Author: jwattenberg

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Baby Time: Fun with Links

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You may have received a bag of oval links at your baby shower from mother exclaiming “These are the best things ever!” You look at her with a puzzled look thinking, “How?”

Links are a great way to encourage your infant to be more active by bringing toys down to him. Use the links in combination with your baby gym. Link the ovals together until they are on the baby’s chest or near his hands. Place baby’s favorite rattle at the end of the links, or… simply use the links themselves at the end. As your baby moves his arms randomly, he will inevitably touch the links causing the chain to move. This will gain his attention visually and he will move his head toward the visual stimulation. This activity strengthens the neck muscles and trunk muscles in preparation for independent head control as well as strengthens the arm muscles in preparation for active and accurate reaching.

If it is too difficult for your child to lift his arms off the ground when you do this activity, place him in a boppy pillow laying under the play gym, this will make it easier for him to lift his arms and contact the links.

When is the best time to start this activity? You can start a few weeks after baby’s birth, when he is alert enough for some play time!

For more suggestions on promoting gross motor skills for your little one, like this page and check out Babies First Fitness on Facebook.

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Toddler Time: Core Strength while sitting on a small ball

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Click here to check out a video of core strength activities you can do NOW with your toddler

Core strength is essential to great movement patterns. It is never to early to start! Sitting on a ball causes your baby’s core and leg muscles to activate more than sitting in a solid surface.

As a pediatric physical therapist, I often use what a family has around their home to create my exercise programs. This video shows a sequence of activities that you can put into place today with your little one. All you need is a small playground ball for a toddler 18 months to 3 or a large playground ball for 4 to 5 year older, another ball and a puzzle.

In this video I start getting the little one comfortable sitting on the ball with a song. We follow that with play using both hands with a ball. I work in moving up down and rotating. The trick to getting a child to use both hands is providing a little resistance to the object so that they bring the other hand to help! We then work with a puzzle reaching in all directions.

This little one loved it and wanted more!

Have fun with your little one today and have purposeful play!

For more information on exercises to progress your babies and toddlers like this page and check out Babies First Fitness on Facebook.

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Toddler Time: The Power of Pushing

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Toddler Time: The Power of Pushing

Often, as a Mom, I am looking for something to wear my kids out! Don’t underestimate the power of pushing!

Pushing activities are great for pre-walkers to older children. It is an activity that you can do with all of your kids. Pushing activities strengthen the muscles in the front and the back of the body in balance, this me…ans that the abdominals and pectoral muscles are strengthened in balance with the hip extensors and back muscles. If you choose to push lower objects (see picture in comments) your child is lengthening his hamstrings and activating the muscles on the front of his foot (dorsiflexors). This is great for all those kids who walk on their toes out there!

There are so many ways to modify this activity and to make it fun for your entire family.
. Place objects around the house and have the kids push a laundry basket around to pick the objects up.
. Play choo-choo with your kids and have children push each other in those large Amazon boxes that all the holiday gifts arrive in!
. For more core work, push diaper wipes containers or wrapped diapers around and knock down a stack of blocks or cups.

The trick with this activity is that pushing a box or a laundry basket has more surface area and therefore is harder to push than something with wheels, make it harder for the older kids and a just right challenge for the toddlers.

Enjoy this great activity and tire those kids out indoors!

For more suggestions on promoting gross motor skills for your little one, like babiesfirstfitness.com. and check out Babies First Fitness on Facebook.

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Toddler Time: Arm and Core Strengthening Using the Stairs

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Click here to check out a video of how to strengthen your toddler using the stairs in your own home!

As a pediatric physical therapist, I often work with many of my clients in their home. There is no better piece of exercise equipment in the home than the stairs!

One of my favorite exercises to do on the stairs is to have children walk on their hands up the stairs. Now, don’t get me wrong, if someone asked me to do this 5 times in a row I might be mad, however let me assure you most kids love it! They love the challenge, the fact that they can use their hands on the stairs and love the fun and excitement in whatever game you are playing.

This activity strengthens the arms and trunk. It also strengthens the hips and legs if you are holding a bit lower. Here are the steps:

– Grab a motivator, sometimes I use a stuffed animal and throw it up the stairs, other times I specifically place puzzle pieces in the stairs so we go up a few stairs at a time
– Place child’s hands on the stair
– Hold child by the pelvis
– Encourage child to go up the stairs to a puzzle piece or stuffed animal 5-12 steps away depending on your child’s strength.
– To make it easier for the child, hold child at the pelvis.
– To make it harder for the child, hold child below the pelvis

Your child can be ready for this activity anywhere between 18-24 months old and up. A good rule of thumb is if your child can walk in his or her hands on the floor while you hold their pelvis for 10 steps this is something you can start. Just be aware of your child collapsing their arms, we would not want him to hurt his face!

Enjoy this activity to wear your little ones out during crazy cooped up days! For more information on how to exercise your little one, like this page and check babies first fitness on Facebook.

 

Toe Walking Tips: Exercises you can do today with your toddler

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Have you ever noticed that your child walks on his or her toes?  Do you ever wonder if there is anything you can do at home to decrease this problem?  YES there are things you can do!

Do you wonder if it is a habit, a problem, or if it’s normal in development?  The truth is that there are times in development that kids walk on their toes.  My purpose in this article, however, is not to discuss etiology of toe walking or when it is a problem, but rather to provide some simple exercises that you can do at home, right now, with your kids BEFORE it becomes a problem.  The biggest concern is that toe walking, if done for a long period of time, can tighten the muscles in the back of the ankle, the muscles called the plantarflexors (the soleus and gastrocnemius).  This does not allow the child to come down on their heels and changes the mechanics of the foot causing atypical use of the muscles of the foot.

The goal when a child is toe walking is to stretch the muscles in the calf and strengthen the muscles in the front of the ankle.  The following exercises would be appropriate to do during transient toe walking (toe walking that occurs once in a while), if you are unsure if it is becoming a problem, if you are waiting to see a physical therapist or in addition to the exercises that your therapist has already provided for you.

Three Exercises you can do TODAY

1. Calf Stretch: Place a small book (start with 1″) in front of a stool.  Have your child stand on the stool while they are coloring, playing with play dough at a table, doing a puzzle or while they are playing catch with you.  Make sure the feet are straight forward and not turned out.  Have your child stay in this position for 5 minutes.

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2. Down Dog: The down dog position is great for so many things.  This position will stretch the hamstrings as well as calf muscles. I like to do this on a stool, it keeps the child more attentive to the task.  Other tips to have the child stay in the position is to roll cars underneath the child and have them count how many cars go by.  If you have multiple children, have one child hold the down dog position and the other child will crawl under and while we are singing London Bridges and then have the children switch positions. Hold for 2-3 minutes.

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3. Bear Walking: Walk like a bear on hands and feet around the house.  Make a game out of it, put puzzle pieces on the floor and have the child get the puzzle pieces by bear walking to them.  You can also use packs of wipes, have your child put her hand on the wipes and push the packages around the house in a down dog position.  Place a stack of solo cups in front of your child and have them knock them down 10 feet away.

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Enjoy these activities. As always, my purpose in this blog is to help parents to action, help parents find activities they can do to strengthen their children at home.  I hope you enjoy the blog and activities found in it. If you would like more information on activities you can do with your little ones please sign up for the blog and like my page on facebook.

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Toddler Time: Tips for teaching your toddler how to catch

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As a pediatric physical therapist I am often charged with the task of teaching children how to catch.  For some, this is not that easy!  I have a few tips that have worked over the years that I would love to share!

  • For many children, you can start working on catching and throwing around 20-24 months. If your child is not ready at that age, feel free to work on it when they have the ability to stand on the stool and attend to you while you are a few feet away.
  • Have the child stand on a stool while you are working on catching.  The stool makes the child attend to the task better because they have to stay in one spot or they will fall off.  It simply heightens the child’s attention.
  • Start off catching items that have a lot of places to grab.  I like using beanie babies, a stuffed animal with weight to it or bean bags from your favorite bean bag game.  The weight provides more input for the child and the fabric allows more places for the child to grab on to for success.
  • Make sure the child presents his or her hands in front of them like a shelf to catch the object.  You may have to place their hands in this position the first few times.
  • In order to establish success, I often will start out throwing the item to the child and hold my opposite hand under their arms so that they are successful in catching the item.
  • After you have some success with fabric items, transition to balloons.  They move slow and are very engaging for little ones.
  • Once you have success with those items, transition to large round balls, as those are easier to catch than small balls.
  • In order to advance the skill, stand to the side of your child and have them rotate towards you while you throw the object.

As a reference.  Children should catch a large and small ball at first by trapping it to their chest.  The next step is catching a large ball with their hands and not trapping it. This is followed by catching a small ball with hands and not trapping it.  Often a child is not able to catch a small ball without trapping it until 4 or 5 years old.

Enjoy this activity!  I am always excited to tell Dad that this is something he can work on with his little one, and they are always excited to do it!

For more tips on activities to promote your little one’s development, please like Babies First Fitness on Facebook and subscribe to this page.

 

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Baby and Toddler Time: Easy activity to improve your child’s core strength

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Click here to check out a video of an easy way to improve baby and toddler trunk strength

If there is one activity that I wish each family would do with their child, it would be this one! As a pediatric physical therapist, some variation of this activity is typically the first thing I do at the beginning of each session because if your trunk is not ready and active it is hard to get the rest of the body active.

This is an easy activity that you can do anywhere, with anything to strengthen you child’s core muscles. Think of this activity as a side plank combined with an oblique sit up…. feel the burn!
This activity is great for babies who are able to support weight on their extended arms (some time after 7 months) all they way up to childhood. In fact, sit on a chair and try it yourself, it’s not easy!

Tips for this activity
. Hold child facing you with legs straddling your body
. Place toy diagonally behind the child so they will reach to get it with an extended trunk, not flexed
. Hold child at their trunk, the lower you hold, the more the child has to work, for younger children you may hold at the upper chest and for older children at the waist or lower
. Slowly lower child to the floor so they support themselves on one arm and reach for the toy with the other arm, this brings rotation into the movement which is very important for core strength
. When It is time to get up, gently press down on the top hip while just supporting the child on the lower side to encourage the child to sit up
. Do 8-10 times per side
. I love doing this with puzzle pieces. It is perfect!

Enjoy and let me know how it works for you!

For more developmental exercises and tips for your little one, please like this page and check out babiesfirstfitness.com.

Exercies for Preemies:  Post 2 – Legs and Trunk

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In honor of the March of Dimes’ March for Babies walks, I am providing some exercises that families can do with their former premature infant upon discharge.

The posture of a premature infant is often characterized by the baby having trouble holding themselves tucked in like a full term infant.   Instead former preemies tend to have a straighter posture.  This posture often over-activates the muscles of the back of the body and under activates the muscles of the front of the body.  This may result in difficulties with activities that require flexion like sitting, rolling and crawling.  It is for this reason that we it is beneficial to do stretches to prommote elongating of the muslces in the back of the body and exercise to activate muscles in the front of the body.   

Exercises for Legs and Trunk 

1. Elongation of the lower body

leg to ankle

  • Purpose:  Premature infants often have stiffness in the outside of their hips from laying with their legs too wide. When the hips are tight it limits the ability to shift weight (move side to side) effectively in all positions.  This exercise will stretch the outside muscles of the hips.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your hand on baby’s back by the tailbone.  Bring your hand with gentle but firm pressure down the leg to the ankle. Follow with the opposite hand so that the baby has continuous pressure.
  • Repetition: Do this 2-3 minutes as your baby tolerates.

2. Gentle Pelvic Rocking

pelvic rocking

  • Purpose: Premature infants often have difficulties rotating their body and pelvis.  Effective pelvic rotation helps with bowel function (pooping) which can be a problem for former premature infants.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your right hand around baby’s thigh and left hand on baby’s ankle.  Rock leg front and back so that you are rocking the pelvis as well.
  • Repetition: Do this 2-3 minutes as your baby tolerates.

3. Gentle Bicycles

real bicycles

  • Purpose: Premature infants often have difficulties rotating their body and pelvis.  Effective pelvic rotation helps with bowel function (pooping) which can be a problem for former premature infants.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his back with bottom at your belly and legs bent.
  • Exercise: Place your hands hand around baby’s thighs and bring right leg to belly and then left.  Be sure to make the pelvis rotate a bit when doing this.
  • Repetition: Do this 2-3 minutes as your baby tolerates

4.  Massage Baby’s Feet

  • Purpose: Premature infants are exposed to painful procedures to their feet with frequent blood draws. This can make his feet more sensitive.  Gentle massage to the bottom of the feet helps to provide positive sensory input to the feet.  
  • General tips:  Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby on her back or side with her bottom at your belly and legs bent.  
  • Exercise: Provide firm but gentle pressure to the bottom of his feet paying special attention to the heels with positive pressure.  If you have a great blanket or stuffed animal with a nice texture feel free to rub this on baby’s feet too.

Do exercises 1-2 on one side, followed by 3 and 4 then repeat 1-2 on the other side.  Add the arm and shoulder recommendations from a previous post

Disclaimer: If you are uncomfortable performing an exercise please consult with your pediatrician or physical therapist.

Exercises for Preemies: Post 1 Shoulders and Arms

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In honor of the March of Dimes’ March for Babies walks, I am providing some exercises that families can do with their former premature infant upon discharge.

The posture of a premature infant is often characterized by the baby having trouble holding themselves tucked in like a full term infant.  Instead former preemies tend to have a straighter posture.  This posture often over-activates the muscles of the back of the body and under activates muscles of the front of the body.  This may result in difficulties with activities that require flexion like sitting, rolling and crawling.  It is for this reason that preemies would benefit from  stretches to promote elongating of the muscles in the back of the body and exercises to activate muscles in the front of the body.

Exercises for Arms and Shoulders 

1.  Gentle shoulder stretch

shoulder down

  • Purpose:  Premature infants often have trouble with breathing,so they use their shoulders (specifically their upper trapezius) to help them pull in air.  This causes the shoulders to be tighter than we would like.  Try this exercise to help your baby relax his or her shoulders
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your hand on shoulder and gently pull down, hold for 3 seconds, then stroke your hand down the baby’s arm to their hands bringing hands together.
  • Repetition: Do this 5-10 times as your baby tolerates

2.  Hands to Mouth and Hands Together

hand to mouth  hand to hand

  • Purpose: Former premature infants need help to activate the muscles in the front of their body.  Practicing self calming skills (hand to hand and hand to mouth) reinforces the flexor muscles in the front of the body to activate.
  • General Tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his side with bottom at your belly and legs bent.
  • Exercise: Bring the top hand toward baby’s mouth and stroke the side of the mouth with his hand.  The baby will want to suck on their hand.  Let him!  When he is done, bring hands together with gentle pressure,, this is very calming.
  • Repetition: Do 5-10 times as your baby tolerates.

3.  Upper Back Stretch

shoulder to hand

  • Purpose: Former premature infants can pull their arms back and have trouble bringing ands together.  This exercise will elongate the muscles of the upper back making it easier for baby to bring arms forward.
  • General Tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his side with bottom at your belly and legs bent.
  • Exercise: Place your right hand on them middle of her upper back, right at the shoulder blades.  With gentle, but firm pressure, bring your hand from shoulder blade to wrist, following the arm.  Do the same with your left hand.  Think of this as a waterfall with continuous massages from shoulder to wrist alternating hands.
  • Repetition: Do 2-3 minutes as your baby tolerates.

Do 1-3 on the left side and repeat on the right side.

Disclaimer: If you are uncomfortable performing an exercise please consult with your pediatrician or physical therapist. If you are concerned that your child is delayed, please consult your pediatrician or a physical therapist in your area.

Honoring March for Babies Walks . . . Dedicated to Families and Children affected by Prematurity

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My tired boys and I at March for Babies 2013

My tired boys and I at March for Babies 2013

The months of April and May are filled with March of Dimes’ March for Babies Events.  These events raise funds to research and prevent prematurity, assist families who have premature infants and assist women in achieving healthy pregnancies with full term deliveries.  The next few posts this week are dedicated to my friends and families I have worked with that have endured the NICU with their little ones. Thank you for allowing me to be a part of your family’s life and allowing me to learn more from you than you have learned from me!

One of the most treasured aspects of my career so far has been my time spent as the Lead Physical Therapist in a level 3 NICU.  Seeing beautiful miracles weeks before they are supposed to be born is truly a blessing.  More importantly, being able to shape their development so intimately by providing positive and beneficial touch while they are in the NICU is extremely rewarding.  Instructing families on positive touch and instructing activities that they can do with their babies provides families with a sense of confidence that they can participate in some of the care for their babies during a time feels perhaps overwhelming.

My role as a physical therapist in the NICU was to provide care for the premature and medically involved babies that assists in preventing unnecessary delays.  Further, I provided education for parents on the importance of early therapeutic intervention which can maximize the abilities of their child.  One cannot be an effective pediatric NICU therapist if they are not aware of the possible structural concerns, sensory concerns and motor concerns that can result from being in the NICU. I have followed hundreds of premature infants through direct treatment and NICU follow up clinic throughout their development, allowing me to continue to learn how I can better care for the babies while they  are in the NICU.

Over the next few days, I will provide some suggestions for common problems seen in NICU graduates and some exercises you can do with your former premature infant.  Please remember if you have any concerns about the suggestions posted, please ask your doctor or therapist for the appropriateness of the exercise for your baby.

If you are interested in finding a March for Babies in your area, please go to http://marchforbabies.org.