Classes & Groups

Buy This…Not That: Play Table vs. Jumper

BUY THIS: Play Table

This type of toy is fairly new on the scene. I had one for my son and loved it. Even though it does have quite a few cause/effect buttons, sounds, etc. which can be overwhelming at times, I look past that due to the versatility of it! Below are three common uses:
1.) Legs Off/Flat on Ground. This is great for babies 2 to 6 months. Baby can activate it during tummy time, once he learns how to weight shift, and can also easily push buttons when sitting independently. Always make sure you supervise your little one as baby will likely bonk his face into the table during tummy time or tumble forward if a new sitter! If your baby is not yet sitting independently, you can provide assistance by supporting/putting your hands on the trunk. The lower your hands are, the harder he will have to work!
2.) Table with legs on/All 4 sides accessible: Your baby is ready for this around 9 to 12 months – when they start standing with minimal support and cruising. When baby is just starting to stand, he will likely lean on the table quite a bit so wedge the table in a corner (like between couch/wall) to prevent table and baby from toppling over! Baby will become more skilled at pull to stand and more controlled when squatting to sit back down. Eventually, you may notice a step or two to each side – that’s the beginning of cruising!
3.) Table Placed near another surface (couch): Your baby will likely be ready for this around 10 to 12 months. This may likely be the first time you see your little daredevil attempt to take steps on his own to reach the other surface. Creating safe opportunities to transfer between surfaces (especially YOU!) and allows your baby to build more and more confidence to eventually let go and step where he desires to go!
Although they may come with a few too many bells and whistles, these play tables meet other requirements to make it a great toy to have as your baby grows: can be played with in multiple positions, can be played with in multiple ways, appeals to many senses, etc. Look for them on Craigslist, garage sales, or baby resale shops too. Most parents won’t realize how versatile these tables are and you can score a great bargain! Check out the other creative ideas in this link  and always remember to supervise AND PLAY with your little one during these play table activity times!

537681_543116985699885_1459151832_n. . . NOT THAT: Doorway Jumpers

These jumpers look like so much fun and many parents think it is a great way for baby to exercise and gain strength in their legs. Although the American Academy of Pediatrics does not take a stance on the use of jumpers, the Consumer Products Safety Commission has banned many jumpers for design flaws.

Consider the following for your baby:

*The primary reason to avoid: RISK OF INJURY. Babies often jump too forcefully and hit their heads on the doorways or, even worse, cause the apparatus to come dislodged and crashing down. There are also other physical and developmental reasons why we recommend choosing a different product.

*Babies are often placed in them before they are truly excellent independent sitters causing baby to hang in the sling seat. This puts undue stress on their hips. Because babies tend to jump forcefully in these things they do not learn slow controlled movements needed for walking. These jumpers do nothing to develop strength in the core and leg muscles for balance and walking since the movements are fast and ballistic instead of slow and controlled. And, since baby is supported, there is no need to use any type of protective or balance reactions as would be needed in the beginning stages of standing and walking.

There are better choices out there! If you really need a place to “put” your baby, consider the old fashioned “play pen” (pack and play) or simple floor time where they can reach for objects, roll, creep and crawl!

Buy This: Toys to Encourage Movement

We love toys that encourage movement. Yet, if you think about it, you can make many toys encourage movement. Think about using bean bags, puzzle pieces, blocks, or stickers as a means to encourage physical activity with your child. Set up puzzle pieces at one end of the room and the puzzle board on another. Have your child do a different animal walk to retrieve each puzzle piece! Side walk chalk can be used to draw hopscotch boards, obstacle courses instead of simply drawing! Bean Bags serve as wonderful items to search for in a scavenger hunt!

Consider the “old school” toys for encouraging movement as well: balls, jump ropes, riding toys. With movement, encourage use of the arms and legs to build strength in the large muscle groups but also to work on developing balance and coordination. Jump ropes can be used as snakes to jump over and lines to walk along!


Buy This: Multi-Purpose Items

Buy this: items that serve more than one purpose. As discussed earlier, infant positioning and alignment are important but often overlooked. One item that accomplishes all these criteria is a U-shaped head support pillow that cradles baby’s head in car seat, keeping it in midline. Car seats often have infant inserts, but they rarely keep baby’s head from falling to the side. These pillows, when used correctly, successfully do so most of the time.
This pillow also serves as a great prop for tummy time for younger babies up to 5 months. It lifts baby’s chest slightly, not overextending her back, helping her weight to shift backwards towards pelvis. It hugs her chest to prevent rolling to the side. It provides a barrier to keep elbows in line with or in front of shoulders.
I love finding truly useful, multipurpose items that are reasonably priced. The infant head support pillow fits these criteria beautifully.

Buy This…Not That: Stocking Stuffers

Next up in the Buy This/Not That Series . . .
Stocking Stuffers (or Gift Bag Loot)!

BUY THIS: For Toddlers on up, consider purchasing items such bubbles, kazoos, water bottle with straw, water flutes, or crazy straws. The common theme of these items is that they require a child to either blow or suck to complete the task. The benefit for YOU: blowing and sucking activities are great ways for a child to calm down, transition, or get organized! For example, a child who plays a song on a kazoo will likely calm down a bit due to the blowing and humming required. Blowing and sucking activities also help with oral muscle control, eye tracking, to name a few.

For babies, consider items such as rattles, teethers, board books, bathtub toys, music, or feeding supplies. Baby is still too young yet to grasp the concept so take the opportunity to stock up on some baby items that will be needed in the future. However, he will likely enjoy discovering what is inside!

NOT THAT: It’s simple – candy and sweets! Purchasing the items above saves you from the proverbial “sugar crash” and meltdowns because the entire stocking of candy cannot be eaten that day! You also get items that serve multiple purposes, provide developmental stimulation, and even may calm your kiddo after a long day of celebrating! As with all items, please supervise your child carefully!

Happy Stocking Stuffing!

Toys, Toys, Toys

As a pediatric physical therapist and a mom, I have played with many toys!   When I became a school therapist, I no longer had the luxury of being able to choose from many toys in many shapes and sizes.  Instead, my therapy “equipment” had to fit in the trunk of my Toyota Corolla.  I needed to have toys that were multi-functional, portable, and loads of fun.

As the years have passed, it seems harder to find these toys.   Toy manufacturers are making more toys that are either: one trick ponies, overstimulating, or oversized.  Perhaps it is becoming a bit too much? With the ever expanding influence of electronic media, our children spend more of their time being passively entertained by or minimally interacting by way of an electronic device. Today’s toys use onboard computers that dictate the play experience. This robs children of both unstructured play with friends and individual creative play.

A child’s job is to play.  That is how they learn about themselves and their environment.  A child’s natural curiosity facilitates learning from play.  It is what childhood is all about.  Toys can be “tools” to help a child grow physically, mentally, and socially.  But, with so many toy options out there between the big toy stores, deal sites, and Amazon, how do you know what toy would be the best choice?  Sure, you could read the list of reviews but here is another option.  The American Occupational Therapy Association has put together a Checklist for Toy Shopping, which lists questions to consider before purchasing a toy.  The Top 5 Questions that I use as a mom and a PT are listed below:

1.)    Can the toy be played with in more than one way?

Cups provide hours of self-initiated creative entertainment

Building toys (blocks, bristle blocks, tinker toys) encourage creativity, problem solving, and also focus on fine motor skills and hand strengthening.  Stacking cups are another great option.  This simple toy can be used to build, hide, scoop/pour, put in/take out.  In fact, this link provides 20 different ways to use stacking cups.

Think about some things that you may have used as toys when you were little!  Tupperware, pots/pans, and cardboard boxes all inspire imaginative play in your little one for a fraction of the cost of many fancy toys on the market today.  Stacking cups, measuring cups, Tupperware, and pots/pans can move from a play kitchen to the bath tub!  You can “bake” many yummy items in the bath tub with cups and bowls and it also reinforces activities such as pouring/mixing (ingredients), counting (cups of flour), etc.


2.)    Does the toy appeal to more than one sense?

Music-making brings in the year and remains a staple throughout

We want the child to be drawn to a toy and to remain interested.  Often, bright colors, lights, music, and textures will do just that.  However, be cautious not to provide too much stimulation!  A toy that provides too much can have the adverse effect of shut down or disinterest.  Instead of your child pushing a button and hearing music, consider musical instruments.  They are portable, encourage rhythm and imagination.  Helpful hint: if you do have a toy that is too loud, try placing tape over the speaker to dampen the sound.




3.)    Can the toy be used in more than one place?

Wiki Sticks provide a great non-messy art project that can travel anywhere, especially to restaurants!

Consider items such as crayons, write on boards, stickers, and small steno pads carried in a small bag for trips to restaurants, etc.  Toys like wood puzzles and magnet toys (animals, letters, etc.) can also be moved from room to room.  I have used magnet toys for many different activities as well. Remember, you can always use a cookie sheet to stick the magnets to if a metal surface isn’t always nearby.





4.)    Can the toy be used in more than one position?

Chalk drawing
Chalk provides hours of active, creative play on any outdoor surface

Play mats are great for tummy time but also for practicing side lying and for reaching up in supine.  Books can often be read in more than one position.  It is often a wonderful idea to encourage our children to read, write, and color on their tummies (strengthens neck and back muscles while providing shoulder and forearm stability) since most of their day is spent upright in sitting, standing, and playing!




5.)    Does the toy encourage activity and movement?

It’s never too young to play with balls!

As a pediatric physical therapist, I love toys that encourage movement.  Yet, if you think about it, you can make many toys encourage movement.  Think about using bean bags, puzzle pieces, blocks, or stickers as a means to encourage physical activity with your child.  Set up puzzle pieces at one end of the room and the puzzle board on another.  Have your child do a different animal walk to retrieve each puzzle piece!  Side walk chalk can be used to draw hopscotch boards, obstacle courses instead of simply drawing! Bean Bags serve as wonderful items to search for in a scavenger hunt!

Consider the “old school” toys for encouraging movement as well: balls, jump ropes, riding toys.  With movement, encourage use of the arms and legs to build strength in the large muscle groups but also to work on developing balance and coordination.  Jump ropes can be used as snakes to jump over and lines to walk along!

In the end, make sure that the toy is developmentally appropriate for your child to prevent frustration and encourage independence.  In therapy, we often work to find the “just right challenge” – making the activity challenging enough to foster growth but does not overwhelm them or cause frustration.  Choosing the right tools for play is so important.  Hopefully the checklist and ideas provided have helped you begin looking at toys in a new way and have allowed you to become more excited about the role of toys and play as your child moves, plays, and grows!


Buy This…Not That: Infant “Chairs”

Buy This: Bean Bag! For positioning infants who are NOT rolling yet! Here’s why:

Our babies are born with the innate desire to be upright, mostly driven by vision. However, for the first several months they do not have the postural control to hold themselves up against gravity. All the work they do on the floor, being carried, transitioned from position to position, getting diapered and clothed provide opportunities for their bodies to respond and react and, eventually, to anticipate and initiate. These daily activities provide the foundation for postural control and eventually independent sitting, standing, and walking.

Despite not having control, sometimes babies want to be upright out of DESIRE to see more or NECESSITY to digest the latest meal without spitting it all back up. And though we love to cuddle with our babies, we can’t always be there to hold them in supported positions. We have to do laundry, make meals, SLEEP, take showers, make phone calls, answer emails, etc. We then have three options: put them on the floor on tummy or back, wear them, or put them in some sort of container. Though the floor is a position of choice and one that we advocate to try first, it does not resolve the issues stated above.

The market has attempted to answer this call with myriad products: swings, infant seats, bouncers, walkers, standers, jumpers! All are designed to position your infant in a place that he can’t get to by himself, often relying on postural control that is not there yet. We’ve all seen the infant in their seats, sliding down to the base, falling down to the side, held up only by small straps that protect them from falling out, but doing NOTHING to help align the baby and protect his body and joints while in the seat.

Enter Bean Bag: thought of as a suitable chair for toddlers, preschoolers and up, but rarely considered for an infant, especially a young, 0-4 month baby who is not yet rolling. Just make sure baby is awake and being watched closely.
-Bean bags are portable: they can be carried in a single hand and squeezed through narrow places. They don’t have metal legs or corners that slam into your leg or twist your wrist as they are transported place to place. They can be placed in front of a large mirror, right next to your chair by your computer, in front of the bath tub as you bath your other children, or in a “circle time” reading group with siblings before bed.
-Bean bags are moldable: you can manipulate them to precisely fit your baby in order to support whatever position you want. You can change the angle your baby sits in, tilt the baby slightly left or right to keep pressure off the back of the head or to help aid digestion (RIGHT side). You can even mold them to hold a book!
-Large bean bags are secure for a baby who is not yet rolling: Once baby is positioned and supported, you can push up the sides, top and bottom to create a barrier.
– Bean bags with a blanket (especially ones with waterproof backing) laid over the top are EASY to clean after the inevitable leaky diaper or spit up. No wrestling to get covers off frames that then leaves your seat useless until the laundry is done. Just throw first one in hamper and place another blanket down!
-Finally, bean bags are far less expensive than most infant seats and other containers and are functional pieces of “furniture” for your entire family! They grow with your child

Bean bags are an ideal answer when your pre-rolling infant needs to be in a more upright position compared to the floor. However, bean bags are not a surface that encourages a lot of body movement. Because the head and body are supported well, this is a good place to work on eye gaze and visual tracking as well as reaching with arms/hands. Note of caution: Once baby is rolling and trying to sit up, they can fall off of bean bag unless they are secured down with a strap and buckle. Watch for a future post about sitting options for infants who are moving more but not yet sitting independently.


In the meantime, we would love some feedback or stories about how you use bean bags in your family!

“Not That: An Infant Chair to Avoid.”

Most infant chairs out there are okay to use in small doses with your pre-sitting baby, especially if you use towel rolls or a Snuggin’ Go  to help align your baby. Remember, though, straps in chairs are for safety only, they do not help align your baby properly. Most infant chairs are okay because they provide full support of the back and head in a reclined position.

However, there is one chair that we do not recommend: the Bumbo. This chair is designed to have your baby sit upright before she has the capacity to do so, and there is minimal if any capacity to modify it enough to provide good alignment because it does not support the entire back or head. A baby often sits with a rounded back, and leans on the sides, relying on the chair to hold her up. Undo stress and strain are placed on joints and muscles are unable to accommodate because they are not developed enough.

Parents often believe this chair is okay because it simulates the position of upright sitting parents often facilitate by placing their hands on baby’s trunk. However, the crucial difference is that your hands are directly on your baby, providing dynamic support that responds to your baby’s needs to stay in the middle. The Bumbo is a static plastic chair that does not move, respond or accommodate. It allows your baby to lean into a surface to remain upright, which in addition to placing stress on joints teaches them through practice how to be upright without turning on core muscles. We want our babies to spend this precious, short amount of pre-sitting time developing foundations for movement, not compensation strategies that can affect development of more advanced motor skills.


So, we therefore recommend that you save your money with this product. For other strategies to help teach your baby to sit independently, see our recent blog, Independent Sitting: How to Get There.



Buy This…Not That: Books

Books are a wonderful gift! This post will focus on babies up to 12 months but my 3 year old still enjoys many of these – at a different level.

By 6 months, vision is developed enough for baby to recognize some images and to begin understanding that pictures represent objects. Baby starts to prefer certain pictures, pages, or even entire stories read over and over! While you read, your baby will respond by grabbing for the book and vocalizing. By 12 months, your child will start to help turn pages, pat or start to point to objects on a page, and repeat your sounds.

Buy This: for this age, look for board books that are sturdy, that can be propped, and small enough for baby to try and hold – and taste! Babies love books with photos of babies, bright colors, textures, flaps and familiar objects. Also look for simple content with language that is short and repetitious.

Some Favorite Books in Our Home: Baby Faces, Colors, Giggle Baby, Peek-a-Who. Some Favorite Authors: Karen Katz (Where is Baby’s Bellybutton?), Sandra Boyton, and Eric Carle. A small plastic photo book with familiar faces is another great idea!

What are your family’s favorite books/authors?


Yesterday we covered “Buy This: What to look for in Books for Babies.” Today is “Not That: Things to Avoid in Books for Babies.”

Avoid books that are too wordy. You can always reword some parts, skip parts, etc. but remember you will be reading some of these books A LOT! The book on the left shows a great starter book – one color and one picture. The book on the right introduces many images, some of which baby may not even know (eggplant, beet).

Avoid books with fragile pop ups and paper pages. Choosing durable books in the early years will allow your child to explore the book, attempt to turn pages without the risk of tearing/ripping.

Avoid books that are too long. Attention span can be quite fleeting when babies start to move since that becomes quite a focus. Be okay with reading only a page or two!

Avoid the same type of book: Provide a variety, limit books that are too repetitive and look for those that rhyme! Babies seem to love those!


Here are some great Do’s and Don’ts when reading with your baby. It is so important to remember that it isn’t always about the content but about the actual act of reading. Speed up, slow down, point at pictures, make different sounds, etc. Realize that you won’t always finish every book, that your baby may lose interest. Have books throughout your home, in your car, diaper bag, etc. as an easy tool for distraction. Take the time to snuggle your little one and read the book through the eyes and heart of your child!

And to complete our “books” topic, check out this link called “Love Books!” It is a collection of many different blog posts of book reviews and corresponding activities! How cool is that — especially for our older kiddos! Can’t wait to check some of them out!
Happy Reading!

Buy This….Not That: Tummy Time

This December will be dedicated to offering ideas on the great and not-so-great gifts for infants birth to 12 months! Check back often!

We start with my favorite find for our 3rd child, wishing of course we had found it for #s 1 and 2! It’s the Lily Pad playmat by Nook. It is portable, washable and is PERFECT for tummy time! The cushion is made of breathable air cells, so there is always good air flow around your baby’s precious nose and mouth no matter what his head position. It is firm enough for baby to push into and work to pick his head up, YET cushy enough to soften the inevitable head bob face plant, even when placed directly on hardwood floor!

Enjoy this find and Happy Tummy Time!






Just as there are products out there that truly help our babies discover new ways to move, become aware of what their bodies can do, and encourage active development of pathways to increase the body-brain connection, there are also products that do all this hard work for them.

Product manufacturers create new items every year that make the hard work of developing seemingly easier and more fun, but often with unintended consequences. We don’t want our babies to be passive participants in the hard work of creating foundations for their own independence.

The Wingbo, pictured here, is an example of a product that seems to solve the problem of tummy time blues. However, the swing carriage is plastic and is the same every time you put your baby in it, offering no variety, the very hallmark of movement and movement development. Though it adds the element of whole body movement through space that your baby otherwise would not get, it does not encourage absolutely essential components of being on the tummy, which are:
1) getting active elongation/stretching of the hip flexors (hips are encouraged to be flexed),
2) active connection of the upper body and lower body through lateral weight shifting (upper body is wedged in a hard plastic container inhibiting active abdominal contraction), and
3) free exploration of movement on all planes of motion: front/back, side to side, and rotation (movement from legs and swing is primarily frontal).

All of these essential items are accomplished by simply placing baby down on a play mat surface, holding baby across your chest or lap on their tummy, or carrying them in a tummy down position.

So, please consider saving your money with this product and opt for a great playmat where your baby can do her own independent exploration of movement. If you have this product, no need to stop using it, but please have your baby enjoy it in small doses!432193_537511226260461_9834930_n

The Most Wonderful Time of the Year? Strategies to Help Keep it That Way!

We are nearly in the swing of all things Holiday and that means a more overwhelming “to do” list, schedule changes, and added stress for the adults.  It is also a time when many kiddos can become overstimulated, overscheduled, and overtired.  Here are some strategies that may help us all have a more “over”joyed holiday season with our kids:

Routine: DO try and stick with your routine to decrease stress levels of the family!   When possible, try keeping normal nap, bed, and eating times to avoid increased irritability.   If our babies and kiddos know that their routine “travels” too, they are less likely to be anxious or stressed by not knowing what is coming next.   Bringing a comfort item from home can also help with the differences.

Remind/Rehearse: For children preschool age and older, as the holidays approach, routines change at home but also significantly at school as well.  It is important to compensate by providing greater predictability and structure at home.   Some children may benefit from visual or verbal prompts to remind them of the different events throughout the day that stray from the “norm.” Consider making a holiday calendar.  Create a list or insert pictures of planned activities that are outside the regular routine.

Respect: DO show respect for your child’s age and stage.  At four months, I know that baby is more alert and becoming more attached to mama.  I want to be respectful of just how overwhelming new faces, sounds, smells, etc. may be to this new little life.   I also respect that my preschooler may still be a bit shy around family he has not seen in some time.  Talk to your child about good times with each relative. Then, as you introduce them, you can remind them of the pleasant story and your child may feel like they know them.  Pictures are also helpful!  If a child is sensitive to touch, perhaps offer for him to give a “high five” instead of a hug!

Realize: Do realize each child’s limits and build in some down/quiet time for the babies and younger kiddos!  Some quiet time with mom or dad, reading, talking or resting, often allows the child to reset.   When possible, try to schedule only one or two outings per day as this is often plenty for young kids.   Remember the malls and stores are now more crowded with people, “things,” decorations, etc.  This bombardment can overwhelm even the strongest of sensory systems!

Reward Yourself: Mamas are often the glue that keep the family together and running smoothly.  We can feel a tremendous emotional fatigue during the holidays -which means fewer emotional resources with which to manage our kids. If we are emotionally fatigued and anxious, we are not available to be there for our kids emotionally.  Try not to overload yourself with obligations or extra stressors . . . the holidays in themselves bring plenty of extra!  Sometimes with extra hands around you can get some extra “YOU” time.  Reward yourself mama, you deserve it!

Our childrens’ behavior is highly meaningful and they are communicating something with their actions.  It is our job to watch, listen and interpret the message.  I am hoping to be more aware of that this holiday season.

Now, on your marks, get set . . . “Holiday”!!  ~ Rachel


Tracking Tummy Time to Prevent Plagiocephaly and Torticollis

The importance of tummy time play cannot be overstated. Since the introduction of “Back to Sleep” in 1994, many published studies have cited an increase in medical diagnoses such as plagiocephaly, brachycephaly and torticollis*(see below for descriptions) and developmental delay of gross motor milestones. Though this program successfully cut in half the rate of Sudden Infant Death Syndrome (SIDS), the rise of other mostly-preventable diagnoses illustrate some of the unintended consequences of “Back to Sleep.”

Many parents are anxious or even fearful about the tummy down position because of its connection to SIDS. Just because an infant is awake, that anxiety does not dissipate, so parents often avoid placing their infants on their tummies from the start. In addition, parents are not aware of the importance of tummy time when babies are awake, so there is little reason for them to even try.

Tummy time is important for many reasons. Babies are often positioned in utero in asymmetrical positions, and many stay in the same position for most of pregnancy. These asymmetries do not disappear overnight after babies are born. They need to be worked out with babies’ spontaneous movements against the floor and gravity. Babies need to have plenty of time to move freely on the floor, to be out of containers such as car seats, infant seats, swings, and strollers. The position of choice when putting an awake baby down should be tummy down. Newborn babies do not have the strength to lift their heads for sustained periods of time. They rest their head on the floor with their cheek in contact and their neck turned 90 degrees. As long as they position themselves looking both directions, gravity and the floor provide a long, low-load stretch on the SCM and other muscles implicated in torticollis. Tummy time also eliminates any pressure on the back of the head, preventing flatness or allowing any flat spots to round out.

Parents should look at their baby from head to toe after birth to look for any asymmetries in baby’s preference for turning his head or flexing his body one direction or another. Parents can also take pictures of head shape over time to ensure that any flat spots round out. Keeping a photo diary or a log of activity over time helps parents to determine patterns that either exacerbate or alleviate any asymmetries present at birth.

I looked at a few different smart phone applications that would help me do just this after my son was born. I settled on iBabyLog, which is a great tool to track nursing, diapering, sleeping, and activity schedules (many other categories are also available for tracking). I can customize my comments, take photos, and easily look at patterns over time to track progress. For example, when putting my newborn son down for sleep, I make sure that he looks to the left one time and then to the right the other. When working on awake tummy time, I also track the time he looks left versus right. With the ability to track and summarize positions and alignment over the day and the week, it is easy for parents to notice any asymmetries that are present. And, at this very young age, parents have the power to fix asymmetries early with great results.

Using iBabyLog or other tracking tools to document positions during sleep and awake times can help parents to be more aware of their baby’s alignment. Proper alignment is a crucial foundation to symmetrical movement, which is essential for baby to properly achieve motor milestones. By being aware and tracking some of the foundation elements of movement, parents can intervene early and prevent medical problems in alignment and movement from ever occurring.

*      Plagiocephaly is a misshapen head secondary to abnormal and asymmetrical forces placed upon the skull as an infant’s head is growing. It causes a diagonal asymmetry with flatness on the back of one side of the head and protrusion of the opposite forward side. It affects the shape of face, position of eyes and ears, and shape and symmetry of joints of the jaw and cervical spine. Since “Back to Sleep” began, the incidence of plagiocephaly has increased from 1 in 300 to 1 in 15. Though many pediatricians state that misshapen heads are merely a cosmetic issue, there are two very important joints that articulate with and are affected by skull shape: the jaw (TMJ) and the upper cervical vertebrae (OA). Atypical alignment in any joint, but especially those that require simultaneous action of two sides, increases abnormal wear and tear, leading to premature joint breakdown, arthritis and pain. Though this is a well-known and accepted medical phenomenon, because the first “Back to Sleep” babies are only 18 years old, long-term consequences of this specific malalignment due to misshapen heads have not yet been documented in medical literature.

*      Torticollis is a shortening of the sternocleidomastoid (SCM) muscle on one side of the neck. Other neck muscles can be involved as well, but this muscle is most often implicated because of its long ropelike and very superficial location. When this muscle is short/contracted, your baby will have a head tilt to the same side, rotate to the opposite side, and prefer to extend head backwards rather than tuck his chin. Babies often avoid turning their head in the other direction and cannot achieve midline orientation of the head. Torticollis can be congenital, most often due to position in utero, or acquired, often due to asymmetrical head shape and positioning, such as with plagiocephaly. These two diagnoses frequently present together.

*      Brachycephaly is a flatness on the back of the head that is more symmetrical from left to right, but causes protrusions laterally on both sides, making the face and head wider than otherwise would be. It reduces the space for the cerebellum to grow and decreases the distance between the back of the head and spinal cord, possibly placing the spinal cord at greater risk for injury with any head injury. It also changes the orientation of jaw and cervical spine joints. Brachycephaly is due to constant pressure on the back of the head from sleeping and positioning in infant “containers” such as car seats, infant seats, strollers, and swings.

What I DIDN’T Expect The First Year . . . or the Second & Third Year!

My boys are now 3 months and 3 years old.  I find myself obsessed about the same thing with both of them, something I didn’t expect to be so obsessed with, something that I try and ensure that my boys get enough of each day.  Can anyone guess?  The “word on the street” (as I steal a phrase from Sesame Street) is SLEEP!!!

As most first time preggo mommies do, I devoured many a book when I was pregnant with #1 but did not even think to look into “sleep books.”  Isn’t that what babies do – eat, SLEEP, poop?  It’s simple – feed baby then baby sleeps peacefully in the super fancy crib in the super cool nursery you designed!  For many, this is how the story goes and the family travels happily down the proverbial sleep road.   In our case, it was different.  When baby #1 was about a month old and our lives had settled a bit, I was wondering why sleep was so tough for him.  I was obsessed with Googling (that’s got to be a word now) everything about infant sleep.  I was bonding (and continue to) with other new moms over this exact same topic at play dates, play gyms, and parks.   Early on, I relied on Dr. Harvey Karp’s “Happiest Baby on the Block” book and the 5 S’s.    As baby #1 got older, sleep (getting him to do it for a long period of time by himself) continued to be challenging.  By the time my first was 10 months old, I had read about sleep everywhere, gotten all of the advice I could stomach, and finally hired an online sleep consultant.  The sleep consultant was to advise me with MY child’s/family’s specific needs and to keep me accountable to follow through with changes that I knew would be extremely hard.  Since then, we have had waves of good and bad sleep – making it through sleep regressions, teething, and now, working through being scared of the dark.  Best advice: sleep begets sleep.  No matter how many times I try and trick the “system” and have my son stay up later so he sleeps later, it is an epic fail!!!

When Baby #2 came, I thought I was prepared.  I was armed with my “I am not going to do it like I did with Baby #1” sleep plan.  Well, at 3 months, it is better but not perfect!  This time, I have tried to get a routine/rhythm sooner.  This is out of pure necessity of needing time to take care of my 3 year old and take care of life.  The routine that I found most helpful is Tracy Hogg’s “The Baby Whisperer” EASY.   E = eat, A = activity, S = sleep, Y = You Time! The hardest part: the YOU time since I am trying to be “super mom!” The best part — knowing the general flow of what to “expect” in terms of how long baby should be awake at certain ages.  For example, at 3 months, Baby # 2 should be awake about 80 minutes before going back down for a nap and should nap about 3 or 4 times per day.  All babies follow similar sleep stages: I should look for yawns, and have him all but in the co-sleeper by yawn #3!!!  It doesn’t always work but it is better.  Best advice: even at a young age, there is a “flow” (if baby is healthy medically).

So, why this blog now?  Because there was one bump in the road that blind-sided me and, it is coming up again!  DAYLIGHT SAVINGS . . .November 4th . . .  there is no stopping it.  For those of you that have kiddos that can easily adjust, Yay for you and cheers to your extra hour of sleep.  For those that have babies and little kiddos that still struggle with the change,  the baby sleep site is always helpful to me.  “Falling back” is the hardest because even if we are “sleeping in” until 5.30 – that means a crazy 4.30 wake time soon.  Time to start preparing.

More reviews of our preferred baby books/references is coming soon to this blog but I simply wanted to share my “real life” reflections and obsessions.  I am still so amazed by my children and their development.  I have a 3 month old who is just learning about himself and his world, that his smile makes mommy smile, that his voice makes sweet sounds too, and that he has hands and they are cool.  I have a 3 year old whose hands are busy all day building, writing, coloring and who likes making things “dis-pear” by saying “abracadabra,” spending time in his pretend schools, forts, zoos, and oceans, and talking himself to sleep!   I can imagine a time soon when both boys will be difficult to wake (like their daddy) and I will be Googling “ways to wake up your teenager.”  Until then, I will keep traveling along this sleep road hoping that the gets easier.  Even though I am sleep-deprived and sleep-obsessed, I am blessed!  Sweet Dreams and Sweet Sleep for All!

~ Rachel

Tummy Time, Part II: Newborn to Four Weeks

The tummy down position for newborns looks awkward to adults. Babies have their little tushies in the air like a beetle, their legs tucked underneath them, and all their weight pushed forward on their upper chest and face. To most of us, that position looks like torture. To others, it may remind them of the yoga “child’s pose” that is meant to relax and center us, bringing our spirit back to a state of equilibrium. This position is actually exactly what a newborn infant needs to help calm and give them the opportunity to learn how to self-soothe. When newborns are on their tummy, the floor provides support to counteract the ballistic movements that are typical and can disorganize babies’ states of consciousness. Their arms are tucked underneath them with their hands conveniently close to their faces and mouths. Newborns frequently get their hands to their mouths when in this position. However, when on their back, they do not have the motor control to easily reach their hands to their mouths. The floor provides that support.

Full term, healthy newborns can turn their head each way and effectively clear their airway when awake and placed on a firm surface, so there is no need to be concerned about suffocation when baby is in this position. They drag their faces, including cheeks, lips, and chin across the floor, which provides rich sensory information to those parts of the face. Again, conveniently, these are the parts that are essential for feeding; the extra sensory information provided by the floor causes more frequent firing of neurons in this part of the brain, and strengthens the pathways that are needed to reinforce successful feeding.

In regards to vision, newborn infants see best 8-12 inches from their face. When on their tummy, parent and caregiver faces and voices (the best toy around) can easily be positioned in that precise spot so you can marvel, talk to and bond with your baby where they see you best. It also gives the parent an opportunity to lie down: Something all new parents need to do!  Also, if babies’ hand happens to move a bit away from their face, they can visually regard it and start learning about self-discovery: Wow, that is MY hand!

You can also start working on the coordinated connection/integration of auditory and visual information with behavioral/motor responses. By positioning yourself on the opposite side of way baby is facing and softly calling to your baby, they will first hear and then listen, locating your voice and the hearing sound of their name, responding with motor movements to try and turn their head the other direction in order to SEE the source of what they heard. This simple game helps to connect sensory information with motor output AND ends with an amazing gift to both you and the baby: They get to see your smiling face! Added bonuses are that they 1) crossed midline in the process, which strengthens the integration of right and left sides of the brain, and 2) practiced looking both directions, increasing mobility, length, and strength of joints and muscles on both sides of the body. It truly is amazing how a simple game can positively affect so many systems and contribute to their development and maturity.

One of the best ways to ensure that your baby likes tummy time is to start at birth. If your baby is still not tolerating this position well after consistently practicing throughout the day for a couple of weeks (such as short times after each diaper change), there are many ways to modify the tummy-down experience to make it easier and more successful. Try chest to chest tummy time, lap soothe tummy time, and tummy down carrying. If you are still struggling to help your baby enjoy this time, live workshops and individual consultations are available in the San Diego area and online video consultations are available for those further away!

A recent search for online videos of infants on their tummies highlighted a misconception that many parents have. Despite the very calm, happy babies that were on the floor on their tummies for minutes at a time, parent’s voice-overs indicated they thought they were torturing their babies, that they were doing this merely to follow doctors’ orders to force their babies to “workout.” Rather than interpreting what your feelings would be in this position, take the time to read your babies’ expressions. This position is one that calms and nurtures our newborns’ immature systems; it provides rich sensory and motor experiences that no other position provides; and it allows the opportunity for babies to build foundations in these domains that will positively contribute to development for the weeks, months and years ahead. Enjoy this position with your baby; it is one of the easiest and least expensive ways to support your babies’ development.

The content on this website is based on Wendi’s personal and professional experience and general research. It is not meant for individual medical diagnosis or treatment. If you are concerned about your child, please consult with your primary physician and/or therapist.