Wednesday, March 31, 2010

Movement Begins at Birth!

Making sure our children get enough movement begins when they are born. I can't emphasize how important this is. Until about the age of six, everything that a child knows is based on his physical relationship with the world. Therefore it is critical that he be given as much opportunity as possible to explore it freely and interact with it successfully.

To begin with, babies need lots and lots of tummy time. We have been cautioned not to put babies on their bellies while they sleep, but when they are awake, tummy time allows them to begin to raise their heads against gravity and develop strength and stability in their necks and trunks. It forces them to use their hands and arms to push themselves up off the floor. The pressure from pushing begins to separate the thumb from the rest of the hand, which is critical for development of fine motor control, and the shoulders develop the solidity they need to support the arms and hands.

Babies need to work their bodies against gravity in order to develop their nervous systems and acquire coordination. Think about all the work a baby must do when it is carried on its mother's hip. It has to use its flexor muscles to hold on. It has to hold its head up against gravity. It has to constantly adjust its head position to maintain its balance in response to the mother's movements. If the mother bends over, the baby bends over, and when the mother straightens up, so does the baby. Every time the mother turns, bends, or moves, the baby experiences itself in a different relationship to gravity and learns to maintain its balance and upright stature in any position. This is crucial for development of depth perception and many other aspects of vision.

Now think of the work that a baby does when it is placed in a stroller or a carriage. There is none! Being strolled and rolled is an entirely passive activity. The baby is experiencing one type of movement in one dimensional plane and is not required to make any postural adjustments. Strollers that face the baby outward and are low to the ground do not allow for eye contact or easy conversation between the baby and whoever is rolling her, so she's missing out on opportunities to interact. Less interaction means less opportunity to develop language and social relatedness.

Car seats are fine for the car, but babies who are left to sit in them for long periods or are habitually carried in them also lose out on opportunities to work their bodies against gravity and develop strength and balance.

The more opportunities we can give babies to move and explore, the more we are facilitating their physical, emotional, and intellectual development. Pick up your baby, turn on some music, and dance!

Tuesday, March 30, 2010

Welcome to pediatricOT!

Welcome! I'm an occupational therapist living and practicing in New York. I love what I do and I love to talk about and write about my work. You can leave questions for me about your child in the comments section.

Today, I want to share something that I tell all of the parents of the children I treat. Much has been written about prescribing sensory diets for children, and I could get quite clinical about the reasoning behind choosing different activities to achieve different behavioral outcomes. But here is a simple thing that everyone should do: make sure that your children play outside every day.

I was raised just outside the city limits of Chicago and am old enough to recall when there was still a good bit of prairie surrounding our neighborhood before it was developed. Soon after I learned to walk and talk, I was free to roam around the neighborhood, playing jump rope, hopscotch, tag, statues, and red rover with the other children on our block. When we were about seven, my friends and I all got bicycles, and we took off in packs. We went to one of the many parks in our town, or we went to the empty lots behind the golf ball factory looking for golf balls, or we went to the dime store on the little shopping street nearby and bought comic books and candy. Our parents didn't have to worry about our safety and they never tried to curtail our activities. Every day in the summer and on the weekends during the school year, our mothers let us out the back door after breakfast and expected us home sometime before dinner.

Now I live in New York City, and this opportunity for young children to operate with such a large degree of autonomy and freedom simply doesn't exist. As far as I can tell, most of the children I treat in my practice rarely get to play outside on any regular basis. This has the effect of delaying the development of their gross motor coordination and their core strength, and aside from the inability to bounce a ball or do a jumping jack, it affects their postural control, which in turn makes it hard for them to sit still for long periods and to regulate their behavior. I have almost never seen a child who was born and raised in Manhattan hit anything close to age appropriate gross motor skills acquisition. No wonder there is an epidemic of school related issues these days!

Now that the weather is getting better, it's important to take your children outside every day. Take them to the park, put them on the swings and slide and jungle gym, let them climb on the rocks, play tag with them, teach them how to jump rope and play hopscotch. It's more than mere fun. It's necessary to help the body to support the mind and spirit for learning and for behavior. If your child has a hard time sitting still in school, try making sure that he or she has an opportunity for intense movement before school starts. Take him to the playground and let him play for twenty minutes before drop off. Or arrange for your child to walk at least partway to school.

Last year I evaluated a little boy who was almost three years delayed in his gross motor development, and I suggested that he be taken to the park near his home every day. I ran into his father a few months later, who told me that this simple prescription had made a huge change in the child's behavior. He was more confident, since his balance and strength were better, and he could sit and focus for much longer periods. Also, he and his dad, who was taking him most of the time, had become much closer and had improved their often rocky relationship by having so much happy play together.