BabySparks App Store  BabySparks Play Store 

01 Nov

children-403582 960 720Have you heard? The American Academy of Pediatrics issued its 2016 recommendations about screen times for children. Their report makes it clear that there are long-term negative consequences for introducing screens too early or allowing kids to view them for too long. Screens includes electronic devices like smartphones, tablets, TVs, gaming consoles and other similar toys.

This group of over 64,000 pediatric professionals has reiterated its stance that entertainment screens should not be introduced before a child is 18 months old. After that, they recommend no more than one hour per day from 18 months to 5 years old, with parents actively watching with their young children to provide context.

Whoa, you say! That’s not possible – there are screens everywhere. Or, you might be thinking, I need to use screens to keep my young child quiet in public. We have all been there. This is not a guilt-inducing post – but a practical set of guidelines to help you navigate a challenging issue.


First Things First: Why Should You Care?

It’s just a little game or video time, right? Not so much. The pervasiveness of screens is increasing rapidly and, with it, research to determine the impact. For now, though, there is fairly universal agreement that too much screen time can lead to:

So that’s the bad news. Here’s the good news:

  1. It’s never too late to set guidelines for screen time. An easy option is to set a rule from the outset that screens are only for weekend use. Apple has come up with some handy tools to limit usage on iPad and iPhone that limit the need for you to be the enforcer.
  2. Just as screens and games have evolved in recent years, so too have non-electronic activities. For babies and toddlers, there are plenty of toys and books that can easily replace screens to keep kids engaged or distracted.
  3. When you are using screens, there are some apps that are better than others. Stay away from high-speed, action games and videos. Utilize games that require action/response from the toddler vs. those that are just for consuming fast imagery. Nursery rhyme apps, coloring apps, and letter drawing are some better choices.

Maureen O’Brien, PhD is a developmental psychologist, parenting coach and author of Advantage, Mom: 20 Lessons from a Parenting Pro, available at https://www.createspace.com/6024139 and Watch Me Grow: I’m One-Two-Three, available at http://amzn.to/1QtvyFlMore parenting tips and resources can be found on www.destinationparenting.com.

17 Oct

premieAccording to March of Dimes, approximately 1 in 10 babies are born prematurely in the US each year. Definitions are evolving, but premature babies are generally those born before 37 weeks gestation.
Most hospitals consider 24 week old fetuses viable, although some hospitals will treat them as young as 22 weeks. Delivering a baby at 24 weeks’ gestation is no guarantee of survival, but care in a Neonatal Intensive Care Units (NICU) can help increase the odds.

With every week that the fetus remains in utero, the higher the chance for thriving and surviving. By full-term all organ systems are mature and fully functioning, including the brain, lungs, heart, eyes, ears, bowel and muscles.

Fortunately, medical research and advances have increased the chances of survival in even the tiniest of babies. As a pediatric physical therapist, I have cared for these tiny “micro-preemies” from day one in the NICU and have had the pleasure of assisting many of them as they grow, thrive and become independent children.

With premature babies, their development may lag behind full-term babies in the earliest stages. That does not mean they will not catch up, but here are a few things to keep in mind to support your preemie.

Development in Premature vs. Full-Term Babies
When babies are born early, their systems have to continue development outside the protected environment of a mother’s womb. For this reason, there are several differences that should be taken into account when talking about the development of a premature baby, including:

1. Adjusted age vs. chronological age:
The adjusted age is calculated from the date a baby should have been born (the baby's due date). The chronological age is calculated from the actual birth date. Premature babies usually catch up with most developmental milestones by age two. Before this, and especially in the first year, they often develop in line with their adjusted age instead of their chronological (actual) age.

These differences may be demonstrated across many areas, including the timing of:

  • Gross motor skills (rolling over, crawling, walking)
  • Fine motor skills (pincer grasp, clapping)
  • Social skills (e.g., eye contact, smiling)
  • Speech (making vowel and consonant sounds)

Keep in Mind: The timing of their development milestones will most likely be aligned with their adjusted age, instead of their chronological age; so a baby that was born 2 months early will likely hit milestone ranges 2 months later than their age calculated on a calendar.

2. Muscle tone:
Premature babies often have less muscle bulk and tone than full-term babies. Their muscles are loose and floppy or sometimes described as "hypotonic." As newborns, this makes it harder for them to stay in a flexed position and may delay development of their motor skills. Full-term babies are able to keep themselves in a nicely flexed position with arms and legs tucked up (in the fetal position). I often explain to families that this is the result of their preemie babies having had a shorter “workout program” than a full-term infant. They did not get to push and kick against resistance the same time frame leading to lower muscle tone and overall body weakness. Because of this, it is strongly recommended for premature babies to be followed up by field specialists such as pediatric physical therapists. They can help them catch up and strengthen the right muscle groups to accelerate progress.

Keep in Mind: Preemies often need the support of specialists to help them overcome some of their limitations; talk to your doctor early to start getting them the help they need.

3. Brain development:
The brains of premature babies also had less time to develop, often resulting in lower gray matter volume and neural connectivity at birth. These differences can have implications in timing and quality of cognitive and social development.

premiebrain

For this reason, sleep is extremely important in the case of these little ones. It allows their brain and body to grow. Premature infants have two sleep states: active sleep and quiet sleep. Their brain is creating new pathways and perfecting wiring during these sleep cycles:

• Light sleep (also called active sleep or REM sleep) -
When a baby is in a light sleep, they will move around quite a bit and make some noise. You may even see the baby’s eyes open and rolling back into their head. Don’t worry, this is completely normal. They will spend most of their time in light sleep. As they grow older and stronger, they will begin to have more full cycles of light and deep sleep.
• Deep sleep (also called quiet sleep or non-REM sleep) -
This deep sleep is a baby's most restful stage of sleep. Most preemies will have very little deep sleep until they are closer to term in age.

Keep in Mind: Sleep is critical for all babies, but especially so for premature infants. Make sure you have a cozy environment for them and factor quiet sleep into your plans. Many babies are happy to sleep in strollers or on the go – for younger preemies, try to give them some consistent sleep in their beds.

With patience and attention, your premature baby will make their unique developmental journey step by step. Understanding their differences is the first step to your child’s wonderful journey ahead!

Editor's Note: When your premature baby is ready to start doing BabySparks activities, the app will automatically use their adjusted age to provide recommended activities. We do not recommend any premature baby doing development activities until a gestational age of at least 36 weeks.


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.

01 Oct

2016-10-1 object permanenceWhen babies reach around 4 months of age, they have a cognitive growth spurt. Skills appear that form the foundation of a new, more advanced way of thinking. One of the concepts that emerges around this age is what developmental psychologists call ‘object permanence.’

A simple way to understand object permanence is to imagine a magic trick where the magician puts a ball in his hand, covers it with a handkerchief, waves his hand over the handkerchief, and ‘voila’, the ball is gone. Except we know that it really isn’t. And we wonder what happened to it. We have all these thoughts because we know that even though we can't see it, the ball continues to exist, whereas for a young baby that hasn't developed this understanding, it is as if the ball no longer exists.

How does object permanence develop?
As with most complex concepts, object permanence develops gradually through various stages. It can usually be first observed around 4 or 5 months when babies realize that partially hidden objects are still there in their entirety (to see this in action, cover part of a stuffed animal with a blanket and watch the child reach for it). At around 8 months babies are able to recover objects that have been completely hidden if the item was hidden while they were looking. By the age of one, they even look for objects that were hidden while they were looking away, but might still only look for them in the last place where they saw them.

There is no clear consensus in the scientific community about the exact moment when object permanence emerges. Based on various experiments Swiss psychologist Jean Piaget, who first studied it, believed that it was around the age of 8 months. More recently, scientists have devised methods to more accurately estimate the onset - combining a baby's bodily and facial reactions with brain wave patterns measured via an EEG. Increasingly, their belief is that it emerges around the age of 4 months. To see what some of these experiments typically look like, click here.

A stepping-stone to other critical development milestones
To develop an understanding of object permanence babies must first be able to form mental representations of objects (they can picture a ball in their head vs. just seeing it in front of them). As their ability to understand object permanence grows, they exercise their ability to develop and manipulate these mental representations and vice versa. This link is very important as it makes it easier to understand how object permanence is related to subsequent critical development milestones, for example:

  • Working memory: object permanence is considered a method to evaluate working memory in early stages. It is easy to see the connection between the ability to form and use mental representations of objects and their last seen location, and working memory. Working memory is a core executive function and its capacity is often considered a strong predictor of cognitive abilities at a later age.
  • Separation anxiety: for babies to display this behavior, which usually peaks between months 9 and 18, they need to realize that Mom or Dad still exist when out of their sight. The link is very direct. This is the reason that, even though many parents struggle with separation anxiety, it is good to remember that not only it is perfectly normal, but also a sign of healthy cognitive and social-emotional development.
  • Symbolic thought: as children's understanding of object permanence and their ability to manipulate mental representations improve, symbolic thought gradually emerges. At around 18-20 months, it can be observed during play time, as they use an empty plastic bottle of water to represent a rocket or a wood block to represent a car. Later, they will also use symbolic thought to come up with the solution to a simple problem without having to use trial and error, as they have done until this stage.

The list continues, which is the reason that understanding this concept is such an important event in a child's overall early development. It opens a door to reaching other milestones for which this concept is a prerequisite and moves your child's understanding of how the world works significantly forward. Your child will develop this skill over time. You can support its development through simple games like peek-a-boo and hide-and-seek, or by doing some other of your Babysparks activities specifically designed for this purpose. Once again, your baby’s play time is doubling as learning time!


Maureen O’Brien, PhD is a developmental psychologist, parenting coach and author of Advantage, Mom: 20 Lessons from a Parenting Pro, available at https://www.createspace.com/6024139 and Watch Me Grow: I’m One-Two-Three, available at http://amzn.to/1QtvyFlMore parenting tips and resources can be found on www.destinationparenting.com.

13 Sep

tummytimeWhat is tummy time?
Simply put, tummy time is time your baby spends on their stomach while they are awake. Seems easy enough, right? As a pediatric physical therapist, I consider this topic the foundation for my profession. I enthusiastically proclaim the benefits of tummy time like a Southern Baptist preacher at church...or so I’ve been told by my patients’ parents.

Benefits of tummy time
In 1994, the "Back to Sleep" (now “Safe to Sleep”) campaign was launched - recommending infants sleep on their backs to reduce the risk of Sudden Infant Death Syndrome or SIDS. This National Institutes of Health campaign dramatically decreased the incidence of SIDS (over 50%), but also resulted in increased motor delays. A 2008 survey of 400 physical therapists found that two-thirds of those surveyed felt that they had seen an increase in motor delay over the prior six years.

What does “Back to Sleep” have to do with motor delays? Because babies are spending so much time on their backs (12 – 16 hours in the early months), they are missing out on some fundamental development that used to happen on their bellies. So it’s up to parents to make sure those babies spent time face-down when they are awake.

The American Academy of Pediatrics (AAP) recommends placing babies on their backs to sleep and on their tummies to play when they are awake and alert. Starting with a few minutes from birth can have long-reaching impacts in many health- and development-related areas. Take a look:

t1   Head & Brain:

  • Prevents cranial asymmetry (flat head/plagiocephaly) that can require helmeting
  • Increases body spatial awareness
  • Improves sensory integration (one benefit of this can be to decrease meltdowns due to overstimulation)
  • Supports progress in cognition

t2   Eyes:tummy

  • Improves hand-eye coordination
  • Supports visual motor depth perception

t3   Arms:

  • Improves strength and ability to reach
  • Helps prepare arms for crawling

t4   Tummy:

  • Decreases gas, constipation and improves gastrointestinal (GI) motility

t5   Hands:

  • Increases strength
  • Supports independence

t6   Hips & Legs:

  • Improves flexibility, strength and mobility
  • Helps prepare legs for crawling

t7   Neck & Back:

  • Prevents torticollis (atypical position of head and neck), which can require physical therapy
  • Strengthens shoulder, back and neck (crucial to reach future gross motor milestones)
  • Improves posture

Tummy time helps your baby crawl, grasp toys and eat?

Here are a few developmental skills babies acquire during the first year of life:

  • Cooing & babbling
  • Reaching and grasping a toy
  • Rolling
  • Eating
  • Sitting up using abdominal muscles
  • Crawling on all fours
  • Walking

All of them have one thing in common. Can you guess what that is?

To be performed they all require strength of the muscles on the front side of the body, known as flexors (e.g., muscles of the hips, quadriceps, stomach, head/mouth and neck). Babies strengthen these muscles by pushing against gravity – the most effective way to do that is lying face down. Babies that don't spend enough time on their bellies often have delays in areas ranging from talking and grasping to crawling and walking.

When to begin and how much time?
Tummy time can begin as soon as your little one comes home from the hospital. You can start by simply putting your baby on their tummy for a few minutes after every diaper change each day.

AAP recommends tummy time two to three times a day for three to five minutes each time from birth, with more time added gradually. AAP research also revealed at four months of age, babies who spend at least 80 minutes per day playing on their tummy while awake are able to more successfully reach motor milestones involving the prone (belly), supine (laying on the back), and sitting positions than those who spend less time playing on their tummy.

The Mayo Clinic recommends about 20 minutes a day. Start slowly. Place your baby on his belly for a minute or two at a time, four or five times per day. The goal is to increase each tummy time session to 10 minutes, four or five times a day. By four months of age, your baby can be on their tummy 90 minutes daily.

Different tummy time positions
Although 80-90 minutes sounds like a lot, it’s really not very much time throughout the course of a day. The BabySparks app includes several activities in tummy time position to make it more fun and engaging for your baby. You can also alternate different tummy time positions to help your baby adjust:

  • Tummy to Tummy: Lie down and place baby on your chest or tummy, so that you’re face-to-face.
  • Tummy Down Carry or Football Hold: Position one hand under the tummy and between the legs and carry baby facing down.
  • Prone on Lap: Place baby face-down across your lap.
  • Eye to Eye: Bend down so you are level with baby. Offer additional support by placing a rolled-up blanket under baby’s chest and shoulders.

Every minute that your baby spends on their tummy will make a difference. If you have done plenty of tummy time with baby, but are concerned they are not meeting their milestones, bring your concerns to the baby’s pediatrician or a health care provider.


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.

30 Aug

2016-08-31 Attachment

Just like adults, babies are social creatures and seek out others for love and comfort. They communicate from the start that they seek nurturing. For a long time, the parents’ emotional connection to the newborn was referred to as a bond that happened instantly. This put a lot of pressure on new parents who needed a bit more time to adjust to their new caregiving role. We now know that the burgeoning parent-infant relationship is actually more like a marathon than a sprint. The relationship process, or attachment, does not happen overnight. Rather, attachment is created over the course of thousands of brief but meaningful parent-child interactions that occur as part of daily caregiving in the first year or two. Every diaper change, every bottle or breast feeding, every gentle touch; all contribute to attachment. As such, attachment takes many months to fully develop.

What is secure attachment?
Nearly 50 years of research on the subject have taught us a lot about how attachment forms, as well as its lifelong benefits. Babies come into the world prewired to understand that their survival depends on others. But attachment is about more than survival; it’s an emotional connection that meets the needs of both parent and child. It’s often described it as a dance, because when babies have a strong, secure attachment with their caregivers, there is a smooth, give and take quality that feels effortless between them. That is not to say that babies who are securely attached never cry or fuss, because they do. But securely attached babies are distinguished by the way they are more easily comforted in the presence of their nurturing caregiver. They actively seek out their caregivers when they are distressed, without being overly clingy or dependent on their parent. As they grow, they are able to explore their environment with confidence, and return as needed for emotional connection.

How can parents support secure attachment?
Parents who react sensitively and consistently to their infants put them on the pathway to secure attachment. The idea is that babies who regularly receive such care start to see the world as a dependable and nurturing place. They can then focus their attention on learning about the world and their place in it, instead of being concerned with whether they will be nurtured.

How do we know what babies experience when they feel this way? For decades, the strategy researchers used to study secure attachment was videotaping parents and their infants together under mildly stressful situations, and then observing the tiny moments of connection that occurred, or didn’t occur. More recent research uses cortisol (a stress hormone) to measure a child’s level of response. Interestingly, it is under moments of stress, such as separating from their caregiver and then reuniting, that securely attached babies show the clearest signs of healthy relationships. Usually, this is shown through crying at some point during the separation, then recovering well soon after the parent returns to comfort them, and finally moving on to happily play.

Parents are often distressed when they hear their infants cry when they are apart, but this is actually a positive attachment sign; the baby is communicating that their “secure base” is out of their sight. What matters most is what happens next. Babies who feel safe in the world usually recover in the presence of others who care for them. Their energy gradually returns to playing, feeding or otherwise interacting with those around them. There is also a clear difference in how calm and reassured they are in the presence of their parent (or other primary caregiver) compared to the reassuring presence of someone less familiar to them. Even before verbally able to say so, your baby is communicating, “I feel better when I see you. I trust that you’ll take care of me.”

Does this mean I need to respond to every whimper or risk attachment problems?
No, not at all. Attachment doesn’t require you to be at your baby’s side every second. Some have misinterpreted attachment research to think that this is the case. In fact, the parent-child relationship is meant to be a balance between dependence and independence. In the early months, babies cry for a lot of reasons: discomfort, overtiredness, and hunger are a few. Parents need to be reasonably available to their baby’s needs, but that doesn’t mean that a baby shouldn’t be given the opportunity to learn to self-comfort at times. In fact, that is an important skill for infants to learn over time. Parents across cultures differ in terms of how comfortable they are with letting their babies cry. They get a lot of advice about how to behave from family members and strangers alike about crying, spoiling, sleep routines, and more. Know that the evidence shows that a wide variety of parenting approaches can result in secure attachment. So as long as you are fairly consistent and nurturing with your baby, you will develop a healthy relationship pattern that works for the both of you.

Can babies have more than one attachment?
The answer to this, experts agree, is yes. This research should be reassuring to working parents who worry that prolonged absences from their infant is a risk to a secure attachment between them. Babies can hold simultaneous secure attachments with adults who regularly nurture them. The key is to be fully present when with babies, so that you can truly read their cues. It takes practice to distinguish between a hungry cry and an overtired one. It takes patience to snuggle an upset infant and figure out what works best; whether rocking, swaddling or humming (or a combination of all three.) If your baby interacts with multiple caregivers on a regular basis, it is key to communicate what each of you has learned about your baby’s temperament and which strategies work best to reassure her. It is equally important to agree on which tactics and routines to implement. This will teach the infant that the world is a predictable, comforting place and that she can rely on all of you to meet her needs when she is distressed.

What are the benefits of healthy attachment?
Studies show that an early, healthy attachment is one of the strongest predictors of a child’s well being. Among the positive outcomes are children who grow up to be self-reliant, manage stress well, do better in school and form healthier relationships themselves. So certainly, healthy attachment is the goal all parents want for their children. And the best way to achieve it is to recognize that no single interaction is going to make or break the attachment, but rather to commit to be being as responsive, nurturing and consistent you can be with your infant. The dance you and your baby do together will not always be perfect, but your relationship will certainly benefit from your constant, loving efforts.


Maureen O’Brien, PhD is a developmental psychologist, parenting coach and author of Advantage, Mom: 20 Lessons from a Parenting Pro, available at https://www.createspace.com/6024139 and Watch Me Grow: I’m One-Two-Three, available at http://amzn.to/1QtvyFlMore parenting tips and resources can be found on www.destinationparenting.com.