Common Foot Postures

Feet that turn in

The foot turning in can be the result of:

• a twist in the foot
• a twist in the shin bone
• a turn in the hip
• sometimes all of the above

Later on this can be made worse by your child always sitting back between their feet (’W’ sitting). Correcting habits may help some feet and legs to straighten. Often the problem will resolve itself. Other times, such as for Metatarsus Adductus ( a bend in the forefoot) and Talipes ( a bend in the whole foot from the ankle) intervention may be required. Sometimes these are described as the baby looking like their foot is an “L’ shape, or their foot is a ‘C’ shape. If you are concerned, seek advice from your local paediatric physiotherapist.

Feet that turn out

Some infants are born with their feet turning out. Generally this also spotaneously corrects over time. If this doesn’t resolve spontaneously it may also require intervention. It may be more noticeable when baby starts to try and reach their feet and pull them to their mouth which is a common stage in physical development. It may become more obvious when a toddler begins to stand or walk.

Exercising your baby’s feet

Parents are often told in the early stages to just massage the baby’s turned foot and it will resolve the position. This is true in mild cases in my experience. Encourage your baby to push and kick with their feet to help stimulate muscle development. If it doesn’t start to move to the same position as the other foot with tickles, rubbing  and massaging; it may be worthwhile to take your baby to your local paediatric physiotherapist for assessment and advice.

Flat feet

Flat feet don’t tend to be noticed until your child becomes a toddler and is weight bearing on their feet. Babies and toddlers normally appear to have “flat” feet because the arch of the foot doesn’t develop until later. Five to six years old is normally when this develops more fully. Flat feet commonly run in families. If your child is looking like they have a flat foot because they are rolling inwards from the ankle, not just in the arch, this may make their foot more unstable for walking. This can impact on balance later on.

If you have any concerns, this is something that a paediatric physiotherapist can give you advice and help with in treatment.

• Delays in achieving motor milestones such as sitting, crawling, walking.
• Dropping things
• Clumsiness
• Poor performance in sports
• Poor handwriting

What is DCD?

Children with DCD  do not have an identifiable medical  or neurological condition that explains their coordination problems. They usually have normal or above average intelligence, however their coordination difficulties impacts physical, social, and emotional health. DCD may co-occur with other developmental conditions such as attention deficit hyperactivity disorder (ADHD), learning disabilities (LD), speech/ language disorders, and behavioural disorders. Children with DCD vary in their presentation, so motor milestones may not be delayed, but the development of motor skills and learned movements or tasks will be delayed.DCD persists into adolesence and adulthood.

DCD continues to be an under recognised disorder. When children begin to participate in structured setting such as preschool and kindergarten, they usually struggle with pre-academic activities including colouring, and cutting and pasting. In early school grades, they may have difficulty with printing, copying notes from the board. Gross motor skills such as learning to throw and catch a ball are equally problematic. Teachers may describe children with DCD as falling off their chairs in class, or not being able to sit up at circle time. Although the motor coordination difficulties are easy to observe in the classroom and physical education settings, children with DCD are commonly not picked up until their difficulties begin to affect their schoolwork.

Identification

Identification of all developmental concerns is important  for management of DCD. A collaborative interdisciplinary approach provides more effective management and better outcomes for the child. This is a recognised medical condition, but awareness is just beginning to increase with a growing body of research.  Children with DCD need to be monitored more closely than the the average developing child for:

• deterioration in physical and cardiovascular fitness (with potential for obesity)
• withdrawal from social activities
• victimisation and bullying
• depression and anxiety

What do I look for?

In summary, DCD may be suspected if the child:

• moves awkwardly
• seems clumsy or poorly coordinated
• frequently trips, or drops things
• prints or writes poorly, and with much effort
• has trouble with daily activities such as
  • handling utensils
  • catching a ball
  • cutting with scissors
  • tying shoelaces

• avoids participation in physical or motor based activities
• has difficulty learning and transferring new motor skills

Intervention

Intervention for DCD focuses on learning and transferring specific motor tasks. Encouragement of an active lifestyle can help prevent secondary consequences. Early intervention and treatment may help reduce the emotional, physical and social consequences that are often associated with this disorder.

A physiotherapy  assessment can be helpful for setting intervention goals and ongoing management of this condition. If you would like to have your child assessed and receive futher information on DCD, please call us on  free call 1800985996 or 98777304.

Information based on Canchild research site.

The last year at home and pre school is a very busy time, which you are sure to be experiencing if you are reading this article. Before your child ventures out into the world of school you may stop and think and look at many things as you ensure your child is ready for school.

Some of the common questions we hear are:

Has my child reached all their developmental milestones?

How do I know my child is ready for school?

Is my child co-ordinated?

I think my child is clumsy, he seems to be tripping and falling over a lot, what do you think?

Is this a physical delay, is this a problem?

My suggestion is have a look at the list below and tick if your child can confidently do these physical tasks well. If you have any concerns after that, give us a call to make a time to come in and discuss your concerns and assess your child if needed.

• Able to walk with feet straight ahead, not turning in or out.
• Able to walk (or run) up and down stairs with one foot per step, not holding on.
• Climbs ladders, playground equipment and trees with agility.
• Able to stand, walk and run on tip toe.
• Able to turn around corners, people or obstacles while walking or running without stumbling or tripping.
• Able to ride tricycle like an expert and make sharp turns easily.
• Able to carry objects with confidence.
• Able to balance on one foot 10-30 seconds.
• Able to sit with knees crossed.
• Able to jump on the spot.
• Able to jump off objects.
• Is able to “gallop” or skip.
• Has good posture.
• Able to hop.
• Able to sit still, on chair or floor.
• Able to copy movements with arms and legs.

If your child is challenged with motor activities such as those on this checklist, give us a call to discuss an assessment time.

Issues impacting on school readiness

• seems clumsy or poorly coordinated
• frequently trips, or drops things
• prints or writes poorly, and with much effort
• has trouble with daily activities such as
  • handling utensils
  • catching a ball
  • cutting with scissors
  • tying shoelaces

• avoids participation in physical or motor based activities

If you have noticed any of these issues, have a look at our article on DCD on this website and call us on 1800  985 996 regarding a physiotherapy assessment and advice.

You can print out this checklist for your reference.

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Working in a family/person centred organisation for nearly a decade, means Audrey believes that physiotherapy should be another tool for the child to get the most out of life, not to be centred around!

She loves innovative and child focussed exercises that are individually tailored to meet the child’s needs and interests. In the past, this has led to physio sessions in school, gyms, and shopping centres as children and families strive to meet their goals.

She has extensive experience in Cerebral Palsy and Spina Bifida in children from newly diagnosed to young adults. The needs of a child with either condition change as they go through the different stages of growth and development and it is important that their physiotherapy program and their equipment reflects this. She is also experienced in seating and wheelchair prescription for those with complex needs.

Audrey also has personal experience with disability, as her brother has cerebral palsy. He is part of the reason why she chose the profession, and also why she is passionate about what she does.

To book in or talk with Audrey call us on 1800 985 996

The baby may commonly have an unusual head shape due to their position in the uterus. This often resolves within about 6 weeks after birth due to the thin and flexible nature of a baby’s bones.Many children with positional plagiocephaly do not require any treatment as it naturally resolves in the 6 week time period as they grow. If treatment is necessary it is important to see a specialist ( a plastic surgeon) between 4-6 months of age, as well as an orthotist and paediatric physiotherapist.

The soft and flexible nature of a baby’s head  can also cause flattening of the head once a baby is born if they lie with their head in the same position for a long time. If you follow the SIDS guidelines of sleeping your baby on their back, it is also recommended that you also alternate the position of their head. So you could put them down on their back with their face looking straight up, and also alternate turning the head to the right side and the left side.

Some babies can only turn their head to one side because of a muscle condition called Torticollis. When their head is stuck only turning to one side, they commonly develop  positional plagiocephaly and this is an indicator of needing physiotherapy to treat them for a Torticollis. The care of a paediatric physiotherapist has been shown to provide appropriate treatment and effective outcomes for torticollis. Please look at the other article on our website for further detailed information on your baby’s head being turned only to one side.

Our paediatric physiotherapists can assist you with advice and positioning techniques for the plagiocephaly to help relieve the pressure on the head which is causing flattening, and more detailed and specific treatment if your baby has a Torticollis, as positioning alone does not resolve this problem, nor massage or “manipulation”  of the spine.

Kinder is a busy time for your child as they are gathering skills to be ready for prep. Is your child physically ready for school?

Can your child…

*Climb playground equipment, ladders and trees with agility?

*Turn round obstacles and corners while walking or running without stumbling or tripping?

*Walk forwards?

Walk backwards?

Walk sideways ?

*Carry objects with confidence?

*Walk alone up and down stairs with one foot per step?

*Sit with knees crossed?

*Stand on one foot for 10-30 seconds and hop on their preferred foot?

*Throw and catch balls of different sizes both over arm and underarm?

*Kick a ball?

Our paediatric physiotherapists can assess and assist your child in gaining age appropriate gross movement skills, and the strength and posture to achieve this so that they are ready for school. If you have any concerns regarding their physical skill development, please contact your local paediatric physiotherapy service on 98777304

At Blackburn North Physiotherapy Centre we have increased our staff to 2 paediatric physiotherapists that are available, so you can be sure you can contact someone about your child every weekday.

Our Paediatric Physiotherapist are well trained to diagnose, treat, and manage children with special needs.

If you have any physiotherapy questions regarding your baby, toddler, or school aged child, you can contact us and we’ll be glad to help you out.

Just as for adults, children are subject to a wide variety of conditions which require surgical intervention.

Also, there are a number of conditions specific to children which require specialised surgical intervention and physiotherapy.

Here are some examples:

Greenstick Fracture Repair

Cerebral Palsy

• Botulim Toxin A (Botox) injections into muscles with hypertonicity
• Single Event Multi-Level Surgery (SEMLS) invovles multiple procedures performed in one surgical event
• Muscle Lengthening
• Osteotomies
• Muscle transfers

Perthes Disease

Spina Bifida

Physiotherapy can assist in:

• Regaining mobility
• Regaining strength and flexibility
• Regaining balance and co-ordination
• Regaining cardio-vascular fitness
• Maximising the benefits of orthopaedic corrective/reparative  surgery
• The safe and graduated return to an active lifestyle
• Prevention of re-injury
• Return to sport

In fact, in the majority of orthopaedic cases, physiotherapy is a fundamental component of post operative management.

Additionally, physiotherapy can assist children who have repeated and/or lengthy hospital stays to get back on their feet and into the playground.

Post Intervention Physiotherapy (PIP) Funding is available in some cases, and Medicare funding (under the Enhanced Primary Care Plan) is available to all with a chronic condition.

Children will reap more benefits from their rehabilitation if their program is relevant, functional and enjoyable. Choosing the right physiotherapist, especially one with paediatric experience, will make a difference. Not only in the outcome, but also in the journey.

For further information, contact us.

There is a great variety in the times when babies start to “achieve” what we label as motor milestones. This just means that there are certain gross motor activities that everyone learns to do to get their bodies moving. As parents we all want to know if our precious child is OK and doing well at what they need to do, when they need to do it. Remember that individuals vary; some babies will do things earlier than others, some will take longer. If it seems to be a fair time delay, just call us or call and check with a health professional who specialises working with children, because friends, family and others tell you lots of different things. So here is a general guideline of what to expect from your baby in gross motor skills as they learn and develop…when they begin to be “on the move”:

Rolling

4 to 6 months

Creeping

(Pulling themselves along the ground)

6 to 8 months

Sitting

Sits with support around 6 months

Sits alone on floor for 10-15 minutes by around 9 months

Crawling

8 to 10 months

Pulling to stand

10 to 12 months

Babies pull themselves into a kneeling position to play to start, then pull to stand via the kneeling and half kneeling (one foot forward) position.

Cruising

( Walking sideways along the furniture and other objects)

10 to 12 months

Walking

12 to 15 months

These are the major steps a child takes as they learn to move. It’s also important to realise that a baby needs to be able to independently move between positions. If they can only sit when you place them there, or they scream for you to come and save them to get back down on the ground, there may be a reason why they are so frustrated.

If you have any concerns, please contact us with any queries, or alternatively if you are more comfortable, visit your maternal health nurse, GP or paediatrician.

Note: There is a print link embedded within this post, please visit this post to print it.

Knowing whether your child is achieving milestones when they are expected can give an early indication of any developmental difficulties and the need for proper assessment and an early diagnosis if there is one.

These early years (0-5 years old) are exceptional years for a child, as they have a remarkable ability to learn and adapt. Developmental difficulties picked up during this time respond better to therapy than later in life. The younger the better!

Here is a list of SOME of the developmental milestones from birth to pre-school.

Babies.

Your child’s first year is a very busy one, as they learn to interact with their surroundings, and reach milestones in leaps and bounds.

My baby is 4 weeks old, what can I expect?

• Many reflexes are still present, such as ‘walking’ when the soles of their feet touch the ground and the grasp reflex when a finger/pen is placed in their palm.
• Spontaneous movement is large and jerky. Both left and right sides are used equally.
• Minimal head/neck control when pulled into sitting from lying,
• Able to look at objects and focus on them for short periods of time,
• Startles with sudden noises
• Sleeps most of the time when not being fed or playing.

My baby is 4 months old, what can I expect?

• Able to bring both arms together in front of chest/face.
• Waves arms symmetrically.
• Kicks vigorously with both legs alternating or together.
• Able to hold head up when pulled into sitting from lying, and can lift head and upper chest up when lying on tummy.
• Moves head deliberately and attentively to gaze around.
• Beginning to react to family situations, such as feeding times.

My baby is 6 months old, what can I expect?

• When lying, will lift one, or both feet and grasp it with hands.
• When hands are grasped, will pull up into sitting.
• Can roll from front to back and sometimes back to front.
• When held in standing, bears weight through feet and bounces up and down actively.
• Uses whole hand to grasp and passes object from one hand to another.
• Can visually follow an adult moving across a room.
• Laughs, chuckles and squeals aloud in play.

My baby is 9 months old, what can I expect?

• Sits alone for about 10 minutes on the floor.
• Attempts to crawl.
• Pulls up into standing.
• Reaches and grasps objects in hands, able to turn them about and pass from hand to hand.
• Beginning to point at objects.
• Looks for fallen toys in the correct direction.
• Babbles tunefully, and understands ‘no’ and ‘bye-bye’.
• Plays Peek-a-boo and imitates clapping.

My baby just turned 1! What can I expect?

• Can raise from lying to a standing position.
• Can walk around a chair/coffee table while holding on.
• May stand alone/walk alone.
• May crawl up stairs.
• Beginning to show an interest in pictures.
• Picks up objects with thumb and index finger.
• Turns to own name (if they feel like it!).
• Tries to help with dressing and feeding.
• Likes to ‘share’ and will offer toys when requested or spontaneously.

Toddlers.

This stage in life is often regarded as the most mobile with the least ‘sense’!

At 18 months:

• Kneels without help.
• Runs carefully.
• Can carry an object, like a large teddy-bear while walking.
• Imitates writing/drawing.
• May begin to show preference with one hand.
• Speak 6 – 20+ recognisable words.
• Understands and obeys simple instructions.
• Holds and drinks from cup.

At 2 years:

• Runs safely, being able to stop and start and run around objects.
• Can climb up onto furniture and can climb down.
• Can turn individual pages of a book.
• Puts 2 or more words together to form simple sentences.
• Spoon feeds self without spilling too much.
• Defends own possessions toys with determination.

At 3 years:

• Climbs up and down stairs with alternating feet, usually can jump from the bottom step.
• Rides a tricycle and can steer around wide corners.
• Throw and catch a large ball.
• Can negotiate playground equipment well.
• Can thread large beads (or pasta tubes) onto a string.
• Asks many questions, and carries a simple conversation.
• Enjoys vivid make-believe play.

Pre-school and beyond.

Over the next couple of years, your child may learn to:

• Climb ladders and trees.
• Dances rhythmically.
• Hops.
• Draws recognisable objects (house, person, etc.).
• Shows sense of humour in conversation and activities.
• Enjoys reciting or singing songs and rhymes.
• Undresses and dresses self independently.

When should I be concerned?

The milestones listed are only a few in the long list on the path to your child’s growth and development. There is a large range of normal variation!

However, here are a few things to look out for to help you ask the right questions:

• Significant asymmetry or a right/left preference in the first 18months. For example,this could be only reaching for toys with one hand or keeping their head turned to one side.
• Not tolerating tummy time by 3-4 months of age.
• Avoids weight bearing through legs (feet) or arms (hands) from 6-8 months onwards. (Dislikes the crawl position or being held in standing with feet on the floor.)
• A significant, unexplained delay in reaching milestones.
• And quality of movement. What does it look like? From about 3 months onwards, movement is relatively smooth and fluid. If your baby’s movements are small and jerky or they lack large spontaneous movements, it’s time to ask more questions.

This is a guideline only, and there are many other factors which may influence the achievement of milestones, and when they occur. If you have any concerns, talk to your doctor/paediatrician or Maternal and Child Health Nurse, or book an appointment with one of our paediatric physiotherapists for an assessment.