Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Physical Therapy’ Category

May 17, 2017

Why the Push for Tummy Time?

By: Colleen Donley, PT, DPT

Often as physical therapists, we push and push for tummy time. We work with families on how to make tummy time easier. We help parents figure out how to fit tummy time into their schedule, while hitting the recommended amount of tummy time. Lastly, we educate parents and caregivers on the reasons tummy time is essential to development.

Back in the early 1990s, The American Academy of Pediatrics advised parents to adhere to the Back to Sleep program to reduce the risk of Sudden Infant Death Syndrome (SIDS). Following this start of this suggestion, there was a significant decrease in the incidence of SIDS. However, doctors and therapists have seen a rise in developmental delays, torticollis (twisted, tight neck), and plagiocephaly (flat head syndrome) since babies were spending more time on their backs and less time on their tummies. We now recommend Back to Sleep, Tummy to Play!

Tummy time is essential to integrate primitive reflexes, develop muscle strength throughout the trunk, and begin to experiment with early movement.

Integrate Primitive Reflexes

Initially, a newborn is curled in a ball because of the “primitive flexion” present at birth. Think the “fetal position” or how the newborn was curled up in the womb. Spending time on the tummy helps break up this flexion tone by providing deep input from weight bearing. This input helps relax the muscle tone of this primitive flexion and allows the baby to spread out their limbs and begin to extend through their neck and back muscles. As the flexion muscle tone continues to relax and fade, baby will begin to move their arms and legs separate of one another.

Develop Strength

When lying on their tummy, babies have to use the muscles neck and back to hold their head up or turn their head to look at parents or toys. This is the key to developing head control early on. As the baby gets stronger during tummy time, they will push up their elbows or arms and begin to hold the chest up. This weight bearing thru the arms will help develop proximal stability to hold the shoulder blade on the back. This is necessary for the baby to begin to bear weight thru one arm at a time to crawl.

Explore with Movement

As the baby gets stronger on their tummy and those muscles begin to relax, they will begin to move their arms and legs. They will continue to experiment with his movement and learn how to roll off their tummy to their back or to move towards a toy. The movement and exploration continues as they start to push up on straight arms and reach for toys. You might see they begin to kick or push their feet. As they learn to combine this reach and kick movements, they will begin to move forward in a belly crawling motion!

Tummy time should start as soon as you come home from the hospital with baby. Start off with small bursts, such as 1-2 minutes, throughout the day. Some parents find it easy to remember to fit in tummy time by making it a part of the routine after each diaper change. Gradually work up to a 60-90 minutes spread out over several increments by the time baby is 3 months old. By the time baby is 4 months old, they should enjoy tummy time since they now have full head control and push up on their elbows to play with toys. Around this time, you might see that baby sees tummy time as play time and nor work time.

Check out some of our other resources about tummy time here:

Making it Easier

Using a Boppy Pillow

Tummy Time Tips Video

May 8, 2017

Safe Sleeping Positions

By: Colleen Donley, PT, DPT

In October 2016, the American Academy of Pediatrics released new sleep guidelines for children up to 1 year of age. Our SLP, Tracy, summarized those suggested guidelines here.

As a physical therapist, I often work with families on safe and appropriate positioning for play and sleep. Frequently, I run into positions that may be unsafe, or safe but position baby improperly. Unsafe positions often put the baby at an increased risk of harm or Sudden Infant Death Syndrome (SIDS). Other positions may be considered safe as they adhere to AAP guidelines but baby’s head or body may be placed in a position that puts them at risk for other developmental issues. Here are some of the most commonly used undesired sleep positions:

  • Tummy: We always want to remember back to sleep and tummy to play. Tummy time is appropriate for playtime and a wonderful activity for baby to develop strength and motor skills. It is always recommended that you put baby to sleep by placing them on their back. Once baby learns how to roll, they may roll in their sleep from back to tummy and tummy to back. Many experts feel that once your baby has learned to roll, it is safe for them to sleep on their tummies but they still recommend starting sleep on their backs.
  • Bumpers in the crib: Bumpers serve as the purpose to protect the baby from getting their little hands or feet stuck in between the crib rails and cushioning the head should baby roll into the crib side in their sleep. AAP recommends babies should be placed to sleep on a firm crib mattress with no soft bedding or stuffed animals. Bumpers pose a serious risk of suffocation should baby roll into them or get pinned against them in their sleep.
  • Car seat: Riding in the car can be very soothing for baby and often a trick parents use to help get a fussy baby to sleep. Sleeping in a car seat poses a similar risk to sleeping on the tummy. If the baby’s head flops down, it could get pinned against the side of the car seat and put the baby at risk for suffocation. Additionally, prolonged positioning in the car seat creates uneven pressure on baby’s head, especially if this is where they sleep and their head falls to one side. Uneven pressure and the head dropping down to one side can lead to plagiocephaly (flat head syndrome) or torticollis (tight neck muscles on one side).
  • Rock ‘n Play: The Rock ‘n Play is widely popular in the world of baby gear must-haves. The Rock ‘n Play places the baby in a semi-reclined position, which goes against the firm, flat surface recommended as a safe way to reduce the risk of SIDS. Additionally, it allows gravity to help pull baby in their most preferred position, exacerbating slight preferences to one side. This can cause or exacerbate torticollis. The soft surface of the Rock ‘n Play makes it harder for the baby to move their head out of a certain position, which allows pressure to remain in a focused spot for longer periods of time. This is often why physical therapists see plagiocephaly associated with prolonged positioning in these soft sleepers.

Remember, it is always best to ask your pediatrician questions or share concerns about sleep positions. Your pediatrician will work with you to educate you on safe sleeping and determine what is best for your baby and family.


May 8, 2017

Tummy Time Tips

At Spectrum Pediatrics, we often focus on helping parents make small changes during their daily routines to help build their child’s overall development. Many people hear that tummy time is a crucial part of a child’s motor development, but often times parents are unsure why or how to incorporate tummy time into their routine. Our occupational therapist, Ashley, and our physical therapist, Colleen, are sharing some helpful tips on how to make tummy time easier! Check out the video below to hear both Colleen and Ashley discuss various ways to make tummy time less challenging and how much tummy time your child should be getting!

Stay tuned for another video full of tips on behaviors during mealtimes!


March 21, 2017

Bike Riding 101

By Colleen Donley, PT, DPT

Here are a few tips to remember while picking out a bike:

  • Kid’s bike sizes are determined based on the wheel size, not the seat height- wheel sizes include 12, 16, 20, and 24-inches.
  • A child should be able to dismount and straddle the frame while standing flat-footed.
  • When riding, the knees should not be scrunched up under the handlebars or straight out at the lowest position. There should always be a slight bend in the knee.
  • There are different types of brakes- rear-coaster brakes and hand brakes

Before you get into the standard “big kid bike,” there are different styles to help get your child prepared. Here are some explanations of different styles to help you choose where to start and which is right for your child.

  • Pedal and push bikes let your child sit on the seat with their feet on or off the pedals while you push them along. As your child gets accustomed to the feel of movement on the seat and begins to push the pedals on their own, you can gradually fade out how much you push them along. Most of these bikes come with removable handles to convert into a toddler bike.
  • Tricycles have three wheels and serve as great starting points to help your little one develop the coordination to pedal. Moving the pedals requires moving the right and left leg in a reciprocal manner, a skill that many children actually have to learn! Kiddos steer tricycles by using the handlebars only and not by leaning their weight to one side or the other.
  • Balance bikes have no pedals. They let your child develop their sense of movement, momentum, and balance while learning how to steer without the added complexity of a pedal. Many like balance bikes as a first step as they allow the child to keep their feet on or close to the ground for extra stability while they learn to control their body on the bike.
  • Training wheels have become more of a contentious point as the popularity of balance bikes has grown. Training wheels widen the base of support in the back of the bike to eliminate the need for balance while your child masters the coordination of moving the pedals and steering. Many say that training wheels teach the child how to unbalance the bike, as the child will lean their weight against the outer support of the wheels. Then when the training wheels come off, the child has to unlearn to lean against this leverage. So for a child that has already mastered balance on a balance bike, it might be worth skipping the training wheels.

Before beginning to ride, don’t forget the helmet!! Be sure to get the right size by measuring the circumference of your child’s head one inch above the eyebrow. A properly fitting helmet should be placed on top of your child’s head and remain in place as they shake their head yes and no. Head out to an open parking lot or empty tennis court to give your kiddo lots of open space to explore and experiment with speed and steering. Have fun!


January 23, 2017

Crawling Part 3: Tips and Tricks

As I mentioned in the first edition of our crawling series, I like to encourage parents and children not to give up on crawling due to the many benefits. Here are a few tips and tricks to help both you and your child work on crawling.

Tummy time

Most of the time, I see babies who are not crawling simply because they hate being on their tummies. The first, and toughest, step is to get them accustomed to experimenting with movement on their tummies. Refer back to our blog post here for some ideas to make tummy time more enjoyable and easier for both parent and the baby.

Belly crawling

If your baby is stuck on their belly and reaching their hardest for those toys out of reach but just not crawling, try making that forward motion easier. You can slip your baby into long sleeve shirts and pants or a long-sleeve footie pajama suit and let them play on their belly on a slick floor. By reducing the friction, belly crawling becomes much easier. You can also let your baby kick off your hand with their foot to help get that forward motion initially. Once they begin to move forward, they will learn to pull along with their arms to help get that motion.

Blanket under the belly

A lot of the time, the core muscles that help keep the trunk upright and supported in a variety of positions is weak. We see this when the baby might have difficulty getting their belly up off the ground. Try rolling or balling up a small hospital or receiving blanket and sticking it under the tummy when playing on the floor to help teach them to bring the belly up. If your baby has longer arms, you can place your shin under than belly rather than a blanket.

Wheelbarrow walks

Sometimes, we see little ones having difficulty moving onto the next stage of crawling due to weakness at the shoulder muscles. The term proximal stability refers to keeping the shoulder blade still and supported against the back of the rib cage. Wheelbarrow walks is an easy, and sometimes fun, way to help promote more core strengthening and proximal stability. I like to start holding baby at the hips while having them wheelbarrow walk on their hands. As they get stronger, I move my hands to their thighs, knees, and then ankles.

Make crawling fun!

You can encourage crawling most easily by placing favorite toys out of reach. Other fun games include playing near a mirror or a diaper box as most babies love to see their faces or other baby’s faces. Some little ones enjoy crawling through a tunnel or over obstacles and learn or to problem solve their way around the home.

Have fun crawling!


January 20, 2017

Crawling Part 2: The Basics

By Colleen Donley, PT, DPT
  • What does it look like when a baby is learning to crawl?
  • Crawling, either on the tummy or hands and knees, is one of the first times we see a baby piece together “I can move and get to this toy.”
  • True crawling on hands and knees follows a fairly typical progression beginning around 7-8 months and lasting a few weeks.

Belly/commando crawling or creeping: Most babies start with belly crawling as they learn they can move forward to get places, but do not have the strength to maintain a hands and knees position yet.

Rocking on hands and knees: Babies will learn how to push up to a hands and knees position and then begin rocking back and forth. Holding this position and rocking helps babies build stability and strength at the shoulder joint and learn what it feels like to bear weight through their hands and knees.

Inchworm crawling: Sometimes babies will skip this stage, but don’t be alarmed if you see what looks like an inchworm crawling pattern. This looks just like it sounds…baby up on hands and knees, rocking, launching forward onto belly, and pulling legs under them back to hands and knees. Your child has likely learned to use this pattern to move forward because they are still building the stability at the shoulder to pick one arm up at a time.


Hands and knees crawling- Jackpot! The key to know they have mastered crawling is reciprocal arm and leg movements. This means they move the right arm forward while pulling the left knee along and vice versa.

Is your baby stuck at one of these stages and not moving to a new pattern or mastering hands and knees crawling? Stay tuned to the last edition of our crawling series for strategies and tips to make crawling easier and more fun!


January 17, 2017

Crawling Part 1: The Benefits

By: Colleen Donley, PT, DPT

As an early intervention therapist, I often start working with little ones around their first birthday because they are not crawling yet. More times than not, I hear parents ask if we really should address crawling because walking is the ultimate goal and can’t we just start there. Despite popular belief, crawling on hands and knees is still a major motor milestone!

So why do we really want to push crawling on hands and knees? The benefits of crawling extend far beyond the gross motor domain. Crawling on hands and knees stimulates virtually every area of development from gross motor to cognitive, and even, to speech and language.

Here are my Top 10 reasons why not to skip crawling:

1. Development of arches in the hand: All babies are born with fat pads in their hands. While these pudgy hands are super cute, the fat pads need to disintegrate in order for muscles of the hand to develop. Weight bearing through the hands is the most effective way to help those fat pads disintegrate while encouraging all the tiny, but important, muscles in the hand to develop.

2. Integration of primitive reflexes: Maintaining and crawling in a hands and knees position provides input all throughout baby’s body to help primitive reflexes integrate. Two reflexes are key players during crawling- the symmetric tonic neck reflex (STNR) and the asymmetric tonic neck reflex (ATNR). ATNR is present shortly after birth and is seen when baby lays on their back and turns their head to one side, that same-side arm will extend out to the side while the opposite-side arm will bend at the elbow and come up to the shoulder. We see the STNR emerge around this time and help with crawling. With the STNR, baby’s arms will extend in response to neck extension while the legs will bend. This is seen very easily when baby is on hands and knees and looking ahead.

3. Development of visual system: The visual system actually develops in multiple ways with crawling. Baby will learn to keep their eyes fixed while moving and move separate from their motion. As baby is moving, they must be able to stabilize their gaze on an object and hold it steady or else they will just see blurry images as their weight bounces from side to side.

4. Development of the thumb: Shifting weight from hand to hand when crawling helps elongate the space between the thumb and the index finger. This creates more room for toys to be held with maturing grasp patterns. It also promotes development of the muscles of the thumb.

5. Trunk strength for basic activities: With all this hands and knees positioning, the belly is lifted off the ground and muscles of the trunk and core are in constant contraction/relaxation, or co-contraction. Developing muscles of the trunk have massive implications on feeding, talking, and play skills in sitting.

6. Proximal stability: Crawling helps strength and stabilize the muscles close to the center of the body, like neck, shoulders, hips, and back. The muscles close to the joints that help keep them strong and stable are given constant input to contract and thus strengthen. As these joints and muscles strengthen, baby has a stronger base to move and learn new motor skills, both gross and fine.

7. Motor planning: As baby begins to move more in their environment, they will undoubtedly encounter many obstacles. Obstacles can come in all shapes and sizes and can be put in baby’s way intentionally or not. The brain will be stimulated to help baby problem solve how to move around these obstacles. This is one of the first times we see baby begin to motor plan movement strategies, but it is just the very beginning of motor planning.

8. Bilateral coordination:  Remember up top where we talked about what reciprocal crawling looks like? Hint: right arm and left leg move at the same time. This shows us that both sides of the brain and working at the same time and communicating. Activating both sides of the brain at the same time is huge for cognitive development.

9. Exploration of environment: Tied in with motor planning, crawling on hands and knees provides baby with a new independent form of mobility and allows them the opportunity to explore their environment. Babies still learn best at this stage through exploration and experimentation! Let them have the run of the place and see what they get into. So break out those baby gates while encouraging exploration!

10. Of course the best reason for any new skill is to give baby new opportunities for play! We begin to see expansion of baby’s concept of cause and effect with crawling. They begin to engage in more social play, such as peekaboo or hide and seek, now that they can move and find a familiar face around the corner or behind the sofa. Babies also begin to grow their reciprocal interaction skills as they play ball and chase after rolled balls.

Not sure if what baby is doing looks right? Having trouble or feeling frustrated in helping baby master crawling? Stay tuned for parts 2 and 3 on crawling for what typical crawling looks like and how to make it easier to master!


Photo 2

January 10, 2017

W-Sitting: What’s the big problem?

By: Colleen Donley, PT, DPT
  • A w-sit is often seen as a very preferred position for play
  • W-sitting can be harmful to the hip and knee joints as well as muscles throughout the legs
  • W-Sitting can have a negative impact on little ones developing appropriate trunk strength and postural control

A w-sit is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body. If you were to look with a bird’s eye view at your child sitting, their legs would make a W.

Before the age of 3, the bones in little ones are still very malleable (aka flexible) and can twist, turn, etc. due to the stresses put on their body. If we let them sit in a w-sit all day, the ball of the femur bone that goes in the hip joint can actually rotate to a more forward position. This ends up looking like the classic “knock-kneed” position when your child stands, their thighs angle inwards so their knees almost touch. Additionally, a w-sit position puts a child at an increased risk for hip dislocation.

W-sitting can also shorten or tighten muscles in the hip and legs. The hamstrings and hip rotators are most at-risk to become tight in kids who prefer w-sitting. Their knees are always bent so the hamstring is put in a shortened position for a long period of time. This can negatively impact a child’s coordination, balance, and mastering other gross motor skills such as galloping or skipping as they get older.

Most often, I see kiddos prefer to w-sit when they are getting tired and especially those with low muscle tone. W-sit can be considered a “lazy position” because the child does not have to use their trunk muscles to sit upright and not fall over when they want to reach for a toy. W-sitting takes away the hard part of sitting and playing! We do not see children rotate through their trunk to reach for toys when w-sitting. This also discourages crossing midline, which is an amazing skill to develop for the growing and learning brain. Also, splaying the legs out in a w-sit creates a very large base of support so the child doesn’t have to worry about falling over when reaching for a toy. Their legs are going to make sure that doesn’t happen but this does not let them develop the trunk stability and postural control to learn how to balance appropriately. Think…if a child cannot balance appropriate in sitting then they will have a harder time learning how to balance in standing as their center of gravity is raised higher.

At the end of the day, it is likely virtually impossible to follow your busy infant or toddler around the house for all awake moments. As they move from crawling to sitting to rolling and back to sitting, it would be exhausting to correct every instance of w-sitting. Of biggest concern is when you might see your little one sitting in this w-position for an extended period of time while playing with toys or hanging out there during story time or a movie break. This would be the perfect time to ask them to “fix your feet!”

Here are some alternative sitting positions to encourage during playtime: Criss-cross applesauce, long-sitting, side-sitting.


December 2, 2016

Trick of the Trade from Colleen Donley, PT, DPT

Crawling Up the Stairs

I love to work on crawling up the stairs with a baby that is crawling and moving around. This is an especially great activity for a baby who may have difficulty pulling to stand at their activity table or your coffee table. Sometimes those tables are a little too high to reach up from hands and knees. A stair is a much more reasonable height, most are typically less than 8 inches.

I work on having the baby practice the same motion:

  • Going from hands and knees to a half-kneel position
  • Pushing up through their arms to bring that second foot up
  • Have both hands on the top step and both feet flat in a supported standing position

You might need to be hands-on at first to teach them the motor pattern or provide a little support for their confidence since stairs are a scary place. You might also need to help them figure out how to negotiate moving their hands up to the next step or how to bring their knees up. This will help reinforce the motor pattern to pull to stand at the taller heights, such as their musical activity table, while building the strength in the legs needed for this movement. Crawling up the steps is an easy activity to incorporate into your already-busy days!


November 8, 2016

Trick of the Trade from Colleen Donley, PT, DPT

Making Tummy Time Not-So-Terrible

Tummy time for teeny babies is no small feat! And it can be equally as difficult a time for parents if their baby gets very upset during tummy time. Here are some tips to make tummy time not as horrible (and maybe even fun!) for your baby right after coming home:

Tummy to chest is one of the first and easiest positions for a new baby to have tummy time. Parents should choose a comfortable position, such as reclined on the couch or propped up in bed, and then lay baby tummy-down on their chest. This puts baby at a slight incline, which makes lifting the head slightly easier. And it puts them closest to see their favorite motivator, you!

I also like to have a baby lay on the floor over a rolled-up blanket right at chest level. This creates a slight incline similar to being on your chest but challenges baby a little more. Try folding a receiving blanket from the hospital in half and rolling it up tightly. These aren’t plush so they won’t give under baby’s pressure but will give baby just the little bit of lift to make tummy time more enjoyable. And always, add something fun to the floor during tummy time, like a mirror or contrasting book!

For more information on tummy time, check out our previous post about why tummy time is important!