physical therapy for children

Lumiere Children's Therapy Chicago: Mastering Gross Motor Milestones

Reaching and mastering gross motor skill milestones, is vital for proper child development. The following explains the five sequential milestones (tummy time, rolling, sitting, crawling and walking) and tips to help your child achieve them.

David Precious

David Precious

Tummy Time

Tummy time is important for your child to develop strength in his neck muscles. Neck muscle strength is important for your child to begin holding his head upright and in the middle, and contributes to his ability to roll over, sit, crawl and walk.

If your child seems fussy on their tummy, this is because it is a difficult position for your child. It is similar to an adult version of a plank— very difficult! Tummy time looks different each month of development, depending on your child’s age and level of strength, call Lumiere Children’s Therapy or attend one of our parent trainings to learn more about developmental positions and motor milestones.

Where can I do tummy time?

You can do tummy time on a blanket or foam mat on the floor, over your chest facing you while you are laying down, over your lap or carrying the child on his/her tummy across your forearms.

What should my baby look like in tummy time?

Tummy time looks different at each month of age. Initially in the first month, your baby will barely be able to lift his head off the surface to rest his cheek. Then, closer to 3-4 months you child will be able to lift his up further and further until it is at a right angle to his back. By 5-6 months, your child will start to push up on his hands with straight elbow. Then, it’s time to start pivoting and belly crawling.

Tummy Time Tips

  • Always supervise your child during tummy time. Get on the floor with your child so he/she is motivated to lift his/her head

  • Use a mirror, rattles, music-playing toys, or bubbles

  • Sing to your child during tummy time

  • Begin tummy time early on, as early as a week old!

  • Start in 2-5 minute increments and work your way up to total 60 minutes a day.

  • Perform exercises when your baby is the most energized and ready to play, such as after your baby has slept, eaten, and has a clean diaper, to ensure your baby is the best mood to “exercise”!

  • Note: some babies will need to wait an hour after eating before tummy time to minimize spitting up, especially babies with reflux. Ask your doctor about specifics if your baby has reflux.

  • Use a fun tummy time mat a comfortable tummy time mat will motivate your baby to stay on his tummy, engage in the toy, and be comfortable! Fisher-Price Deluxe Kick 'n Play Piano Gym or a water mat will also motivate your baby to perform tummy time! Hoovy Baby Inflatable Water Play Mat


Rolling

When should my baby be rolling?

Babies typically roll from back to belly around 4-6 months, and belly to back ~3-5 months. However, this is a range, and every child is different!

How can I help my baby roll?

There are a few fun activities that you can do with your baby to encourage rolling:

  • Reaching for feet: Rolling from back to belly requires quite a bit of core strength, so a great place to start is by encouraging your child to reach for his feet to really engage his core muscles.  You can do this by placing rings on your child’s feet to encourage him to reach up towards his feet to grab the rings. You may have to help him at first, but once he is able to do so let him do it more and more on his own until he does it on his own.

  • Reaching to one side: With your child on their back, use a toy to guide your child to look to one side and encourage him to reach for the toy by reaching across his body and rolling to his side. Sometimes you have to move the toy farther than you think to get him to reach!

  • Assisted rolling: Once your baby is reaching across his body for a toy, you can help your baby to his side by assisting at his hip. This helps teach him how to complete the motion with both his upper and lower body together. As he continues to gain strength, you can gradually decrease your support until he rolls on his own!  

  • Tummy time: The more comfortable and strong your baby is in tummy time, the more your baby will want to roll and tolerate floor time. Read above for tips on tummy time!

When and why would my baby need physical therapy to help with rolling?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not reaching with arms for toys at 6 months on back

  • Not able to lift head up in tummy time at 3 months

  • Not rolling back to belly by 8 or 9 months

  • Only reaching with one arm

  • Only rolling to one side

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the motor plan to roll, as well as strengthen muscles!


Sitting

When should my baby be sitting?

Babies can begin prop-sitting while leaning on hands as early as 4 months, however while having a caregiver close by to assist with balance. Babies typically can sit on their own between 6-8 months. However, this is a range, and every child is different!


How can I help my baby sit?

There are a few fun activities that you can do with your baby to encourage sitting:

  • Prop-sitting: Hold your child around his trunk and help him lean forward onto his arms. At first, your child may only be able to do this for a few seconds at a time, but it builds arm strength! Work up to 30 seconds, then 1-2 minutes at a time, to your child’s tolerance. At first, your child will place his hands in front of his feet (around 4 months). As your child gets stronger, his arms will move closer to his knees (around 5 months), then hips, then he may place his hands on his own legs until he can sit without his arms (around 6-7 months). As your child gains strength, continue to sit close by and assist your child as needed.

  • Assisted sitting: Hold you child around his trunk and decrease your assist until your child can sit on his own. You can place toys directly in front of him to encourage him to sit up straight and lean his hands on a toy if needed.

Note: Babies do not gain the reflex to catch themselves on their arm from falling sideways until 6-7 months, and they do not gain the reflect to catch themselves on their arm from falling backwards until 10 months. Always be nearby and ready to catch your child from falling when practicing sitting exercises.

  • Tummy time: Similar to rolling, the more comfortable and strong your baby is in tummy time, the more your baby will have the core strength to sit. Read Part 1 for more tips on tummy time!



Toys for sitting

Cube activity Center: A vertical surface such as a large cube is great to provide some support for your child to place his hands on, and also encourage an upright trunk. Check it out here

Shape Sorter: A larger type toy is helpful to provide some support for your child to put his hands on as he learns to sit. Once he is sitting on his own, it encourages reaching and manipulating toys to further challenge balance in sitting. Check it out here


When and why would my baby need physical therapy to help with sitting?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not able to sit on his own by 8 months reach for toys on belly at 7 or 8 months

  • Not able to prop-sit while leaning on his hands by 7-8 months

  • Not able to sit upright when he sits (leaning to one side)

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the balance to sit, as well as strengthen muscles!

Crawling

When should my baby be crawling?

Babies typically begin pivoting in a circle on their belly around 6-7 months, belly crawling forward on their belly between 7-9 months, and crawling forward on hands and knees around 8-10 months. However, this is a range, and every child is different!

How can I help my baby crawl?

There are a few fun activities that you can do with your baby to encourage crawling:

  • Sitting to belly: Once your child is able to sit on their own, its time to start introducing weight shifting to transition to his stomach. To do this,  start in sitting and you can lean your child to one side to lean on one arm while reaching towards a toy with his opposite arm. Then guide him up and over his leg and onto his belly.  Make sure to have him go over his side to protect his hips. This strengthens his arms and core and helps them learn how to shift his weight from side to side.

  • Kneeling at a surface: Next, help him kneel at a surface or a a low step to encourage weight-bearing on his knees in a modified crawling position. This a great place to practice lifting one arm to reach for a toy, to simulate reaching forward on all fours when crawling.

  • Rocking on all fours: You can also help him rock on all fours to help them slowly build strength in his core and arms. As he begins to get into all fours on his own (typically anywhere from 5-9 months) you can provide support at his trunk and legs to help him rock back and forth. Once he gets stronger, you can support his trunk and help him crawl forward as he moves his arms.

  • Tummy time: Similar to rolling and sitting, the more comfortable and strong your baby is in tummy time, the more your baby will want to pivot and crawl! Read Part 1 for more tips on tummy time!

When and why would my baby need physical therapy to help with crawling?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not able to reach for toys on belly at 7 or 8 months

  • Not trying to pivot on belly or move position on belly at 7-8 months

  • Not rolling back to belly by 8 or 9 months

  • Only reaching with one arm

  • Only rolling to one side

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to teach your baby the motor plan to crawl, as well as strengthen muscles!


Walking

When should my baby be walking?

Babies can begin walking between 10-14 months. However, this is a range, every child is different, and this depends on their motor milestone acquisition thus far!

How can I help my baby walk?

There are a few fun activities that you can do with your baby to encourage walking. Always stand close by with your hands out during such exercises to catch your child from falling if necessary:

  • Assisted cruising: Once your child is able to pull to stand and stand at a support surface, you can start teaching him to move on his feet by stepping sideways to cruise along a table, coffee table, or ottoman. The surface can be about the height of your child’s chest. Once he has mastered cruising, you can encourage larger steps by having him cruise between two support surfaces at a 90 or 180 degree angle. Gradually, you can increase the distance between the surfaces to make it more challenging.

  • Reaching in standing: Walking incorporates both balance and coordination, and a great way to target this is by practicing weight shifting while standing. You can start by having your child stand with his back against a couch or wall, and practice reaching forward or sideways. You can do this by having him reach for a toy or pop bubbles, whatever interests him. You can also have him hold onto the toy as you for another way to help him gain balance in standing with decreased assistance.

  • Walking practice: Practice taking steps by holding your child around his trunk and walking/kneeling behind them. This promotes proper alignment while walking.  When your child can stand on his own >20-30 seconds at at time, he is likely ready to start taking steps. Stand a few feet away from him to encourage him to walk to you. You can start by holding his hand, or holding the same toy, then fade assist as he gains strength and confidence!

  • Squatting: When your child can stand at a surface, hold objects at the height of his knee to encourage him to bend down and pick up an object, then return to standing. Both knees should bend, and this strengthens his muscles! As he gets stronger, you can hold the object lower and lower until the object is on the floor. Make sure to do this to both sides.

  • Tummy time: Similar to rolling, the more comfortable and strong your baby is in tummy time, the more your baby will have the core strength to sit. Read Part 1 for more tips on tummy time!

Walking tips

  • Start with your child barefoot so your child can feel the ground and use his toes for balance.

  • Use positive praise and get excited for your child so he stays positive!

  • Use bubbles or a fun toy to distract him!

  • Note: Some children may need some support in their shoes to add some stability to assist in standing and walking. A physical therapist can assess your child’s foot alignment to determine if an insert or brace is indicated.


When and why would my baby need physical therapy to help with walking?

Babies are all different and can develop at slightly different times, and that is okay! If your baby is showing any of the following “red flags” listed below, it might be a good idea to ask a physical therapist for an evaluation. (However, these are child specific. Call our and ask to speak with a physical therapist with any questions):

  • Not standing at a surface by 12-14 months

  • Not cruising along a surface at 16 months

  • Refusing to bear weight through legs at 10 months

  • Standing/cruising on tip-toes

Additionally, your child may have another medical diagnosis that will make meeting motor milestones tougher, and a physical therapist can educate parents on treatment ideas and home exercises to give your baby strength and confidence to walk!

Thank you for reading our motor milestone series! If this blog post has sparked any questions about your child’s development, feel free to call our office to speak to a physical therapist! We also offer two “mom and tot” classes about teaching your child to move, listed below. Call our office at 312.242.1665 to try a class!



PARENT/TOT CLASSES

BUDDING BABIES* (ages 4-10 months)

Your baby may not be crawling yet but there’s lots they’re learning – and you can help! Learn how to position your baby to build strength and develop stability. Explore the senses and support visual and auditory development with tummy time, rolling and other key exercises. This class includes parent discussion time to help learn about your child's development.

*Parent Involvement Required

WEE WALKERS* (ages 11-22 months)

As your baby becomes vertical, a whole new world of wonder is revealed. Play environments are vital to encourage discovery, problem solving, balance and coordination. Parents learn to understand how their infant interacts and communicates with them and others.

*Parent Involvement Required

www.lumierechild.com

Lumiere Physical Therapy: What is Plagiocephaly?

Plagiocephaly, or “flat head syndrome” is a condition in infants that is more common than you think. In a study done in 2013 and published in Pediatrics, the incidence of plagiocephaly in infants 7-12 weeks old was 46.6%¹. That means that this condition affects ~1 in every 2 infants. Read below to learn more about this common diagnosis, the causes, and which medical professionals can help.

What is Plagiocephaly (Flat Head Syndrome)?

Plagiocephaly, also known as “flat head syndrome”, means that your child’s head has flattened due to the fact that your child’s skull sutures have not yet closed. This may be caused by an infant spending too much time on his back, especially looking only to one side, resulting in a flat spot on one side of the head. This also may be due to Torticollis, which involves a child only looking to one side due to muscular tightness in the neck/trunk/pelvis. If this is the case, it is important to begin to work on opposite head rotation as well as positioning, to help get your child off his back. A physical therapist can help with this. (Check out our previous blog post on torticollis which helps with specific exercises/positions.)

Once a flat spot develops, it will be more difficult for your child to look the other way due to the flattening, which further exacerbates the issue, creating a type of ridge on the back of your child’s head. There also can be facial asymmetries associated with the flattening. On the same side as the flattening, your child’s eye and cheek may be slightly larger, with a slight forward bossing on the same side of the forehead, and the same side ear may also be pushed forward. Facial asymmetries are typically corrected when the skull is properly aligned, which will depend on the severity of the head flattening.


What is Brachycephaly?

Additionally, your child may develop a flat spot on the entire back of the head (not just only one side), which is called Brachycephaly. This is also caused by an infant spending too much time on his back, or in equipment such as car seats or bouncers². A shaping helmet may be indicated for both plagiocephaly and brachycephaly, depending on your child’s age and the severity of the flattening, described below.



Who can I see about my child’s flat head?

If you’re concerned about your child’s head shape, first talk with your pediatrician. Your pediatrician may refer him to a plastic surgeon or an orthotist. A specialist can measure your child’s head shape manually or using a scan. Depending on the results, they may recommend a shaping helmet, physical therapy, or both. It will depend on your child’s age and the severity of the flattening. The ideal window of time to receive a shaping helmet is around 6 months of age, however a child can receive and wear a shaping helmet up to 12 months old. After 12 months of age, there is minimal benefit to wearing a helmet.



A few places you can go in the Chicago area:

  • Scheck and Siress

  • Transcend Orthotics

  • Dr. Frank Vicari at Advocate

  • Head Shape Evaluation Program at Lurie Children’s Hospital

  • Cranial Technologies



How long will my child wear a shaping helmet?

This will again depend on your child’s age and severity of the flatness. Your orthotist or plastic surgeon will decide based on your child’s progress with subsequent scans. Helmets are typically to be worn 23 hours a day, with two 30-minute breaks permitted. A child may wear a helmet for as long as in indicated to correct the head shape, which can be anywhere from 4-6 weeks on.


Will it make my child’s head harder to lift?

The shaping helmets are pretty lightweight. A child will not receive a shaping helmet until he has enough head control. There may be an adjustment period while your child gets used to wearing it, however some infants do not tend to notice.

How can a physical therapist help?

A physical therapist can help with the underlying muscular factors such as muscular tightness that causes your child to look one way (torticollis), or low muscle tone that makes it more difficult for your child to move around and transition to different positions. A physical therapist can help with strengthening your child’s muscles during tummy time, as well as help your child with positioning and exercises to teach your child to roll and sit on his own and tolerate more time on his tummy.


If you have any additional questions about your child’s head shape or alignment, you can call our office at Lumiere Children’s Therapy and speak with a physical therapist.






References:

  1. Mawji A, Vollman AR, Hatfield J,McNeil DA, Sauvé R. The Incidence of Positional Plagiocephaly: A Cohort Study. Pediatrics. 132 (2). August 2013.

  2. https://www.cranialtech.com/my-babys-head-shape/


Lumiere Children’s Therapy: Autism and Physical Therapy

Happy Autism Spectrum Disorder (ASD) awareness month! Many recognize speech therapy as an important component of the overall treatment plan for ASD due to difficulty with spoken language, eye contact, facial expressions, and emotional recognition. Although language deficits are a core symptom of autism, children may also demonstrate difficulty with coordination, motor planning, and hand-eye coordination. Therefore, physical therapy can help facilitate gross motor development to increase participation in everyday activities and social activities such as gym class, sports, playing, etc.

Lecates - Flickr

Lecates - Flickr

What are the signs and symptoms of Autism Spectrum Disorder?


  • Social communication challenges

    • Difficulty with social interaction including initiating and maintaining topics during conversation

  • Pragmatic difficulties

    • Children with ASD may present with poor eye contact, difficulty gauging personal space, and decreased facial expressions

  • Difficulty identifying emotions

    • Difficulties may include recognizing one’s own emotions as well as the feelings of others. They experience trouble expressing their emotions during a variety of situations. Also, children may lack knowledge of when to seek emotional support or provide emotional comfort to others.

  • Repetitive behaviors

    • Repetitive behaviors present differently for each individual but some examples may include repetitive body movements (arm flapping, spinning), motions with objects (spinning wheels), staring at lights, and/or ritualistic behaviors (lining up toys in order)

What physical difficulties may a child with autism experience?

Children with ASD may present with the following physical challenges:


  • Developmental Delay:

    A developmental delay is when a child is lacking the age-appropriate skills in one or more of the developmental areas: cognitive, social-emotional, speech and language, fine and gross motor. If a child demonstrates a physical developmental delay, they may have difficulty rolling over, holding up their head, sitting up, crawling, and eventually walking and jumping.


  • Low muscle tone:

    Muscle tone is the amount of tension in muscles used to hold up our bodies while sitting or standing. Low muscle tone is when the muscles require more effort to move properly while doing an activity. They may have difficulty maintaining good posture when standing and sitting, and often affects their overall gross motor development.


  • Difficulty with motor planning.

    Motor planning is the ability to conceive, plan, and then execute the physical skill in the correct sequence. Motor planning assists children in attempting new tasks without the need to consciously learn the steps to each new task. Motor planning arises from organizing sensory input from the body, and having adequate body awareness and environmental perception. Children who have trouble with motor planning may experience difficulty carrying out new tasks, following physical commands when given verbal instructions, and appearing clumsy while executing new tasks.


  • Decreased body awareness.

    Children with ASD may lack awareness of where their bodies are in relation to their environment, causing children to become accident-prone or present clumsy.

Who is a Physical Therapist?

Physical therapists, often referred to as PTs, are professionals that help people gain strength, mobility and gross motor skills. They are experts in motor development, body function, strength, and movement. Pediatric physical therapists can help children with a variety of disorders gain functional physical skills so they can participate in everyday activities.

What does physical therapy target?

  • Basic skills. Physical therapists can help children develop the primary gross motor skills of sitting, rolling, standing and running if they are experiencing a developmental delay.

  • Coordination. Physical therapists focus on the necessary muscles and skills to improve balance and coordination in everyday activities.

  • Improve reciprocal-play skills. Help children use motor planning to coordination throwing and catching a ball, and other activities that involves interacting and reacting to another person.

  • Development of motor imitation skills. In order to learn new skills, a child must be efficient in imitation and following physical directions. PTs can offer strategies and practice of imitating movements.

  • Increasing stamina and fitness. For older children, physical therapy may focus on skills required to participate in play and sports such as kicking, throwing, catching, and running.

  • Parent education. PTs create home exercise programs so that family members can help facilitate building on strength, coordination, and development of specific goals into their natural environments and routines.


Why is physical activity important for children with ASD?

Physical therapy increases a child’s ability to participate in physical activities by improving strength and coordination. Once a child is able to functionally participate in physical activities, they are able to reap the many benefits of daily exercise.


  • Social skills. Gym class, playgrounds, and organized sports teams offer opportunities for children to develop friendships and social skills. For children with ASD, physical activity programs provide a fun, safe environment to develop and practice social interaction skills.

  • Improvement in behaviors. Physical activity may help decrease maladaptive behaviors and aggression. Children with ASD have difficulty expressing and understanding their feelings. Physical activity can aid in reducing stress and frustration in children, often helping them adjust in different activities without aggression.

  • Overall health improvements. Staying active and participating in daily physical activities can decrease the risk of general health problems in individuals with ASD, including obesity.

  • Increase quality of life. Daily activities such as climbing stairs, walking on the sidewalk, and going grocery shopping require the use of gross motor skills. Improving one’s strength and stamina can positively affect their participation in everyday chores and activities.


If your child has Autism Spectrum Disorder, and is experiencing difficulty with coordination, strength, and motor planning, physical therapy might be right for you. Our physical therapists at Lumiere Children’s Therapy can offer evaluations, customized treatment plans, and home exercise programs for carryover into the home.





References:

“Does Physical Activity Have Special Benefits for People with Autism?” Autism Speaks, www.autismspeaks.org/expert-opinion/does-physical-activity-have-special-benefits-people-autism.

Morin, Amanda. “What You Need to Know About Developmental Delays.” Understood.org, www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/what-you-need-to-know-about-developmental-delays.

“Motor Planning.” North Shore Pediatric Therapy, nspt4kids.com/healthtopics-and-conditions-database/motor-planning/.

“Physical Deficits.” Mental Help Physical Deficits Comments, www.mentalhelp.net/articles/physical-deficits/.

Rudy, Lisa Jo. “What Can a Physical Therapist Do for a Your Autistic Child?” Verywell Health, 24 July 2018, www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052.

Ries, Eric. “Physical Therapy for People With Autism.” Physical Therapy for People With Autism, www.apta.org/PTinMotion/2018/7/Feature/Autism/.

“What Are the Symptoms of Autism?” Autism Speaks, www.autismspeaks.org/what-are-symptoms-autism.