Tag Archives: gross motor

Floor Time for Babies

Infant Health & Safety, , , , , ,

Your baby’s gross motor development occurs along predictable Cephalo-Caudal principles. As a reminder, this means that your baby develops motor strength and muscle control starting from from the top (Cephalo, Latin for “Head”) toward the bottom (Caudal, Latin for “tail”). This principle of development means that first, your baby works on achieving head and neck control, then upper body strength in the arms, shoulders and upper torso, then lower abdominal strength, and finally, leg strengthening and balance for walking.

For this context, think of the first year of life for a human child as a timeline from birth, essentially laying flat with very little muscle control, to one year, when a baby is now upright, standing and moving independently (cruising, crawling or walking).
The mid-way point, six months, the baby is halfway there. During the sixth month, most babies will be working on sitting upright, and on finding some way to move. Here’s how tummy time plays a critical role in building strength for these skills. Tummy time doesn’t go away, it evolves into “Floor Time”.

Between 2 – 4 months, babies (hopefully!) are working on tummy time, beginning to push up on bent arms and support their head, neck and eventually shoulders and upper body (pushing their chest up off the floor to the nipple level, even) for increasingly longer periods of time. What the 2 month old found frustratingly hard work when placed on his tummy, the 4 month old effortlessly performs: remaining propped up on his bent arms for much longer periods of time.

At five months, he’s ready for a new challenge: rather than resting on his bent forearms during tummy time, he may push straight up on extended arms, getting almost all his chest off the floor down to his belly button. After doing this for a week or two, you’ll begin to see some fancy developments: he’ll start pivoting in a circle and then moving (creeping) backward. Using some combination of pushing off with his arms, typically these earliest movements will take your baby sideways and backwards. These fun efforts mean that your baby will creep backward until he’s halfway under the couch or coffee table. You’ll watch him get stuck many times over, often to your amusement.

To encourage him to pivot (which strengthens his upper body) yet to lower his frustration (Frustration Tolerance – another skill) place a few tempting toys around him in a circle. This way, when his efforts take him away from the object of interest in front of him (because early movements tend to take babies sideways and backwards!) there will be a new and rewarding item that catches his attention.

This activity is called “Floor Time”. Unlike Tummy Time, where you may have needed to use a prop, position your baby carefully, and a receiving blanket was all that was needed, Floor Time requires more space. Your baby needs some space to begin to explore how his body can move, and motivation to investigate his environment. Months before he can crawl and even though he may not yet be able to roll, he’ll still figure out ways to somehow scooch, creep, wiggle or otherwise inch and arch himself a few feet in one direction or another.

A clean area rug or foam matting makes a perfect surface for floor time. Blankets and quilts tend to get bunched up under your baby’s efforts to move. When possible, bare feet is best for sensory input and for traction. Watch those little toes flex and dig into the surface to get leverage to push off with!

By six to eight months, your baby will figure out some version of movement. Though it may not be what you think of as “crawling”, most babies in this age group have some way of getting a few feet away from where you left them. HOW they move matters less than having the motor strength to move, and the cognitive desire to explore. Some babies will use their arms to pivot and creep backward, others will “commando crawl”, using lots of effort with their upper body to drag themselves forward. Some will use an amusing combination of rolling, shimmying or scooting to get around!

Time to Baby Proof!

Baby’s Head Shape: Flat Spots, Torticollis & Plagio

Baby Sleep, Infant Health & Safety, New Moms, , , , , , , , ,

Does your baby have a flat spot on the back of his head? Many babies do. Fortunately, most flat spots, called Positional Plagiocephaly, are mild and need no treatment other than positioning changes and monitoring. Learn how to prevent and treat flattening of your baby’s head, and when to speak with your pediatrician about concerns.

 What is Deformational Plagiocephaly or “Flat Head”?
Also called Positional Plagiocephaly, Deformational Plagio refers to the misshapen or asymmetric shape of the head. The flat spot is usually on the back of the baby’s head, though in some cases, for example, with torticollis, the flat area may be on one side of the skull.

What causes deformational plagiocephaly or “Flat Head”?
The most common cause of deformational plagiocephaly is positional. A newborn’s skull is soft and designed to grow quickly. When babies rest in one position for long periods of time, the skull begins to flatten from the external pressure against it. Since babies can spend a lot of time in the “passive recline position” (car seats, bouncer seats, swings, back-to-sleep position), it’s possible for a flat area to develop. Once a flattening occurs, it’s easier for the head to “resettle” there each time, allowing other parts of the skull to grow but not the flat area.

Shifting your newborn’s sleeping and resting positions is the best prevention for developing a flat spot. During diaper changes and for sleep, try alternating his “head and feet” position, reversing the way you usually lay your baby on his back. When your baby is awake and observed, use more tummy time and side-lying positions. Lots of awake tummy time with encouragement will also help by strengthening the neck, shoulder and arm muscles, which will eventually help your baby shift his own positions. Carrying, holding or “wearing” your baby without pressure on the back of his head will also encourage muscle development and prevents pressure against the flat spot.

Is a Bald Spot or stripe on the back of the head cause for concern?
No. It’s common for babies between 4 – 7 months to “wear away” an area of hair from turning their head side to side when in car seats, bouncer seats or sleeping on the back. This bald patch is normal and if not accompanied by significant skull flattening, is not a cause for worry. Bald patches tend to resolve between 9 to 12 months, as your baby will be sitting, crawling and moving more, spending less time on his back, allowing hair time to fill in again. Many fashionable babies sport a fine mullet.

Torticollis and Flat Head – 
A common cause of deformational plagiocephaly is muscular torticollis. Muscular torticollis (sometimes called “wry neck”) is a tightening of specific neck muscles, which prevent full motion and keep the baby’s head slightly tilted or turned to the side. Because torticollis causes the baby to keep his head at a specific angle, a flat spot may form as the baby’s head rests against the mattress or seat at the same position for repeated periods of time, leading to positional plagiocephaly.

Torticollis is often missed by parents and health care providers, since newborns have short necks and tend to lean or “slump” to one or another side. Make sure your baby is an “equal opportunity slumper” – sometimes leaning to the right side and other times the left, when sleeping, and check that your baby can turn his head equally to both sides. If you’re concerned about your baby’s persistent head-tilt or suspect restricted neck motion, speak to your pediatrician.

Treating Torticollis – for a baby with torticollis, treating the tightened muscles early is important to achieve full head movement as baby grows. Full motion of the head and neck helps with balance as well as the physical appearance of the head shape (and sometimes facial symmetry). Torticollis is best treated early, during your baby’s first several months of life when specific stretching and repositioning techniques are most effective. Your pediatrician may refer you to a pediatric physical therapist to learn specific stretching exercises and positioning tips for your baby’s particular needs.

What about Helmets?
Maybe you’ve seen a baby out in the store or mall wearing what seems like an infant-sized football helmet. This is a therapeutic device called a Cranial Band or Orthotic, worn to help correct a misshaped head.  In more severe Plagio, when flattening or asymmetry is significant and beginning to affect facial appearance (one eye or ear may begin to move out of line with the face), or, in situations where a baby was born very prematurely or has early closure of the skull bones, an Orthotic may be recommended. Made by a specialist, baby helmets are very lightweight, with a hard outer shell and foam lining. Very gentle pressure restricts growth in some areas while allowing the skull to “fill out” and freely grow around the flattened areas, rounding out the head. Helmet therapy typically takes 3 to 6 months with good results.  Babies generally adjust to wearing a helmet quickly – it’s harder on the parents usually due to comments from well-meaning strangers and additional appointments. But remember that mild flattening is common and usually doesn’t require treatment with a helmet.

 

How Babies Develop

Infant Health & Safety, , ,
Baby finding feet around 5 months, and eating them around 6 months is an example of typical infant cephalocaudal motor development
Baby finding feet around 5 months, and eating them around 6 months is an example of cephalocaudal infant development (and one of my all-time favorite baby poses…)

There are two overriding principles of overall infant motor development called: Cephalo-Caudal and Proximal-Distal. 

Cephalo-caudal development literally means “from head to tail”. Babies develop motor strength and muscle control starting at the very top: Cephalo- the Latin word for “Head”, toward the bottom: Caudal- Latin for “tail”.  This is why Tummy Time, which strengthens the head, neck and upper truck muscles, is so important.  Your baby will first work on achieving head and neck control, then upper body strength in the arms, shoulders and upper torso, then lower abdominal strength (watch for “sit-ups” and leg-thumps), and finally, the balance and strength and needed for sitting, then walking. There’s a reason we develop muscle strength and control from the top downward rather than from the bottom up: just imagine if our legs were able support the rest of our body when the trunk muscles and head/neck were still floppy and unable to stay upright and aligned! That wouldn’t work at all!

Proximal-Distal development means “from near to far”, with “near” referring to the very center of your baby’s body. In other words, development starts at the center, with increasing control gradually spreading from the center, outward, further and further. As an example, first your baby will work to control his arm movements (to fling his arm out in the correct direction to hit a dangling toy), then his whole hand (to grab something in a clumsy fist), then finally his fingers (the ability use two fingers – pincer grasp – to pick up a bit of cereal, or one finger to point or poke a toy).

Both principles of development, Cephalo-Caudal and Proximal-Distal exist and work together simultaneously. All humans, all over the world, for thousands of years, develop this same way. Your baby will follow these similar patterns of development. Though the timing may vary from baby to baby, the order that the developmental achievements occur will remain similar. Babies must achieve head control before they are able to work on sitting or walking. A baby needs to be able to control his arm movements before he can learn to pick up a grain of rice.

In addition to these principles of development, there are various areas of development, many of which may overlap one another.

Gross Motor Development refers to the bigger body muscle groups and movements. Some examples of Gross Motor Milestones are head control, sitting, crawling, standing, walking and running. Surprisingly, “rolling” is not considered a motor milestone. Rolling is quite variable and doesn’t happen in a predictable fashion.  Most gross motor milestones do occur in a predictable order (though not necessarily at an exact predictable age).

Fine Motor Development refers to the coordination of the smaller muscle groups. Intentionally bringing hands to the mouth, passing a toy from hand to hand or picking up a small bit of food are examples of fine motor development. Learn more about How Babies Find Their Hands

Other areas of infant development  include Language Development, Social-Emotional Development and Sensory Development.

Vary your baby’s position many times throughout the day. The passive recline position does not offer much in the way of muscle development or stimulation. Tummy time, holding and carrying, “wearing” your baby in a sling are all richer developmental opportunities.