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Saturday, October 21, 2017

As a pediatric occupational therapist for the past 20 years, I’ve been guiding parents on how to handle and play with their children. The types of children I see have had motor delays secondary to prematurity, low muscle tone (hypotonicity) increased muscle tone (hypertonicity), genetic disorders, neurological disorders and a variety or syndrome-based delays. Early intervention is extremely effective when skilled hands can guide the baby/toddler through the developmental milestones and build up the underlying skills. I have found that the babies and toddlers who do best are the ones who begin with intervention very early in life. OTs who specialize in early intervention are experts in understanding the baby’s developmental milestones and assisting babies who need help with fine motor skills, adaptive/self help skills, visual motor skills and sensory processing skills.

Parents generally are interested in the growth and development of their neurologically typical child. A parent may be concerned about why their child fought “tummy time” and skipped the crawling stage and progressed right to standing and early walking. Whether skipping tummy time or crawling actually affects the baby when they become functioning adults is debatable. Nonetheless, the crawling stage has many agreed-upon benefits and is encouraged, as it improves trunk strength and arm strength. Positioning the hands on the floor with the wrists extended helps the arches of the baby’s hand develop, which is necessary for grasp and most fine motor skills.

Parents have asked: How soon can I keep the baby on their tummy for play? I suggest beginning to encourage your baby to tolerate the tummy time or prone position as early in life as possible, even if he or she does not have the head control to lift the head. Gravity will strengthen the neck and upper back muscles; the earlier you begin, the easier it will be for your baby to tolerate tummy time for longer periods of time. As the baby progresses, you can place a rolled-up washcloth or small towel under his or her chest. You can place your hands on your baby’s hips in this position to help him/her maintain the “all-fours” or quadruped position. Encourage rocking back and forth in this position as a means of priming the muscles in preparation for crawling. Placing objects on the floor, like a cushion or a pot, will encourage the baby to put his/her hands onto the surface, thereby further increasing upper body and core strength even more.

You can assist your baby’s development by trying some of these approaches: Crawling typically occurs between 6-10 months. Get on the floor and crawl alongside your baby and provide play tunnels or a box they can crawl through. Position toys a bit out of reach so your baby is motivated to move toward them. A mirror is a big motivator for crawling, as a baby is usually eager to play near a mirror. A long mirror can be placed horizontally along the floor, with half of it well-secured behind a couch or dresser for safety. Allowing the baby opportunities to explore their environment by crawling will encourage improved fine motor skills, visual motor skills and motor planning by giving the right and left sides of the body an opportunity to work together cooperatively.

Today we have easy access to a multitude of baby supports such as car seats, infant seats, exersaucers, bumbo seats and bouncers, which tend to restrict the babies and not allow them the ability to move and explore. Granted, we need to keep the baby in some type of supported prop in order to accomplish various home tasks, e.g., a shower or quick meal preparation, while ensuring the baby’s safety. Experts suggest that babies can be in this supportive equipment for a total of two hours per day for 15-20 minutes at a time. My best advice is to place a baby in a safe, gated or partitioned-off section of the floor in the home where the baby can explore freely and practice moving about.

Should you have concerns regarding your baby’s development, consult with your pediatrician, developmental pediatrician or a pediatric occupational therapist specializing in early intervention.

By Stacey Berman Gardin

 Stacey Berman Gardin, OTR/L, is a pediatric occupational therapist licensed in New York and New Jersey. She has been practicing OT since 1981. For the past 20 years, the focus has been treating children through early intervention. Stacey is a graduate of SUNY Downstate College of Health-Related Professionals.