Last week at The Nook we hosted Brianna Fong, Pediatric Physiotherapist from Kids Physio Group, speaking on baby motor skill development and milestones.

Brianna started her talk with the most common reasons to see a pediatric physiotherapist: 

Motor Milestone checkups - if your little one seems to be stuck on a motor skill we can check on those "mini skills" that help them get to the next milestone

Torticollis/Plagiocephaly - more common with young infants, a preference to turn their heads to one side especially during sleep that can cause flattening to one side of the head

Clicking in Hip - noticing when changing diaper or dressing a click or clunk in the hip, which may be a sign of hip dysplasia

In this day of social media there is a lot of information out there and like all parenting issues it can be contradictory. A physiotherapist will be trained and up to date on the latest research, so will be able to advise on why there may be differing information and make a recommendation relevant to your specific situation.

Tummy Time: especially before babies are doing much upright sitting, at 4-5(ish) months, tummy time is the main way they start developing strength and head control to preset sitting skills. Sometimes it can be tricky to get started; they might lift their heads a little and give up or go to sleep on their tummy. Some things that will help are giving them a little bit of a prop like a rolled towel underneath them or lots of chest to chest time. Anything that gets them on a little bit of an incline can help them hold their heads up a little bit longer. The general recommendation by the time babies are about 4 months old is 30 minutes cumulatively throughout the day (lifting up their heads, trying to look around, reaching for a toy). 

Often parents will say their baby will immediately start screaming or have reflux and that is something that physiotherapists can work with, helping take some pressure off baby's belly so they can still have tummy time in a more comfortable and individualized way.

Baby Wearing/Carriers: Time on the floor is optimal, but of course there are times when you need to be wearing your baby or having them safely contained in a positional device. We need to make sure we are offsetting that time with floor play to give them opportunities to move around on their own.

With a carrier we want to make sure their legs are in an "M" shape with their bum at the bottom, their knees up and feet outward. That way we ensure their hips are in the best position in the hip socket to avoid the risk of dislocation or shifting of their hips. At this age babies' hips aren't completely developed enough to fully hold themselves into the socket yet, but most carriers can be easily modified to hold them in an optimal position. Wraps are very easy to adapt to your growing baby because they are flexible and can be wrapped different ways.

Side-Lying Play/Rolling: a nice adjunct to bridge between tummy time and sitting up on their own. At around the 3-4 month point, especially when they're not quite rolling, we're focused on getting their midline movements strong, so bringing their hands forward to play with a toy or even when they're lying on their back bringing their hands together to grasp a toy is building the strength they need in their trunk and core to do those rolling and sitting skills later on. If you're noticing that baby has a little bit of flattening on one side of their head, side-lying can take the pressure off that side. We want little ones to be successful so we always start by giving them a little bit of help. To start them rolling to their tummy you can put them on their sides and then put a toy on a diagonal upwards from them to encourage them to reach towards it and come over. You can help turn at the hips and they can finish the roll, then help them bring their head up. To help roll back over, bring one arm in front and forward, then get their head down onto the ground and use visual tracking of a toy to get them to finish that roll. Rolling to their back with their head up can be a bit scary, so teaching them to bring their head down supported on the ground will help them be willing to do it. In Brianna's experience, most babies will roll from back to tummy first. They see something they want and will find a way to move towards it.

Sitting/Transitional Sitting: Once babies are sitting upright we'll see them come down forward or lose their balance side to side and put a hand out to catch themselves. It's not until about 9-10 months that they will catch themselves when tipping backwards. Sitting allows babies to get some independence playing with things, but they often need some help getting in and out of sitting. Side sitting will get them comfortable with moving into to hands and knees position later for crawling. Use a toy that they find interesting to keep their attention and position them on their side, weight bearing on one arm with their knees bent to one side. To come out of that position you can help them come over onto their tummy. Make sure you place them on both sides to build the muscles equally. From a side sit it is much easier to get to hands and knees by coming slightly forward than it is to come forward from a regular sitting position with both legs in front. Side-sitting is different from a "W" sit where their knees are forward and feet are back and to the sides. If you notice your little one sitting in that position try to bring them out of it to a side-sit or regular sitting position.

Crawling: Once they are sitting securely on their own and comfortable getting in and out of sitting their trunk strength is strong enough for them to move towards crawling. You can give a little bit of help positioning from a side-sitting position onto hands and knees. Offer a toy in front of them on one side and then the other so they can practice transferring weight from one hand to the other. A less slippery surface and bare skin will give them more friction to make crawling easier when they're first getting started. Exploration time unrestricted by clothing and in a safe space where they can move will encourage exploration, which is vital at this age.

Standing: Once they are crawling on hands and knees, the next skill we're looking forward to is pulling up to standing. Offering a surface like the edge of your couch or even you sitting on the floor with them will allow them to push up to high kneeling and then to a standing position. Encourage them to use both sides so their bodies develop equally on both sides. If they are not crawling yet, they are not physically developed enough to be standing and so we should not be pulling them into a standing position too early. When they are showing that they are ready and are starting to push up to standing from crawling or sitting on their own, you can support them at the hips rather than pulling them up by their hands. This way their balance does not shift suddenly and your hands are in control of their hips so they can't let go of your hands and fall.

For the same reasons, from a physiotherapist's perspective, jolly jumpers and similar play frames are not recommended as babies are often in them before they have the core/trunk strength to support themselves and are only strengthening their legs. They can also often lead to toe walking later on. If there are times that young babies need to be in a play frame keep it to 10 minutes or less cumulatively over the day.

*These are general guidelines and recommendations and don't take into account whether your infant was born early or late or tends to be a little bit fussy and need more cuddle or contact time. When physiotherapy is recommended for little ones it will usually be play-based, often by positioning toys in ways that encourage babies to get into the positions we want them to practice. If you feel that you have specific questions or concerns you can make an appointment with a pediatric physiotherapist to address them.