Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Physical Therapy’ Category

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!


November 1, 2016

Toe-Walking: Should You Be Concerned?

By: Colleen Donley, PT, DPT
  • New walkers often experiment with toe-walking, but it should not persist.
  • Toe-walking is not an early indicator of autism.
  • Toe-walking can become a long and vicious cycle if not addressed early.

Toe-walking refers to instances where a child is walking without their heel in contact with the ground. This includes walking on the balls of the feet or tip-toes. There are many different reasons a child may toe-walk, which may be an indicator of an underlying diagnosis, but there are also times where we see children walk on their toes for no reason. Sometimes children outgrow toe-walking on their own, but some require skilled intervention to address the problem from worsening.

Most pediatricians and baby books address toe-walking when a little one is beginning to cruise and take their first steps. I often see new walkers experiment with being on their toes and this goes away in time. Young toddlers go up on their toes for a host of different reasons, most often just to experiment with new positions and movement. Being up on their toes helps a toddler to have a more stable arch in their developing foot. Since they are experimenting with walking and do not feel secure, they are often moving quickly with a push toy or “falling” into a parent. Walking at an increased speed imposes more instability on the child and they want to feel stable at the foot/ankle. The American Academy of Pediatrics recommends that toe-walking should not persist beyond 2 years of age. Personally, I feel toe-walking is a problem before 2-years if the child never comes down to flat feet and toe-walks consistently.

As autism has become a more widely discussed syndrome, many people have begun to associate toe-walking with autism. It is true that some children who have autism do walk on their toes for a variety of reasons. Toe-walking has not been linked to autism and is not an early indicator of autism. However, toe-walking can be an early indicator of cerebral palsy or muscular dystrophy in the presence of other symptoms.

The biggest concern with toe-walking when it is not related to an underlying diagnosis, like cerebral palsy or muscular dystrophy, is that it turns into a very vicious cycle that is tough to break. When a child is up on their toes, their calf muscle and Achilles tendon are in a shortened position. If they stay on their toes consistently then the muscle and heel cord are never put on slack and, as a result, tighten up. So now we have a child with a tight calf muscle and heel cord who cannot get their heel down even if they wanted to. Alternatively, the muscles in the front of the shin are in a constant lengthened position and become weak over time due to not being used.

At Spectrum Pediatrics, we like to address toe-walking with a simple stretching and strengthening program while making it fun for the kiddo. No child will enjoy sitting still and letting me stretch their heel cords because most adults wouldn’t either. Spectrum uses a creative approach to put children in a stretched position and encouraging strengthening those-now-weak muscle during play and functional activities.

Photo 1

Photo 2


October 5, 2016

Trick of the Trade from Colleen Donley, PT, DPT

Push, Pull, Carry

These are 3 of my favorite words to teach parents with kids who have low muscle tone. By adding weight to simple chores or playtime activities, we provide our kiddos with more input to help with position sense and muscle activation. This is especially helpful when talking about a kid with low muscle tone.

For younger kiddos: I like to let little ones play around with full diaper boxes or pretend the laundry basket is a zoo train full of their stuffed animals. They might enjoy building a fort or tower with all the throw pillows, which would require them to pull them off the sofa and carry them over to the pile. Jumping into the tower is just the added bonus!

For older kids: Try adding weight to their normal chores or routines. It may seem simple that a kid would pick up the stack of books and take it back to the shelf, but it also has amazing benefits. I also like to encourage parents to have their kids help carry groceries in from the car. As we head into fall, it will be the perfect opportunity to have your child help rake up all the leaves, pick up a pile and put in the wheelbarrow or bag, and push the wheelbarrow/pull the bag out to the curb.

Can you think of any other playtime games or household chores that might involve push, pull, or carry?


September 23, 2016

Trick of the Trade From Jamie Hinchey MS, CCC-SLP

Category Ball

This is a creative, fun way to work on both motor and language skills. At Spectrum Pediatrics, we use a volleyball with 10 small pieces of masking tape with various category labels such as foods, animals, or drinks. I use this category ball with different clients who are all working on different goals. This could be a great way to target gross motor and language skills at the same time such as throwing the ball to a partner and identifying items in a specific category. Children enjoy this game because it includes movement, which is always a good motivator! You could make this category ball with any type of ball around the house, including a soccer or basketball.

Depending on what your child is working on, you could choose which categories to put on the tape. I have also used this ball as a way to target asking questions. For example, if your hand lands on the “food” category when you catch it, you have to ask “Ms. Jamie, what is your favorite food?” This ball is able to target speech, language, and motor milestones in so many creative ways! The next time your child is looking for a fun activity, grab a ball and some masking tape!


September 15, 2016

“Low Tone”: What does it mean?

By: Colleen Donley, PT, DPT
  • Low muscle tone is a widely-used term but is not always explained fully to parents.
  • Low muscle tone does not mean weakness.
  • We cannot change a child’s muscle tone but we can help them grow stronger.

We hear pediatricians, therapists, and other parents toss around the word “low tone.” But do we really know what that means and its implications? Interestingly enough, there is no standard definition or diagnostic criteria to qualify someone as low tone. Muscle tone is defined as “resistance to passive stretch while the patient is attempting to maintain a relaxed state of muscle activity.” Common words I hear or sometimes use with parents to help explain low muscle tone include: floppy, loose, flexible, and soft. I have also likened low tone to a stuffed animal- Think of the “muscles” in a teddy bear that are not constantly firing at a resting state so the bear must work harder to make the muscles move.

Unfortunately, there is no true diagnostic criteria for low muscle tone. We often hear a child described as being low tone based on qualitative assessment and how they are presenting. A recent survey of physical therapists and occupational therapists came to a consensus of 7 characteristics that often are related to low muscle tone.

1. Decreased strength                                    5. Leaning on supports
2. Hypermobile joints                                     6. Delayed motor skills
3. Increased muscle flexibility                    7. Decreased activity tolerance
4. Rounded shoulders

Many times, we see that kiddos who are delayed in their gross motor development have low muscle tone. But the reverse is certainly not true…having low muscle tone does not by any means lump a child into the category of having delayed motor skills. Kiddos with low muscle tone have to work harder to move for a variety of reasons- their muscles have to work harder to get stronger, they might have poor position sense due to their joints being hypermobile, and they might fatigue easier since they have poorer activity tolerance. While we cannot change a child’s muscle tone, increasing muscle strength will help compensate for the low muscle tone.



August 24, 2016

Trick of the Trade by Colleen Donley, PT, DPT

Push Toys

A typically developing child should be taking their first steps around their first birthday. Often, little ones start cruising at furniture and taking steps with their hands held around 10 or 11 months. This is a perfect age to begin introducing a push toy to your moving baby.

Pushing a push toy along puts a child’s hands in the perfect spot to learn how to walk independently: down at chest/waist height and in front of their bodies. Using a push toy will teach babies to shift their weight forward to move forward. Parents often have concerns because they see their child literally fly across the floor as they lean forward on these push toys. We want our little ones to learn how to walk in a slow and controlled manner rather than a coordinated fall for a long distance. Bring on the weights! You can add ankle weights around the bottom, go shopping for canned goods in the pantry for the shopping cart, or load up heavy baby dolls in the stroller for a ride. Adding weight to push toys makes kiddos have to activate their muscles much more, slows them down, and allows them the chance to take a coordinated step each and every time!

Don’t have space for another baby gadget in your house or your little one gravitates to anything but toys? Try diaper boxes or the laundry basket!


August 15, 2016

Baby Container Misconceptions

By: Colleen Donley, PT, DPT
  • Where can you safely put your baby when you need a moment to empty the dishwasher or fold laundry?
  • Exersaucers, jumperoo’s, and walkers can teach babies how to stand and take steps incorrectly.
  • Often times, little ones are too little for baby containers, which makes positioning even worse.

In exersaucers, jumperoos, and walkers, a little baby learns from a very early age to lean their trunk forward against the front of the bucket seat or to sit in the bucket seat. Both of those positions are not ideal because the child now has their feet either behind or in front of the hips, not under their hips for appropriate weight bearing. The child isn’t learning how to control their posture and develop balance appropriately. In addition to learning poor postural control, babies learns to put weight through their toes rather than flat feet since they are in front of or behind their body. Typically, babies sit with their hips opened, which can cause twisting at the top of of the hip or put force on the growing bones to encourage a bowing appearance.

Walkers pose a greater concern than exersacuers and jumperoos because your child is learning to stand inappropriately and move their feet incorrectly. In order to make the walker go forward and fast, baby learns to simply lean forward and then move their feet along with the movement. They also will lean from side to side to shift their weight and take a “step” so they appear to shuffle when out of the walker. When a little one has grown accustomed to sitting in the bucket seat, they tend to have extra flexion in their hips and knees as the step forward. A final note on walkers, walkers pose a significant safety concern to our little ones. The American Academy of Pediatrics has called for a ban to the manufacture of all walkers with wheels and the US Consumer Product and Safety Commission has issued a warning discouraging parents from using these walkers due to such serious safety concerns. Infants have been found to be at an increased risk for fracture when using a walker, especially a skull fracture. Other potential injuries include burns, falls, poisoning, and drowning.

There are many great alternatives to these containers so babies can stay safe, but in a good position for motor development, such as baby play yards in your living room or a pack n play. Putting your little one in these containers when you’re in a bind or really just need a moment does not make you a bad parent. The American Physical Therapy Association’s Section on Pediatrics recommends limiting use of commercial baby containers to 10-20 minutes per day. This is not a lot of time so that is why finding an alternative is so necessary. At the end of the day, being down on the floor and learning how to move is the best position for baby!

For more information, visit Colleen Donley’s blog here!

Click here to learn more about creative ways to have your baby on the floor!



June 26, 2016

Adaptive Clothing Lines: What are they and where do I find them?

By: Ashley Glasser, M.S. OTR/L
  • Tommy Hilfiger announces adaptive clothing line.
  • Clothing to fit the needs of those with disabilities now has the same look and pricing as other lines of clothing.
  • Children can feel more stylish and included with their peers.

Every day we wake up, go into our closets, and pick out an outfit. That outfit sends a message to those around us about our style and our personality. Most of us have compiled a wardrobe of items that we know fit, represent us as a person, and can easily be thrown on as we head out the door. But what if it wasn’t that easy?

While there are a plethora of options for the typical shopper, those with disabilities do not usually have it so easy. Many require clothing that has been adapted to fit their specific needs. This can mean loose fitting pants that can slip on over braces or orthotics; Velcro closures so those with fine motor difficulties can open and shut items that usually require zippers, buttons, or snaps; shirts that can go over feeding tubes and other ports; etc.

There are many companies out there who specialize in adapted clothing, but according to many parents these options are not always the most ideal. The clothing is often expensive and not always the most stylish, creating a difficult situation for children who want to go to school and fit in with their peers. Luckily, this is starting to change with the help of advocates like the mom behind Runway of Dreams. Thanks to her and others’ efforts, it was recently announced that Tommy Hilfiger has come out with a line of adaptive clothing, which not only looks the same as their other pieces but is priced the same as well.

Major clothing brands are selling adaptive clothing, along with other brands like Target including children with various abilities in their marketing campaigns (check it out here). This is a big step forward in the overall push towards acceptance and inclusion for these children.



April 26, 2016

Technology Tuesday – GoNoodle

go noodleWe have shared about GoNoodle’s yoga program for kids, but the website has even more to offer now!  Once you sign in for the FREE program, the site has something to entertain all of your children!  It includes silly characters and activities that motivate kids to dance, practice coordination, and use positive thinking.  The activity program is great for a rainy day or you can use it as part of your daily routine to make sure that your kids get moving.  Check out the website HERE, and GoNoodle with your kids today!

Photo Credit

December 15, 2015

Trick of the Trade from Ashley Glasser, MS, OTR/L, CEIM


During a recent trip to a home supply store, I came across a set of numbered wraps that could be placed around water bottles. The bottles could then be used for a lot of fun play activities, including bowling. Bowling is a great activity to work on a variety of skills, such as hand-eye coordination, motor planning, taking turns, social support and encouragement, etc.

kids set plasticYou don’t need to take a trip to a bowling alley or buy a bowling set to get in on the action!  Save up several water bottles and label them with a Sharpie or different colors of paper, and let the kids help you decorate!  This works on fine motor skills and creativity!  When playing, your children can also work on number or color identification.  Have your kids tell you which number they knocked over, or have them aim for a different color.  Use balls of various sizes (a large heavier soccer ball versus a small foam ball) to have your children experiment with weight and speed. Throw the balls and kick the balls. Have your kids keep up with everyone’s score – or at least all their strikes!

Photo 1