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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.

03 Aug

20160803 music3

Music is a vital part of human culture. It’s how stories are told, it’s a powerful way to express emotions, and can be how we tell someone we love them. Music can be calming, energizing, spirit lifting and concentration inducing. Studies show that certain types of music can stimulate parts of the brain responsible for expressive language, problem solving, and improved memory. In babies, music has a profound effect on learning and development in a broad range of critical areas, which is why it is important that your child experiences music as young as possible.

Communication Skills
When my daughter was first born, I would sing her to sleep every night and it was one of the only things that would calm her down and soothe her to sleep. 8 months later, I sing her the same lullabies and she tries to sing along. Babies often begin developing language by babbling in long drawn out musical tunes.

When a child sings, key areas of the brain related with output and input of speech engage. As a result, it is not surprising that studies show that babies who engage in music frequently are likely to speak earlier in life. The more she engages with the music, by moving to the rhythm or by playing simple instruments (e.g., drums or maracas) the bigger the benefits on this area.

Cognitive Development
The cognitive benefits of music are multiple. It provides a channel for children to learn basic concepts in an entertaining fashion. Think about songs like “Head, Shoulders, Knees, and Toes,” which teaches children the parts of their body while they are dancing or "Old McDonald," which helps them to learn animal sounds.

Playing with instruments is a great way to introduce the concept of cause and effect while experiencing music. Your baby can play along to the music or create their own, all while developing an understanding of sound, pitch, tone, and rhythm.

Music helps strengthen neural pathways in the brain responsible for learning and memory. Babies as young as 6 months old can recognize a tune they’ve heard two weeks before. It also helps develop problem-solving skills.

Motor Development
Clapping to the beat and dancing to music adds a physical element. It helps children learn rhythm and body awareness while exercising. Songs with sequential dance moves like the Macarena teach children coordination and timing.

Performing the hand gestures for the Itsy Bitsy Spider helps children develop coordination and fine motor skills. When they are older, learning to play an instrument continues to provide similar motor benefits.

Social-Emotional Benefits
Singing, clapping, dancing or simply enjoying music with your baby will likely turn into a fun and bonding experience. In different studies with mice and humans, researchers have discovered that singing and listening to music resulted in higher oxytocin levels in the body. Oxytocin is a neuropeptide released during breastfeeding often called the "bonding" hormone as it serves as a catalyst for increased trust and bonding between people.

Because music is so significant to development, it is important to nurture your baby’s natural curiosity and enthusiasm towards it. Most often, classical music is suggested due to its intricate compositions and the variety of instruments that it incorporates. However, any music will work as long as you experience it together. Remember that babies learn from their environment and take cues from their parents, so play, clap and sing with your baby. And don’t worry, your baby won’t notice if you don’t have a great voice.


Heather Gordon is a certified occupational therapy assistant, mom, and writer. Follow her blog at: http://heathersabovethedin.blogspot.com/

18 Jul

2016-07-24 EmpathyYou’ve seen it for sure. Your baby looks at your concerned face, and the bright smile washes away from hers. Or your toddler looks over at the crying child at the playground, frowns and hands him a toy. Can babies and toddlers be so intuitive about emotions at such a young age? Or are they imitating without actually feeling the same way? Early childhood researchers are getting to the root of such complex questions, thanks to creative experiments and brain imaging techniques. One of the areas under study is the development of empathy, which is defined as the ability to imagine how someone else is feeling in a particular situation and respond with care.

Until quite recently, we thought babies and toddlers were too young for empathy, but it’s not true. For example, the skills needed to be empathetic include understanding how others feel and recognizing that you are a different person than your caregiver. Babies certainly do that in the first two years. As discussed in other BabySparks articles, babies learn to understand the world and the people around them in part by referencing their parents. As early as 6 months, babies show sensitivity to their parents’ emotions, which is one reason parents are encouraged to act upbeat when separating from their infants.

Scientists know that certain areas of the brain ­including the frontal and parietal lobes­ are actively involved in how humans develop ‘social intelligence’. Now they are digging into the specific brain circuitry behind it, and their search has highlighted the role of ‘mirror neurons’. Mirror neurons fire both when we do an action ourselves, and when we watch others do a similar action. This means the infant is learning from her environment and she learns best through loving, responsive interactions with caregivers. For example, when your toddler points at a dog and looks concerned, she looks to you for your response. If you say, “Uh, oh. You look worried. Let me pick you up, so you feel safe around the puppy,” you are helping these pathways develop. And when you smile as you proceed to pet the puppy, your child learns to take her cues from your relaxed response and her stress levels will mirror yours. In this way you are role model for empathy.

Why does empathy matter? How can I support it in my baby?

Empathy is a foundational skill that will help your child understand the emotions and experiences of people around her. This is an important anchor of your child's social development and her ability to build friendships and other important interpersonal relationships with children and adults as she grows. Caring adults who role model and prioritize empathy play a vital role and parents have opportunity to influence empathy at home, as I discuss in my latest book, Advantage, Mom: 20 Lessons from a Parenting Pro. We live in a society where middle and high school aged children often value achievement and individual happiness over caring for others, so it’s never too early to start encouraging empathy.

Think of yourself as your child’s emotion coach. Point out feelings and talk about them throughout your day. Your child may not understand every word, but she’ll cue into the fact that you are paying attention to how she treats others. A few ways to begin:

  • Praise your little one when she acts in a way that shows concern for others, whether it’s waiting her turn going down the slide or hugging her distressed friend. Rather than saying, “What a good girl for helping”, say “Look how happy Vin is that you found his train and gave it to him!”
  • Engage in games like peek-a-boo and itsy-bitsy spider. Remember to exaggerate your facial expressions, gestures, and tone of voice. This communicates increased excitement and promotes your child’s focus for learning the sequence and steps of the game. During these activities the baby is able to mirror what’s going on, which is one way to practice the feeling of being in-sync with their partner by matching the partner’s actions.
  • Choose books that talk about feelings or picture books that show different emotions. Ask questions, like “How do you think the little boy felt when he fell down? Look how happy he is when his daddy picked him up.”

Moving along the road to empathy

Development of empathy changes a great deal in the first few years. For instance, when one-year-olds witness another child crying from an injury, they seem to realize that distress is being felt by someone else, yet they're often confused over what to do about it. They will, for instance, look at their own finger if they see another child’s finger is hurt, as if to double-check who is hurt. Beginning in the second year, they will offer active support, like hugs or giving a toy to the other child. Because toddlers are impulsive and still egocentric, this will not always happen; the same toddler who offers a toy today may hit his playmate with the toy tomorrow. But, like most abilities, your child will develop her skills over time. In most children, acts of empathy will eventually become more routine by age 3 or 4. So your patience is needed, along with your coaching, in order for your child’s abilities to blossom.


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.

05 Jul

20160707finemotor smallFine motor skills are often thought of as the movements of the fingers and hands, but they also include movements of the toes, mouth, and eyes.

Many important tasks related to fine motor skills, like tying shoes, writing, or eating independently develop after the first or second year of life.  For this reason, it is common for many parents to de-emphasize this area with their infants and young toddlers. But during their first two years of life, children develop the key foundational elements upon which fine motor skills rely for appropriate development.

For example, in order for a child to learn to fasten buttons, among other skills, he first needs to have a good pincer grasp to handle the button, as well as a good hand-eye and bimanual coordination.  All of these are skills that a baby begins to develop during his first year. A similar analysis could be done for other complex fine motor tasks like fastening their pants for independent dressing, scooping food and bringing it to their mouth, or grasping a pencil for writing and coloring

In general, for a child to be able to perform these types of tasks and continue to develop other sophisticated fine motor skills, he will first need to be able to:

Perceive the texture, shape and details of an object in his hand

Try to perform any of the fine motor activities above with gloves. Fastening a button, tying a shoe or any other similar task can be significantly more challenging. The thicker the gloves, the more difficult it will be. Similarly, if a child has any type of sensory issue that results in poor tactile perception, he will struggle with these type of tasks. There are plenty of fun activities to support your baby's sensory development.  You can start as early as his first month of life and babies usually love them.

Adequately manipulate the object with his hand

Even if your child has a good tactile perception, he also needs to be able to manipulate the object accurately with his hand.  In the example of fastening a button, he needs to be able move the button towards the buttonhole and then line the two up properly. It also requires some strength to be able to push the button through to the other side. Strengthening his hand muscles and learning how to use his fingers with accuracy are crucial to this process.

Coordinate the movements of both hands and arms

Often fine motor tasks require some form of bilateral coordination. Take, for example, cutting paper with scissors. Even if you are very skilled managing scissors, try cutting a simple shape with just one hand.  Activities that involve clapping, changing objects from one hand to another or banging two objects in front of their chest can help support the development of your baby's bilateral coordination.  Many of these activities are appropriate when your baby is as young as 6 months old.

Provide the required gross motor stability to comfortably perform the task

Performing most fine motor tasks is very challenging without the development and stabilization of gross motor skills first. Finger movements will be challenging before proper wrist, elbow, and shoulder stabilization and strength is gained. Similarly, wrist, arm, and shoulder coordination will suffer without the strength and stabilization of trunk and core muscles. Supporting your baby's gross motor development can start in his first month of life with simple activities like tummy time while he is awake. These activities become more interesting as he is able to roll over, sit and crawl.

Without the development of fine motor skills, children will not gain independence with self-care tasks like dressing, bathing, and feeding themselves. Fine motor skills are also important for success in school activities such as cutting with scissors, writing with a pencil, and typing on a keyboard. Because the development of fine motor skills is so essential for your child to be happy and successful, it is important that you facilitate activities that contribute to the development of them.

The BabySparks app offers hundreds of activities to support your baby early on in all aspects of this process, including fine motor skills, bilateral coordination, sensory and gross motor development.


Heather Gordon is a certified occupational therapy assistant, mom, and writer. Follow her blog at: http://heathersabovethedin.blogspot.com/