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Friday, April 29, 2016

How Can I Get My Baby to Stand and Walk? by Trisha Roberts

Getting to  Standing

There are few things more exciting for a parent than seeing their baby take their first steps! (Well, maybe sleeping through the night......!)  When should a child start walking?  Most babies start pulling to standing between 10 and 12 months and most children take their first steps before 14 months.  If your child is over 15 months and shows NO interest in standing, you may want to talk to your Pediatrician and possibly ask for a referral to your state’s Early Intervention Program for further evaluation.

Progression to Walking:

  • Standing with support (parents holding both hands) or standing holding onto furniture
  • Cruising sideways along furniture
  • Cruising forward facing with one hand on furniture
  • Cruising between stable objects or furniture
  • Walking with 2 hands held
  • Walking with 1 hand held
  • Standing alone
  • Independent Steps

When babies start crawling they begin exploring and looking up to see what is within reach. If something tempting is above their eye level, they will try to reach the "treasure" by pulling up to standing.
Holding Onto Baby Gate
Secure all Stairways 
Dangers for Baby
Dangling Cords and Unstable Furniture
This is why it is crucial to baby proof your home before your baby starts crawling and walking!  Any dangling cords should be tucked out of reach or bundled.  Any shelf or piece of furniture that is not stable should be secured to the wall, as a new crawler will try to pull themselves to standing and the unstable furniture could topple on their head. All stairs should be gated securely and checked frequently to insure that the gate can’t be easily shifted.  

Baby in Half Kneel Position
Getting to Standing at the Couch
Getting to standing through half kneel
Half Kneel to Standing
A great place to learn to pull to standing and begin cruising (walking along furniture) is at the sofa or couch.  Get down on the floor near your baby and the couch, and get their attention with a toy.  Place the toy a few feet away and have them start crawling toward the toy. (Some Motivating Toys can be found on our Website--Click Here.)  When they reach the toy, give them a minute to play and then gentle remove the toy and place it on the couch.  Encourage your baby to crawl near the couch; if they do not reach up or get themselves into ½ kneel position (one foot on the floor with knee bent, other knee on the floor), them help them to get to this position.

Baby getting to standing at furniture
From Floor to Furniture

 If they do not pull themselves up to standing, give a little lift under their bottoms to assist.  Let them play in standing at the couch with the toy.  Show them how they can get down from standing “bottom first” by bending at the waist

Sitting Down from Standing

 and bringing their head forward and doing a controlled landing on their plump, diapered behind. Repeat the process of getting to standing through ½ kneeling and sitting down again until they are able to do it smoothly on their own.

Once your child is able to pull to standing and sit down, they are ready for cruising. Encourage them to get to standing with their favorite toy on the couch, then start to shift to toy to the right or left; if they do not make a sideways step to get to the toy, assist them to do so by sliding their foot.

Let them bring the second foot over to meet the first.  Let them play with the toy and then move the toy slightly to the side again, encouraging the sideways stepping or cruising.  Once they reach the end of the couch, start moving the toy to the opposite side to cruise to the other end of the couch.

 Babies usually cruise sideways with both hands on the couch. 

Cruising Sideways on the Couch
Cruising Sideways on the Couch
Cruising Forward Facing with 1 Hand on Furniture

When they are almost ready to walk, they will frequently drop one hand and start to walk with their body pointed in the direction they are walking, taking forward steps rather than sideways steps, holding onto the couch or other furniture with just one hand.

At this stage you might place a stable chair or coffee table 10 inches from the couch and put their favorite toy on that new piece of furniture.  Encourage the baby to reach toward the toy, grasping onto the new chair.

Stepping between stable objects
Cruising Between Stable Objects

Soon the child will be moving confidently between both pieces of furniture and you can slowly inch the furniture further away to increase the distance they need to walk. This is called cruising between stable objects.

Most babies are able to walk behind a Baby Push Walker at this stage.  Make sure the Push Toy is stable with a wide base. (Check out our Baby Push Walker--Click Here!)

Baby Push Walker
Baby Walking Behind a Stable Push Toy

Walk next to your baby with your hand guiding and controlling the Walk Behind Toy until your baby demonstrates that they are able to control the toy.

When the baby is moving well between stable furniture, they are ready to walk with 1 or 2 hands held.
Baby Walking with Hands Held
Walking with 2 Hands Held

Parents walking baby with hands held
Baby Walking with Parents, 2 Hands Held

Learning to walk with 1 hand held
Baby Walking with 1 Hand Held

If you can get them to grasp just your finger instead of your whole hand, it makes releasing them a bit easier.  As a therapist, I prefer to aid walking by controlling a child at their shoulders.  I stand behind the child and have a parent call to them from several feet away.

Shoulder Control to aid Baby Walking
Using Shoulder Control to Assist 

Helping Baby learn to walk using Shoulder Control
Walking with Shoulder Control
I give the minimal amount of assistance necessary for the child to walk toward dad or mom by holding the top of the child’s shoulders. I can give more or less assistance as needed until the child is able to take those first steps alone. By holding the baby's shoulders or tops of their sleeves, I am in control and can release the child when they demonstrate that they are stable and moving on their own.

How to encourage those first independent Steps
Walking from Dad to Mom
There is rarely anything more motivating than Mom and Dad.  When your baby is showing all the abilities above, they are ready to take those first steps.  Have baby stand with their back against Daddy.  Position Mommy 3-4 feet away and call to baby.

Walking between Mom and Dad
Walking Between Parents
Baby Taking her First Steps to Mom
First Steps to Mom
She should take those first wobbly steps toward Mom.  Praise her and don't make a big deal when she falls--it's all part of the learning process!  

Author:  Trisha Roberts

Watch for our next blog, 

CommonQuestions Regarding Walking

Copyright © 2016 TNT Inspired Enterprise, LLC, All rights reserved.
Unauthorized duplication is a violation of applicable laws.

Monday, April 25, 2016

Child Development: Red Flags by Trisha Roberts

Red Flags: An Early Intervention Guide

by Trisha Roberts

Is my Baby delayed?  Does my Baby have a problem? These are questions parents frequently ask in relation to their newborn, baby, or toddler.  This is an article compiling some of the “Red Flags” that indicate that there MIGHT be a problem.  “Red Flags” are warning signs that there may be delays in development or something more serious that warrants further investigation. Red Flags are a signal to parents and care providers that they should initiate a discussion with their pediatrician.  Multiple Red Flags are a strong indicator of a potential problem and should signal parents and physicians to seek an evaluation by an Early Intervention Therapist or Team of Evaluators specializing in child development.

General Red Flags

Signs of stress- especially frequent or “interfering” changes in vitals (Heart Rate Fluctuations, Baby seems to struggle to breathe, difficulty regulating temperature, etc.), color changes, frequent yawning, finger splaying, excessive hiccups or gas
Poor head control after 3 months
Arching of back
Stiffening of legs
Floppy or limp body posture
Head consistently turned or tilted to one side
Unusual shape to head
Loss of Language Skills at any age
Unequal movements one side of the body compared to the other side of the body
Consistently ignores one side of the body
Poor visual tracking when head is supported
No leg kicking when on back
No hand on body exploration when on back
Poor sucking at breast or bottle
Doesn’t startle at loud sounds
Doesn’t turn head to Mom’s voice
“Scissoring” or continual Crossing of legs          

A child is displaying a Developmental Delay if there is a failure to reach milestones appropriate for their age. Children develop at their own rate, but there are normative charts for the average time frame for major developmental achievements.  If a child is significantly outside of the normal range, it is considered a Red Flag.  The following are Red Flags by Age.  NOTE:  If a Child was born prematurely, they will most likely be slower in acquiring their developmental milestones of early childhood, but the progression should follow the normal sequence, not necessarily the timing and age range.

Red Flags By Age  

Developmental Red Flags
Red Flags of Child Development by Age

      Red Flags 3 Months

Crosses eyes most of the time
Doesn’t seem to focus on Mom’s face
Baby doesn’t “track” a toy (follow a toy with his eyes from mid-line to right and left)
Doesn’t hold a toy if placed in their hand
Doesn’t smile at father or mother

Red Flags 6 Months

One or both eyes turn out all the time
Baby doesn’t reach for a grasp a toy when held out front
Reaches with only one side
Does not bring toys or hands to mouth

Red Flags 9 Months

No rolling
Only using one arm
Poor midline orientation of head and hands
No attempt to pull self to sitting when hands are held
Cannot prop sit and falls over and can’t catch themselves
Only gets out of sitting throwing body backward
Does not bear weight through legs when supported in standing
Seems to drag one side when crawling on belly or on hands and knees
Shows no enjoyment in being around people: doesn’t squeal or laugh, doesn’t like to cuddle, has no interest in games like “Peek-a-Boo”, etc.

Red Flags 12 Months

Does not move out of prone when placed there
No Babbling
Doesn’t respond to their name
Cannot get in or out of sitting position
Does not have some form of locomotion- scooting, belly crawl, creeping
Multiple Ear Infections
Baby isn’t reaching, pointing, or waving
Doesn’t point to objects or pictures
Doesn’t look for an object that is dropped or covered up
Only uses one hand for grasping and playing
Doesn’t take food off a spoon
Unable to pass a toy or object from one hand to the other

Red Flags 15 Months

Unable to stand briefly, if placed
Does not have a single word that they use consistently (mama, dada, no)
Not pulling to standing
Not Cruising
Consistently walks on toes
Not picking up and eating finger foods

Red Flags 18 Months

Not Walking
Unable to get to standing from the middle of the floor
If child has been walking for at least 6 months, should be able to squat and return to standing
Only plays with one toy

Red Flags 2 Years

Unable to squat to stand
Does not have stair mobility
No running
Doesn’t scribble
Trouble with “playground skills:” unable to climb a ladder, seat self and slide; unable to step over playground boundaries,
Falls on uneven surfaces consistently
Unsteady gait
Unable to jump down from a stable object
Doesn’t follow simple instructions
Doesn’t point to body parts (“Where is your nose?” “Where is your belly button?”)
Isn’t using 2-word combinations
Doesn’t imitate simple actions or gestures
Doesn’t know the function of common objects like a comb or glass (“What is this used for?”)
Unable to take off socks or hat

Red Flags 3 Years

Unable to get on/off Riding toy
Unable to produce movement on a Riding Toy
Unable to jump in place or jump forward
Unable to build a tower of 6 or more blocks
Doesn’t or try to imitate drawing a circle or horizontal line
Eats with a spoon and very little spilling
Unable to undress independently

Red Flags 5 Years

Is not talking in sentences and can’t be easily understood by strangers
Isn’t able to tell a simple story
Unable to gallop
Unable to skip
Fearful of playground equipment
Unable to hold a crayon correctly
Can’t draw a circle or square

What Should I do if my child is displaying Red Flags of Development?

Early intervention in the form of Physical Therapy, Speech and Language Therapy and Occupational Therapy can dramatically improve a child’s development.  The sooner treatment starts, the better the prognosis and outcome--The “Let’s Wait and See” is not the best approach. If a parent is concerned and has noted several Red Flags, they should seek an evaluation of their child by a physician or Early Intervention Therapist.

Therapy with an infant, baby or young child can significantly improve that child's overall function and development.  Early Intervention Therapists will use unique toys and activities that will engage your child in play and promote development. Your therapist will give you exercises, activities,  and suggestions to help you help your child at home, at school, and in the community.  Regardless of the cause or severity of a problem, our Goal as Early Intervention Therapists is to maximize the potential of each child!

The Website associated with this Blog, has a wealth of excellent toys that can be helpful in advancing the skills of your child whatever their age or problem.  Click Here to visit

Toys can Promote Normal Development
Toys are Used in Therapy to Promote Skills

Children Learn by Playing
Children Learn Through Play

Unique Toys that enhance Kids Development

Therapists will Give Suggestions for Unique Toys and Activities to Help Advance Your Child's Development!

Author:  Trisha Roberts

Copyright © 2016 TNT Inspired Enterprise, LLC, All rights reserved.

Unauthorized duplication is a violation of applicable laws.

Saturday, April 23, 2016

Torticollis by Trisha Roberts

    Torticollis Definition:  What is it?  

Shortened Neck Muscle in Torticollis
Right Torticollis

Torticollis is a condition that occurs in the muscles of  the neck. Torticollis refers to a shortened or tight Sternocleidomastoid (SCM) muscle that causes, in laymen's terms, a twisted or, ‘wry’ neck.  The Sternocleidomastoid is a major muscle on both sides of  the neck, that is responsible for turning the head (cervical rotation) to the opposite side and tilting the head (lateral flexion) to the side of the muscle.  The Sternocleidomastoid muscle is a complex muscle that has attachments to several different bones and joints. Because of the compacted position in utero that  children maintain in the latter weeks of gestation, all children are born with a tendency to turn their head to one side or the other.  After birth this usually evens out and children are able to keep their heads in mid-line.  Young infants typically revert to their preferred position of comfort when sleeping, which can sometimes lead to an acquired torticollis if care is not taken to encourage even head turning to both sides.  There are children whose Sternocleidomastoid muscle (SCM muscle) is actually shortened at birth or may have a cyst or nodule in the muscle or surrounding tissue; this is referred to as congenital Torticollis.

Torticollis Signs and Symptoms:  How Does it Manifest?

When the Sternocleidomastoid Muscle (SCM Muscle) is tight on one side, it produces a head tilt to that side with head rotation to the other side.  For instance, if the right Sternocleidomastoid muscle is tight, the child’s resting position will be one of head tilt to their right and head rotation to their left, or Right Torticollis (Torticollis to the Right).
Infant Torticollis to the left
Left Torticollis
Right Torticollis
Right Torticollis
This makes looking over their right shoulder difficult and keeping their head in mid-line nearly impossible.  If the left Sternocleidomastoid (SCM) muscle is tight, children have a Left Torticollis (Torticollis to the left) and have difficulty tilting their heads to their right and turning their heads to the left to look over their left shoulder. Sometimes a child will be able to get their head to a mid-line position, but the shoulder on the affected side will be elevated.  It is important that a Physical Therapist perform a Torticollis Evaluation on every child with Torticollis and design a treatment plan specific to that child. 

Implications of Torticollis:  Why is this a Big Deal?

We need to use our bodies evenly and keep our head in mid-line in order to orient ourselves to the world.  It is not normal to keep our head tilted to one side when looking at another person or object.  The uneven musculature in a child diagnosed with Torticollis can lead to permanent changes in that child's body. If Torticollis is left untreated, it can lead to the development of a Totorticollis Facial Asymmetry, which is a shifting of the facial features.
Untreated Torticollis
Torticollis Left Untreated
The body, in an attempt to even itself out will sometimes develop a scoliosis (curvature of the spine) to compensate for the asymmetry at the head and neck.  This leads to a distorted thoracic cavity and encroaches on the space used by the lungs and heart.  Children with scoliosis are more prone to respiratory and cardiac issues.  Wolffe’s law states that the stress placed on a bone will cause the bone to re-shape itself. Cranio-Facial Structures can be affected by Torticollis which can have lifelong implications for that person.  If a baby’s head is always tilted to one side, and they are frequently on their back (supine position), they may develop a flattening of the head (skull)
Baby with Torticollis and Plagiocephaly
Torticollis and Skull Deformity
on the area where they are weight bearing the most; this flattening is called Plagiocephaly (on one side) or Brachiocephaly (flattening along the entire back of the head). If a child develops a severe Plagiocephaly they may need a Cranio-Helmet to correct this skull deformity. Talk to your doctor and physical therapist about the use of a Helmet for Plagiocephaly.

Torticollis can cause asymmetrical sitting
Asymmetrical Sitting due to Torticollis
PT intervention for Torticollis
Physical Therapy For Torticollis
 Torticollis can also delay a baby's Gross Motor Skill Acquistion, keeping a baby from rolling, crawling and walking within the normal time parameters.

Torticollis Treatment:  What can be done about it?


Physicians agree that babies should be placed on their backs to sleep, as there is a reduced risk of Sudden Infant Death Syndrome (SIDs). But babies need to be on their tummies when they are awake so that they will begin to develop strength in their neck and trunk extensor muscles which leads to the development of crawling skills and good core control (See previous blogs) Making sure that children get Tummy Time is extremely important.  Paying attention to a child’s position in their crib, bassinet, car seat, etc. is also important.  Children will naturally turn toward stimulation.  If they always see their parent coming into a room from the right, they will want to turn their head in that direction.  If they hear mother’s voice, the TV or radio from the left, they will want to turn their head to that direction.  We can use this to help improve the mobility or active range of motion of a child’s neck. For instance, if a child has difficulty turning their head to the right (right Torticollis), placing a child in their crib on their back with the door to the room to their right will encourage looking to that direction, as they will  naturally turn to that direction, anticipating the arrival of their parent, food and comfort. Presenting Stimulating Infant Toys to the affected side can encourage a baby to turn to that side.

Toys for Babies with Torticollis
Toys can Stimulate Baby to Turn Head
 Using feeding time as a therapy intervention is also beneficial.  Again, as in our previous example, if a child has difficulty turning to the right, breastfeeding on the mother’s left side first will facilitate head turning to the child’s right.  Or offering the bottle with the child positioned in your left arm will also encourage the child to turn their head to the right.  When placed in sitting, offering toys to the right side of the child will promote more head turning to that side. A skilled Physical Therapist will talk with you about how to position your baby in their car seat and other situations so as to minimize or correct the effects of the Torticollis.


Physical Therapy Intervention for Torticollis

 An Early Intervention Physical Therapist (one who specializes in Physical Therapy with children birth to 3 years old) will be able to analyze the problem, take initial range of motion measurements, provide direct, skilled intervention and instruct parents and care providers in exercises

Physical Therapy for Torticollis
Physical Therapy for Torticollis
 and activities to promote improved head mobility and control as well as facilitate the progression of gross motor milestones of early childhood.

Torticollis Exercises and Treatment might include passive range of motion (stretching exercises), active range of motion, Home Exercise Program, Myofascial Release techniques, Skull Molding Techniques, Kinesio-Taping for Torticollis, Cranio-Helmet (for severe Plagiocephaly), Infant Massage, and Neuro-Developmental Techniques.

Plagiocephaly Treatment with Helmet
Cranio Helmet for Plagiocephaly

Torticollis Treatment using Kinesio Tape
Kinesio Taping for Torticollis


In Summary

The earlier Torticollis is detected, the easier it will be to correct. Therefore the sooner the child is able to get intervention in the form of Physical Therapy, the better.  Take a critical look at your child, your grandchild, your neighbor's child; do they always have their head tilted to one direction?  When you look at pictures of them are they always looking in the same direction? Look at them from the front, back, and a "Bird's Eye View" (Top of the head looking downward)--is there any deformity seen?  Any irregular shape?  Any redness in the creases of the neck?  These may be indicators of Torticollis.

Talk with your doctor and get professional help immediately!

Author:  Trisha Roberts

Copyright © 2016 TNT Inspired Enterprise, LLC, All rights reserved.

Unauthorized duplication is a violation of applicable laws.

Parachute Games by Trisha Roberts

Great Parachute Games for Kids

Parachute Games are Great Fun Indoors, Outdoors, or anywhere a group of children, teens or adults gather.  Parachute Games are not only stimulating and fun, but they are a wonderful tool for building cooperation, social interaction, and active exercise!

Kids Parachute Games
Parachute Games for Kids, Teens, and Adults

What You Will Need      

  • Parachute

              Parachutes can make out of 2 large flat bed sheets sown together, but a ready-made parachute is not expensive, can be used many time, is easily cleaned and usually comes with handles or cutouts for easy griping.  We Suggest our 12 Foot Parachute with easy-grip handles.

  •         Several balls of different shapes and colors
  •     5-10 (or more) Children, depending on the size of your parachute and your tolerance to Fun, Joyful Noise!

Parachute on Floor with Kids evenly spaced around edges
Parachute on the Ground with Kids Evenly Spaced Around Edge

   How to Get Started  

Place the opened parachute on the floor
Have the children stand or sit around the edge of the parachute, depending on the activity
If the parachute has handles, the children will grasp the parachute firmly by the handles
If the parachute does not have handles, show the children how to gather several inches of the fabric into their hands and hold tightly.
Designate a person (older child or adult) as the Caller or Counter.  It will be their job to give directions in a loud, clear voice.
Practice lifting the parachute in unison and lowering it together; it should billow out like a big balloon when rising and then collapse back to the floor when lowered.  The called should say, “UP” and all the children should gently lift both arms together to make the parachute float up.  When the caller says, “DOWN”, the children should lower their arms to the starting position. If a child is having difficulty, an adult could give some hand-over-hand assistance until they are able to perform the task independently.  When the children are able to raise and lower the parachute in a fairly coordinated fashion, you are ready to try some of the activities below.

Suggested Activities

Run Under  
Kids Parachute Games--Run Under
Run Under Parachute
As the children raise and lower the parachute, the Caller will say the name of a child.  The child will let go of the parachute and run under the parachute to the opposite side.  When the child has reached the opposite side and take hold of the parachute, the Caller will name another child to run under the parachute.  This can continue until all of the children have had at least one chance to run under.

Mouse Trap 

The Caller will name a child to run under the parachute, but this time all of the children will bring the parachute down at the same time in an effort to “trap” or “capture” the running child under the parachute.  Make sure that none of the children are “claustrophobic” ahead of time.  The first child to be captured should be one you are sure will set a good example about being “trapped”.  The game continues until each child has had a chance to be caught.

Ball Bounce

Parachute Games Ball Bounce
Ball Bounce
      The children will stand or sit so that the parachute is taut.  Place a ball in the middle of the parachute and see how many times the children can work together to flip the ball in the air and get it to land back in the parachute.  You will need a person to run after balls that escape and pop out of the parachute. The Caller will help to coordinate the efforts of the kids by rhythmically calling “up” and “down”.  The children should all count the number of successful bounces.  (You might want to practice counting in Spanish, French, or another language you know).

Popcorn Balls 

Kids Play with Parachute using Multiple small balls
"Popcorn" Balls
Kids Play Parachute Games with Small Balls in Middle
Use Multiple Small Balls

     Place 2 or more balls in the Parachute.  Try to keep all of them in the middle of the Parachute as you pop them up in the air and catch them again.

Parachute Games for Kids Popcorn Balls
"Pop" the "Corn" by Lifting and Lowering

Ball Roll 
Play Parachute Games Ball Roll
Ball Roll

Have the children stand with the parachute taut.  Place a ball on the edge of the parachute and try to make the ball go around the perimeter of the parachute by having the child closest to the ball raise one arm and lower the other in order to move the ball toward the child next to them.  Each child in succession will perform the same task, so that the ball will circulate.  (Think “wave”)  This takes a great deal of coordination and may not be appropriate for young children.

Get the Parachute moving up and down in a smooth fashion.  The Caller will name two children who will then run under the parachute as it rises and change places.

Parachute "Soccer"
Divide the parachute in half.  The children on one side will compete against the children on the other side of the parachute.  Each side will work together to lift their side of the parachute in order to make a ball roll off the opposite side.  Each team will score a point when they make the ball roll off their opponent’s side of the parachute.


Parachute Game Mushroom

Have one child or adult stand under the parachute in the middle.  The rest of the kids will sit under the parachute, tucking the parachute under their bottoms, thus making a Mushroom.
Under the Parachute Mushroom
Under the Mushroom

We welcome your comments and other game suggestions.  The goal is to have fun, develop cooperation, interact socially,  improve gross motor skills, and get a good cardiac work-out!!

Author:  Trisha Roberts

Copyright © 2016 TNT Inspired Enterprise, LLC, All rights reserved.

Unauthorized duplication is a violation of applicable laws.