Category Archives: Babies

Sensory and Motor skills for Babies

OT for Babies – Never Too Young

Parents are often surprized I work with babies. I usually hear ‘aren’t they too young’ or ‘what do you do with a baby?’

Babies are always learning new skills and reaching new developmental milestones. As everybody says, they do mostly feed, poop and sleep, but they also, move, play and interact. These skills all develop from birth onwards.  An OT experienced in working with babies can evaluate which foundational areas the baby is struggling with and how to improve them

Here are three scenarios:

1) When a baby struggles with feeding, we would assess their tolerance for touch with their body and in their mouth, oral motor skills in their mouth for nursing or eating foods, muscle control in their core / neck / shoulders, and their body alignment and positioning for feeding.  See more here.

2) If a baby has a flat spot on their head or turns their head to one side (plagiocephaly or torticollis), we assess their core strength, body awareness on the weaker side, motor planning, eye movements, jaw alignment and oral motor skills, which muscle groups are weak or tight, tolerance for movement and motor skills using both sides of their body.

3) Another common scenario is when the child is described as a ‘lazy baby.’  Usually there’s a reason for this.  They may be sensitive or fearful of movement, have difficulty figuring out how to move their body, or have weak body strength and stamina.  Sometimes the baby could have a lower state of arousal and need more sensory input (touch, muscle / joint and / or movement input) to rev up their engines the so they feel the urge to move and play.

When we explore deeper, there are underlying areas we can develop. And as babies are changing and growing so fast thanks to brain plasticity, they have amazing potential to progress at a faster rate. Early intervention helps.

Babies whom I treat usually may have:
-Plagiocephaly (flatness on head)
-Torticollis (turn or bend their head to one side)
-Avoid moving to one side of their body
-Don’t use one arm or leg
-Dislike being on their tummy
-Have difficulties with breastfeeding or transitioning to foods
-Appear colicky or are described as a fussy baby
-Sensitive to sounds or being moved
-Not meeting motor milestones
-Feet tend to turn outwards
-Born prematurely so need extra help to catch up
-Have diagnoses such as Down’s syndrome, Cerebral palsy, Hemiplegia or other genetic syndromes

If you have any concerns about your babies’ development, feel free to contact me to have a chat and discuss further.

For more information:
Sensory and motor developmental milestones month by month by Pathways Awareness:

http://pathways.org/milestones/

What does a baby OT assessment with me look like?

http://ot4kids.co.uk/baby-evaluations-never-too-early

Infant red flags for sensory processing difficulties

http://ot4kids.co.uk/babies-early-signs-how-do-you-know

Baby Owned Movements

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Baby Owned Movements

My son crawled at 9 months, sat at nearly 10 months, and walked at 16 months. According to developmental charts, his sitting and walking are considered to be within the later range of ‘normal.’  Charts indicate that babies sit at six months when placed in sitting by an adult.  The baby does not own that movement of sitting by being able to move in and out of positions. Most are actually stuck in sitting and struggle to get ‘unstuck.’

When treating babies, my main goal is for them to figure out and plan how to move their own bodies in and out of rolling, sitting, crawling, standing and walking. For example, to stand, the baby must be able to get onto hands and knees and push off the floor into standing. To cruise along the sofa, they need to crawl up to the sofa to pull themselves up and then cruise.  I do not put babies in positions that they cannot get into themselves. There are so many benefits to this including:

1) Baby uses their own muscle strength to get into a position versus being forced to hold a position that their body can’t handle which can lead to muscle strain or locking joints for stability.

2) Develops body and spatial awareness. As the child uses their own body (muscle and joint) sense to get in and out of positions, they develop an innate body awareness and sense of space around them. This is much safer as the child can get their own body not only in the position but ‘unstuck’ to get out of it. When placed in a physical position by an adult, they aren’t required to use their own body sense to move.

3) Develops motor planning skills – the baby has to come up with the idea to move, plan how to move their bodies, and then make the move. These skills are so important for motor planning and the beginning to problem-solving, sequencing, and figuring out how to do new things – all skills children need for pretend play, being independent and school projects.

4) Increases balance – by completing movements actively themselves, balance and confidence improves. Active movement develops ones movement sense and stability more than passive sensory input.  The movement system has strong links to one’s ability to calm and self-soothe, be alert and focused and much more so it’s a good one to strengthen.

In my professional and personal experience, I find that children who can move in and out of positions on their own versus being placed in positions are more safe and stable, have better posture and are less slumped over, more flexibility and variation in their motor skills, less sensitive or fearful of being moved, and are comfortable getting in and out of different positions.

As a paediatric OT, I will use sensory processing, Neurodevelopmental, myofascial, socio-emotional or play-based strategies to help the child develop the skills they need to be flexible and functional in their motor skills so they own their own movements, and can be more safe and independent in their play.

Here are some other interesting reads on this subject:

http://mamaot.com/2013/07/14/to-sit-or-not-to-sit-developing-functional-sitting-skills-in-babies/

http://www.janetlansbury.com/2012/04/sitting-babies-up-the-downside/

http://www.janetlansbury.com/2009/12/dont-stand-me-up/

http://www.janetlansbury.com/2011/03/9-reasons-not-to-walk-babies/

Breastfeeding & Sensory Processing Difficulties

BREASTFEEDING AS A THERAPY

This is my first blog post in perhaps two years!  I’ve been pretty busy with my now-toddler-then-baby but this is a topic very close to my heart. I lived it and breathed it for a whole year which is how long it took for my little guy, M, to become ‘functional’ at breast feeding. It is also something that many of the families I work with have or do struggle with so I wanted to share our story.

Here’s our abridged story.

Following birth, M immediately struggled to latch on and nurse. He was only 2.2 kilos so we were kept in the hospital for a few days. We received a lot of advice from the midwives of which all were conflicting and really, although my Occupational Therapy head knew better, my new-mum head was a bit overwhelmed and second-guessed myself. I always tell parents to trust their own gutt instinct.

Some feeding difficulties my son had were:

-Gagging (I hated it when the midwives or GPs would say ‘big mouthful’ and to put a lot of breast in the baby’s mouth. This did not work for my baby who was sensory defensive and couldn’t organise his body, let alone his mouth)

– difficulty latching on

-struggled to mould or ‘snuggle’ during feed and other times

– hiccups, gasped for air, guzzled liquid down while bottle drinking

– difficulty getting in a rhythm of suck swallow breathe

– took over an hour to feed

– struggled to move one side of his face, tongue, cheek, lip

– lopsided wonky smile (one side didn’t turn up or move), drooled only on one side, preferred feeding on one side

– jaws seemed to wobble

– held up his head from birth (yes, this is a red flag as he had tightness in his neck and back muscles which led him to always lift his head and arch his back. He could not relax at all when on his back. This position also brought his tongue back so he couldn’t bring it forward to latch on and suck /swallow.)

Our Team:

I contacted a speech feeding therapist of mine whom I hugely respect at day 3! We were so fortunate to have her support as the NHS speech therapist said there’s nothing to do until M eats foods. Not only couldn’t we wait but I knew better. Please know this is so not true. It was important to strengthen and develop M’s jaws, cheeks, lips, and tongue so he could nurse and later, eat foods and talk.

At 4 months, we saw an osteopath I’ve known and worked with. She worked with M using a classical approach, loosening and mobilising tight areas, so he could be more comfortable in flexion and move his body forwards, ESP his tongue. She also worked on his gutt mobility so that his body could best absorb nutrients, digest, pee and poop.

A craniosacral therapist who treated me saw M and worked wonders on his cranial system so he could be less sensitive, relax his body, and again, bring his neck and tongue forwards for nursing

A Jin shin Jyutsu therapist worked with M on relaxing his body via different Asian flows.

I, OT mummy, worked with M to become more comfortable with touch, movement, and sounds, develop his body awareness to move with more flexion and be able to bring his head forwards, move smoothly in and out of positions, and coordinate both sides of his body versus only move via one side. We also worked on positioning M’s body so he could be more comfortable with feeds. Once his body was more comfortable, his mouth followed suit.

The oral motor therapist worked with us on different feeding positions for myself and M to support his breastfeeding needs, supporting and strengthening his jaw, how to strengthen the oral muscles using specific, targeted exercises on the tongue, cheeks, lips, and jaws.

Private DAN doctor inspired by Asian medicine – He confirmed he wasn’t concerned about weight and size, continue with breastfeeding versus formula, but was more concerned about gutt absorption of nutrients. So he prescribed us some chinese herbal supplements, vitamins, probiotics and MCT oil which apparently is a natural ingredient already found in breast milk.

By 10 months of age, breastfeeding had finally become very comfortable.

Later speech and feeding therapy sessions worked on spoon feeding, emerging munching, eating different textures and building interest in foods, working on chewing tougher foods, and developing sounds of consonants and particularly lip sounds such as ‘m’ and ‘n.’

Using breastfeeding as a therapy gave us the chance to work on M’s sensory processing and oral motor skills soooooo many times during and before every feed.

We were fortunate to receive a lot of amazing, private support from very early on. During times, we felt desperate so also tried many ‘wrong’ things before figuring out what they worked. But as they say, it took a village and I really believe we need to support families with breast feeding challenges using a whole body and a collaborative team approach.

What did I, OT mummy 🙂 do that helped?

-Worked on sensory defensiveness, flooding M with calm, sensory input. Deep pressure input, linear movement input, building tolerance for movement in different planes using music, rhythm and predictability, heavy muscle and joint work for added proprioception to his body and mouth, and building tolerance for multi-sensory input. ‘Baby wearing’ was a huge part of our life for all sorts of positive sensory input.

-Before every feed, we did some gentle body work to build motor skills and body symmetry and encourage flexion.

-Targeted oral motor exercises for cheeks, tongue, lips, and jaws before feeds and later, when starting solids, we had therapeutic feeding strategies.

-Used straw and open cups as no concerns with aspiration, or safety of swallow.

-Positioning – Swaddling for feeds was a huge help and he relied on this till 7 months. I laid semi- reclined so M kind of ‘fell’ into me and gravity could help.

-Music –I remember using classical 90-beat Baroque music for children feeding in the hospital so we tried this too.

-Mental stuff  – meditation, imagery, positive self-talk, trying to keep the feeds happy despite it being so stressful

-Surrounded myself by like minded and positive people

 

Resources:

Kellymom.com

-An invaluable source on breastfeeding and busts so many myths.

Dr Jen 4 kids

http://www.drjen4kids.com/

www.talktools.com

Book-

Supporting Sucking Skills in Breast Feeding Infants by Catherine Genna Watson

It’s very in depth, but I love it’s team approach and whole body outlook

 

Babies – Early Signs: How do you know?

Does my baby need Occupational Therapy?

People often wonder how soon can you tell a baby requires early intervention therapies. I thought I’d share a little bit based on my experience with my own son and babies I treat as well as common red flags from other parents.  I hope it will help others.

First of all, parents just know!  They have a gutt instinct and are always right. Sometimes as a mum, I know it’s hard to follow your own gutt especially when others around you say it’s too early or your child will grow out of it. Please know that as a parent, you know your child best.

Secondly, babies’ main daily living activities are to move, sleep, feed, and poop. Usually, if these areas are a challenge, you will have an idea that they need some support.

For my son, I knew as soon as he was born and we were moved into the maternity ward. He was the only baby constantly crying, he had a hard time with breast feeding – struggling to nurse more on one side, startled at every sound that went by, only wanted to be on his tummy being very uncomfortable on his back, had too great head control for a newborn, and was unable to fall asleep.  Everybody, including strangers on the street, always commented on his head control (which was too good for his age because of tightness) and how alert he was (due to being in an over-stimulated state of arousal).

Babies benefit from Occupational Therapy when the following red flags are present: 

Sensory processing

– doesn’t mould their body to you when held, hates baby massage

– arches back, lifts head as a newborn (newborns should be able to turn their head and clear their airway but not hold up their head yet)

– only sleeps or soothes with intense movement input

– needs to be held all of the time

– startles to sounds easily, appears on edge or in distress, doesn’t like busy places

– very alert (as in sensitive to all sounds, sights, movements)

– difficulty sleeping, takes hours to fall asleep

– unable to tolerate sitting in car seat or stroller

– difficulty with car rides

– becomes upset when laid down on their back for diaper and clothing changes

– described as ‘colicky,’ upset or unable to settle

– doesn’t move and prefers sedentary play

– does not interact or make eye contact with parents

Motor

– only wants to lay on stomach and cannot tolerate laying on back (due to strong back muscles, weak flexors, and overall imbalance of muscles on front and back of body)

-arches body backwards

– flat spot on head, turns head more toward one side

– uses one side of body more than other side – babies do not have a hand preference or sidedness

– delayed motor milestones

– moves to one side only such as rolls or comes up to sit via one side

– tightness in limbs during dressing, diaper changes, or bathing – parents may feel arms are stiff to get into sleeves, or legs do not open for diaper changes

– motor milestones are a bit delayed

– doesn’t move, described as ‘lazy’

Feeding

– nurses better on one side or unable to nurse on both sides

– pulls away from breast

– difficulty figuring out how to latch on during breast feeding

– takes excessive time to nurse

– difficulty drinking from the bottle, liquid pooling out at sides

– drools on one side of mouth, smiles a bit wonky

– difficulty transitioning to foods, refuses to eat

– does not put toys in mouth for exploration

These are just some examples. If you have any concerns about your child’s development, please see an occupational therapist right away. Do not wait and see. Start early, there’s so much to do from the beginning versus when the child starts school and skills become ingrained. Babies are like sponges due to brain plasticity. Its really so encouraging to see how quickly they respond with the right support and early intervention.

Baby Occupational Therapy Assessments – Never Too Early!

People are often surprised that I work with babies. They wonder whether it’s too early, do all babies just develop at their own pace, or how does one work with a baby.

Fortunately we now know a lot about early intervention and milestones tell us about a child’s development. Early detection and early intervention can minimize or in some cases, eliminate issues that arise. I know this both professionally and personally as a mum to a 15-month old who has thrived due to having early intervention support from his very early days.

As they say, babies mostly sleep, eat, poop and I add, move. 🙂 If any of these baby ‘occupations’ are a challenge, occupational therapy may help.

What’s involved in an Occupational Therapy Assessment with Babies? 

Generally for infants, this is what I look at in an assessment:

  • Sensory processing skills – alertness, activity level, response to touch and movement, internal body and spatial awareness for motor skills, visual and auditory processing, motor planning and problem-solving skills
  • Gross motor skills – head control, shoulder and pelvic stability, core strength, respiratory muscles activation, arm and leg movements, and transitional movements (how the baby moves in and out of positions)
  • Fine motor skills – reach, grasp, release, object manipulation, two-handed play, eye-hand coordination, how the child moves and plays with their hands at the same time
  • Social-emotional skills – how the baby calms, self-soothes, copes with multi-sensory input and either everyday or novel experiences, relates to and interacts with familiar or new people
  • Neuromuscular development – muscle tone, strength and coordination, body alignment and movement patterns, are there any asymmetries, positioning and posture in seats and equipment at home and whether modifications are required
  • Oral sensory and motor skills particularly related to feeding and daily hygiene skills

Based on the assessment findings, we do different exercises to address areas of need. I show parents various carrying techniques, positioning and therapeutic handling strategies to develop sensory and motor skills, as well as ideas of how to address sensory, emotional, motor and play skills for the baby’s age. Parents are given a home program of exercises to complete with their baby and we address skills during therapy sessions.

Prior to the assessment, I ask parents to send me information regarding the child’s birth and medical history, services to date, general concerns, any medical reports, and a completed questionnaire. I also love to see photos of the baby in various positions to help me get to know the baby and plan for the session accordingly.

If parents are concerned about their babies’ development, I suggest do not wait and see, early intervention is critical, and better to address areas of need now versus waiting till the child is older and struggling in school.

 

 

Therapeutic Benefits of Babywearing

 

I’ve an 8-month old baby with sensory processing difficulties and who has had a bit of a rough start from a traumatic birth.  Babywearing has been a huge part of our lives as he struggles to tolerate any seating devices especially strollers and car seats.  We started with a ring sling when he was home from the hospital, then a hop tei (a modified mei tai Asian carrier), and now as he is older, we also use a more supportive Ergo carrier. It’s our favourite therapeutic, ahem “fun, ” activity. 🙂

 

I have found many therapeutic benefits to babywearing and often recommend it to parents for these reasons:

 

SENSORY:

 

1) Deep pressure input, warmth, and comforting smell of parent are calming and organizing. This is particularly helpful for babies who are sensitive to touch, movement, or sounds, who have had long NICU / SCBU stays, or who need support settling into the big, outside world.
2) Boundaries of the carrier give body input and awareness for comfort and motor skills development such as babies with low tone, sensory motor difficulties, or prematurity.
3) Vestibular / movement input – the gentle bouncing, rocking and swaying motions provide movement input which is again soothing but also helps stimulate tone for balance and coordination and make sense of one’s body. The vestibular system is also strongly connected to the visual, auditory, and emotional centres of the brain. Movement helps kids focus, learn, and coordinate both sides of their bodies.
4) Powerful way to bond after a traumatic birth and from personal experience, so fun to interact with baby wherever you go.
You can see how it can either help decrease sensory overload for sensitive babies or provide extra input to babies who need more sensory information.  By integrating, touch, body and movement input, we are helping develop multi-sensory processing.
MOTOR:

 

1) Encourages flexed  positioning – oftentimes babies with traumatic births, brain bleeds, prematurity, low tone, or sensory processing disorder assume an extended posture due to tightness, arching their back or sensory overload.  Heathy, full-term babies are in a flexed curled-up position from the womb. Extension is a red flag. Slings and carriers can be used to help encourage this flexed position.  Have your occupational or physical therapist help with positioning.
2) For positioning, remember it is important to face inwards and assume a squatt position. See this article:

http://blog.ergobaby.com/2012/02/facing-inward-or-outward-the-physiological-aspects/

3) Alternative to tummy time – many babies struggle wit tummy time for varied reasons. Baby carrying can be a gentle step towards tummy time by holding your baby against you.
4) Upright positioning can be more comfortable for babies with reflux, gutt, or respiratory problems.
Resources:

 

UK Sling Libraries
Visit a sling library to try different carriers and find what suits you and your baby.

http://www.ukslinglibraries.co.uk/

Babywearing International

http://babywearinginternational.org/

Babies and Strokes

It’s Hemiplegia Awareness Week!

Oftentimes people associate strokes with the elderly.  Kids have strokes too, most often from a brain bleed / hemorrhage either while in the womb, at birth, or afterwards which causes tightness and difficulty using one side of their body, also known as Hemiplegia.
Red flags common for children with a stroke are:
-Inability or difficulty  using one side of body – the baby may hold their arm tightly at their side, fist their hands, or predominantly use one side.
-Early hand preference – Please know that babies are never right- or left- handed, they should not yet have any hand or foot preference.  If they do, it’s important to see a neurologist and be assessed by an OT and / or PT.
-Difficulty feeding, slurry speech,asymmetric facial features such as droopiness on one side of face or a crooked smil
-Stiffness in arms or legs while dressing or bathing
-Reaches with only one arm, head tilts to one side, body bends or cures to one side like a banana
-Delayed milestones
-Seizures
-Abnormal eye movements
-Extreme sleepiness, lethargy

 

I often hear health professionals say a baby with hemiplegia doesn’t need Occupational Therapy till they’re older and using utensils. This is a myth! Babies use their arms from the very beginning to self-soothe, find the breast for feeds, randomly move their body and then to reach for their parent’s face, bring their hands together, put toys in their mouth, push up on their arms or grab their feet. All these developmental experiences require core stability, strength, coordination, sensory awareness and more.  It is NEVER TOO EARLY.  An occupational therapist experienced with babies can help achieve these skills. This is so important because each skill creates a foundational building block for more advanced skills.

 

Infancy is the best time to intensely work with babes with neurologic impairments for several reasons:
1) Brain neural plasticity allows the best chance for change by developing new  neuronal maps and pathways for increased function
2) Develop good alignment and movement patterns from the very start so the baby can learn to roll to both sides, sit straight, crawl, walk with good balance, point, and clap their hands. Then the baby doesn’t need to compensate and only use their unaffected side.
3) Reduce chances of muscles becoming increasingly stiff over time
4) Collaborate closely with parents on handling techniques to encourage bilateral movements and incorporate exercises in a fun way into daily routines

 

The following treatments can help:
1) Baby massage – it’s calming, builds body awareness, and decreases tightness.
2) Neurodevelopmental Treatment / Bobath trained therapist.  Note that some have advanced training for babies which is a bonus.
4) Developmental play approach using therapeutic exercises to achieve milestones, ESP reaping the benefits of rolling and crawling
5) Kinesio taping, splints, orthotics, suits or compression garments to promote good alignment, posture and movement
6) Adapting daily activities and games
7) Sports and hobbies such as swimming, horse riding, gymnastics, yog
8) Baby wearing for many reasons including it’s comforting after a traumatic birth, provides deep pressure and boundaries for body awareness, movement input helps balance and is calming, and better able to promote body alignment.
9) Parent support groups – HemiHelp and HemiChat in the UK.

 

HemiHelp has a fact sheet and video to raise awareness about Hemiplegia here:

Kinesio Taping for Babies and Children

There’s a lot of buzz about that coloured tape now with Wimbledon and the Olympics approaching.  I am a certified Kinesio® Taping practitioner and have been using it to improve children’s body alignment, movement patterns, and muscle activation for motor skills development since 2003.  Being quite accident prone myself, I personally use it on myself for relief and to get up and moving again.

I have used taping for babies to older children, and have found it to be a fantastic adjunct to my Occupational Therapy sessions. It has been so helpful to have an understanding about development, children’s motor skills, and specifically, little bodies and then apply kinesio tape accordingly.  I have often used kinesio taping for babies who are struggling to reach their milesontes, and young children with hemiplegia, Erb’s Palsy, Down’s syndrome, Cerebral Palsy, and general low muscle tone although it can be used for any motor impairments.

Taping is a skill and must be applied correctly according to the child’s desired goals.  It is important to have Kinesio Taping done by somebody who has been properly trained, particularly for pediatrics.

For more, please see www.ot4kids.co.uk/kinesio-taping.

Last year, I wrote an article for PediaStaff which can be viewed here:

http://www.pediastaff.com/resources-a-look-at-kinesio®-taping-featured-may-26-2011

 

PARENT BLOGS-It’s always helpful to hear how other parents have found a treatment technique. Have a look at these blog posts.

Erb’s Palsy-

http://jadonsjourney2009.blogspot.co.uk/2010/10/kinesio-taping-success.html

 

Down’s Syndrome-

http://jendawnscowgirlup.blogspot.co.uk/2011/10/31-for-21-day-20-kicking-it-olympic.html

http://teal915.blogspot.co.uk/2011/10/kinesio-tape-for-baby-with-down.html

 

Cerebral Palsy-

http://cerebralpalsybaby.blogspot.co.uk/2006/05/kinesio-tape.html

http://cerebralpalsybaby.blogspot.co.uk/2006/05/kinesio-photos.html

http://www.octamom.com/2009/04/kinesiotape-baby.html

 

Parents’ Feedback about Kinesio Taping-

https://www.facebook.com/MommiesofMiracles/posts/344423925624665

 

ARTICLES:

Tales of the Tape – pediatric case studies

http://physical-therapy.advanceweb.com/Features/Articles/Tales-of-the-Tape.aspx

 

Uses of Athletic Tape-

http://physical-therapy.advanceweb.com/Features/Articles/New-Uses-for-Athletic-Taping.aspx

 

Taping in an Acute Pediatric Setting-

http://tapingbase.net/sites/default/files/level_4___pilot_study_investigating_the_effects_of_kinesio_taping_in_an_acute_pediatric_rehabilitation_setting._0.pdf

 

Taping for Abdominal Muscles-

http://www.advancemed.co.il/userfiles/file/kinesio/research/kinesio-taping-for-abdominal-muscl.pdf

 

Treatment of Brachial Plexus Injury using Kinesio Tape and Exercise –

http://informahealthcare.com/doi/abs/10.3109/09593980903578872

 

For very good articles with pictures on Kinesio® Taping for children with Brachial Plexus Injuries, check out the Outreach Magazine Spring 2005 Issue, Pages 8-10, as well as Outreach Magazine Fall / Winter 2005, Pages 8-9.

 

Sensory Processing – Early Warning Signs for Babies

In my practice I work with many children with sensory processing difficulties that are identified during their school years.  These children may struggle with concentrating in class, coping with transitions or changes, or playing with peers.  They can be clumsy, have difficulty holding a pencil or writing, awkward with their movements, or be either withdrawn or aggressive.  Oftentimes, they are very bright and as a result, their sensory processing difficulties are misunderstood.  Usually, warning signs were present as babies however parents were told to ‘wait and see,’ ‘your child will grow out of it’ or that their child is misbehaving.

Early signs of sensory processing difficulties I have seen amongst babies include:

  • Hates tummy time, prefers to sit or stand
  • Plays while sitting still versus moving around and exploring their environment
  • Tend to get ‘stuck’ with their movements, delayed milestones (e.g. rolling, crawling, clapping hands, waving)
  • Cautious with movement, dislike being laid down or moved
  • Fussy or irritable babies, cry easily sometimes for no known reason
  • Not a ‘cuddly’ baby, resists being held
  • Struggle to settle down or going to sleep
  • Difficulty with nursing, transitioning to other textures
  • Startles easily to loud sounds, distracted, avoids eye contact
  • Very easy going, described as a ‘lazy baby’, don’t know they’re in the room

These difficulties indicate that a child’s central nervous system is struggling to process sensory information.  It is a neurological problem that can impact on their movements and development, learning, and social-emotional skills.

Here’s a nice article that discusses the early warning signs of Sensory Processing Disorder amongst infants.

Due to the plasticity of a young child’s brain, there is hope and good potential for progress and improvement with Early Intervention.  If you are concerned about these early warning signs, seek advice from an Occupational Therapist who specializes in working with infants and younger children, particularly those with sensory processing difficulties.  It is never too early or never too late to get help.

Look here for links and books about sensory processing.

Sensory Processing and Babies

1 in 20 children have sensory processing difficulties!   Clearly, this is very common and impacts on childrens’ behaviour, motor skills development, learning and confidence.

As an Occupational Therapist, I specialize in treating infants and younger children.  I’m often asked ‘what can you do with a baby’ or how do you know a baby has sensory processing difficulties?

Meet Ryder from Pathways Awareness’ newest video!  🙂

Ryder’s sensory processing difficulties were noted at FIVE months of age.  He had difficulty lifting his head, hardly moved, tired easily, and was anxious during new situations.  He was overwhelmed by sensory input leading to sensory overload.  Later on, this also impacted on his ability to communicate with peers, play with other children, and keep up with his motor milestones.

With Early Intervention therapies (OT, PT, and SALT) and a home program from very early on, Ryder showed improvements in his coordination, behaviour, confidence and ability to organize and respond to sensory information.  He was able to be in group settings, keep up with peers, multi-task, and have fun with age appropriate activities.  Hooray for Ryder.

Another great video by Pathways Awareness.  I admire their efforts in advocating for early detection and Early Intervention as well as raise awareness about sensory processing.

Sleep Problems and Sensory Regulation for Babies

Whose mood and behaviour isn’t affected by their sleep? We are generally much happier and focused after a good night’s sleep. For some, it takes ages to fall sleep while others zonk out right away. Myself, I can’t exercise before going to bed as I’m too awake. However, I have friends who say exercise helps them sleep faster and deeper.

Many babies I work with, particularly those born prematurely, also have sleep problems. Parents will try any and all strategies to help soothe their baby to sleep. Rocking, nursing, heartbeat sounds, swaddling, bathing before bedtime. Parents themselves are exhausted. Oftentimes, these babies are labeled as ‘colicky’ which technically refers to when a baby has abdominal discomfort however ‘colicky’ now seems to be overused to suggest a ‘fussy’ baby.

***It is critical to rule out gastrointestinal problems, food allergies, reflux, sleep apnea, ear infections, and medical issues.

Sleep is a regulatory process where a baby learns how to change and monitor their arousal level to self-soothe and fall asleep. Babies and young children with sleep difficulties likely have sensory processing or regulation difficulties. A baby who is HYPERsensitive to sensory inputs will have difficulty soothing or regulating themselves to sleep. This baby may not tolerate sucking on their hands to self-soothe or being rocked, and may wake up to the quietest of sounds. They are in sensory overload. On the contrary, a baby who is HYPOsensitive or seeks out sensory inputs may only be able to fall asleep after they’ve been swaddled tightly, bounced up and down, and patted firmly on their back. They need more sensory information to help them regulate their arousal level for sleeping.

When babies are unable to figure out how to soothe themselves they become fussy and irritable, more commonly described as ‘colicky.’ As this article says, there is no such thing as “just” a fussy baby.

A baby needs to regulate their arousal and sensory information for sleep. An OT can help parents sort out what sensory strategies to support sleep. According to Maria Anzalone, an occupational therapist from the States, “either way, they’re (babies are) out of sync.” They need to learn to regulate their arousal, sensations and emotions, and relationships. All of this impacts upon their sleep.

This is not something that parents should feel guilty about!

When a baby has sleep problems, it is important to also consider whether they may have sensory processing or regulation difficulties. An Occupational Therapist who specializes in treating infants can help to determine the baby’s sensory profile, which soothing strategies can help regulation based on the individual child’s needs.

Prematurity Resources

ot4kids is now on FB where I’m sharing information and resources to support families and professionals re: children with developmental delays.  Do come on over. 🙂

I had planned to put up this post for National Premature Awareness Day on 17th November.  Oh dear, it’s already December.

As an Occupational Therapist, I screen, follow-up and treat premature babies due to their risk of developmental delays as a means of prevention and Early Intervention.  This allows me to work closely with parents and provide therapy input early to prevent problems from escalating.

In this post, I wanted to share some of my favourite resources for premature babies. However, please keep in mind that as every premature baby is different and has varied needs, this does not replace the advice provided by their medical professional.  Also, an OT or PT experienced with babies is better able to provide individual advice and support geared toward individual children and families

March of Dimes has an excellent interactive program called “Understand Your Premature Infant” to help others recognize a premature babies’ signals and understand how they respond to their world.

Baby First has a nice article on promoting motor development for babies born prematurely following their NICU stay.  These are general guidelines regarding positioning and recognizing the baby’s cues.

CDC has a developmental chart where you can track a child’s movement, social-emotional, fine motor, cognitive, hearing and visual milestones from 3 months to 5 years of age.  These milestones can offer important clues regarding a child’s development.  Be sure to adjust for a premature baby’s age, however parents should follow their gut, they are the expert on their child.

Premature babies are also at-risk of having sensory processing difficulties due to having an immature nervous system.  Check out Sense-Ablebaby for more information as well as this article on sensory stimulation and premature babies.

Here is an article written by myself regarding ‘red flags’ that can indicate a delay amongst babies and toddlers.

***Premature babies should be screened early on to determine whether there are possible motor, neurological, sensory processing, orthopaedic, or cognitive delays. It is never too early to start therapy input.  Early Intervention is key!

First Signs-Early detection and intervention for Autism

I often work with parents who are concerned that their baby or child is not making eye contact, struggling to meet their motor and learning milestones, or doesn’t respond to their name.  Oftentimes, the wonder whether the child has Autism.

First Signs is a wonderful organization dedicated to educating parents and professionals about early signs of autism and the importance of Early Intervention.

They have great pages on:

  • Red Flags
  • Hallmark milestones from birth to three years
  • How to share your concerns with your doctor?
  • Screening, Diagnosis, and Treatment

I love how they emphasize that paediatricians should better screen children during routine visits and the importance of partnership between parents and healthcare providers.  Parents know their child best and have a gut instinct when there is a problem.  It’s our job as healthcare providers to listen carefully to what parents are saying and make a proactive action plan. Rather than wait-and-see, let’s act early and make the most of a child’s early years when they are constantly learning and growing.  Let’s use prevention versus trying to remediate a problem later.  It’s never to early and Early Intervention is key.

Plagiocephaly-more than just a flat head?

Sadly, plagiocephaly (flat-head syndrome) is often dismissed as being just a cosmetic issue or one that babies will outgrow.  Finally, studies done at the Children’s Institute in Seattle, Washington, US, show that there may be an association between plagiocephaly and developmental delay.

In this study led by Matthew Speltz, PhD, 472 babies between 4-12 months were screened for cognitive and motor development. Half of these babies had been diagnosed with plagiocephaly from Seattle Childrens Hospital’s Craniofacial Centre and the other half were a “normal” control group.

It was discovered that babies with some degree of plagiocephaly were more likely to perform worse on the Bayley Scales of Infant Development III than the control group.

These findings indicate that there may be an association between plagiocephaly and developmental delay or that children with existing motor problems are at risk of developing flatter heads due to lack of movement.

I find that babies with plagiocephaly often have other underlying problems such as:

  • low muscle tone
  • poor strength and coordination
  • sensory processing, movement sensitivities
  • motor planning
  • organizational skills
  • poor regulation
  • …….and more

Research shows the following babies can be at-risk of developing plagiocephaly:

  • those born prematurely
  • multiple births
  • torticollis (tight neck muscles on one side)
  • developmental delay
  • certain syndromes
  • eye muscle problems.

****Babies with Plagiocephaly should be screened early on to determine whether there are possible motor, cognitive, neurological, orthopaedic, or cognitive delays. Definitely worthwhile catching a problem early!

Understanding Premature Infants and their Signals

I have been wanting to write a follow-up to my last blog post about premature babies being at higher risk of disability and how important it is to know the early signs which can indicate a delay.

Just in time, March of Dimes has posted about an excellent interactive program called “Understand Your Premature Infant” which is designed to help educate parents and professionals and explain how premature babies respond to their world.

Premature babies communicate to their parents and caregivers how they feel and what their needs are using SIGNALS.  Due to having immature nervous and motor systems, their signals may be different than a term baby.  They may communicate using their bodies, through movement, crying and fussing, and by how they respond to various sensations.  These cues help you know when the baby is ready to feed or interact, when they are stressed, when they need a break, or what is soothing to them.  It’s critical to be able to recognize these behaviours and signals and understand what they mean to best support the baby.

The program reviews a premature baby’s sleep and awake cycles, their development of senses, feeding, and how to interact with the baby.

I highly recommend this program to any parent, family member, or professional who works with premature babies.

P.S. ot4kids is now on Facebook where I post more regularly. Feel free to share with others who may benefit.  🙂

Premature Babies At-Risk – Early Intervention!

The EPICure Study by University of Nottingham (UK) was established in 1995 to determine the rates of disability and long-term outcomes on children born before 26 weeks of gestation in the UK & Ireland. The children were followed up at 1 year, 2.5 years, 6-8 years, and 10-11 years of age.

The results of the study found that children born very prematurely had a high risk of disability.  Please see site for further details.

Considering these results, it’s critical for premature babies to be followed by an experienced Occupational Therapist, Physiotherapist and consultants when they go home as a preventive measure. They can keep an eye on the babies’ development and if they notice any early red flag signs, start therapy input early to prevent problems from becoming worse. It’s important for families and health professionals to know the early red flag signs. Early Intervention is key.

I’ve also recently written an article for TAMBA (Twins & Multiple Births Association) called ‘Know the Signs.’ Feel free to check it out for more details on ‘Red Flags’ for babies and children.

The Sippy Cup Issue & a Game Plan!

As therapists we often recommend parents to avoid using a Sippy Cup with their child. It’s great to see a blog post by a well-reputed Speech Therapist, Sara Rosenfeld Johnson, which explains why it’s best to transition to a Straw cup.

Reasons to avoid a sippy cup include:

1) Child has to continue using a suckle pattern with their tongue. There are very few sounds produced using this tongue movement pattern.

2) Increased incidence of cavities as sugared liquid (i.e. juice) remains in the mouth.

3) Child tilts their head which allows liquid to enter the Eustachian Tubes (near the ear) which increases the incidence of ear infections.

4) Discourages mature feeding development where tongue moves up-down, side-to-side, and inside the mouth. The sippy cup encourages tongue protrusion (i.e. tongue to move forward outside the mouth).

*** Please do check out this article in BabyTalk by Mindy Berry Walker, a Speech Therapist, for a cup drinking GAME PLAN! 🙂 ***

Do Colicky Babies have Sensory Processing Problem

“Colic” describes when a baby cries or fusses for prolonged amounts of time for seemingly no reason.  These days, the term colic is used very freely and not in its true clinical diagnosis.

In this study, researchers followed a group of colicky infants for several years and assessed them again between 3-8 years of age. They discovered that 75% of colicky infants demonstrated sensory processing problems when older!  For example, they not only had difficulties in responding to sensory information, but also in coping with the environment, attention and behavioural regulation. I have also seen this in my practice.

When a baby’s fussiness and irritability cannot be explained by medical problems such as reflex, abdominal difficulties, etc, look at their sensory processing. For babies, it’s important to consider that behaviours which are typically thought of as ‘difficult’ temperament may actually reflect a sensory processing problem.

Visit www.sense-ablebaby.com for more information on sensory processing for babies and calming strategies.

Learn the Signs-Act Early!

Learn the Signs-Act Early is the message of the CDC (Centers for Disease Control and Prevention) in the US. It’s also the message I share with families and colleagues.

CDC has a great developmental chart where you can track a child’s social-emotional, movement, fine motor, cognitive, hearing and vision, and language milestones from 3 months to 5 years of age. (The vision and hearing sections are quite limited though.) The age at which a child reaches their milestones can offer important clues regarding their development.

This video highlights the importance of keeping track of how a child moves, plays, learns, speaks, and acts.

The earlier parents and health providers recognize that a child has a delay in reaching their milestones, the more intervention can help the child reach their fullest potential. It is never too early. Parents should follow their gut, they are the expert on their child.

If one suspects a problem, or is concerned that their child is not reaching their milestones, ACT EARLY! It is critical to seek specialist advice and support immediately. According to the CDC, most often, children will not grow out of a developmental problem on their own. However, with help, they can reach their fullest potential.

TEACHING BABIES 101

Recently, I did a talk for parents on ‘Movement and Brain Building’ where we discussed how movement has a profound effect on not only motor skills but also vision, hearing, emotional regulation, attention, learning and academic skills.

This article is about the benefits of early education and teaching babies. Do think about ‘learning’ as being both physical and cognitive skills development.

Two major points were:

  1. From five months of gestation (i.e. when the fetus is five months old in the womb!) to five years of age, the brain is highly plastic and adaptable. As a result, teaching a child during this time presents a ‘unique window of opportunity for learning.’ This is a critical time for the baby’s brain to develop and set the neurological foundation for future physical and cognitive development. I find it particularly amazing that babies are already learning before they are born!

Consider this:

The brain at birth weights 25% of an adult’s brains weight.

The brain at 1 year weights 50% of an adult’s brains weight

The brain at 2 years weights 75% of an adult’s brains weight

The brain at 3 years weighs 90% of an adult’s brains weight

As a Paediatric Occupational Therapist, this is a crucial time in which to treat infants who are at risk of or have a developmental delay, or with delayed milestones or a medical diagnosis. The earlier we start therapy intervention, the more significant and longer-lasting benefits noted. It’s NEVER TOO EARLY!

If we wait till school years, it is not too late, however we miss out on the unique opportunity to enhance baby brain development, and create strong neuronal maps and foundations.

2)    Four essential ingredients in teaching babies are:

AFFECTION – Happier the child, more likely they are to learn

NUTRITION – A baby’s brain is sensitive to the quality and quantity of nutrients it consumes

REPETITION – Children master skills by repeating them over and over again. This helps develop and strengthen correct neural maps and pathways in the brain

STIMULATION – Teach children through all their senses (touch, vision, hearing, movement, body sense, smell, and taste), however consider that ‘too much’ can be overwhelming

These are also critical ingredients for treatment sessions with babies. We aim for sessions to be fun and motivating for both parent and baby. 🙂 Repetition and stimulation are also used to help develop good neural pathways and foundations for movement and learning.