Expert Q&A: Pediatric Physical Therapy
Today we’re sitting down with Aneri Bhansali - previous Chicago New Mom Group member, mom of two little ones and the doctor behind the pediatric practice, Leaps and Bounds Therapy. Aneri received her doctorate in physical therapy at University of Illinois at Chicago in 2009 and has been practicing physical therapy ever since with a focus on children.
What are the most common developmental issues newborn parents face?
As parents, we not only are adjusting to our new role and also to our new family member, but then faced with the utmost responsibility of now taking care of our baby and making sure our baby is developing on track, feeding on track, sleeping on track and growing on track. And when you are a first-time parent knowing what is typical versus atypical is not always easy. Then you add in the sleep deprivation on top of all the pressures and it can feel beyond overwhelming. When it comes to a newborns development, it is nice to have some pointers and some guidance for any red flags or concerns that may elicit intervention. A pediatrician can often guide you, but many times we will have a parent who initiates the conversation with the pediatrician or calls us directly because they are finding that a certain area of development is behind or difficult for their baby. As far as early developmental issues for newborns, there can be anything specific from an actual diagnosis to more of a general concern from a parent that their child may have a developmental delay or difficulty with a daily routine. I find that all areas of development overlap, especially early on. Often, we will see a gross motor issue that may also be tied to a feeding issue. For example, babies suffer from reflux, and they will dislike certain therapeutic positions that will impede gross motor development.
What common developmental delays should I keep a lookout for?
As far as gross motor development, these are the things to look out for in your child.
Does your baby look in both directions equally?
Does your baby favor a side?
Does your baby tilt his/her head to one side?
Does your baby demonstrate a strong negative reaction to tummy time or being laid flat?
Does your baby have a flat spot on their head?
Does your baby feel floppy or extra stiff?
Does your baby reach with both hands equally?
Check out our blog at https://leapsandboundsil.com/gross-motor-checklist/ for a list of milestones and red flags to look out for.
How do you know if a baby under 6 months is delayed?
Ask yourself, before 6 months of age, does your baby do the following?
Have good head control
Hold his/her head in midline alignment
Reach for his/her feet when on his/her back
Reach for toys/rattles in all positions
Tolerate tummy time and pushing up through his/her hands
Prop sit or independently sit
Have any flat spots on their head
Roll from back to stomach and stomach to back
In addition, does your baby play on their back, sides and stomach equally and with tolerance.
What kind of physical therapy does a young baby under 6 months need?
In addition to working with children, we do primarily see babies. When it is before six months of age that we are seeing them, we may be seeing them because they have a specific diagnosis at birth that requires a close eye on physical development. Other times, we are seeing them for diagnoses like: torticollis, plagiocephaly, hypotonia, hypertonia, decreased strength, gross motor delays (not yet rolling or tolerating tummy time). We are working on strength, balance, coordination, flexibility.
If my baby is not hitting current milestones at home, what are some things I can do to help?
First of all, always talk to your pediatrician if you are concerned. Once you do that, look at your baby’s environment. Does your baby spend time in a device/container, or does he/she spend a considerable amount of time playing and exploring down on the floor on an activity mat or blanket? The best strengthening and problem solving happens on the floor. A toy moves out of reach, and now your baby has to think through how to move their body to get it. Motor planning happens on the floor as well. While they are on the floor, are they getting several bouts of tummy time in, in addition to being on their sides and stomach. You can assist them with rolling by helping to show them, and you can make tummy time fun by getting down with them. Babies love their parents, so getting down on the floor with them and letting them have sensory experiences while in difficult positions with you by their side is a great start. If your baby is not yet crawling, make sure you have them practice reaching on their stomach, playing in a variety of positions and that they are pushing up on hands and knees for starters. If your child is not yet walking, consider moving toys up higher, and make sure they are pulling to stand and have appropriate balance in independent standing before you work on walking. If your child is still not hitting milestones, then consider a physical therapy evaluation. Physical therapy will never hurt, and knowledge can always be power!
What is torticollis and what does it mean for my child?
Torticollis is a common condition that occurs when one of the muscles in your baby’s neck is tight or weak making it difficult to turn the head to one side or causes the head to tilt or pull to one side. Sometimes it is how the baby was positioned in utero and other times it is developed after birth. Check out our blog for more info: https://leapsandboundsil.com/what-is-torticollis/
Are there ways that I can avoid Plagiocephaly (head flattening) for my baby?
Babies heads are very malleable, so anything that puts pressure on the skull can cause flattening. This can then cause facial asymmetries. Positional head flattening is common based on positioning in or out of utero. It can often be linked with torticollis as well. Some babies are more disposed to head flattening than others.
A baby always laying at an incline or in a bouncers/car seat/swing/rocker/ stroller can cause plagiocephaly to worsen. Consider baby wearing, increase time your baby plays on the floor, increase tummy time opportunities (while your baby is supervised), change positions often, and do not let your baby sleep at an incline for a prolonged period of time (in a bouncer/swing/car seat).
My child was in the NICU after delivery. What do I need to know or consider as I pay close attention to their development?
In the NICU, much of the attention and focus is on the babies’ medical status and growth as it should be.
Once coming home, supporting your baby with ample opportunities for tummy time (on the floor, over your lap, over your chest, over a towel roll) is a great first step while also paying attention to their cues. If your baby is not tolerating tummy time for long or tiring quickly, consider short but frequent bouts of tummy time throughout the day. Also, pay close attention to symmetry. Is your baby using both sides of their body equally? How is his/her endurance when on their back, sides and stomach? If your baby is followed by a NICU follow up team, make sure to be compliant with those appointments as all areas of development will be monitored there.
Also depending on how premature your baby was born, he or she may automatically qualify for early intervention services through the state.
https://eiclearinghouse.org/resources/getting-started/
What are your thoughts on container seats and devices that are marketed for building muscle strength in babies? Yay or nay?
Overall nay - but like most things, it does not have to be all or nothing. When a child or baby is in a container or device, they are not working their muscles. The container is doing the work for them. Containers like bouncers, Bumbo seats, exersaucers, jumperoos, walkers, swings and rockers are supporting your child so they do not need to activate their muscles to support themselves. Also, these containers put your baby/child in a poor posture. Children who spend a lot of time in these containers often can develop delays in their gross motor skills, difficulties with motor planning and body awareness and the poor positioning may even lead to tip toe walking and slouching. On the other hand, I am a parent and can understand sometimes you need to put your baby somewhere so you can make a cup of coffee, make a meal, prepare a bottle, take a break, or even just take a shower! Trust me, I get it. So, what I would say is everything in moderation!
If you are going to use a container device, then do it - but limit it to ten to fifteen minutes maximum if you can. Depending on your baby’s age and where they are in their gross motor skills from a safety perspective, consider wearing them, or putting them in a pack ‘n play, a play yard, or on the floor on a mat or blanket (where you can see them and they can play safely).
What questions and information should I consider when searching for a physical therapist for my child?
First off, if wanting to use insurance, find out if they are in or out of network so there are no surprises. Also, make sure the physical therapist has pediatric experience. That is very important. You will want to make sure they can provide consistent therapy if your baby needs it. Consistency can be important in many cases. Also something to consider is the setting. Would physical therapy at a clinic work well for you and your little one or would a physical therapist who can come to your home and work with your baby in their natural environment be more helpful and put your child at ease?
Once you get started, in general, pediatric physical therapy should be fun and all play-based. This will not only help to engage and ease your baby into it, but make it a positive experience for you and your baby. It is also important for the physical therapist to encourage parent/caregiver involvement so that the hands-on practice can be carried over into a home program. All things to consider and ensure.
Learn more at www.leapsandboundsil.com
**Please note that the tips and strategies described above are general suggestions without formally assessing your child and do not take into account medical conditions or atypical movement patterns. If you have any questions or concerns about your baby or child, please do not hesitate to call me at 312-480-7433 or email at aneri@leapsandboundsil.com. You can also check out our website at www.leapsandboundsil.com for more information.