Archives for posts with tag: development

Jan 09 022

Educators often hear from therapists, “When in doubt, crawl, crawl, crawl!” It seems from the onset, crawling is an amazing develop-mental activity that translates into all kinds of academic success.

The importance of a long crawling and creeping period in development is often overlooked by Pediatricians and parents. Many just don’t know the vital importance of this developmental milestone and impact later on in life.

As Occupational Therapists, we see children daily that have poor reading skills, difficulty tracking visually left to right, poor hand dominance or crossing of midline, decreased trunk strength (may look fidgety or ADHD), poor handwriting, immature grasp patterns and difficulty with fine motor skills all due to short or missed belly time!

Infants should spend as much time as possible on their bellies from the time they can turn their head at a few weeks when playing. Babies should not spend their “floor time” in supported sitting, car seats, entertainers, walkers, or johnny jumpers! Floor time should be a priority every day, getting down in the floor on belly learning to control their bodies, gain core strength, learn what their hands can do while their vision is engaged, and making millions of neural connections for later skills. Getting on their bellies sooner will prevent a myriad of developmental and learning delays later in development!

If an infant does not like belly time or is not crawling by 7 months or creeping by 9 months, then there could be issues that need to be evaluated by a pediatric PT and OT. Some children who have food sensitivities to cow’s milk and heavy sinus pressure avoid this position due to the pressure on their ear canals. A child with touch sensory defensiveness will avoid being on belly and hands, a sure sign that pediatric sensory based OT is needed asap! Infants with clinically low muscle tone will need therapy to help get them in this position and help this important stage develop. All red flags need a pediatric OT or PT eval, this is not something to wait and see about.

Please don’t “wait and see”…the time is NOW for therapy evaluation if a child is 9 months and is not crawling and beginning to creep, or avoids belly time all together. Most infants start creeping within a few therapy sessions!

Crawling is when you are on your belly “like an army man or snake”.
Creeping is when you are on your hands and knees like a “cat creeping up on a mouse”

Doing this activity even through older ages helps in all areas of development:
• Calms by activating heavy work receptors in the muscles and joints
• Continues to calm by building muscles that help breathing
• Helps children sit in chairs by building back and stomach muscles
• Coordinates two body sides so hand specialization is more likely to occur
• Improves handwriting by developing shoulder, arm, and wrist stability
• Helps develop fine-motor coordination as it builds the arches of the hand
• Decreases touch sensitivities by deep input and rubbing the floor
• Integrates many of the primitive reflexes, integration of these reflexes is vital to gaining higher motor skills
• Strengthens trunk, shoulder and arm strength which is needed to sit and attend
• Sets up the communication in the brain across the midline of the brain which is needed for reading skills to occur
• Increases muscle tone, muscle strength, and coordination throughout the body

The benefits of a good long crawling and creeping stage are too many to just “wait and see” about. An early walker is not always a sign of good development. Many of the children we see later in 1st-4th grade with reading, writing, and handwriting issues were early walkers. Please don’t hesitate to get an evaluation and necessary treatment for your precious one!
Center of Development Pediatric Therapies Cookeville TN
http://www.developmentaldelay.net 931-372-2567 Heidi@covd.biz

 

Pouty FaceCall 931-372-2567             FAX Orders 931-372-2572

Early Intervention is the key to better outcomes!

The earlier we can evaluate and intervene for children 3 and under, the more improved functioning we can see by Kindergarten.  Medically necessary therapies are very different than educational therapies through TEIS or school systems.  Most children need both to make huge gains in development!  Families rely solely on their pediatrician’s referral for medically based therapies.  Using the Bayley Scales of Infant Development and other standardized assessments, we can evaluate to see if a child is greater than 25% delayed and may need therapy.  The sooner we can evaluate, the sooner the family will know if therapy is going to benefit their child. 

Here are some “red flags” to know when to refer for medically based pediatric therapies.

Gross Motor

If a child is…

  Not rolling by 6 months of age

  Not pushing up on straight arms, lifting his head and shoulders, by 7 months of age

  Not sitting independently by 7 months of age

  Not crawling (”commando” crawling–moving across the floor on his belly) by 9-10 months of age

  Not creeping (on all fours, what is typically called “crawling”) by 11 months of age  or any abnormal creeping patterns like bottom shuffling or scooting.

  Not sitting upright in a child-sized chair by 9 months of age

  Not pulling to stand by 10 months of age

  Not standing alone by 12 months of age

  Not walking by 14 months of age

  Not jumping by 28 months of age

  Not independent on stairs (up and down) by 30 months of age

  “walking” their hands up their bodies to achieve a standing position

  only walking on their toes, not the soles of their feet

  frequently falling/tripping, for no apparent reason

  still “toeing in” at two years of age

  unusual creeping patterns

  any known medical diagnosis can be considered a “red flag”: Down’s syndrome, cerebral palsy, congenital heart condition, frequent ear infections, sensory avoiders, low muscle tone or high tone, etc. 

Fine Motor

 
If a child is…

  Frequently in a fisted position with both hands after 6 months of age

  Not bringing both hands to midline (center of body) by 10 months of age

  Not banging objects together by 10 months of age

  Not clapping their hands by 12 months of age

  Not deliberately and immediately releasing objects by 12 months of age

  Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age

  Still using a fisted grasp to hold a crayon at 18 months of age

  Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age

  Not imitating a drawing of a vertical line by 24 months of age

  Not able to snip with scissors by 30 months

  Using only one hand to complete tasks

  Not being able to move/open one hand/arm

  Drooling during small tasks that require intense concentration

  Displaying uncoordinated or jerky movements when doing activities

  Crayon strokes are either too heavy or too light to see

  Any know medical diagnosis can be considered a “red flag”: Down’s Syndrome, cerebral palsy, low or high tone, other developmental delays.   

 

Cognition/Problem Solving

 
If a child is…

  Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)

  Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)

  Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth)

  Not able to match two sets of objects by color by 31 months of age

  Having difficulty problem solving during activities in comparison to his/her peers

  Unaware of changes in his/her environment and routine

 

Sensory

 
If a child is…

  Very busy, always on the go, and has a very short attention to task

  Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)

  A picky eater

  Not aware of when they get hurt (no crying, startle, or reaction to injury)

  Afraid of swinging/movement activities; does not like to be picked up or be upside down

  Showing difficulty learning new activities (motor planning)

  Having a hard time calming themselves down appropriately

  Appearing to be constantly moving around, even while sitting

  Showing poor or no eye contact

  Frequently jumping and/or purposely falling to the floor/crashing into things

  Seeking opportunities to fall without regard to his/her safety or that of others

  Constantly touching everything they see, including other children

  Hypotonic (floppy muscles, weak grasp, poor trunk tone, usually poor motor coordination)

  Having a difficult time with transitions between activity or location

  Overly upset with change in routine

  Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.

  Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.

Sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Possible visual problems may exist if the child…

 Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes.  Any eye turns in or out separate from another. 

  Does not reach for an object close by

 Avoids doing near work,  poor at puzzles, and avoids eye contact

Self-Care

If a child is…

  Having difficulty biting or chewing food during mealtime

  Needing a prolonged period of time to chew and/or swallow

  Coughing/choking during or after eating on a regular basis

  Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)

  Having significant difficulty transitioning between different food stages

  Not feeding him/herself finger foods by 14 months of age

  Not attempting to use a spoon by 15 months of age

  Not picking up and drinking from a regular open cup by 15 months of age

  Not able to pull off hat, socks or mittens on request by 15 months of age

  Not attempting to wash own hands or face by 19 months

  Not assisting with dressing tasks (excluding clothes fasteners) by 22 months

  Not able to deliberately undo large buttons, snaps and shoelaces by 34 months

Social/Emotional/Play Skills

If a child is…

  Not smiling by 4 months

  Not making eye contact during activities and interacting with peers and/or adults

  Not performing for social attention by 12 months “in their own world”

  Not imitating actions and movements by the age of 24 months

  Not engaging in pretend play by the age of 24 months

  Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)

  Fixating on objects that spin or turn (i.e. See ‘n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun

  Having significant difficulty attending to tasks

  Getting overly upset with change or transitions from activity to activity

Water play fun!

Water play fun!

 

Communication:

·        Difficulty making and maintaining eye contact with an adult by 6 months

·        No big smiles or other warm, joyful expressions during interaction with another person by 6 months

·        No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months

·        No babbling by 12 months

·        No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

·        No consistent responding to their names by 12 months

·        No words by 16 months

·        No following simple and familiar directions by 18 months

·        No two-word meaningful phrases without imitating or repeating & says at least 50 words by 24 months 

·        No back-and-forth conversational turn-taking by 30 months

·        Any loss of speech or babbling or social skills (like eye contact) at any age

 

Most babies who are doing well with development exceed these milestones by leaps and bounds.  These are very, very low thresholds for all the skills listed.  If your child or patient is not meeting these basic guidelines, please don’t dismiss your feelings.   Seek professional help from your pediatrician and ask for a medical based therapy evaluation. The earlier we can evaluate, the earlier we can see improved development!