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10 Mar

23aGreat news! Your sweet baby has graduated from the NICU and is now home. This means he can breathe, eat, regulate his body temperature, and is maintaining a healthy weight.

In a full-term baby (40 weeks), all organ systems are mature and fully functioning when he is born. This includes his brain, lungs, heart, eyes, ears, bowel and muscles. When a baby is born earlier than 37 weeks, these systems must develop outside the womb, which means your baby will need your help.

Below are ways to support your baby’s development in three important areas: Muscle tone and strength, gastrointestinal (GI) tract, and sensory system (auditory, tactile, smell/taste, and vision).

MUSCLE TONE & STRENGTH

Premature babies tend to be weak and hypotonic (low muscle tone), especially through the trunk. It’s difficult for them to bring their hands to their mouths and keep them there, which is important because when babies bring their hands to their mouths they are learning to cross the midline (the middle of the body). Crossing the midline is integral to things like coordination and balance.

It’s also hard for them to stay in flexion (curled up). They will try to gain a sense of control by stiffening their muscles. They may arch, stick their limbs out straight, make fists, or point their toes. Your baby will start to relax these movements as he gains strength and control through the trunk.

How to Help

  • Keep your baby in flexion. Full-term babies inside the womb are in flexion and pushing against the uterus, which builds muscle tone. You can help your premature baby by swaddling him or keeping his limbs bent and tucked in when you position or carry him.
  • Adjust your baby’s positioning in the following areas: Behind the head—keep his chin tucked to his chest. Behind the shoulders—bring his arms forward and his hands to his mouth. Along the hips—bring his legs together. Under the knees—keep his knees bent.
  • Focus on midline. Keep his head in the middle, facing forward, and bring his hands to his mouth.

In the beginning your baby will need continuous support. As he gains strength and control over his body, he will need increasingly less help.

GI TRACT

It’s often difficult for premature babies to pass stool. Even though their stools are not hard, they may appear constipated or strain during a bowel movement. This is because their abdominal muscles are weak. It takes a lot of abdominal strength to move stool!

How to Help

  • Swaddle your baby. Swaddling pulls your baby’s body in towards the abdominal muscles, which turns them on and helps them get stronger.
  • Do GI massage. Your pediatric physical therapist can show you how to massage your baby to manually help move stool through his body.
  • Do appropriate abdominal exercises. Your pediatric physical therapist can also teach you exercises to help him move stool.

SENSORY SYSTEM

Because premature babies have trouble integrating the information they receive through sound, touch, smell/taste and sight, they can easily become fussy or lethargic. Your baby will give you cues to let you know if he wants to interact, or if he needs a break.

Cues that he wants to interact: He is quiet and alert, with his eyes open and focused. His body is relaxed. His arms and legs are tucked in. His hands are at his mouth. He is smiling (around 6 weeks corrected age), or cooing.

Cues that he is overstimulated and needs a break: He is looking away. He appears stressed. His body is limp or stiff. He is yawning or sleepy. He has hiccups or is spitting up.

How to Help

  • Bonding touch. Touch, when your baby is showing you that he wants to interact, can help calm and regulate your baby. Provide calming, firm pressure, as soft strokes can be overstimulating. Skin-to-skin touch is also helpful. Lay your bare baby on your bare chest and cover him with a blanket.
  • Infant Massage. Studies show that for premature babies, regular massage can lead to better growth and development, better intake of oxygen, and a slowed heart rate during and after massage. Ask your pediatric physical therapist to help you learn this skill.
  • Swaddling. A firm swaddle with your baby’s arms and legs tucked nicely creates a sense of security, and helps him regulate sensory information he receives from his environment.

These tips should get you off to a great start with your little one. For more ideas, our BabySparks app includes over 100 activities designed specifically to support the development in babies 0-3 months.


Morgan Bryant, PT, DPT has a doctorate in physical therapy, practice owner of Matrix Rehab, LLC visit www.matrixrehab.net, wife and mother of 2.

08 Mar

22You might have thought breastfeeding would be a breeze. What could be easier than feeding your baby as nature intended, right? The truth is that breastfeeding can be tricky, and for many mothers and new babies it takes practice to get into a groove. Here are some of the top tips to help you get started.

Feed frequently, especially at the beginning. Because new babies have tiny tummies and seek closeness, yours will likely want to breastfeed often. Frequent breastfeeding also helps establish your milk supply because it sends a message to your body to make more milk. Many experts recommend that for at least the first month you feed your baby on-demand (whenever he is hungry). Others, like Tracy Hogg, author of the “The Baby Whisperer”, say you can start a feeding routine as early as 4 days old. Some mothers and babies are better suited for routine, and feeding every 2-2.5 hours works well. Others do better with feeding on-demand. The important thing to remember is that if you try a routine, you should still feed your new baby if he shows signs of hunger before the next scheduled feeding. Signs of hunger include rooting for the breast, sucking on his hand, restlessness, and crying.

Pay attention to positioning. There are several ways to position yourself and your baby for breastfeeding. Here is a great slideshow on nursing positions you can try. Check to make sure you are comfortable and your back and feet are supported; you are not feeling any pain; and your baby is supported, latched on well, and feeding efficiently (more on latch and efficient feeding below). A nursing pillow (like the Boppy or the My Brest Friend) can also help you position your baby.

Make sure your baby is latching on correctly. Latching refers to the way your baby places his mouth and establishes suction on your breast. Poor latch is a common source of breastfeeding woes, like inefficient intake of milk and ongoing nipple soreness. It is normal for nipples to be sore, and even cracked, for the first few weeks (you can rub breastmilk or nipple ointment on them), but if breastfeeding remains painful it might be due to poor latch. For a good latch, you want your baby to open his mouth wide and place his mouth around your areola, not your nipple. To get your baby to open wide, tickle or gently pull on his chin and then guide your breast into his mouth.

In some instances (if you have flat nipples or your baby is born early, for example) getting a good latch can be difficult at first. Temporary use of a nipple shield can help your baby learn to latch on (and save you from ongoing nipple soreness).

Listen for an even suck/swallow rhythm. One sign of proper latch and efficient breastfeeding is the sound of a suck/swallow rhythm. This indicates that your baby is getting a steady flow of milk.

Stick to one breast per feeding. Throughout a feeding, the consistency and fat content of breastmilk changes. It starts out thinner (foremilk) and becomes thicker towards the end (hindmilk). Hindmilk is higher in fat and is important for your baby’s weight gain. To ensure that your baby is getting hindmilk, stick to one side until it’s empty. If your baby wants to continue, switch to the other side. If he’s satisfied, start with the other side at the next feeding.

Share a room with your baby. When you are feeding your new baby frequently at night, having him in a bassinet next to your bed will make nighttime feedings less disruptive for you.

Keep track of diapers. After your baby’s first week of life, he should have 6 or more wet diapers in a 24-hour period. His stool will be yellow, seedy, and loose. This, along with normal weight gain, are indicators that he is getting enough breastmilk.

Take care of yourself. Try to eat well, drink plenty of fluids, rest when you can, and make sure any medications you take are breastfeeding-approved. Also, ask your pediatrician if you should give your baby vitamin D supplements, as many exclusively breastfed babies do not get enough through breastmilk alone.

Ask for help! Lactation consultants are trained professionals who can help answer breastfeeding questions and troubleshoot any bumps in the road. The hospital where you gave birth, your pediatrician, or even an internet search can help you find a lactation consultant in your area.

If breastfeeding is difficult but important to you, don’t give up! It can take a few to several weeks to get into a groove, and challenges can pop up from time to time after that. But, with some troubleshooting and/or professional help, you can get on track and enjoy this special time with your baby.

02 Mar

21As any adult who’s had trouble sleeping knows, the habits around sleep (like winding down before bed and creating a comfortable sleeping environment) play a big role in falling and staying asleep. Good sleep habits are lifelong skills that you can start teaching your baby from day one. These habits can also set the stage for successful sleep training, which many parents turn to when their babies are around 4-6 months old.

Below are common tips for instilling good sleep habits for your baby, separated into two age groups, since babies younger than 3 months have different needs than older babies.

Sleep Habits for Babies 0-3 Months

Although opinions differ about every aspect of baby sleep, most child development experts advise that until 3 months of age you go with your baby’s flow. He will need to eat frequently both day and night, and he will seek comfort as he adjusts to the world after months of being in a cozy womb. Even though it might be too early for a schedule at this age, you can still do the following to promote good sleep:

  • Keep daytime bright and gently active. In the morning, open the curtains and let light into the room. Give your baby tummy time, sing, play, do your BabySparks activities with him, and take him outside for fresh air. We say “gently active” because babies at this age can easily become overstimulated. They also need lots of cuddles!
  • Avoid an overtired state. When we are overtired, our brains produce the stress hormone cortisol, which wakes us up. Watch your baby for signs that he’s tired, like yawning or rubbing his eyes, and help him fall asleep before he becomes overtired.
  • Keep nighttime calm, dark, and quiet. Close the curtains and use a soft voice. When it’s time for sleep, consider using a white noise machine to drown out sounds (like loading the dishwasher or still-awake older siblings).
  • Create a comfortable sleeping environment. Soft pajamas and sheets and a moderate temperature in the room can help.

Sleep Habits for Babies 3+ Months

At this age, babies are typically ready for more routine. You can set feeding, nap, and sleep schedules. While it’s generally not an issue to feed newborns to sleep, many experts agree that by 3 months it might be good for babies to learn to fall asleep by different means so they do not become dependent on nursing or bottle feeding. Here are things you can add to promote sleep when your baby turns 3 months old:

  • Develop a schedule. Set a regular wake-up time, mealtimes, nap times, and bedtime. This can help your baby prepare for sleep at predictable times.
  • Follow a bedtime routine. A bedtime routine (bath, book, lullaby, for example) both calm your baby down and condition him to prepare for sleep. Routines can be brief and simple or long and elaborate, depending on how much time you have. The important thing is to do similar things in a similar order at a similar time each night.
  • Replace feeding-to-sleep with another activity. To avoid your baby becoming dependent on nursing or bottle-feeding to fall asleep, try feeding him at the start of your bedtime routine. As the last step, try rocking or gently bouncing your baby until he’s sleepy but still awake, then put him in his crib to finish falling asleep on his own. When babies start getting a majority of calories from solid food (by 12 months or so), you can consider dropping the before-bed nursing or bottle altogether. Your pediatrician can help you determine when that’s appropriate for your baby.
  • Give baby a chance to settle on his own. Sometimes babies wake up, make noise or even cry, but quickly settle on their own. If your baby fusses in the night, try waiting a minute before you respond to see if he really needs your help.

The key to maximizing good sleep habits is to stay as consistent as possible. These habits will help ease changes like traveling or switching from a crib to a bed, and will serve your child for a lifetime.

02 Mar

20If you’re a parent of a new baby, you’re probably tired! Most new babies wake up frequently. Tiny tummies fill up and empty quickly, and babies seek comfort as they adjust from womb to world. Child development experts tend to agree that for the first 4-6 months, it’s best to wake up with your baby at night to ensure that she is fed and comforted.

The good news is that if your baby is healthy and your pediatrician gives you the okay to stop feeding her at night, you can consider sleep training.

What is Sleep Training?

Sleep training is a wide range of methods aimed at teaching your baby to fall asleep on her own at bedtime and when she wakes in the night. Before starting, see our article on creating good sleep habits, which are a common thread in all of the approaches below.

How do I Choose a Method?

To decide which method to try, think about your baby’s personality, and yours. Consider how different approaches might affect other family members, like older siblings. If you share caregiving with anyone else, talk to that person about what would work for both of you. The dynamics of every household are different, so choosing how to sleep-train your baby will be a personal decision based on what feels right for your family.

The Three Most-Common Sleep Training Approaches

While there are many sleep training methods, most of them fall into one of the categories below.

Cry It Out

Cry It Out (CIO) involves allowing your baby to cry when you put her to bed or when she wakes in the night. Supporters say it works quickly to teach babies how to self-soothe and fall asleep without needing you to intervene.

CIO might be a good fit if your baby is generally easy-going, or if sleep deprivation is negatively affecting your functioning.

Two popular proponents of CIO are Dr. Richard Ferber, author of “Solve Your Child’s Sleep”, and Dr. Marc Weissbluth, author of “Healthy Sleep Habits, Happy Child.” Ferber developed a method that guides you to respond briefly to your baby’s cries (without picking her up) at increasingly longer intervals until she falls asleep. Weissbluth advocates for a stricter CIO method involving less parental intervention.

No-Cry

No-Cry methods encourage parents to use gentle approaches to help baby sleep, and say it’s okay to respond to babies by picking up, holding, rocking or feeding them when they wake in the night. Supporters say it promotes bonding, baby’s emotional development, and a positive association with sleep.

This might be a good fit if you don’t mind waking up in the night with your baby, or you want to try the most gentle approach first.

Elizabeth Pantley, a parent educator and author of “The No-Cry Sleep Solution”, is a well-known proponent of no-cry methods. Pantley offers tips for gradually teaching your baby to self-soothe without allowing her to cry, like rocking her until she's very drowsy but not fully asleep before putting her in her crib.

In-Between Methods

“In-Between” methods are a middle ground between CIO and no-cry approaches. Parents intervene in limited, systematic ways to help baby fall asleep. Supporters of this approach say it teaches independent sleep with very little crying.

This might be a good fit if you prefer a middle-ground approach and are willing to put in some time, effort, and patience to follow the method you choose.

Kim West, a licensed clinical social worker and author of “Good Night, Sleep Tight”, suggests sitting next to your baby’s crib for a few nights, where you can offer a pat or reassuring word if she becomes upset. Every few nights, she says, move further from the crib ­to the other side of the room, then the doorway, then the hall, and so on, until your baby can fall asleep without you in the room. Tracy Hogg, nurse and author of “The Baby Whisperer” books, developed the Pick Up/Put Down method: Pick up your baby from her crib when she cries, then put her down as soon as she is calm, and repeat this until she is asleep.

No matter how you choose to sleep-train your baby, one of the most important things to remember is this: Research shows that all of these methods are effective if followed consistently. Choose one that feels right for you, and stay the course. Before long you should be seeing zzzs!

21 Feb

EatingOne of the biggest questions new parents have is when to introduce different types of solid foods. As specialists in feeding, speech and language, Integrated Children’s Therapy (ICT) has a simple approach: When your baby reaches new gross motor milestones (like sitting up, crawl-ing, or walking) that’s your cue to introduce new types of food. This is because your baby’s oral motor skills (like biting, chewing, and swallowing) develop alongside his gross motor skills. When he’s ready to do something new with his body, he’s also ready to do something new with his mouth.

Why is it important to introduce solid foods at the right times?

According to ICT co-founder Mandy Alvarez and one of their speech language pathologists, Chris Rowlee, introducing solid foods either too early or too late can lead to food aversions, obesity and other health problems, and speech-language delays. By introducing foods at the right times, you can avoid these problems and set your baby up for a lifetime of healthy eating.

Here’s more information about how three gross motor milestones relate to feeding and speech, and how you can set your baby up for success!

Sitting Up = Purees on a Spoon

Feeding

We recommend that unless your baby has a medical issue (like reflux), you stick with breast milk, formula, or a combination of the two until your baby can hold his head up and sit with little to no support. This typically occurs around 6 months of age.

As your baby begins to control his head and sit up, his larynx (voice box) lowers, his cheeks thin out, and his body becomes stronger and more mobile. All of this leads to the jaw stability and tongue movement required to eat purees from a spoon.

Speech

The body and mouth movements that develop with sitting and eating purees prepare your baby to babble. Your baby will begin to make lip sounds like “ba-ba” and “ma-ma”, and tongue sounds like“da-da”.

Extra Tip

To optimize oral motor development and encourage your baby to eat new things, try making your own pureed food. This will give the food more texture and different tastes, as store-bought purees tend to be very finely pureed and similar-tasting. We get it that this can be time consum-ing! As an alternative, try mashing up a banana or avocado and adding it to store-bought pu-rees.

Crawling = Soft Foods to Chew

Feeding

The left-right movements of crawling are also happening with your baby’s jaw, tongue and lips, so when he begins crawling he is ready for soft foods that he can bite and chew. Try pieces of cooked vegetables, soft fruits, or pasta. As a bonus, when you give your baby these foods on a tray or plate and encourage him to eat with his fingers, he is using his thumb and first fingers in what’s known as the pincer grasp. This fine motor skill will be crucial later on for skills like hold-ing utensils, crayons, and pencils.

Speech

The coordination and strength involved in biting and chewing help your baby make more com-plicated speech sounds. Babbling will now have different combinations of sounds (da-gee-da).

Extra Tip

Let your baby get messy! Imagine if someone was constantly wiping your face and hands with a wet cloth during a meal. You’d probably get turned off by the whole experience! Babies learn through curiosity, so we say let them smush food between their fingers, get it on their faces, and rub it around the tray or plate. This sends the message that eating is a pleasurable experience and encourages them to try different things.

Walking = Variety of Foods

Feeding

Walking brings in increased up-down, left-right, and side-to-side movements, which lead to a more controlled ability to bite and chew. Your baby can now begin to handle a variety of tex-tures, like harder vegetables, cubed fruits, cheese, and soft meats.

Speech

When your baby’s jaws, tongue and lips are coordinated enough for more complicated biting and chewing, more complex speech will emerge, like jargon (making sounds that imitate adult speech) and his first true words.

Extra Tip

Allow your baby to feed himself. At this stage he might become interested in using a utensil, but if not it’s okay to let him eat with his hands. It’s important for him to control both the amount of food he eats and how fast he eats it. We also encourage creative eating at this age; if he wants to scoop up food with a cracker instead of a spoon, or if he wants to use a spoon backwards, let him go for it! Babies that learn to feed themselves typically become better feeders for life.

In addition to following this approach, you can find a variety of exercises on the BabySparks app designed to help you introduce solid foods to your baby and encourage him to feed himself.


Integrated Children's Therapy is a pediatric speech and occupational therapy practice in Miami, FL. ICT provides individual and group therapy for speech, language, feeding and sensory-motor issues - all with a special emphasis on social communication development.