Category Archives: Motor Skills

Gross motor, fine motor, visual motor, core stability and motor skills to reach developmental milestones.

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!

Strokes Happen Amongst Children Too!

People often think of strokes for adults, however they occur amongst children too.

Approximately 5 children a week in Britain have a stroke. 2/3’s of those that survive suffer long-term disability that affects their movement. 1/3 of those that survive have no lasting impairment. Oftentimes, there’s already another pre-existing condition such as congenital heart disease.

Due to lack of public and medical awareness of childhood stroke, kids are being diagnosed too late. It is critical to have faster diagnosis and earlier treatment for a better outcome!

Some common signs that indicate strokes can be: headaches, unable to feel or move right side, floppy, and difficulty speaking.  Clumsiness and an alteration in consciousness may also be noted.

Do share with family and friends to raise awareness so others can get support and access to appropriate services faster.

HemiHelp in the UK is a great organization supporting children with hemiplegia.

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 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.

What is Sensory Processing Disorder?

I just saw a brilliant animated video on ‘What is Sensory Processing Disorder?’ I think this would be great to share with kids, parents, and teachers. It’s developed by

Please do also listen to Lucy Jane Miller, PhD, OTR, the foremost sensory processing researching in the USA for the past 30 years, explain sensory processing disorder, it’s various manifestations, and three subtypes. This is really worth a listen for 8 minutes. 🙂


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.

Tummy Time and Early Intervention

This is a great resource and should be shared with all parents with babies. I love their documents, pictures, video clips, research, and advice.

Pathways Awareness is an organization in Chicago dedicated to increasing knowledge about the gift of early detection and the benefit of early therapy for infants and children with early motor delays. As an Occupational Therapist, I share this belief and value early detection and Early Intervention for children to prevent problems from escalating and affecting a chlid’s future learning and development.

According to Pathways Awareness, research shows that one in 40 babies is diagnosed with early motor delays and 400,000 babies a year are at risk of developmental delays.  ‘Early motor delay’ can refer to conditions ranging from low muscle tone to Cerebral palsy. Some ‘early motor delays’ are present at birth and others develop or become worse over time. On a positive note, most of these children respond well and catch up quickly when provided early therapy and strategies involving Tummy Time while the baby is awake.

Pathways Awareness has a section on their website called ‘Tummy Time Central.’ It includes details to questions such as: How much Tummy Time does a child need? When to do Tummy Time? And when to be concerned a child is struggling with Tummy Time?

The main points were:

1) Tummy Time helps:

-strengthen neck, shoulders, back, stomach, buttocks, and hand muscles.

-develop eye-hand coordination

-shape arches of the hand for reaching, grasping, and object manipulation

-develop motivation, problem-solving, body and spatial awareness

2) Incorporate Tummy Time into your daily routine such as while carrying the baby, during feeding, or following diaper (nappy) and clothing changes. See their handout called ‘Five Essential Tummy Time Moves’ which contains great images. The site also has video clips of what tummy time should look like and when to be concerned regarding early motor delays.

3) Change the direction your baby lies on their back while sleeping in their crib to build strength and prevent early motor delays.

4) If concerned regarding a child’s development, seek advice from a healthcare provider, Occupational Therapist or Physiotherapist who specializes in infants. If they give you a wait-and-see approach, don’t hesitate to get a second opinion or to self-refer to a trained therapist.

**Please share this valuable information with parents, grandparents, friends, nursery and daycare providers, and others.

Take a ‘Brain Break’ to boost Memory and Learning!

Researchers at UC Berkley and NYU have found that taking rests can improve learning by 10%!

Google Headquarters have also recognised the importance of taking a rest or nap to boost brain productivity. This is the ‘nap pod’ which blocks out light and sound. Perhaps students will learn and remember more  information if given opportunities to take a break.

Meanwhile, I wonder if catnaps on the train between patients will help boost my memory. 🙂

Down’s Syndrome Awareness Week- 15th to 21st March 2010

This week is Down’s Syndrome Awareness week. Having worked with many infants and young children with Down’s Syndrome, I have been inspired by their hard work, loving personalities, and achievements, particularly with the right support.

One of the events is the ‘Shifting Perspectives Photographic Exhibition‘ which examines the lives of people of all ages with Down’s syndrome, their connection to the photographers and the changes throughout the course of their lives. This is a free exhibition at the Oxo Tower from 17th to 28th March, 11am to 6pm.

2010 also marks the Association’s 40th Anniversary supporting individuals with Down’s Syndrome!

Check out the Down’s Syndrome Associations website for further details of this week.

To Chew…..or Not To Chew!

This article from the Autism Perspective in 2007 looks at whether there is a connection between chewing and not moving.

I’ve heard many parents and teachers in the past 12 years ask why their children grind their teeth, chew through their shirt sleeves or pencils, or put non-edible objects in their mouth.

Although there are lots of theories and ideas regarding this matter, this article looks at the interesting connection between chewing and lack of movement.

As an Occupational Therapist, I believe that lack of movement is certainly a big reason that children mouthe on objects, however, it is also important to consider the impact of other sensory systems (e.g. touch and muscle/joint input). For example, are children who use their mouths for exploration able to use their hands to explore objects adequately and efficiently? And are there other ways to provide the child with more appropriate oral sensory input during their day?

An Occupational Therapist trained in Sensory Integration would be able to identify causes of such difficulties, provide appropriate sensory based activities for home and school, and help determine what intervention or modifications are needed.

Sorting Out Developmental Delay for Infants

Today I found a newsletter called A Pediatric Perspective put out by Gillette Children’s Specialty Healthcare in Minnesota, US. I really appreciate their articles focusing on Early Detection and Early Intervention.

This particular article written by a Neurodevelopmental Paediatrician, Dr. Raymond Tervo, M.S., reviews Red Flags for infants, toddlers, and preschool aged children that can indicate Developmental Delays in the areas of language, gross motor, fine motor, and cognitive skills.

The article can be slightly heavy but a great read for parents and definitely for health professionals. It was so nice to read what I say and believe on paper! 🙂

Here are the main points:

1)    PARENTS KNOW BEST!! If a parent is worried, chances are that something needs attention. Concerns may be in areas of speech and language, fine motor / hand skills, cognition, or difficulty reaching motor milestones.

2)    Early detection of problems is vital because brain development is very impressionable at an earlier age. Therefore, if you observe a delay, REFER on early for necessary medical treatments and therapy services. Early Intervention is crucial.

3)    Monitor infants with risk factors such as low birth weight, prematurity, brain bleeds, or known diagnoses including Down Syndrome or Fetal Alcohol Syndrome.

4)    Delays in one developmental domain (e.g. language) can impair development in another area (e.g. motor skills and/or cognition).

5)    Red Flags for parents to look out for at specific ages for babies and young children.

Physical Activity Helps Academics!

According to an article from the NY Times, a recent study shows that play, down time and recess are just as important to learning as academics such as reading, math, and science. The study even showed that fitness and recess can positively impact upon a child’s attention, concentration, behaviour, and……. GRADES!

As Occupational Therapists trained in Sensory Integration, we often recommend that children receive opportunities for movement breaks and physical activity during their school day to help maintain optimal attention and focus. This is also important to keep in mind for children with low muscle tone, hypermobility and decreased strength to sit upright. It’s a challenge to focus on academics when you struggle to hold up your body.

This is why many of you will see me sitting or bouncing on my therapy ball while working hard at the computer. 🙂

It’s great to see more research that proves physical activity helps academics!

Therapeutic Riding for Children with Prematurity

Many years ago, I won’t say how many, I had the chance to observe children with physical disabilities at a Therapeutic Riding program. I was amazed by all that they could do while riding a horse, so I’m a huge Therapeutic Riding fan.

I just read an interesting story from the NY Post about twin girls who were born prematurely and now, at 4 years of age, go for Therapeutic Riding in NYC.

Oftentimes, reading an article gets me thinking about ‘what else’? Being relatively new to London, this article made me wonder what Therapeutic Riding programs are available in London. I discovered that there is a Riding for the Disabled Association in the UK and they have a list of Therapeutic Riding (Equine Therapy) programs in the UK by location. I’ve seen great results with children I’ve treated in the past who’ve gone for Therapeutic Riding and wanted to share this with you.