There are a few good reasons why babies may hate tummy time. The most common one I see is when they have a torticollis, and their head turns or tilts only to one side. This makes it too hard to hold up their head for tummy time and needs physiotherapy treatment. It only takes about 4 visits if you do your homework and has fabulous outcomes, so if this is  looking like the reason your baby objects to being on their tummy, read the article on this site and book them in for an assessment quickly, early intervention makes a big difference to outcomes. Studies have shown that conservative physiotherapy for this common condition is the most effective approach.

Some other babies find tummy time a challenge because they are a bit floppy. It’s difficult to assess this muscle tone if you are not experienced, so if the distress continues and tummy time doesn’t increase with the techniques you are trying, it may be helpful to come in for some suggestions on ways to individually improve your baby’s tummy time. I have lots of tricks up my sleeve to assist this after many years working in paediatrics and having had a child with reflux! If it’s not just practice needed, or changing the time in babies routine if reflux is impacting on their comfort, and things don’t improve, seek professional advice as development is impacted and can delay motor milestones like independent sitting, rolling and crawling if the muscle strength has not been gained by tummy time. If it’s no real cause, you’ve just had the chance to get some helpful tips on promoting age appropriate movement and motor milestones personally tailored for  your child.

Early intervention, like in all things is of great importance in the treatment of idiopathic toe walking, helping prevent dramatic muscle tightening and so on. Nevertheless, many people wait and see if their child will grow out of this habit. Some children just toe walk periodically (often after a growth spurt). These children manage and run around and play and function well. It’s not until later we sometimes see children that have this history in late primary school or teens finding that toe walking is interfering with their sport, they mightn’t be able to run as fast or get the power they need in their legs.

We have seen some great improvements of late in an additional treatment option we have tried to assist these idiopathic toe walkers. We have been custom making night splints as an adjunct to out traditional physiotherapy treament that stretches muscles, deals with joint stiffness and strenghthens to correct posture. If you have any queries or would like to discuss possible treatment options, please call and discuss this with one of our paediatric physiotherapists.

In summary, the position a baby rests in the sling causes them to turn in their hips and  step on their toes rather than flat feet. As a consequence babies often develop muscle tightness in their groin and calf muscles. They also do not develop appropriate strength in the thigh and gluteal (bottom) musles that they need to stand up and walk in an erect posture. Over the years I have seen and had to treat many children who have an inappropriate gait (walking) pattern due to the time they have spent in walkers and jolly jumpers. Once they finally get up on their own to walk, which is often later because they haven’t had free time moving on the floor, they have trouble kneeling, pulling themselves to standing,squatting  and then walk with what we call an intoeing gait, or on tippy toes. This often causes them to knock their feet against each other and trip.

My advice then is, avoid using a baby walker ( and jolly jumper) even though babies love them and have fun, and you can get through the “witching hour” and prepare dinner. If you feel the need to continue the use of this item, restrict the length of time your baby is in it each day,say just 10 minutes. If you choose, or previously chose to use a walker, be aware of the muscle shortening and potential strength issues that your child may need help to help resolve. Physiotherapy makes a big difference here and makes the changes needed. It’s all about choice in parenting,or awareness of particular information, so don’t feel judged, we are more than happy to help your child. Have a read of the links anyway and decide for yourself.

http://www.babysafety.com.au/faq/default.aspx#A5

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Baby_furniture_safety_tips

http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=305&id=2419

http://www.consumerreports.org/cro/babies-kids/baby-toddler/play-and-activity/walkers/baby-walkers-1105/overview/

What does a new parent want to know? As we become parents we enter a whole new world of discoveries and experiences compared with those we have experienced before. The challenge can be increased in this time of information overload in our information technology age. So as parents navigate this world, I thought it appropriate to encourage them…

Today as I sat down to write this article, I had met a “first time Mum” who had felt “something wasn’t quite right” as she carried and lifted her child. She couldn’t put her finger on exactly what was worrying her. She had mentioned various “little” issues to family members and her maternal health nurse for months. Common feedback was for her (and is frequently for others) reassurance: “All babies are different; they all do their own thing in their own time” and “Don’t compare with other children”. I agree with this advice, the sentiment and reassurance is entirely valid and appropriate BUT if as a parent or grandparent your concerns keep arising, and you just have this “feeling” trust your instincts, and get it checked out. This doesn’t hurt anyone and health professionals are not going to think you are silly or anxious. It is your right to seek assistance and advice. It is far preferable to check all is well with a child’s development, however small and trivial, to make sure the best is achieved for that child. I feel passionately that it is a child’s right to have the best total care of their life. If there is an issue, big or small, early intervention is the key. For example, if they prefer to turn their head only to one side,if we treat it early the muscle doesn’t get as tight and the flattening of their head doesn’t occur. The longer we leave treatment and wait and see, the tighter the muscle neck gets and the more stressful and uncomfortable it is for the baby to have the exercises and stretches.

So, in a nutshell, trust your instincts. If nothing is wrong, no harm is done and you can be reassured that all is well. If there is an issue, we can make things better for our children. Be encouraged and believe in your parenting skills.

Support services  needed to assist families is determined by assessment of the child’s individual needs to help the child achieve their appropriate developmental skills. This approach aims to ‘intervene’ when children are young so that they can ‘catch up’ and continue on a normal developmental path and hopefully not require services once they are of school age.

The term early intervention is also used in referring to the actual treatment and therapy used to assist children. Evidence supports that carrying out early intervention provides better outcomes for individuals. Even if the treatment is not for a developmental issue, but another condition, the sooner things are treated means holistic wellness is achieved sooner and the condition doesn’t have time to get worse. For example, if a baby has torticollis and the head turns to one side because the muscle has shortened, if no intervention is made, the muscle gets tighter and the baby’s head shape starts to change and flatten, making it take longer for baby to achieve total resolution of the condition.

It makes sense then if you or any close family or friends notice something out of the ordinary, it is a great idea to just check things out for peace of mind and ensure everything is at its best for your child. There’s no need  to worry that you are over-reacting, understanding and professional advice is what we aim to provide for the best care of all children. If it’s nothing, we will tell you honestly, and if it’s an issue early intervention can get underway!

Please feel comfortable in making enquiries on 1800 985 996.

Talipes is  one of the most common congenital abnormalities of the foot. It occurs in approximately 1-2 per 1000 births. There are two types of Talipes:

Talipes Equinovarus where the foot points down  and turns in.

Talipes Calcaneovalgus where the foot points up  and out.

There are several components used in conservative treatment. Stretches, active  correction, splinting, taping and plastering. Any combination of these may be used according to the individual presentation and needs of the baby. There are also two groups or classifications- those which are ‘postural’, and those in which there are abnormalities of the bones themselves, with incorrect position of the joints and changes in soft tissue.

Most postural cases are uncomplicated and correct with conservative treatment. If the ‘deformity’  is either untreated or inadequately treated, secondary changes can occur in the bones joint surfaces as the child grows.

Another type of “funny feet’ is called Metatarsus Adductus where the front of the foot (forefoot) curves in, a bit like the shape of a banana.

This also can be treated by physiotherapy with stretches and perhaps night splints.

At Melbourne Paediatric Physiotherapy we have the experience and facilities to address all aspects of management, and can provide plastering/ splinting if necessary. Give us a call if you have any concerns that your baby’s feet look a bit squished or bent and put your mind at rest with our guidance and help.

We are more than happy to liase with medical specialist a for team care to help your baby.

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. See my more detailed article for further information  on these conditions on this website.

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. Call 1800 985 996

• 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