Early Childhood Intervention
This website is a place for families who are facing
challenges pertaining to their child's development and
growth.
It is a place to find answers and practical
suggestions. That's what Early Intervention Support is all
about.
Whether a family has a child with a challenging behavior,
a disability or developmental issue, childhood is short - it
should be savored and enjoyed.
Learn More:
Ask a Therapist
We understand developmental milestones and the challenges
of Special Needs children. We spend a great deal of time
with families understanding the inner workings of childhood
routines and interactions. Ask us about your child today!
Ask a Therapist
Child Development Concerns
Listed below are a few previous questions from our
Ask The Therapist
form relating to speech and language. You may also want to review:
My daughter is 13 1/2 months old. She was born full term. She is not bearing any
weight on her feet. When we try to make her stand, she bends her knees. She never
crawled, never moved. Her mind is sharp, and our family physician says everything
with her is fine. I am extremely worried if everything is fine, how come she doesn't
bear weight? Is this normal or should we do anything about this?
I would not be concerned if your daughter was not walking yet at age 13 1/2 months,
however, the fact that she is not bearing weight on her feet when placed in standing,
nor is she crawling or moving about in some way at this age is somewhat concerning.
Most babies are able to bear weight on their feet between the ages of 6-9 months and
will bounce when their hands are held. I would definitely seek another medical opinion,
from perhaps an orthopedist to determine if there is an underlying medical reason as to
why she is not yet completing these motor skills and make sure to have her hips checked.
I would also look into an early intervention evaluation from a physical therapist in your
area so that she can start receiving therapy to help her progress in her motor skills.
I was unable to locate a specific resource for early intervention/pediatric physical
therapy in your area, however, perhaps if you contact someone at this
website link they
can point you in the right direction for resources available to you in the Toronto area.
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I would like to provide you with more input. She started sitting at 6 months,
and we never ever provided her with support to sit. She decided to sit and started
sitting at 6 months without any support. She loves to jump in her jolly jumper. S
he jumps very well without any help from us. She is not crawling and not moving but
tries very hard to reach her toys while sitting and she manages to get her toys.
Her mind is very active and she learns lots from others at her daycare. She follows
others words but does not following their walking. When I try to make her stand on my lap,
she stands for a second and then bends her knees. Sometimes she jumps as she does in
her jolly jumper(but never stands). She never liked tummy time as well. Our physician
checked her hips and spine and he said nothing is wrong. She is now 13 1/2 months old
and it is very frustrating for me to see her not walking (always very hard for mother).
Is there any technique that I can use to encourage her to bear weight on her legs?
Sorry for the delay in getting back to you with a second response. In speaking with
our physical therapist, we would again advise you to seek the advice of a pediatric
physiotherapist in Toronto so that he/she can do a full motor assessment of your daughter.
Perhaps she has hypotonia or in other words, low muscle tone, which could be one reason
she is not yet crawling, pulling to stand on her own or walking. Low tone would make it
harder for her body to move against gravity to complete motor movements. Also, the fact
that she did not like tummy time and perhaps did not spend much time in this position
could mean that she simply did not develop the core strength in those muscles which are
needed to perform more complex motor movements and she could need some strengthening in
this area. Without being able to see your daughter for a "hands on" evaluation, we cannot
unfortunately pinpoint any exact reason as to why she is not crawling/walking yet. And,
she could also just need more time since some children do not learn to walk until around
age 16-18 months and can still be considered within average, even though late in achieving
this skill. There are children who never crawl and who go straight to walking, however,
from a a therapy standpoint crawling is a very important skill that we do not like children
to skip over because it can sometimes leads to later difficulties with sensory issues
(from not bearing weight on hands and knees) and even some research has shown later difficulty
with reading/writing/visual convergence due to not learning to use arms/ legs independent of
one another at this early stage.
You can do some simple things such as bounce your daughter on a large exercise ball,
shift her weight on the ball from side to side and back to front while holding her as
low as possible at the hips so that she is doing most of the work to "right" her body in
space when her weight is shifted. This can help with strengthening. You can use a smaller
ball and place her on her tummy and roll it forward and encourage her to place her hands
on the floor and bear weight and then roll it back and encourage her to bear weight on
her feet or her knees. You can place her in a hand-knee position over your leg and use
your hand/body to keep her in a 4 point position and encourage her to play while bearing
weight and reaching in this position. Use a small box or tray table and place her in a
kneeling position (make sure her bottom doesn't drop between her feet, her bottom should
sit back on the back of her heels if she is not in a tall kneeling position), entice her
to come up to tall kneel to play with toys or reach for things. Sit her on a small stool
or box so that her feet touch the floor in a flat position, hold her hands and practice
coming from sit to stand and back to sit. Use music and singing and mirrors and bubbles
and things to make all this fun and not work for her. I would limit the use of her jumper,
baby walkers or exersaucers right now since she needs as much floor time to practice and
develop these skills on her own as possible. Many baby items such as walkers, jumpers and
exersaucers have been studied and shown to not actually improve a child's ability to walk,
and on the contrary may develop the calf muscles more than the quad muscles (needed for
walking) or even lead to later toe walking due to the way a child pushes off in these types
of seats. They also inhibit a child's ability to see their feet while moving and some sling
seats hold the child's hips in a position that is not ideal. Another study from Children's
Hospital of San Diego cited that "The exercise your baby gets in a jumper does not promote
the development of trunk and leg control or the balance needed for walking. Additionally,
it may limit time your baby spends on his tummy developing the valuable skills for crawling."
Again, we advise seeking the advice of a
pediatric physiotherapist, as well as keeping in
close contact with your child's pediatrician to monitor the
development of her motor skills.
My son is eight years old and likes to chew on his clothes, pillows,
blankets, backpack, etc. What can I do as a parent to help him with
this? Does he need to be seen by a therapist? Things are getting ruined
and he is teaching his sisters to chew on things also. I am a mother of
four children and need some expert advice, please.
I would recommend that you have your son seen by an occupational
therapist so that she can assess his need for oral-sensory input. Since
he is 8 years old and still chewing on all kinds of things, this seems
to be fulfilling some sort of sensory need for him and an OT can help
you with suggestions for how to channel this behavior into something
more appropriate so that he is not ruining clothes, pillows, blankets,
etc.
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Some children have what is called an
Oral Fixation and you can read more about that here and what therapy
tools are used to treat it. You can also read more about
sensory processing.
This is a facility in your area which offers
pediatric occupational therapy services. You may also want to check
with your son's school to see if there is an OT on staff who could
evaluate him.
I want to know more information on the therapy tool called
Floortime.
Floortime is a treatment method for autism developed by child
psychiatrist Stanley Greenspan. Its called floortime because the parent
actually gets down on the floor with the child to meet and work with him
at his own developmental level. This method builds upon the child's
strengths and taps into the child's own motivation. In addition to
having speech, occupational and physical therapists trained in the
floortime technique work with the child, the parents also do floortime
activities with the child, and the parents learn how to adapt how they
relate to their child.
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We do not typically use specific methods such as floortime in early
intervention, so I cannot give you personal information related to this
treatment method. Our website also details several other treatment
methods for
autism. This link also gives more details regarding
Floortime which may be what you are looking for and if you Google
the word "floortime" you can find many more related links as well as
videos on You Tube
demonstrating floortime such as this one by Stanley Greenspan.
I'm wondering what the best therapy would be for my almost 4 year
old. She's very bright but has self-regulation issues (i.e., blurting
out sounds at home and school as well as repeating herself often- very
sensitive and can have a complete breakdown over little things - if i
accidently press the elevator button or flush the toilet, etc. - things
she knows she can control). I really want to help her. She is very
loving and loves her teacher at school who suggested she get some
therapy. She is seeing an OT at Beth Osten Clinic in Skokie, IL and has
been going for 4 months and I see NO improvement.
There is a nice article on
self-regulation written for teachers and there is also information
on
Sensory Processing
on our Early Intervention Support website.
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It sounds like you have already taken the right steps for helping
your daughter by speaking with her teacher and seeking occupational
therapy for her, which would be what we would recommend. Four months is
a relatively short period of time, but I would speak with her therapist
about your concerns with her lack of progress and if you are not
satisfied you could always seek out a second opinion from another OT.
Make sure the OT has current knowledge and experience with sensory
processing disorders. Has your daughter been diagnosed with a sensory
processing disorder? This link at
Thrive Place
may be helpful for determining whether you need to seek further
treatment for your daughter. There is also a lot of recent research on
yoga being beneficial for self regulation issues such as impulsiveness
and ADD/ADHD.
What is the most heavy duty chewy toy in your opinion? I have a 14
year old who will chew on and crack open pens, metal pull tabs and uses
his front teeth to shred a yellow chewy tube.
The speech therapist's recommended always trying to guide chewy items
to back teeth since there is more chewing input there than at the front
of the mouth. The toughest thing that I've come across is the ARK
Grabber XT. They make a regular grabber too, but the XT version is
supposed to be extra tough material. I believe that they make the XT
version now in different scents and textures too. I used to see a 6 yr.
old years ago that destroyed all other chewies and her mom said that was
the one thing that she was not able to chew apart. Of course, with
anything, you want to watch for signs of wear and tear over time, soaps
may sometimes be hard on chewies, I definitely wouldn't clean in a
dishwasher or anything. Make sure to always wash by hand. I believe most
sensory catalogues or other chewy sources sell them. The blue chewy tube
has a bigger diameter and is even tougher than the red & yellow tubes.
The knobby tube has some texture but is not quite as tough as the blue
one.
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Try the website
www.superduperinc.com and look for "stretchy tubing" on their site,
it seems to be more durable than the others. The only thing that comes
to mind is a product on the Talktools.net website. It is similar to a
bite/chewy tube but the q shape ones are very solid. Much more dense
than the typical chewy (yellow) tube. The q shape tubes are purple and
green in color. Hope that gives you some more recommendations to try.
Keep in mind our therapists work with early childhood populations, so
the children ages 8 and under do not have the same jaw/chew strength as
a 14 year old would have.
I have a 4-year-old son who recently joined a program for kids to
teach them basics of running, hitting & kicking a ball. He has attended
twice with approximately 20 other 4/5 year olds. Each team is comprised
of 5 children. In my observations my son and another ran, played, and
acted silly during the duration of the 60 minute program. One boy in
particular has consistently touched others by pulling hair, pushing,
stealing the ball and generally disregarding his mother(the
"coach")during the game. Each time this child touched or pushed my son,
my son told the "coach." Finally on the third day, my son pushed this
other little boy back. They did this back and forth during the session.
My son did not respond to the "coach" pulling him by the arm. He
resisted as he has been taught to do with a stranger by myself and his
father as he is not familiar with her after (2) 40-60 minute sessions.
After the session, this "coach" came up to me and asked if my son had
ever been tested for "OT". I did not know what it was and she explained
that her son has a Sensory Disorder. I have looked up the
characteristics of this disorder and at best with all of the different
sensory groups, my son MAY touch on 2 or 3 single characteristics, as
does almost EVERY young child I know. This "coach" then also informed me
that she was a teacher after self-diagnosing my son. My question would
be, is it possible for a child to be diagnosed by someone who has had
very limited exposure to the child? And how many characteristics are
needed to be relative in order for a confirmed diagnosis to be made? Of
the 7 sensory categories, each composes 6-10 characteristics...my son
maybe had 2 from visual... that included lining blocks, cars up in a
line, taking things apart and putting them back together, and attraction
to street lights, and shiny things...spoons and metal shiny
wrenches..holding them close and appearing to inspect them. He has
outgrown the fascination with lights and shiny things, but still likes
to pretend to have the cars lined up on a "highway" and likes to tinker
with things like his father and grandfather. His speech is above
average, he can write his name, knows his address and phone number, all
the letters of the alphabet, numbers and can use scissors and color in
the lines. He does not shy away from touch (unless he's in trouble), and
does like to hold hands or hug girls. We are an affectionate family.
Maybe I am wrong but I thought this was how children LEARNED about the
environment around them. Any feedback or advice you can give would be
appreciated as I was a bit offended by this "coach" who prior to this
day had not said a simple "hello" to me.Someone cannot diagnose a
child on sight (teacher or not) with a sensory disorder simply by basing
it on his play during a game which indeed requires some physical contact
with other children. Sensory Processing Disorder (SPD) is diagnosed by a
trained clinician, based on clinical observation over a variety of
settings, parent report and standardized testing. Many typically
developing little boys in the 3-5 age group will have the tendency to
want to rough house, push & tackle each other during physical play,
especially if someone else is touching/grabbing them first. As you said,
there are many typical children who might have several characteristics
of a sensory disorder, we all do, but not actually have a problem with
sensory integration.
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Children with a true sensory processing disorder exhibit
characteristics in visual, auditory, tactile, oral or
vestibular/proprioceptive processing or a combination of these areas
that affect their behavior and ability to complete every days tasks.
After reading about SPD, if you are personally concerned that your son
may have a sensory disorder, he should be seen by someone who
specializes in sensory processing-typically an occupational therapist,
who can determine if your son indeed has any difficulties which warrant
therapy. You can read more about the
disorder on our
web page. This is a
resource for testing in
your area. Education For Handicapped Children's Program (EHCP)
Committee On Preschool Education (CPSE) (3-5) is a program is
for children (age 3 through 5) with suspected or confirmed delays that
will affect learning. This program is directed through the New York
State Department of Education to transition identified children into the
formal school system. The EHCP process will determine placement
opportunities and services to benefit your child and your family at no
cost to you.
My 3-1/2-year-old son seems preoccupied with throwing and dumping
things. His play seems limited and atypical. I would not say that he is
obsessed with one topic or subject to the exclusion of others but just
generally his play seems shallow or does not have much purpose. He is
not around other children his age much but when he is, he still does not
interact with them. I realize this is fairly normal at this age. But,
for example, when we go to a playgroup at the park, my son is content
playing with the woodchips at the park instead of the playground
equipment or even trying what the other kids are doing. When we are
there without other kids, he will try some of the playground equipment.
We live in a small town where there are no pediatricians and only family
doctors. Should I seek out a pediatrician over an hour away for further
evaluation?
Developmentally most children by age 3.5 have moved from parallel
play to cooperative/interactional play with same age peers and children
3-4 years old (unlike 2 year olds) should be showing active interest in
engaging with other children. From your description, it does sound like
your son has limited social skills and functional play for his age.
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Some Red Flags for social/emotional/cognitive development at age 3-4
include: (1) No initiation of interaction with same age peers; (2) No
pretend play skills; (3) Inability to play games with other children and
agree to rules; (4) Limited functional play with toys (i.e., instead of
putting pieces in a puzzle, repeatedly dumping, scattering or lining up
pieces); (5) No interest in spontaneous singing, dancing or acting out
scenarios; (6)Lack of imitation skills. I would definitely suggest
consulting with a developmental pediatrician, but you might want to go
ahead and first contact this Early Intervention service provider in your
area for a free screening to determine if your son is indeed showing a
developmental delay.
Early Intervention services are typically 0-3 and then 3-5. It is better to
seek help for your son now rather than waiting until he is kindergarten age. The
website link I listed states "Parents of children with difficulties in one or
more of the areas of vision, hearing, speech, language, movement, thinking,
learning, or self help skills are encouraged to contact the Region IX Child Find
office. A free developmental screening is available in any of these
developmental areas and children are not required to be of school age to qualify
for these services."
My cousin has a baby girl who is 3 years old. She can speak and sit
but in an odd way it is like her spinal cord is bent. Her development is
a problem because even though she is 3 years old, she cannot walk. She
is small in the bottom and her hands and feet are small. When sitting
she can fold her legs to make them a bracket. Can you clarify the
problem with her?
Your question is difficult for us to answer and would be best
answered by a medical doctor. As therapists we cannot diagnose children.
From your description of your cousin's child a few things come to mind
which you can research, one is
Scoliosis
(curvature of the spine) and another is
Spina Bifida.
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Again, since we are not doctors, we cannot say that any of these
conditions apply to this child. She should be seen by a local medical
doctor in order to receive a proper diagnosis and treatment/therapy. The
way you describe her sitting sounds to me like what we call "W sitting",
this is an article which describes
W sitting and why it should be discouraged.
My daughter started sticking her tongue out under the sippy cup. She
also does this with a straw cup. We switched her to an open cup and now
she is doing it with that as well. What should I do?
I spoke with our licensed speech pathologist and feeding specialist,
regarding your question. She said that she would not call this tongue
thrusting but rather, tongue protrusion. Tongue thrusting is what we see
with a diagnosis of cerebral palsy. Tongue protrusion is when the tongue
is just "hanging out" at times. It could just be something
developmentally she is doing since she was able to drink with it in her
mouth before and hopefully it will return to normal. It could also be
somewhat behavioral at this age, if she is constantly getting attention
for it, she may be apt to do it more frequently. But, if it is not
developmental/behavioral it could be low tone in her face/tongue or her
tongue and postural instability. Be sure her posture is 90/90/90 degrees
when sitting to provide the accurate positioning. In other words, make
sure her back is flat against the highchair or booster chair and that
her feet touch the foot rest of the chair so she is stable while
drinking. Use an electric toothbrush on her teeth, tongue and all around
her mouth if she will tolerate it. This helps to alert her mouth and
help strengthen muscles via vibration.
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Also also you can incorporate tongue movement into play. Look into a
mirror and have her imitate sticking her tongue out, moving it side to
side, up/down etc. Also while the she is drinking you can help place the
cup horizontally on the lower lip while providing some support to the
jaw with your opposite hand. This will help keep the tongue inside her
mouth. The straw cup and open cup you are using are usually preferable
to the sippy cup for more mature oral motor practice. If she continues
to stick out her tongue while drinking from the various cups and you
continue to have concerns, you may wish to seek an evaluation from a
licensed speech pathologist or occupational therapist with feeding
experience who can offer you additional guidance.
My three year old son was diagnosed with autism in Oct. 2009. We are
trying to get him potty trained but are struggling. He is a high
functioning child on the spectrum. He has improved SO much in his social
skills & interactions with his peers. I think he would wear a pull-up
until he was ten years old if we let him. We've tried putting him in
underwear. He wets them and continues playing unphased. He will
literally hold his urine until we give up and put a pull-up on him,
which then he soaks the pull-up. We've tried giving rewards, treats,
praises & even singing when he did eventually go. It's turning into a
power struggle. I'm afraid he'll get a bladder infection from holding
it. Is this "typical" for a child with autism? Do you have any
suggestions or he he just not ready to be potty trained yet?
We often gets questions regarding toilet training from parents of
children in early intervention. Toilet training is difficult for kids
without special needs and even more challenging for kids with special
needs. But, it can be accomplished, if you remember to be realistic,
patient & positive with your goals. This is a really great link to a
website that details ideas and methods specific to
toilet training for children
with autism.
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I hope you found this article helpful. If not, please contact us
again if we can be of further assistance.
My son is 26 months (the only child) and he recently started daycare
2 weeks ago. Prior to this, he stayed home with me or my mother when I
went to work. My son speaks a lot of words, understands simple commands,
and he does every thing on the separate skills checklist. He also knows
everything off of the TV shows on Nick JR (before noggin). He turns off
the light if I tell him to and he names familiar things to him. MY SON
HAS A LOT OF ENERGY. A typical day for him is playing, dancing,
climbing, and short rest periods after meals; he takes no nap. In school
he doesn't listen to the teachers and is extremely resistant when he is
getting him pamper changed. He grabs a toy and goes to play by himself
for about 6 minutes at a time. For these reasons he only goes 3 hours to
adjust to the environment. His teacher approached me and said he should
be evaluated by early intervention because he needs someone on one
attention that can't be given due to the ratio of teachers to children.
But when I look up on early intervention, it mostly targets
developmental delays, which his pediatrician and I feel he doesn't.
Should I still have him evaluated even if every checklist here and other
websites says he's up to speed?
It sounds like your son is very new to the day care environment and
the fact you're easing him into it with 3 hours per day is a great idea.
Perhaps he is overly active and not listening because all the routines
are new to him, and so is the idea of being in a group setting with
structured activities since he is used to be home with either you or
your mom. It is not unusual for 2 year old boys to be busy and active
and perhaps he needs more adjustment time to learn to sit and attend for
more structured play periods, as well as adjusting to diaper changes
from new caregivers. He may need more than 2 weeks for this adjustment
to take place. I would encourage you to speak again with his primary
caregivers at day care and ask them specifically what their concerns are
regarding your son's behavior and/or activity level at day care and why
they think a referral to early intervention might be helpful.
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You can tell them that both you and your pediatrician do not feel he
is exhibiting any developmental delays at this time and that he is
exhibiting age appropriate skills on the several developmental
checklists you mentioned. However, if the day care staff feel like an
early intervention evaluation might benefit your son in his adjustment
and success at day care then there is no harm in completing an
evaluation. That way you can rule out right away if your son is showing
any developmental delays and go from there in order to continue to make
his transition to day care a success. As therapists we would rather
complete an evaluation and say a child does not need our services than
to wait until a child is older and say "why wasn't this child referred
before?". I am sure since the day care suggested it, that they can give
you the contact information for your local early intervention provider,
but just in case, this is a link I found for your area: Medical & Health
Research Association of NYC Inc: Early Intervention Service
Coordination, 9004 161st Street, Jamaica, NY 11432-6103,(718) 206-1000
We've been in PT since 9 months old. My son went from not rolling,
to rolling, not crawling to crawling, and not pulling up to now pulling
up and cruising well. He is now 15 1/2 months old and has stayed in this
development spot for the past couple of months. He does not stand
unassisted, squat to stand or walk yet. He babbles quite a bit, but does
not say definitive words yet-not even mamma or dada, although he says
dada, but doesn't mean anything specific. I'm at a loss, as to whether
or not we should continue PT and look at another early intervention
resource. I feel like we aren't learning anything new with respect to
exercises and are just waiting it out for him to do these last few
things on his own. He has always had a cautious personality and doesn't
take the risk to try to stand unassisted etc. What would you recommend
as next steps? I hate for him to get further behind so I'm desperate.
I would first suggest speaking with your son's PT to discuss your
concerns, if you haven't already. It sounds like your son has made a lot
of motor progress in the past 6 1/2 months and now that he is cruising
he is well on his way to walking. I am sure it is frustrating for you if
he has been in this stage for a few months now and is still not walking
independently, but it sounds like since all his motor milestones were
achieved at a slightly slower pace he may just need that extra time to
get the strength and confidence to walk on his own (especially since you
also describe him as cautious in his personality). Even though you will
often read that most children walk by their first birthday, there is a
wide variance in what is typical for walking and some children walk as
late as 18 months, and although late, it can still be considered within
average. There is nothing magical a therapist can do to make a child
walk before he is ready. Some families choose to pursue outpatient
physical therapy through their local hospital or clinic in addition to
early intervention if you feel like your son would benefit from
additional therapy. Or perhaps your PT can increase the frequency of
service in-home if this option has not been discussed? On our web page
you can also find some other suggestions for exercises to try at home
with your son, since we have received several questions recently
regarding children who are late walkers. The first two questions/answers
at this link might be helpful for you to read:
http://www.earlyinterventionsupport.com/commonquestions/asktherapist-development.aspx
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Regarding your son's speech, I would be looking for him to be saying
Mama and Dada specifically by age 15-16 months, and also be using a few
single words or word approximations (like saying "ba" for ball or woof
for a dog). Your son should also be using gestures and vocalizations to
get his wants and needs met. You may also want to address your son's
speech with your early intervention team so he can receive a speech
evaluation and perhaps begin speech therapy or developmental therapy for
speech if warranted. Keep in mind that his speech progress could be on
hold for the moment since all his energy is going into learning to walk
and this is common. We sometimes see children have quieter non-verbal
periods when focusing all their energy on walking... since both talking
and walking are motor skills, little kids sometimes have trouble
mastering both at once. For more information on typical speech
development and red flags in speech development, check this link:
http://www.earlyinterventionsupport.com/development/speech/12-24months.aspx
I have a 3 1/2 year old that is being potty trained but since we
started, most of the time when we take him to the potty he will start
crying when he feels that the pee is coming, so I have to hold him down
until he pees. The bad thing is that he holds in the pee for hours
throughout the day. We might take him to the potty and he will not pee,
so we come back later and he still won't pee, so when he actually pees
is when he can't hold it any longer. As soon as I see him moving around
or can't stand still is when i know he really needs to go. I try to talk
to him so he can relax. Is this common with some children?
It sounds like your son is new to toilet training so I definitely
would not recommend holding him on the toilet until he pees, as this
only creates a negative experience around going potty and we always want
potty training to be positive. Holding urine is not very typical, but
some children do it out of a fear they developed around toileting (this
can result from anything such as being scolded for an accident, having a
fear of sitting on the toilet, being scared of the toilet being flushed,
etc). Little kids are just learning to control the muscles which allow
urine to either stop or flow and sometimes anxiety can cause them to
hold urine, but they are not really aware they are doing it and when
they try to go, they simply can't because they can't relax those muscles
enough to let it flow. Has your family or your son had any major
transitions in your lives recently?
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Sometimes, a new baby in the house, or a move to a new place, or
starting preschool, can be examples of very difficult/stressful times
for a child to begin toileting training. Since you mentioned that your
son cries when he starts to pee I would definitely make an appointment
with your pediatrician to have him checked for a urinary tract
infection, since holding urine for long periods can cause a UTI, and
pain during urination can be one sign. UTI's are less common in boys
than girls, but they do occur. Children will hold their urine if they
know pain is associated with it. If a UTI is ruled out, I would
definitely back off toilet training for a while and go back to strictly
diapers to alleviate his anxiety related to toileting because you want
to get him back on the right track to success without fear/anxiety and
if he is holding urine and crying, he sounds as if he just isn't quite
ready. You may also wish to go to the library and get some children's
books related to potty training to read with your son. You can find many
book titles at Amazon.com, this is just one example:
http://www.amazon.com/Ferdinand-Uses-Potty-Empowering-Training/dp/1932690824
You can find more tips on potty training at our link here:
http://www.earlyinterventionsupport.com/parentingtips/habits/toilettraining.aspx
Be sure to discuss your concerns with your pediatrician and hopefully
you can begin again in a month or two and your son will be on the road
to potty training success.
I have a 2 year 6 months baby boy. He was born premature (32weeks)
with very low birth weight of 1.3KG 3 days after birth he suffered from
Sepsis and very low blood platelet count. For treating his Sepsis,
doctors did Exchange transfusion twice and then he had kidney failure.
Also he had a small hole in his heart. He recovered from kidney failure
and heart hole with medication but then he had microcephallic skull
which was also cured by 1.5 years through early intervention. But during
his hospitalization of 2 months and every day puncture for checking
platelet count and giving platelets, he had two major shocks in brain.
Also he was on respirator after exchange transfusion for about a month.
His bera (ears test) is perfectly fine but his VOP is not fine. He
suffers from optic atrophy but is able to differentiate between dark and
light. Now, he is 2 year and 6 months and we are doing his occupational
therapy but he is still not able to hold his neck completely and,
therefore, not sitting, not standing, not rolling to sides as well. He
also has hypothyroid due to which he gains weight. And his scissors have
not yet finished in spite of so much medication. His scissors range from
1 - 6 seconds (sudden jerks type) and he smiles after those. I want to
know if there is any scope of improvement in his case. Will he ever be
able to recover from this type of illness?? I know it takes time in such
case but what is probability of improvement in his case and how far can
he recover?? Also can i know online or through email if the therapy
which we are doing is appropriate for him or not? Is there anything else
which we should be doing??
Unfortunately we don't have teacher of visually
impaired here around my area. Can you guide me with
what best can i do at home to improve his visionary
skills. And website or material I can refer to get
trained for my kid?? Also what exercises are good
for his neck holding and back, if you can help me, I
will be really grateful.
It sounds like your son and your family have been through quite a lot
in the past 2 years and 6 months. From your description, your son has
had and continues to have many medical complications that are having an
impact on the development of his physical/motor skills, especially if he
continues to have seizures despite being treated with medication. It
sounds like you are doing the best you can for your son by having
enrolled him in an early intervention program and having an occupational
therapist work with him. Physical therapy, as well as a teacher of the
visually impaired may also be services you may wish to consider if they
are available in your area. I'm sorry, but since we are therapists and
not doctors, it is impossible for us to give you a prognosis as to how
much his condition might improve, but I would recommend discussing these
issues with his doctors, as well as his current therapists who may be
able to give you more concrete information. Best wishes for you and your
son's continued health and physical development.
I have a son who just turned 4 months old on January 29, 2010. He
hates tummy time and due to acid reflux, will often spit up. The problem
is that he doesn't do the mini push up or roll. He's rolled belly to
back twice, but not consistently and it happened almost a month ago by
accident. Should I be worried? While on his back, he'll roll to his side
but not on his belly.
Since your son just turned 4 months I would not be worried that he is
not consistently rolling yet or pushing up on extended forearms,
although I would try to increase his tolerance to belly time as much as
possible since this is the position that will most benefit him in
developing the neck and trunk strength that he needs to complete these
skills. Many babies do first roll by accident and then eventually they
begin to do it consistently. You can also place your son in a side lying
position on his left and right sides several times throughout the day
(you may need to roll up a blanket behind him to keep him in this
position if he already rolls on and off his side), this is another nice
play position which encourages him to bring his hands together and is a
position you can use alternately with belly time. You can review motor
milestones for 3-6 months and red flags in motor development at this
link:
http://www.earlyinterventionsupport.com/development/grossmotor/3-6months.aspx
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I realize that many babies with reflux dislike tummy time, but
remember, tummy time doesn't have to always mean lying flat on the floor
and it doesn't have to be done all at once. For example, instead of 20
minutes straight of tummy time, try doing 3-5 minutes of tummy time
several times throughout the day. For alternate ways to practice tummy
time, have your son lie on your stomach facing you so you can distract
and entertain him with face to face time, singing, etc. You can roll up
a receiving blanket or use a boppy pillow and place it under his armpits
to relieve some direct pressure on his belly as well as encourage him to
lift his head and push up on his elbows. You can also carry your son
across your arm, supporting his chest with your forearm, belly down.
This printable PDF link gives many wonderful ideas that promote tummy
time during play, carrying, diapering, etc:
http://www.orthomerica.com/pdf/tummytimetools.pdf
How can I position my baby to reduce hyperextension when
sleeping? He is 12 months old, has low tone and decreased strength,
poor head control, low vision and seizures when sleeping and is
unable to crawl or turn over.
I would definitely consult with your child's physical therapist (I
am hoping your son is already in your local early intervention
program?) or physician to get the best suggestions for sleep
positioning for your son that will meet his medical needs and allow
him to sleep more comfortably and easily.
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The aim would be to try to position your son in a nighttime
position that involves flexion and prevents him from hyper-extending
his body during sleep. This can be achieved using positional
adaptive equipment. If he is only cleared to sleep on his back,
the Versa Form pillow from Sammons Preston is a multi-functional
pillow that has been really helpful for many medically fragile
children I have worked with in the past. The Versa Form looks like
a small mattress or large pillow and comes in several sizes. It is
filled with styrene beads and works with a reverse air pump. When
a child is placed upon the Versa Form in a certain desired
position, the air is removed from the pillow and the pillow molds
to the child's body to hold him in that position. The Versa Form
becomes very rigid when the air is removed and it prevents the
child from changing to a less desirable position. Here is a link
to Versa Form:
http://www.sammonspreston.com/app.aspx?cmd=get_product&id=46006
There are other pediatric positioners that are also commercially
available, such as the Tadpole Set, in which the different pieces
can be arranged in many positions for side-lying, sitting, tummy
time, etc. and by using Velcro straps, half rolls and blocks the
child can be positioned correctly. If he is medically allowed to
sleep in a side-lying position, this may be one way to encourage
flexion and prevent the hyper-extension. This is the link for the
Tadpole Pediatric Positioning set:
http://www.sammonspreston.com/app.aspx?cmd=get_product&id=48724
The Tadpole is similar to the Universal Side-lyer set for older
children:
http://www.beyondplay.com/ITEMS/K704.HTM
Most of this commercial adaptive equipment is very expensive and
requires a letter of medical necessity to obtain through insurance
(and sometimes is not covered at all) so often a physical
therapist can adapt equipment at home for you to create something
similar without the extensive cost by using such things as sand
bags covered with cloth cases, firm pieces of foam that are cut
and hollowed out to fit your child's body and Velcro strapping,
etc. Any commercial or home made equipment should be used under
the direction of your physical therapist or physician so that your
son's medical & especially respiratory needs are met and not
compromised during sleep. If you need information on early
intervention services in your area please let us know and we can
try to locate a program with physical therapy in your area.
My daughter is 5 months and 1 week old. She is seeing a therapist
for brachial plexus injury. She is doing well and is showing a
full range of motion now. However, she is not rolling over even
one way yet. When we put her on her belly she will reach for her
toys but that is all. Should I be concerned? We don't see her
therapist for another month.
First of all it is great that she has full range of motion
already. Although she should be rolling, the fact that she had the
brachial plexus injury would make it much more difficult for her to
do so as reaching is a part of rolling. It would probably be a
good idea to increase the frequency of her physical therapy to
take advantage of her new range of motion.
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In the mean time you should work on her rolling from back to
belly. Encourage her to reach across her body to grab toys when she
is laying on her back. Do this to both sides. Help her if needed
with the side that had the injury. If she is unable to bring her
hands together at midline, then begin with her laying on either
side and encourage playing with toys with both hands in the
middle. It is easier to reach when laying on your side as gravity
is not working against you. Once she is able to play easily at
midline in right or left sidelying then progress to her playing
with toys at midline in supported sitting or laying. If she has
trouble with this, help her to bring her shoulders forward either
by cradling her in sitting or putting small rolls (burp cloth or
thin blanket) lengthwise at each shoulder while she is laying on
her back. Bringing her shoulders forward will help her to reach
against gravity.
Progress to her reaching in sitting or laying without the rolls or
assistance to bring shoulders forward. Once she has mastered
playing at midline (and she may already be there) then work on her
reaching across her body. Once she can do that, then take it a
step further by slowly moving the toy behind her head. She should
continue to reach for it and follow it with her head. You can help
her at her hips to roll onto her side if needed and then to
complete the roll. Practice going right and left. Give her a
chance to do as much as she can on her own then help her as
needed. Babies tend to accidentally learn how to roll from belly
to back however you can encourage her to do so by having her reach
for toys with either hand when on her belly then move the toy
behind her. If needed, help her to put her head down and roll over
the non-reaching arm. I hope this answers our question. If you
have any further questions or need clarification of this answer
please feel free to email us again.
First, I'm not sure if this is a problem that needs medical
attention. My 8-month-old son Chase seems to need to sleep a lot;
sometimes 5 naps a day plus bedtime and even after that he acts
tired. And, from what I understand, babies his age don't need
swaddling to sleep but I can't get him to sleep without it. The other
thing is, and I'm not sure if these two problems are related, that
most days he is not happy. I have run the list thirty times on
these days, have played with him for hours on end, cuddled him,
laid down with him, walked him. I have no idea what else I can do.
On his bad days, and they are about five days out of the week, he
cries for hours. And when he's not crying, he has this whine that
goes on for hours more. His pediatrician says that there's nothing
wrong with him. I'm not sure what I can do. Any answers you could
suggest would be so helpful.
Babies of Chase's age typically need between 12-15 hours of sleep
in a day including naps and bedtime. Most babies still nap 2-3
times per day at this age. If your son is sleeping through the
night for around 10 hours, as well as taking several one hour naps
per day, it may seem like he's sleeping too much, when in reality
he is not. However, since you are describing him as irritable and
fussy most days, and needing to swaddle him to get him to sleep,
it could be a sign that he is sleep deprived.
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Babies around 8 months are going through a lot of cognitive and
physical changes, with learning to crawl, and cruise and explore and
sometimes patterns of sleep are disturbed in the 6-9 month period.
Babies also go through separation anxiety at this age which can
account for night awakening and difficulty resuming sleep. While some
parents swear that swaddling their older babies helps them when
they are fussy, there is always a caution with swaddling babies
older than 3 months since once a child can roll over the swaddling
limits their movements and there can be a risk of SIDS if they
roll to their stomach during the night and can't move freely.
Also, babies that are swaddled for long periods may simply become
dependent upon swaddling and are then unable to fall asleep
without it because it's become a habit (similar to a pacifier).
For example, a baby who is always rocked to sleep never learns the
self-soothing techniques needed to fall asleep on his own, so when
he awakens during the night and Mom is not there, he cannot get
back to sleep without her rocking him all over again and it
becomes a vicious cycle. If you are sure you are keeping a
consistent daily routine and bedtime routine for your son, with the
same calming nightly routine (warm bath, singing, books, etc.) and
bedtime hour, as well as a consistent nap schedule (even if he
takes 5), and he is getting a total of 12-15 hours of actual
undisturbed sleep, and you are still concerned with his
irritability throughout the day and his need for swaddling, I would
definitely seek a second medical opinion to rule out that anything
medical or perhaps dietary is causing his fussiness. It may help to
keep a journal for a week or two before your next medical appointment
so you can demonstrate his exact sleep patterns (how long he slept,
how long he napped, how many fussy periods he had during each day),
as physicians may find this helpful and may take your concerns more
seriously. You may also wish to have an occupational therapy
evaluation from your local early intervention provider to rule out
any sensory issues contributing to his need for the swaddling to calm
him. Some children really do need that deep pressure on their
bodies to calm them down and to feel secure and this is something
an occupational therapist who is trained in sensory integration
techniques can assess for you. Our website contains a link to Arizona
Early Intervention Services here:
http://www.earlyinterventionsupport.com/resources/links/state.aspx#Arizona
My grandson is 4-1/2 months old. I believe he has hypertone in his
upper body (he arches his back "stiff" when being held body-to-body)
that may be showing up in his legs now (he's starting to "scissor" - to
hold his mom's arms with his legs as his diaper is being changed). Is
there anything that can explain hypertonicity in layman's terms? A
pictorial of behavioral tendencies/assessments? An infant developmental
specialist in San Diego that's familiar with hypertonicity?
In response to your questions, let me start by saying that your keen
observations and reporting provided a clear portrayal of your grandson's
movement patterns. I believe that your observations warrant concern.
Hypertonicity is often called high tone, spasticity, hypertonia and
rigidity.
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Movements will appear stiff and awkward because the
muscles may be tight, and tone is not balanced.
Hypertonic babies will arch their backs and will stiffly
extend/straighten legs. Babies with high tone will often
stand on stiff legs when given the opportunity. You may
also see him standing on his toes and scissoring his
legs tightly when held upright or during diaper changes.
Fluctuating tone will be a combination of low/weak tone
when resting and high tone/rigidity during active
movements. Whether you have high tone, low tone or
fluctuation, there is no damage to the muscles or
nerves; but it is the brain's inability to control the
muscles during movement. You need balance between all
muscle groups involved to have smooth, coordinated
movement.
As a therapist, I cannot diagnose, but I recommend that you
speak with your grandson's pediatrician as soon as possible. Ask
for a referral to either a pediatric neurologist or a
physiatrist for more extensive assessment. You can also seek out
early intervention
services (from birth to age 3) in your area
without a referral. Contact the Infant/Toddler Alliance in your
area for an evaluation. Your grandson does not need a diagnosis
to be evaluated for services. A physical therapist can help with
development of motor skills, and improve strength, posture and
range of motion. She can help you with how to handle your
grandson during daily care and play.
For now, position your grandson on his belly often. If he has
difficulty in this position, use a Boppy pillow or a small
blanket under his chest. Place toys in front of him to encourage
reaching. Promote hand-to-feet play (play 'patty-cake' with his
feet) when he is lying on his back and help him as needed. This
will help him to move in patterns opposite to the stiffness.
I have 10.5 month old boy/girl twins. My son is right on target as
far as crawling, pulling up and getting himself into a sitting position.
My daughter just started crawling a few weeks ago but on her belly. She
can get up on all fours but doesn't crawl this way. She has not figured
out how to sit herself up from her belly and if I stand her next to a
piece of furniture she can support her weight on her legs and stand for
quite a while playing with a toy but she just throws herself backwards
when she has done, there is no getting herself down easy. I am concerned
about her being delayed and was wondering what I can do to help her.
I am wondering if your twins were premature or on time? If they were
premature, than giving them each some extra weeks (especially your
daughter) to complete developmental milestones would be expected to
adjust for how early they were born. Your daughter sounds like she has
some nice skills in place and is just perhaps having trouble
coordinating her movements to transition in/out of sitting, to crawl on
all fours and to get down from a standing position. She may also need to
increase trunk strength to complete some more complex motor movements. I
am happy to hear she can belly crawl, can assume hand/knee position, as
well as stand and bear weight while playing.
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The best way to help her transition up and down into sitting (I am
assuming she can sit independently with hands free for play when you
place her into a sitting position?) is to help her rotate her body.
Instead of picking her straight up from her back or belly when in the
crib, on the floor or changing table, instead try rotating her to her
left side, place your left hand under her left shoulder and your right
hand on her right hip and gently rotate her up into sitting letting her
do the majority of the work and hopefully she will place her left hand
on the floor to help push. Do the same thing by rotating her to her
right side and switching hands, one under her shoulder, one on her hip.
Think of how you sit up...you don't simply sit straight up from lying on
your back, you rotate to either side and rotate up into sitting and this
is what she should be doing. Try doing this after every diaper change.
You can guide her down from sitting in the same way...rotate her trunk
to the side and encourage her to place both hands on the floor as you
rotate her into a hand/knee position. Place toys to her left and right
sides just out of her reach to encourage trunk rotation and encourage
her to rotate naturally down to hand/knee or belly. You can place her in
hand/knee over your own leg or over a roll (tape some large soup cans
together and cover with a towel to make a roll to place under her
belly)...gently rock her back and forth in this position and place toys
to left and right sides just out of her reach to encourage her to shift
her weight and reach for things. This will encourage her to bear weight
on one hand and then the other as well, which she will need to do for
crawling.
You can use a large playground or exercise ball for fun and bounce
her on the ball in a sitting position, slightly tipping her side to side
and then back to front to increase her tummy strength. Babies usually
find this fun and you can sing songs to keep them entertained. Using a
small ball or the roll I mentioned before you can place her on her tummy
and roll her forward encouraging her to place both hands on the floor
and bear weight, then come back to knees and bear weight. Sing songs
such as Row, Row, Row Your Boat.
To work on pulling to stand and returning to sit you ideally want
your daughter to come from a hand/knee position into a 1/2 kneel
position, then up to stand. You can sit by a low table or cardboard box
turned upside-down that is about armpit high for your daughter when she
stands beside it. Place your daughter in a kneeling position (both feet
under her bottom, make sure her bottom doesn't drop in between her
feet), help her bring one foot out into a half kneel and then boost her
up into standing. You can also sit her on your lap, so both of her feet
touch the ground and encourage her to pull up from there, sort of like
doing squats and encourage her to bend her knees and lower into sitting
on your lap again. Many babies simply fall backwards or just plop onto
their bottoms when first pulling to stand, so she'll need practice time
to bend her knees and lower to sitting.
If you continue to have concerns and she is not hand-knee crawling,
or getting in or out of sitting by 12 months you may want to contact
your local early intervention provider to have a physical therapy
evaluation to get other suggestions or see if she qualifies for services
to help her catch up on motor skills if she is still behind. I am sure
it's hard not to compare your twins, but since all children do things at
different rates and boys sometimes tend to be more motor oriented than
girls, it's not that unusual that your children are completing motor
milestones at different times.
I am a mother of a 10 month old baby boy who has stiffness or
hypertonicity in his ankles and keeps his leg claw shaped. By 10months
he has to should be showing independent sitting and crawling but my baby
is not doing so. He was able to roll on tummy before and is not even
doing that for the last two to three months.
His doctor suggested physio exercises. We are doing those and we have
started him in a course of physio therapy under a trained pediatric
physiotherapist. But we are a little concerned regarding the status. Our
baby had seizures three days after his birth and was hospitalized for 15
days in NICU but once out of NICU, he has not had seizures, but
developmental delays concerns me.
I can tell you are concerned about the motor development of your 10
month old son. By ten months old a baby usually can hold his/her head up
well, push up on arms when on belly, roll, sit independently and creep/
crawl to get around, among other skills.
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It's great that you have started having your son see a pediatric
physiotherapist for therapy. I would recommend that you talk to your
physiotherapist about your concerns about your son's delays. Your
therapist should be able to help you understand what is causing the
delays and teach you ways to help your son.
I would also suggest further medical evaluation if that has not
already been done. In the city where I work the major pediatric hospital
has different clinics for different neurological problems where babies
and children are evaluated by a team of pediatric medical specialists
including a pediatric physiatrist, pediatric neurologist, pediatric
orthopedist, pediatric physical therapist, occupational therapist and
speech language therapist. The medical specialists determine which
evaluations a child might need, these are done and then the group meets
as a team to make recommendations for each child. The team looks at all
areas of development including motor and cognitive development. I don't
know if you have such a place where you live but the families I work
with have found a comprehensive evaluation such as this useful in
helping to plan treatment to help their children.
My last suggestion would be to go on the web and look up the NDT
Association and see if any therapists who are trained in NDT
(Neurodevelopmental therapy) where you live - if there is one you may
want to contact them or you may be able to contact the NDT organization
with questions (www.ndta.org ).
When my son was born his shoulder got stuck and was literally yanked
out of me. I put him on his back to sleep from birth and he would always
have his head in one position and he got a serve flat spot on one side.
I took him to my chiropractor who got him to be able to get him to move
his head and neck properly but the shape of his head wasn't changing. I
then took him to a physio that works especially with the skull and after
6 months it is all pretty much normal.
The problem I am having that he hates tummy time. I force him to have it
be he gets quite hysterical. He only likes to sit now. He can go from
sitting to on his stomach but then screams until he can get back up. He
loves to stand and when sitting can hold onto my hands and pulls himself
up. He loves to stand. He is 9 months old now and not crawling. I have
been told by the physio it is very important that he crawls. How can I
get him to crawl when he wont go on to his belly. He use to be able to
rock back onto his knees before in like a crawling position but know he
wont even do that.
It sounds like your son had something called Torticollis early on, a
condition which causes a baby's head and neck to tilt to one side.
Babies with Torticollis benefit greatly from weekly physical therapy
which includes stretching exercises to stretch the neck muscles and
proper positioning to enable the baby to freely turn his head from side
to side and to not keep it turned to one side or the other. Some babies
with Torticollis develop positional Plagiocephaly, because of being on
their backs or in a certain position in a car seat, crib, etc., which
causes their heads to become flat/misshapen on the side or the back.
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Both Torticollis and Plagiocephaly are much more common in babies
these days since the "back to sleep" campaign began in the early 1990's
to combat Sudden Infant Death Syndrome. What many new parents do not
realize, is that while putting a baby to sleep on his back is important,
that during the day and waking hours the baby should spend as much time
as possible on his belly to develop neck and trunk strength needed for
rolling and crawling. By 9 months of age it is not surprising that your
son does not like tummy time, but as your therapist said, it is a very
important position and should be encouraged. Crawling is a very
important developmental milestone and today many therapists agree that
bypassing crawling can sometimes lead to other delays down the road such
as sensory issues or motor coordination problems. Crawling allows
children to learn to move their heads, arms and legs independently and
this helps them develop muscle strength and improve coordination. Since
he likes to stand, we also want to encourage him to come to his
hands/knees, then into a half kneeling position to pull himself up...we
don't want him to hold onto your hands & pull himself straight upwards
into standing without first bearing weight on his knees or one knee and
one foot.
Here are a few ideas to try to encourage belly time and crawling:
- Remember he isn't going to like it at first, but it does not
hurt him, so starting slow and putting up with some tears and
fussing should be expected.
- You can begin working on getting him into a belly position for
only 3-5 minutes per day and then building up to 5 + minute periods
every hour or two during playtime.
- You can use a firm towel or blanket roll under his armpits while
on his belly and lay on the floor in front of him to entice him to
stay in this position briefly, sometimes putting a mirror on the
floor makes it fun.
- Use a small firm ball, and place him belly down on the ball and
gently roll the ball forward encouraging him to place his hands on
the floor to bear weight and catch himself and then roll the ball
backwards and encourage him to place his knees on the floor to bear
weight. You can use music and make it a fun game.
- You can also use a firm roll for the same exercise, covering
large soup cans with a towel or foam, and then encouraging him to
play kneeling behind the roll, gently roll it forward so he needs to
place his hands on the floor and alternate bearing weight on hands
then knees. You can use a low breakfast tray for a play table and
support him in a kneeling position, making sure his feet are
directly under his bottom, so he is bearing weight on his knees and
then leaning on his elbows/hands on the tray to play with toys.
- This same effect can be achieved using a wedge of foam, lying
the baby on his belly on the wedge and encouraging him to place his
hands on the floor to play with toys in front of him and to the
sides.
- When your baby is sitting, encourage him to transition down to
his belly to reach for toys, by placing toys to his left and right
sides, just out of his reach so he has to rotate his body to reach
for them, you can help him rotate his way down to the floor.
- You can also make belly time more fun by lying on your back and
placing your baby on your chest and encouraging him to push up on
you to see your face as you talk and sing to him. Or lie on your
back and place him on his belly on your legs and hold his hands and
raise him up & down giving him a fun "ride".
- You can carry him in a sort of "football hold" by carrying him
belly down with his belly resting on your arms as you support his
chest. Or carry him in a sitting position facing away from you or a
standing position facing away from you supporting him under his
crotch and at his chest. Try to let him do most of the work.
- Some babies enjoy back rubs and massage, so at night time or
after a bath you can try lying him on his belly on the bed or across
your lab and rubbing him with lotion and massaging him.
There is a great article on the internet from Children's Healthcare
of Atlanta which explains some of these techniques a bit more and
incorporates pictures of the various play, and carrying positions:
http://www.choa.org/Menus/Documents/Wellness/final_tummy_time.pdf
Good luck and please continue with your child's physical therapy.
Remember, just a few minutes a day is ok at first and then try to build
up to a total of 15+ minutes per day of belly time.
My baby is 11 months old. He cannot sit unsupported; he slouches in
stroller and in highchair. He can pull himself up but falls back once he
lets go of stroller or highchair. He cannot stand. He can't put himself
into a sitting position. He crawls on stomach and pushes off with both
feet. He maneuvers very well in his walker, but uses both feet to push
himself. He doesn't take steps like for walking. Also he has a deep
indentation in his sacrum area. and I had a CT scan and surgery with
general anesthesia when I was 5 weeks pregnant. He is also allergic to
wheat, milk and soy and I think cinnamon. I have 3 other children and
they developed at a normal pace. I am wandering what can be wrong with
him. Mentally he seems fine.
Thanks for your question. The deep indentation you mention on your
son's sacrum sounds like a sacral simple, they are fairly common and
generally harmless, but in rare cases can be associated with problems
related to the spine or spinal cord and can have neurological
implications. The higher the dimple generally the more of concern it may
be. Since your son is 11 months old and not yet getting into a sitting
position independently, not crawling on hands and knees or bearing
weight independently in standing and not taking steps with hands held, I
would recommend seeing your pediatrician to rule out any medical issues
that may be contributing to his delayed motor skills.
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Sometimes an MRI is done to examine the sacral dimple and any
relation it has to the spine and spinal cord. Some children who have
delayed motor skills have either low or high "muscle tone" and so motor
movements such as sitting, crawling and walking are much tougher. A
physical therapist or your doctor can usually tell you if they feel your
son has low or high muscle tone. I would definitely contact your local
early intervention provider (birth to three program) and ask for a
physical therapy evaluation so your son can begin to receive therapy to
work on getting in and out of a sitting position, crawling on all fours,
pulling to stand, taking steps with his hands held and eventually
walking independently.
My niece was born with micracephaly...I think that's how you spell
it. And we were told that she would have developmental delays... which
was true. She didn't walk until she was two; she is now almost four and
is only at an eighteen month level. The problem is that the doctors seem
to be treating her like she is a normal child who has adhd which, in my
opinion, I have a two year old and a one year old. She is by no means
hyperactive.
She does not seem to be getting the help that she needs; they send her
to speech and physical therapy once a week but it does not seem like the
help that she needs and me and my mom and her mom are getting very
frustrated that this little girl is just falling farther and farther
behind. She will be four soon and just got off the bottle and she ended
up losing two lbs which she cannot afford to lose ...she only weighs
about nineteen pounds because she refuses to eat. And we are very
concerned and we don't know what to do for this little girl. Her mother
is at her wits end. Please give me some suggestions on who to call to
get some help for my niece.
Thank you for your question regarding your niece. Microcephaly is a
condition which means basically a smaller than average head size for a
child's age due to some abnormality in the brain or lack of brain
growth. The majority of children with this diagnosis have developmental
delays, although not always, but it is often associated with things such
as delayed speech and motor skills, seizures, mental retardation and
hyperactivity.
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I would agree that your niece sounds like she needs more than just
physical and speech therapy one time per week. I am also concerned with
the weight loss you mentioned and her refusal to eat. She would
definitely benefit from a feeding evaluation, as this is a separate
therapy that focuses on helping children learn feeding and oral motor
skills. An occupational therapy evaluation may also be beneficial to
determine if your niece has any sensory issues (oral hypersensitivity,
problems with textures in food, etc) that are contributing to her
refusal to eat.
I am wondering if her present therapies are only out-patient in
nature, or does she attend an early intervention preschool program?
Since I do not know where you live, I would suggest looking into your
town's 3-5 early intervention preschool services (you should be able to
contact your pediatrician or local school district for information),
since many areas provide 5 day per week preschool programs which provide
the necessary therapies that it sounds like your niece needs. She should
have a full team evaluation and an IEP (Individualized Education Plan)
should be written detailing her goals for therapy. I would also suggest
being more pro-active and assertive with her pediatrician, particularly
due to the feeding issues, since her weight loss and refusal to eat are
impacting her health and growth. Please don't hesitate to contact us
again and let us know your hometown if we can be of assistance in trying
to locate appropriate early intervention services in your area.
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