feet are placed. Be prepared. You can spread the feet apart a little bit … Read more



baby development exercise for milestonesIf I could offer one short statement which would provide the most help , it would be “trunk control is the key to good development”.

No matter what the underlying problem, if a child has good trunk control, other milestones are attained more easily. Handwriting is easier, walking is easier, dressing is easier, sitting at a desk is easier… everything is easier to learn when the trunk is stable.

Consider an analogy. Cook a noodle until it’s soft, and then try to stand it up. It will collapse in a pile. Even If you attached a strong base (like a plastic disc) to the noodle, it still will not stay up perpendicular to the surface. And so it’s the same with toddlers and children. It doesn’t matter if they have strong arms and legs. Without a strong core, the arms and legs can’t be controlled.

I am going to describe a wonderful exercise that you can do with your baby that will help strengthen her back very quickly.

It is quite easy to learn. This exercise can be performed with a 5 or 6 month old baby providing she has made progress through the early developmental milestones. She should be pivoting on the floor and able to keep her head off the surface. This is not good for babies who are medically compromised, have a feeding tube (NG tube) or who have spinal deformities or other back problems. It is intended for low tone infants who are basically in good health. I also want to caution parents if their baby has Down syndrome. Vertebrae can be unstable and this activity may not be appropriate. You can bring this post to your doctor and get medical clearance first. It is actually very good for babies with Down syndrome … Read more

boy with good trunk controlI believe trunk control is the most important aspect of baby and child development. Without it, the ability to achieve milestones and the quality of developmental milestones is diminished.

 Short term, it can affect sitting independently, crawling and walking posture. Long term, it can impact handwriting, ability to sit and attend and contribute to poor coordination and poor precision movement.

This may sound like hyperbole, but it happens to be true. If you stop and think about how the body functions and how we manage to perform our activities of daily living, you will start to understand how important it is to stay erect from our hips to our neck. That section of the body is the trunk. Stability at the trunk allows us to use our hands for all kinds of activities. It allows us to stay in our seats without falling over. It keeps our body aligned during walking, running, jumping and skipping.

During the natural course of development, most babies acquire good trunk control because of weight bearing and anti-gravity movement.

Babies who have low tone, joint laxity, or other developmental problems are at risk for not developing good trunk control. Babies with Down syndrome, cerebral palsy, torticollis, Spina bifida and more benefit tremendously when therapy exercises are devoted to strengthening the trunk.

I have been getting quite a few emails lately from caregivers who are concerned that their baby is not crawling properly, or can’t sustain independent sitting. In response, I have described for them specific exercises which will help them achieve good trunk control.

Today I am going to describe one of these exercises. It is fairly easy to learn, but might take a few attempts to get the proper hand position and to keep the baby stabilized. This exercise can be … Read more

developmental disorder spina bifidaA little known fact is that Spina Bifida is the most commonly occurring birth defect in the United States.

 It is a neural tube defect caused by the failure of the spine to close properly during the first month of gestation. The brain and spinal cord are adversely affected. Depending on the severity of the damage, the newborn may have significant weakness and/or paralysis, and may have hydrocephalus (fluid on the brain). Many babies born with Spina Bifida also have something called Chiari malformation. It is a brain deformity which results in brain tissue extending into the spinal column.

There are different types of Spina Bifida. They are categorized according to the manner in which the spinal cord has been damaged.

There are three types which are the most common, ranging from severe to mild: myelomeningocele, meningocele and occulta. Although any two babies may have the same type of Spina Bifida, they probably don’t have identical problems. The lesion can occur at different levels of the spine. In those babies who have lesions at the bottom of the spine (lumbar and sacral area), the disability may only involve their legs. Within that group, some may have paralysis and some may only have weakness. The muscles which are affected can differ among all of them. Those babies whose injury occurs higher on the spine generally have more weakness or paralysis and present with more involved physical disabilities. Additionally, babies born with a myelomeningocele may develop hydrocephalus. If so, they require surgery to insert a shunt which will drain the fluid. Unfortunately, the pressure created by the hydrocephalus can cause brain damage to varying degrees. Those who have a Chiari malformation will likely have learning disabilities and muscle issues. The tissue from the brain which protrudes into the spine can … Read more

How to help your child develop better posture

Tuesday, December 28, 2010@ 9:26 PM

As I have said many times, children develop at different rates and it is sometimes difficult to know whether or not your child needs a little extra help.

 I always tell parents that it is better to be safe than sorry. Therapeutic exercise is helpful to all babies and children.

One of the most important aspects of baby and child development is good posture.

 Poor postural alignment can result in problems in a multitude of activities. It can affect gait, coordination, and sitting stability which in turn can impact success at school and at play. In a few of my previous posts, I have discussed exercises for core strength and specifics on eliciting good postural stability. Today I would like to talk about an additional way you can help your child to get stronger.

In one of my first articles, I described what signs to look for to determine if your child was low tone. If you have not read that post, it will be helpful to take a look. Low tone influences all fine and gross motor skills. If it is not addressed early, it can lead to handwriting and other school related problems. Children with low tone are unable to sustain a good sitting position and will fidget and re-position themselves in an attempt to stabilize.

A good tool to get which can help build strength is a small scooter board.

They are designed to be used indoors and are very versatile. Aside from its strengthening benefit, it also offers sensory stimulation. The sensory stimulation can help the vestibular system and improve balance and equilibrium reactions.

Here are some techniques for using the scooter board:

For a child with weak upper extremities, have her lie on her tummy on the board and propel herself forward by … Read more

Great baby development toy

Monday, December 13, 2010@ 3:31 PM

No matter how many new toys emerge, certain toys remain the best for baby development.

It is important to find a toy which interests your baby, and is at their developmental level. A lot of newer toys are visually stimulating and interesting to a baby, but are not helpful for developing either gross or fine motor skills. That is why I always used traditional toys when I was treating infants and toddlers.

One of the best of these toys is the stacking ring.

Although it has changed over time, and acquired some bells and whistles, it remains basically the same as its original design. I personally prefer the simple ones, such as the one made by Fisher-Price.

Stacking rings can help your baby improve her hand-eye coordination, help develop grasp, help improve crossing midline and help with bilateral integration (using two hands together).

As she gets older, it helps with cognitive development and understanding size and spatial relationships. If you guide your baby through the following steps, she will learn this very quickly.

You can introduce stacking rings as early as 5 or 6 months. It is ideal if your baby can sit independently, but if not, use the rings while she is sitting in the high chair. Even better, prop her between your legs as indicated in my blog describing hand-over-hand assistance. No matter what toy you are trying to teach your child, helping with hand-over-hand assist speeds up progress. It is important, however, to do this while seated behind your baby so that your right hand is in contact with her right hand, and not left hand to right.

It is easier to remove the rings, so begin with taking them off. I recommend starting with only the biggest ring. Place your hands over your baby’s and help … Read more

holding up head is hard for a big babyI was recently contacted by a mom who wanted to know how to get her baby to stay in the propped position. It seems that he could hold the prop position briefly, but very quickly his head dropped down to the floor. The mom’s observation was that he had a very big head. In fact, she said his head circumference was in the 98th percentile.

Believe it or not, a big head can cause big developmental delays.

Other potential delay causes include very big babies, cute fat babies and low tone babies. While none of these issues are considered to be a disorder, they can be very problematic to the developing baby. The goal is to have your baby accomplish her developmental milestones within the normal time frame. If you have read my other posts, then you understand that delays can mean that your baby does not realize her potential.

Here is the reason why the above problems can cause developmental delays. Everything we do relies on body mechanics and gravity.

In reality, it all boils down to physics. So when a baby’s head is very big, the weight of her head relative to her developmental progress is disproportionate. Her neck and other muscles cannot hold the head up against gravity. The same problem applies to heavy babies or very large babies. Their weight exceeds their developmental ability. If the child is low tone, then she doesn’t have sufficient strength to move up into gravity and skills don’t emerge on time. The problem snowballs because the older the baby gets, the bigger or heavier she gets as well. When the initial milestones are missed, the subsequent ones are harder and harder to achieve. Progress slows and eventually the baby is substantially delayed. Is there anything actually wrong with these … Read more

The challenge in treating both babies and children who have spastic type cerebral palsy is in working with the combination of low tone and high tone.

In my previous post, I explained how therapists regard spastic tone as being superimposed on low tone. Most of the children I treated had very poor trunk control because of low muscle tone. However, their extremities exhibited spasticity during any kind of movement.

Good therapy always includes focus on trunk control. No matter what the diagnosis may be, trunk control is vital to performance.

 Poor trunk control will influence all movements of the extremities. It can lead to difficulties with coordination and fine motor skills. Symmetry and balance improve when the base of control is stable. This means that treatment of cerebral palsy needs to focus initially on the trunk and then address the tight muscles of the arms and legs.

There are so many types of therapy available for cerebral palsy, and which treatment is best often depends on the type of CP. Over the next few posts, I am going to describe a few of the treatment options that I think produce the best results. Some of these treatments are less well known than others. I encourage anyone who is seeking therapy for their child to look closely at these recommendations. They have produced some dramatic results with extremely involved children. Keep in mind that no matter how effective the treatment may be, there is currently no cure for cerebral palsy. The objective of these therapies is to elicit the most function possible given the nature of the problem. What I mean is that the CP may remain severe, but the child will gain functional skills that you wouldn’t expect with the level of spasticity and involvement.

I personally like to combine … Read more

Don’t Let Your Child Be Labeled

Monday, August 23, 2010@ 3:03 PM

developmental delays in childrenToward the end of the last school year I had a lengthy phone conversation with my neighbor about getting the right treatment for her son. She’s a teacher and was working with my five year old on developing his reading skills. We spoke about the fact that I’m an early intervention occupational therapist. Knowing that, she told me that her 6 year old son’s teacher insisted he needed occupational therapy because of his poor grasp and writing skills, which she claimed were due to visual motor problems. He was reversing letters like B and D, and having trouble accurately copying.

I had gone to her house to evaluate her son, as a neighborly gesture, but he wasn’t cooperative.I had my neighbor perform some tasks with him and had him draw some lines and draw a picture. I told her at the time that I didn’t see anything that indicated a need for O.T. He completed all the requested tasks without difficulty. The only thing I did notice was an overly tight grasp on the crayon and bearing down too hard when drawing or writing. I also noticed that he had, what therapists call, hypermobile joints. For the layperson, that would mean double-jointed. He also appeared a little low tone.

I explained that joints have extra movement because the tendons are a little longer than average and that the surface of the joint is flatter. Most bones work together. One has a sort of ball shape at the end, and the adjacent bone has sort of a cup shape. They fit together, in a way, and limit range of movement. When the cup is less deep, and the tendon is longer, the bones move in more directions and have no way to stabilize. This makes precision tasks … Read more

Does your child W-sit?

Thursday, July 15, 2010@ 1:35 PM

poor sitting positionI’m pretty sure everyone knows the W-sit position, but I’ll describe it for you anyway. W-sitting is the position that happens when, instead of sitting on her heels, your child’s legs slide out so her bottom is on the floor, and her legs form the letter W. I could never sit like that when I was a child, although I thought it looked really cool and tried as hard as I could to make that W.

Well, as a therapist, I can tell you that this is a position you want to encourage your child to avoid. The biggest concern is that the femur (thigh bone) assumes an angle that can be damaging to both the knees and hips. The femur is not supposed to have that much movement in relation to the hip socket.

In my experience, most children who sit in this position will probably not develop problems in the future. In all likelihood, their tendons and ligaments are long enough and the joint space is large enough that a mechanical injury will not occur. But you shouldn’t take the chance. W-sitting is one of the biggest therapy no-no’s when dealing with young children.

There are other considerations as well. When your child sits in this position, a large percentage of their body (buttocks, thighs, and legs) are making surface contact and they are essentially “fixed” into that position. If they have to transition to another position, it is very difficult because their body is not in a dynamic position. If you are wondering what I mean, try to sit like that and then attempt to get an object placed in front of you but just out of arm’s reach. You actually can’t get the object. The physics of your position don’t allow your body to move forward … Read more