My sister- sweet, pure, innocent, altruistic, kind, patient, funny, compassionate, empathetic and friendly was also mildly developmentally, non ambulatory and totally dependent for all activities of daily living.

As a young child, I remember teaching her addition using pretzels and licorice sticks at our kitchen table.

Then as a teen, she always went out with me and my friends.

If I went for ice cream, to the park, movies or bowling, she always came along. I endured walking at half the speed, taking frequent trips to the bathroom with her, and of course, all the stares…..and I wouldn’t have had it any other way!!

I automatically assumed the role of the caretaker.

As a youngster myself, I had to mature quicker than the average teen.

I looked at the world through a different lens. Where others saw despair, I felt inspired. While others were impatient, I learned perseverance.

Where others didn’t see a typical person, I only saw potential for growth.

I understand that bringing up a child with special needs can be challenging, and often frustrating.

But, as the sibling of an adult with special needs, and as her caretaker for the past 20 years, I also learned how to be a passionate advocate for those whom I love, I became inspired to become that person who can change the trajectory of a child’s life, and I realized that I’m a better person today because of the way that my sister was born.

I work each day to help others get past the cacophony of daily challenges and to make lemonade out of lemons.

She was perfectly imperfect!

It’s National Physical Therapy Month here in the US, if you have ANY questions, call us, we’re here for you!!

If you’re already active on this website, you’re looking for answers to a quandary that you’re having with positioning, mobility or function.

As a physiotherapist, I know that proper positioning and posture can improve function or, discourage movement.

If your child had a complicated birth, has been diagnosed with a condition that may be associated with developmental delays or if your child was born early they may be at risk.

Early intervention can provide parents with information about their child that can help maximize their child’s ability to learn through play, regardless of their starting point and negligent of their upper limits.

Purposeful play is essential during the first three years of life.

From the moment a child enters this world there is so much to learn. As a new born, they learn to use their eyes to look around, and they look, eat, and sleep.

Then, they learn how to grasp with their hands and incorporate their mouths to explore the toys that’s in their hands.

As they hear sounds from those around them, there is cooing, gurgling, squealing and eventually, early imitation of consonant sounds.

Then, as their legs begin to push and pull, the ultimate culmination of head, neck, trunk, shoulder and hip control is crawling or creeping.

All that I have described occur usually within the first several months of life.

If there is an interruption or a delay in this sequence due to illness or injury, then early intervention may be merited.

If you’re at all concerned about movement, hearing, vision or communication, don’t wait.

There are so many things that can be done along the way to support your child’s development. There are some very low tech, DIY (Do It Yourself) solutions and some very high tech devices.

October is National Physical Therapy month. I urge you to reach out to a professional, we’re here for you!!

Art is a fun activity that can foster bonding between friends, siblings, parents and children.

More importantly; it’s just another opportunity to have fun and create memories!

As a pediatric physiotherapist, we try to create sessions that are full of fun, filled with age appropriate activities, which also serve a therapeutic purpose.

There are many ways to help a child actively participate in creating their own little piece of art.

If a child can sit independently or if they’re able to move their hands away from their body while in an adaptive seat, there are several ways they can create a master piece.

One way to set up this activity is to get a giant piece of paper and lay it on the table, or post it on the wall.

Draw a line down the middle, and model what the action is. Strokes can be long, straight, diagonal, or just scribbled.

Of course, the most common way to draw is with chalk, markers, crayons (which now can come in different shapes) or paint, and paper.

A child can finger paint or hold a paintbrush, a bingo marker, a sponge, newspaper scrunched up, or material scrunched up and even taped to the child’s hand if they cannot volitionally grasp the material.

Throughout this activity some things to note are whether the child can maintain contact with the paper.

Some additional benefits include: hand eye coordination, grasp, upper extremity strengthening, range of motion, standing, sitting, weight shifting and even communication.

A fun suggestion: turn on different types of music, and ask your child to color according to what they hear. The strokes may be slow, rhythmic, long strokes or short, sporadic, choppy strokes.

This is always a fun and exciting activity.

During warm weather, you can also use finger paints on a sheet of plexi glass outside, and then spray it off with a hose.

You can paint the bottom of the child’s feet and have them stomp on the floor, paper or grass.

If the child is non ambulatory, a parent can hold a trifold up and have them press against it with their feet.

I even had a little guy roll across a roll of paper with washable paint and he created a beautiful masterpiece!

Art is fun, but can also benefit motor, visuospatial and communication skills. So, seek out washable paint, a variety of shapes and sizes for the crayons, markers or brushes, and try a variety of positions. It changes the whole experience.

This information will be relevant to every teacher, therapist or caretaker that you and your child will meet.

You know your child best, so share this information with every professional that will spend time with your child in order to maximize the fun and learning opportunities while they’re together.

As a physiotherapist, it’s integral for me to identify which learning style will motivate your child to explore their environment and participate in their education.

Most learning styles will fall into one of these categories: kinesthetic (learn by movement), auditory (listening), or visual (observing).

Under no circumstance would I say that any child fits into any one category, but there are certain principals that apply to all kids:

Active learning is best. Your child should actively be vocalizing, singing, moving their body (head, hands or legs), pointing (reaching or gazing) to show that they are enthused by an activity.

Remember, learning for your child is more than learning. Learning can teach your child their ABC’s and colors, but eventually lead to practical life skills.

Children are generally more available to participate when they know the plan and the expected outcome for any activity.

It will benefit your child most if you can identify the best way to reinforce positive behaviors, and ignore those that are not desired. Behaviors that are celebrated will be reinforced and those that don’t elicit positive reinforcement will hopefully fade over time.

Some terms that you can use are: ‘When you’re all done please show me or tell me by _____’, or ‘One more then we’re all done’ or ‘First we’ll do ____ , then ____’ or ‘I know this is hard, but I know you can do this’, or ‘If you want this ____(show me, tell me)’…

Pegs, puzzles or large coins in a piggy bank can function as a precursor to hold a fork, pen, or musical instrument. These types of activities can also benefit other fine motor activities such as self-care (feeding and dressing), hand eye coordination, and if needed, augmentative communication devices.

Sorting and matching can be used to teach counting, colors, quantity, and concepts such as in/out/on/off/up/down. As the child becomes more active, this skill can contribute to a child’s ability to participate in management and sorting their own belongings in their room, or maybe one day in the future, a job.

I celebrate all active movement. It doesn’t have to look perfect or coordinated.

Active movement of any sort-rolling, creeping, crawling, walking, running, dancing, moving in a walker, riding a bike or swimming.

Think of the independence and sense of accomplishment one feels when one can explore their environment and discover something, feel something or share a thought about something. In addition, active movements contributes to bowel and bladder function, bone health, skin integrity, vision, body proprioception and awareness, strength, socializing, and IT’S FUN!

Find a way to make movement possible for your child to let them learn (on land or water). Sensory bottles and sensory mats are a great motivators for the younger ones.

You’re the best teacher your child will ever have. You are also the best person to identify your child’s best style of learning because you know them best.

We all learn to know, we all learn to do. Your child’s learning will increase their personality traits, their knowledge, their thoughts, their independence, their fun.

Their learning will contribute to who they will be.

Young children and little ones who are not verbal may not be able to express their wants and needs.

So, as a physiotherapist who has seen many children, I wanted to share some observations I’ve had through my 25 years of practicing and tell you some things to consider when positioning your child.

When you wrap your baby in a swaddle or a onesie, in a stander, position a child in a wheelchair or a stander, where they may spend an extended period of time, our priorities are comfort and function.

However, other priorities should be to prevent skin redness, maintain good postural alignment and of course ensure that the child feels safe and secure.

Your child may or may not be able to tell you exactly what’s uncomfortable, and instead may be giving you cues that are both obvious and indiscernible.

Signs that your child may need to be adjusted include that your child may cry, arch their bodies or appear to be uncooperative, demonstrate decreased eye contact, rock or bang their bodies, or become combative.

Pediatric physiotherapists pay special attention to positioning in and on devices because the right position will support maximum functional abilities for the child, and decrease future musculoskeletal deformities.

Proper positioning is essential for: comfort, to facilitate active movement, maximize body proprioception, help with self-regulation and exploration, head support, good postural alignment, and prevention for skin breakdown and other musculoskeletal deformities.

I’m hoping to touch upon what your child may feel or think but may not be able to eloquate and articulate.

Your child may be thinking…

I feel like I’m falling through space because my swaddle is not tight enough.

I’m so tired of lying on my back.

I’d like to reach that toy however I can’t roll all the way from my back, I wish I was on my side.

I can’t lift my head off the floor because it’s so heavy; I wish I was propped up off the ground a little, like on a towel roll to help me lift it up. (Please refer to your physiotherapist for instruction)

My reclined seat is positioned too vertically; it’s actually more difficult for me to keep my head up this way.

I’m keep slouching down in my highchair/wheelchair/seat. It’s much more difficult to lift my arms and hands when that happens.

My back is hurting because I slid down in my seat; I wish someone would slide me back into place.

I’d like to see what it feels like to go faster when I move.

Please let me know where we’re going and that you’re going to move me before you’re going to move me.

As a pediatric physical therapist I saw this phenomenon evolving, but only recently has it been given a formal label,” Container Syndrome”.

Parents often place their children in swings, infant seats, rockers, bouncy seat, strollers, and jumpers (an anathema for any PT).

Sometimes, it’s to protect the child from older children or pets.

At times, it’s to give parents an opportunity to be hands free from the baby and to tend to other children, take care of household duties or even self-care.

Retail companies have sold these products that play music, flash lights, vibrate, glide and rock the baby, under the pretence that babies are entertained, happy and stimulated.

However, unbeknownst to many parents, there is also such a thing as overuse of these devices and it is actually detrimental to a child’s development to be placed in one device after another, hence the term ‘Container Syndrome”.

Babies that are placed in these ‘containers’, in lieu of being put on the floor to play or held, may develop flat head syndrome, torticollis, plagiocephaly, developmental delay, have poor head control and even worse.

There is a baby rocker product that was recalled in the US because of several infant deaths.

Although the rate of SIDS has decreased by 50% as a result of the ‘Back to Sleep’ campaign, the incidence of Container Syndrome has been identified in 1 out of 7 babies (Move Forward PT, APTA). All of the above mentioned products have been marketed by retail companies, some with adequate safety testing.

Yet, any pediatric specialist will tell you that floor play and tummy time allows opportunities for active learning to occur, it allows your children to explore their environment, experiment with a variety of movement patterns, develop head control, and gain muscle strength.

Prevent container syndrome by

Limit the amount of time your child is in their carseat, swing, bouncer, rocker

Increase the amount of time that they are upright (being held, in a stander, or the upsee)

If you do have to protect your child from older children or pets, let them play in a play pen or Playpak (with adult supervision) and keep changing their position.

Put your child on the floor and place toys around them that will encourage them to look, reach, kick or roll in different directions. This is will benefit them in the long run.

 

Here’s a secret- As an early intervention pediatric physical therapist, when I use a book while I ‘play’ with your baby, I can also assess their fine motor skills, cognition, play skills, expressive and receptive language, and vision.

By the time a child enters kindergarten, they should have read 1000 books.  WHAT?!?

Imagine, if you read one book a day with your child, for 365 days a year, by the time they’re three years old, that’s 1095 books.  I’m sure that there are even days that you read many more than a single book with your child.

A book is a great multisensory toy as it’s essential for learning, at any age, especially in this age of technology. This article will outline the growth and development of a child respective of a book.

Early on in development, a book serves as an oromotor stimulant that a baby can explore.

Handling a book may begin as a single-handed activity, and expand to using both hands at the midline.  Some books have sensory and auditory stimuli that maintain their attention.

Pictures are colourful and can be used to facilitate eye gaze and head control.

Then as the child realizes that there’s something inside this square or rectangular object they begin to use it as a hinge.

Your child will begin to open and close it numerous times, manipulate the book and gaze inside.

As their intellectual curiosity increases, they begin to seek more information from this object and it’s not only a hinge, it’s a hinged toy with content and context.

This next phase is a significant one.  What do those pictures mean to your child?

It’s important to see whether your child gazes at both sides of the page, or do they randomly turn pages.

Your child will develop an association between familiar items and people with sounds or real objects.

They may tap the picture, gaze in your direction; this is referred to as conjoint attention.

At this time, you can begin to label the object, and they may attempt to approximate consonant sounds or words.

They eventually read to themselves with jargon and inflections that mirror your own.  They will increase their repertoire by seeking out different books with a variety of context.

Slowly, their attention span and curiosity will increase.  I’m not specifying the length for each of these phases because this differs for every child.

In the perfect world: your child will love books, love the time you spend together and they will be available to learn.

In short, when I read a book with your child I’m checking the muscle strength of their arms and fingers and their fine motor ability to manipulate this object.

I’ll observe whether they’re eating, banging, opening and closing or just throwing the book.

I’ll listen to the sounds they make or word approximations that they use while they look at a book; lastly, and most importantly, I’ll see what this object with pictures means to your child, and take it from there.

This is the first opportunity we have as parents, and as educators, to signal to them that there is a time to move and play; however, there is also a time to stop, look and listen during play and this is an important message for every child.

Aside from spending quality time with your child, reading will prove to be the foundation for later literacy, cognitive and language skills.

READ ON!

This is Sharon, the pediatric physical therapist.

When I treat a baby, I look at the child and think of how their condition may impact their function over their lifespan.

I often take this into consideration when I develop the plan.

While most parents who have children with special needs gain their information from their specialists or may speak with other parents, I have had the privilege of treating hundreds of children with a variety of needs; and I’ve witnessed many benefits and common limitations that can occur over time.

There are some skills that have a great impact on your child’s function.

Head control is number one!!

Head stability is essential for a child to gaze in all directions, for their heads to move on their body, and to ultimately help a child learn about, and participate in, the environment in which they live.

So, how do we work on head control?

TUMMY TIME!! I can’t emphasize enough that any muscles working against gravity will get a better work out.

The benefits of tummy also include scapular stabilization, body proprioception (knowing where your body is in space), and a safe place for your child to explore their environment, and practice rolling or floor mobility.

The first skill associated with head control is for a child to be able to lift and turn their head side to side.

This is not only functional but necessary for safety and clearing their airway to breathe.

Next, good head control is always recommended before a child begins to eat in order to help with the suck, swallow, and breathing coordination.

Although there are high chairs that can recline, have you ever eaten in a reclined position?

Physiologically, it just doesn’t work.

Aside from that, eating then becomes more of a passive, than an active action of food sliding down the chute.

Next, start working on movement higher up against gravity. Stack pillows, use your thigh, build, buy or create a plinth that lifts your child’s trunk off of the floor; this will help them unload part of their body weight off of their arms so they only have to work on lifting their (2-3 kilo) heads up to see what’s going on.

You can use a Swiss ball or a scooter during play.  If you are handy, you can also install a harness swing or a platform swing and let them fly like Superman.

If your child is older, proper trunk support is key.

Think of the edifice of a building. A good infrastructure serves as the foundation for the higher floors.

If you are working on head control in upright positions, an erect trunk and a neutral pelvis are ideal but don’t wait for perfect alignment.

If your child is supported down low, things will work better up high. Good trunk support will give your child an opportunity to move their hands away from their body in order to reach, play, feed or explore.

It will also make the scenario the easiest for them to move their head around, visually explore their environment and possibly move within it.

That’s the goal!!

Whether trunk stabilization is achieved by stabilizing the child’s trunk with your hands, legs, an adaptive seat, a stander or a walker: find it, use it, give your child the opportunity to visually scan their environment, to see what’s around them and follow their lead.

Let THEM be active in showing you how and where they’d like to go!

Dr. Sharon Galitzer, PT, DScPT, MS, CIMI