“Why mobility? Many children don’t like to stand still, and are innately driven to move themselves about. Thankfully, there are options to help achieve this. The terms “mobile stander” and “dynamic stander” are often used interchangeably in marketing; however, I like to think of them as distinct.

A mobile stander moves because a parent can push it, or because the child can use self-propulsion (with their arms) or power propulsion adaptations to move it. By contrast, a dynamic stander enables the child to be dynamic or move his own body-for example, to move the legs or weight shift at the trunk.

With creativity and flexibility, physical therapists have an arsenal of standing options available to them and their patients. The therapeutic benefits are numerous and we must remember that standers can benefit those children whose immediate goals may not include standing or walking independently. The benefits for those children are, perhaps, even greater because they involve deep emotional and social rewards.

It’s empowering for patients to be able to move around independently or move in a way they haven’t before. They can look into their parents’ eyes and smile, hug their grandparents and realize they’re actually taller than their friends.

For me, this is as rewarding an outcome as improvements in trunk control or postural alignment. I encourage other physical therapists to do some research to find the best stander to achieve the same outcome for their patients.”

Karen Good is a senior physical therapist at the Kennedy Krieger Institute in Baltimore. The above excerpts were taken from her article “Lifting Spirits” printed in the November 2011 issue of Advance for Physical Therapy & Rehab Medicine.

Often we talk about what standing does for the body, but what is commonly overlooked, is what standing does for the mind. Standing can stimulate play and is especially important for the mental development of children with disabilities.

Are you a therapist that uses mobile or dynamic standers? What benefits have you noticed?

There are many reasons it makes sense to keep PCA services in the family. Primary caregivers of people with extensive medical needs may find it challenging to find other employment flexible enough to accommodate frequent absences that my be necessary due to medial appointments or illness. No one dreams of being a PCA to make a fortune, but they may certainly treasure the commitment it allows them to make to providing care for a loved one. When the PCA is a family member who is able to take the care recipient to doctor appointments and therapy, communication between the medical team and home is that much more direct. When it comes to knowing a child’s needs and providing loving care, many times a parent or close family member is the most appropriate provider.

Parent/Teen relationships are challenging enough, but add a heightened Caregiver/Care Recipient dynamic to the equation, and things get more complicated. In learning transition skills, teens need to learn how to direct their cares to someone who may not be able to anticipate their needs. On top of that, they need to learn how to do so courteously. Some families can grow through their changing roles gracefully. However, it is easy (and common) to get stuck in a rut and have occasional difficulties keeping it cordial.

Tina and I spoke the day after the meeting, and it turns out I was correct about the vibe I was picking up from her. Does she want to explore working with other care providers in the future? Yes. Does Mom know that? Not yet. Is Tina ready to initiate the conversation? No. She is just getting the the halfway point of tenth grade, so we still have time. As educational and medical teams, we can support Tina by asking questions at natural times during discussions about the future about how she sees herself being supported in her activities of daily living. We can be asking Tina and Mom how satisfied they are in their Caregiver/Care Recipient roles. They may decide mutually that their professional relationship is putting a strain on their personal relationship. We can direct them to agencies to find additional care for Tina and other flexible employment for Mom.

I’m really proud of Tina, because her quest for independence has led her to seek out additional outpatient Occupational Therapy sessions to work on self cares, and she is requiring less assistance at home and at school. She is becoming a model of what the focus on transition is all about, so I have a feeling we will have that potentially awkward conversation – and get through it without too much trouble – soon.

Therapists – share how you help families go through this transition. Parents – did you go through a similar situation with your child during their teenage years?

When you’re at the mall and a stranger asks, “Hey, what happened to you?” it can ruin your day (especially if you’re trying to buy a shirt or just eat some pizza). But don’t get mad. Humans love to ask questions. It’ll always be this way. You should always have an answer ready, but I know, explaining your disability is hard. Here are my favorite ways to answer this crazy question.

God made me this way: Remember, you don’t have to tell strangers everything just because they ask. You should be treated as politely as anyone else. Say, “God made you this way,” and that’s it. Smile at them too, just so they know you’re not too mad.

Teach them: You can teach others about disabilities whenever they get nosey. A lot of people don’t know what Cerebral Palsy, Spina Bifida, Muscular Dystrophy and a lot of other disabilities are. I’ll describe my hurt spinal cord as if it’s a broken power line that’s been torn down by a tornado when people ask. People really like that . The more people we can teach about our disabilities, the more they’ll accept us.

Create a comeback: Sometimes strangers can be rude when they ask their questions. When this happens, it’s ok to say something snappy back. I know some adults say you should never be rude, but having a disability makes us have tough skin. Create a funny comeback when nosey people get in your face. Try saying, “I’m just lazy” the next time someone asks what’s wrong. I also like, “Something is wrong with me? Oh cool!”

Remember, don’t let the nosey people of the world get under your skin. Learning how to be ok with nosey people is important when you become an adult. Even try practicing your answers in private to see what sounds best, and you’ll be ready for ANY question that comes your way.

How do you answer disability questions?

Photo courtesy of Ian Stannard

When dads are playing around with their kids, a lot more is going on than just goofing off. A number of studies confirm the positive influence dads have on their child, not only from a social/emotional standpoint, but also in regards to child development. These are highlighted in the May/June 2010 issue of Scientific American Mind article Family Guy by Emily Anthes.

One study noted that moms spend more time in the physical and emotional care of their child creating more free time for dads to play. Infants calmed down when they were picked up by their mothers. Their heart rates increased when dad picked up the child, signaling excitement and anticipation of playtime (2006 assessment by Lyn Craig, senior research fellow at the University of New South Wale’s Social Policy Research Center).

The Scientific American Mind article also noted that fathers challenged their children. Psychologist Fergus P. Hughes, author of Children, Play and Development stated that mothers were more likely to engage in verbal play (singing songs or rhymes) and playing conventional games. Fathers on the other hand, used toys in novel ways and integrated them into new games. These less predictable play patterns worked to increase cognitive development.

Moms played it safe when their child was put in new physical challenges while dads were more daring. “In the physical motor domain, that might be one of the functions of dads—to challenge kids a little more.” This creates a balance of mom as “lifeguard” and dad as “cheerleader,” said Catherine Tamis-LeMonda, psychologist at New York University in her 2007 study.

Fathers also do their part to bolster verbal skills. Anthes noted a 2006 study by psychologist Lynne Vernon-Feagans of the University of Chapel Hill and her colleagues. They studied two-year-olds in free play with both mothers and fathers. She wrote that researchers “found that fathers’ language use—but not mothers’—independently predicted their children’s language development at age three. The larger the variety of word roots that fathers used, the better the kids scored on a standard test of expressive language a year later. The size of a mother’s vocabulary seemed to have no effect on children’s scores.”

In an unpublished study, Vernon-Feagans also notes that the fathers used more complex and unusual words talking about sports and cars while mothers talked down to their child according to their perception of a child’s linguistic abilities. Anthes posits, “If fathers are using more complex grammar and vocabulary than mothers, they might disproportionately influence children’s linguistic development.”

It is clear that dads play a huge role in their child’s life. And that is even more so for a child with special needs. Yet in some families the father disconnects from his child. To understand why this happens, we must first look at the gender roles that separate men and women. Traditionally men form friendships based on shared interests. When men get together in the workplace or the neighborhood barbeque, discussions turn to the accomplishments of their own children in academics and sports. As the accomplishments of special needs children are very different, dads begin to withdraw from these conversations.

Some fathers still mourn the loss of their own expectations for their child. It is difficult for the dad who lives and breathes football to connect with the child who is physically unable to play, or the NASCAR dad whose son can’t bear the noise of the race cars roaring down the track. The father is at a loss on how to engage with his child.

In many cases, fathers are suffering from long-term depression which they internalize. This dad may completely close himself off from family members or lash out at them. “He can’t afford to be intimate with others because he is desperately trying not to be intimate with himself,” according to author Terrance Real. The father does not want to face the reality of the disability.

How can we better involve dads in the lives of their special needs children? Find some common ground. This might be doing a chore together, having a father/child movie night or putting dad in charge of reading time. Give a sports dad the opportunity to cheer on his son or daughter. Look into adapted sports programs or Special Olympics in your neighborhood.

The best advice is for fathers to become involved in their child’s interests. Take the time to share a hobby or favorite activity. These shared moments help shape our child’s life. Rebecca Gadomski, social worker at Edgewood Clinical Services encourages fathers to take that extra step. “Fathers help their children grow in their ability to attach and relate to others,” Gadomski said. “Most kids naturally attach to their mom very well, but the attachment to their dad takes a little more time. This process is the foundation of how kids will attach to others in future relationships. They are the model for their kids about how men should act. Boys will model these behaviors as they grow older, and girls will typically look for their male friends/boyfriends to share these traits.”

More reading:
Scientific American Mind
Involving Dads – Links on becoming a more supportive dad and activity ideas
Father’s Day – links on Father’s day activities and perspectives
Fathers and Special Needs – All of our links pertaining to fathers

Reprinted with permission from One Place for Special Needs. Research study information from Emily Anthes, Family Guy, Scientific American Mind, May/June 2010.

Dads, tell us how you stay involved in your child’s life? What activities do you enjoy together?

Finding out what you child wants
While many kids love to go through a toy catalog and check off what they want, your child may have difficulty doing so. There are simply too many choices. So what to do?

Who knows your child better than you? Go through your toy catalog and cut out the pictures of toys you think would be interesting to your child. Tape them in a loose-leaf notebook (one toy to a page). Have him check off the toys he likes in this much smaller version. If your child still has difficulty making a decision, show two pictures at a time. Ask your child to select the toy he likes better. Continue with the next batch of pictures.

Gifts from relatives
Do you have a house full of gifts from relatives that your child has no interest in playing? How do we get our families to purchase gifts our children are sure to enjoy?

Point your family in the right direction. Create a list of items and email it to your relatives along with the link to the store and the product number. Amazon does a nice job with their wish list feature. You can now make one universal wish list combining products from any website.

Another suggestion is to tell family members that your child really likes to pick out her own toys at the the store. Ask for gift cards (e.g. Target). Use the gift cards yourself and let your child go on a spending spree wherever she wants with the total dollar amount. This is a good strategy for older children who may want toys that are no longer age appropriate in the eyes of your relatives.

Look at toy catalogs with a therapist’s eye
Family members don’t like to buy presents from therapy catalogs because they seem more work related than fun. But many toys can be both fun and work on various skills. Look at toy catalogs with a new perspective. Put your occupational therapist hat on. What toys have a hands-on tactile look to them. Now put your speech pathologist hat on. What games promote word recall? What games include player interaction? What games help foster conversation? If you browse through catalogs while thinking about your child’s strengths and challenges, you are sure to begin spotting some great gift item suggestions.

Involve your child in gift giving
Here’s an activity to get your child thinking about other family members. Make a checklist with the names of your family members. Go to a dollar store and let them pick out a present for everyone on the list. It allows him to do something personal for his family members without breaking the bank. If it is difficult for your child to make a selection, give him two suggestions for one family member and help him make a decision. Your child may not be interested in wrapping the presents and that’s okay. You might find him excited later at the idea of presenting gifts he personally picked out for his relatives.

Giving to those in need
The holidays is a great time to work on charity projects. The act of giving shows your child that his actions can have a positive impact on others. Your own town may have a secret Santa program allowing you to buy gifts for a family in need. Or check out The Mint website which gives kids local ideas on how to give, share and help others.

Heifer International is a good organization for children. You can create a team, donate to existing teams or make individual donations. Your donation helps children and families around the world receive training and animal gifts that help them become self-reliant. Rather than just submitting a dollar amount, you can choose the type of animal you want (e.g. Flock of ducks $20) and learn how those animals can help a family. In addition Heifer promotes “passing on the gift.” The recipient family gives the first animal offspring to another family in their village to help build a strong community.

Gift giving time
When it comes time to actually opening presents, a number of challenges become apparent for some children with disabilities. Here are strategies for the following situations.

Your child is unable to open presents
While everyone gleefully opens presents, your child can only watch. Earlier in the day, before the melee of gift giving starts, ask each attending relative to spend time with your child and open the present for her. This will be more meaningful for both the relative and your child. By the time everyone opens presents, your child will have already received hers. Space out the individual gift giving throughout the day.

Your child is uninterested in opening presents
Relatives are waiting for your child to open his presents but he pays them no mind. Even if you open the presents for your child, he doesn’t acknowledge that they are there. What do you do? Prior to the holiday practice opening presents with your child by wrapping a high interest toy or snack item. Practice saying, “thank you” after opening a gift.

If your child still shows no interest on the big day, explain to relatives that your child is so interested in the festivities that he’s unable to focus on the presents. Tell them that he will enjoy opening and playing with his gifts in the quiet of his home or after the party.

Your child is interested in unwrapping presents but not the gift
For your child, it’s all about ripping the wrapping paper. He doesn’t even pay attention to the toy. Take note of who gave which present. On a later day when your child plays with his toy, have him call the relative to say thanks. They will really appreciate it. Another suggestion is to ask some relatives ahead of time if your child can help open their presents too. Your child can look forward to Grandma inviting him to open the presents for her.

Your child focuses on one present
Your child has a mound of presents but stops after opening the third gift. She received a book she likes and wants to inspect every page. Let her open the presents at her own speed. You might end up taking half of the gifts home with the wrapping still on them and that’s okay. She can open the rest the next day.

Your child is overwhelmed at everyone opening presents
Your child may be overwhelmed by the chaos of everyone talking at once and tearing the wrapping paper off their presents. This is usually a sensory issue and can be painful for your child. It’s acceptable to go to another room and watch a holiday TV show while the rest of the family opens presents. You can include your child in the gift giving by allowing her to present a gift to each relative earlier in the day and have them open it. Your relative may also decide to giver her present to your child at this time. Now your child can give and receive a gift in a relaxed atmosphere. Plus this gives you the opportunity to work on conversation skills! If the issue is sound sensitivity, try putting on ear plugs just before it’s time to open presents.

Your child is too excited
Your child is overwhelmed but excited and doesn’t know what to do. Give him a job. Have him pass out presents. Have him organize the presents into piles according to person. Have him put the wrapping paper into a trash bag. Does your child know a holiday song or how to play an instrument? See if he can do a solo performance while people are opening presents.

Your child doesn’t like the present
Some children have a hard time containing their disappointment when receiving a duplicate gift or a gift they do not like. Here is where a little pre-planning is helpful. Remind your child that he may receive a gift he does not like. Tell him that you can return any gift for something that he does like. The important thing is to thank the relative whether or not he likes the gift. For the child that simply must say something, give your child a code word for a bad gift (e.g. jello) or have your child come to you and whisper in your ear.

Other resources
Christmas holiday traditions – Resources communication boards, holiday social stories and videos of children talking about Christmas
Hanukkah holiday traditions – Resources include activities, modified lessons and children talking about Hanukkah
Kwanzaa holiday traditions – Resources include activities, modified lessons and videos of children talking about Kwanzaa
Santa Claus resources – Santa support packet, NORAD Santa tracker and other Santa resources
Winter activities – Plenty of modified and fun winter activities for your child

Seasonal blog posts
Holiday Traditions With Your Special Needs Child
Holiday Baking For Kids With Special Needs
Special Needs Families: Relatives and Holidays
Guaranteed Winter Fun: Accessible Sledding

Reprinted with permission from One Place for Special Needs

How do you modify gift giving/receiving to accommodate your special needs child?

Photo Courtesy: Mulad

2. No more flat heads. Those little babies are so cute in their little custom-made multi-sport helmets, but in many cases a heaping helping of “tummy to play” and early detection can take the helmet from medical device to fashion choice.

3. Playgrounds everywhere! So that children can develop their bodies and brains with unstructured outdoor play.

4. Safe neighborhoods everywhere! So that children and their families will use all those beautiful playgrounds.

5. Expedite the process for obtaining durable medical equipment. I know there are all kinds of things that need to take place. I appreciate having a window of time within which to respond to denials. However, if the insurance provider knows their answer is going to be a “no”, they don’t have to wait a month to tell me. I’m a big girl. I can handle rejection. It just lets me get going on my amazing appeal that much sooner. Bring it. Because seriously, the kid who needs that equipment just keeps growing, and that five-year-old wheelchair just keeps breaking down.

6. Let the appropriate people qualify for a stander AND a gait trainer. I get to stand AND I get to walk. Both activities can yield therapeutic and functional outcomes, but each has its own special benefits. What a choice to have to make.

7. Don’t make me pinky swear and give my firstborn child as collateral when a company agrees to provide a demonstration mobile stander (for the record, this was not EasyStand). The company built it just for me and wanted to feel confident that the demonstration would lead to a sale. Not to worry, the school district did buy the stander and my son is here with me. They don’t keep many mobile standers as demonstration equipment because insurance approval for the mobile feature can be difficult to obtain. So, here I go again being all demanding. If I can stand, but I can’t walk, but I can get myself from Point A to Point B while standing to be a functional and independent person, I suppose that is what I would like to do. I might even spend more time in my stander with the mobile feature. Then I might experience greater health benefits. Yes, but would I experience $1,230 worth of health benefits (the cost of mobile option on EasyStand Evolv)? While that is a bit tough to quantify, I think it’s quite likely.

8. Send the person who designed the mount for the communication device along to install it. Or at least send all the correct parts the first time to give the rest of us a fighting chance.

9. Universal design. Universally.

10. The most important wish is that you have the love and support you need to have the happiest and healthiest of holiday seasons.

Note that this is simply a small selection of things I’ve been pondering recently. Please add your own special wishes to the list.

Items that you will need: apples, toothpicks, cheerios, small colored marshmallows, gold fish crackers. For kids who have trouble holding small objects you might want to try using large marshmallows or gummy bears, soft bite-sized candy bars like Milky Way or fruit loops. For a healthier alternative try cubes of fruit, grapes, bananas slices or raisins. Be creative!

Start by having each child pick out an apple and wash/dry them. Next lay the apple on its side to find out where it sits the best. When the apple stops rolling, you’ve found the right spot! Then spin the apple around so the stem is facing away from your child. The bottom of the apple becomes the turkey’s face.

Now grab the toothpicks and start making the tail feathers. Tip: you may want to file off one sharp end of the toothpick to avoid your child getting poked. Stick the sharp end of the toothpick into the apple (towards the back) just far enough to make them sturdy. Make sure to leave a little space between each toothpick. The turkey looks great with one row of tail feather or multiple rows.

Now the real fun begins! Place a bowl of cheerios (or whatever item you selected) in front of your child and have them fill the toothpicks. This is a fun way to practice hand-eye coordination and lets their creative mind go to work. Place a marshmallow at the top of the toothpick to keep the items from falling off in case the turkey decides to roll away.

The final step is adding the turkey’s face. For this you need two toothpicks, one goldfish cracker, and two cheerios. Insert the toothpicks into the bottom of the apple, pushing them almost all the way in. They also need to be fairly close to each other in order to hold the gold fish cracker. Then have your child take cracker by its tail and hang it between the two toothpicks to create the turkey’s wattle. Note: If your gold fish cracker doesn’t hang between the two toothpicks move them closer together to catch the gold fish’s tail. Finally, place a cheerio on the end of each toothpick to make the turkey’s eyes. Enjoy your masterpiece!

This activity can be done on any surface, but why not try using the tray of your child’s standing frame. Here’s plenty of room to put all the items that they need right in their reach and it can be easily wiped clean afterwards. It’s a great way to combine standing time with holiday fun!

I had a wonderful time doing this activity with my children. I hope that you can find a little time this Thanksgiving to do something creative with your kids as well. Happy Thanksgiving!

Here are three other fun activities to do this winter!
Holiday Baking For Kids With Special Needs
Guaranteed Winter Fun: Accessible Sledding
Shaving Cream Art For Kids

Did you try this activity with your little turkeys? How did your apples turn out?

I started out by talking around in circles about some of the malalignment being related to his recent growth spurt and blaming those troublesome advanced placement classes for making him too fatigued to sit up straight. But, being an honest person, I had to tell him the honest truth. “I know that’s what you need now, and I didn’t know that before. I’m always learning, just like you are.”

At the same school there is another young man with a diagnosis of Spina Bifida. He uses a manual wheelchair for mobility, and until recently had no sensation or voluntary movement below his level of impairment. In September he started telling me about some aching in his thighs. In early October, he could tell where his leg was being touched. In late October, he had some control over the movements in his hips and ankles. There are traces of muscle activity around his knees, but unfortunately the joints are so severely contracted he is unable to move them. His medical team is not sure why he has experienced this change in his sensation and neuromotor control, and we cannot know whether it is realistic to expect increased strength. However, we could make a lot more of the strength he has if we had functional range of motion to go with it.

Experience is the best teacher. Unfortunately, experience is one of those things that take time to accumulate. Apologies to the patients I worked with very early in my career that I didn’t look at with the most discerning eye. Of course, when I have missed the boat on an intervention, I am not sure if it is comforting or disturbing to realize that a number of others did not catch it either.

Parents, teachers, durable medical equipment providers, therapists, doctors, nurses, orthotists, personal care attendants, family members – keep learning. Keep asking questions of each other. Push each other to make sure that everyone is looking at the big picture and the best possible outcome for each individual.

Do you have a similar story to share? An example of how you continue to educate yourself to provide the best outcomes your clients?

“Johnny stands in the kitchen pulling magnets off the refrigerator, while mom gets the dinner meal prepared. While this may sound like a typical event at any household, the difference is that Johnny has physical delays and cannot stand on his own.  Johnny is fifteen months old, and is standing for the first time without help from an adult.  He just received a stander (with casters) that allows his mom and family to have him upright and nearby while they are anywhere in the house. 

Johnny is not sitting, crawling, standing or walking like his typical peers; he is, however, entertained and happy to be in his stander allowing mom to prepare dinner without worries.

How do you begin to assess the needs of a child for standing while also considering what is best for the family and meeting their needs? 

When assessing a child for a stander in early intervention, it is important to consider not only the needs of the child, but also the emotional and physical ability of parents to use the equipment and carry over a standing program at home.

The readiness of the family needs to be considered when determining how soon to begin standing and what equipment to choose to ensure a smooth carry over.”

These excerpts were taken from the article “Comfort Zones: Assessing the home environment for beginning standing“, written by Mary Miles, DPT at the White Bear Lakes School District. It was printed in the September 19th, 2011 issue of Advance for Physical Therapy & Rehab Medicine. For more research supporting standing, visit the Research & Articles section of our website.

Do you agree that it’s important to consider the needs of the entire family when prescribing a home standing program? Does it matter if it’s a pediatric or adult client?

The Occupational Safety and Health Administration (OSHA) has published ergonomic guidelines for employees providing physical assistance to patients in nursing homes that we would be wise to take into account in other settings where assistance for mobility is provided regularly.

A Hoyer lift is used for a transfer that requires total assistance.

The first and most significant recommendation is that manual lifting of individuals “should be minimized in all cases and eliminated when feasible.” The National Institute for Occupational Safety and Health (NIOSH) recommends that those directly handling patients should lift a maximum load of 35 pounds. That means once students approach kindergarten size, it needs to be determined how much they can participate in transfers and how much staff assistance is needed. Planning needs to take place regarding provision of more manual or mechanical lifting help when a need is identified.

For those who need total assistance, there are products on the market that allow dependent transfers in a transfer sling and some that mechanically assist transfers in a standing or semi-standing position. Sliding boards can be used for lateral transfers between surfaces of similar height, allowing the individual being transferred to remain in a seated position. For those who can stand with support but have difficulty stepping, transfer discs may offer a helpful solution for challenging transfers.

Improvements in EasyStand product design such as the Swing Away Front and Removable Back available on the Evolv, have greatly simplified transfers using sling-type mechanical lifts. Mechanically assisted transfers in standing can be facilitated by use of the Rotating Seat. The special Transfer Seat is wider at the front, providing more surface area for balance and safety for those performing lateral transfers.

With all transfers:
- Plan ahead – set brakes, remove straps, minimize the distance to be traveled and the height to be lifted
- Use good body mechanics – maintain a wide base of support, lift with legs, and keep spine in good alignment
- Get training – every wheelchair, every transfer device, and every positioning device has its own characteristics that can sometimes serve to make transfers easier and can sometimes require problem-solving with a trusted rehab professional
- Ask questions – as the patient or primary caregiver, you know the most about your day-to-day activities and environment, what works and doesn’t work, and how your body feels

If you have any questions about transfers and transfer devices, please do not hesitate to talk to your physical therapist, occupational therapist, or durable medical equipment provider. The most important person a caregiver can care for is himself or herself to ensure the continued ability to provide care for others.

What transferring techniques do you currently use with your clients?

Here are some simple methods to help your child tolerate or enjoy the tummy position better:

• Begin with placing your child on your chest when you are lying down, they will like the comfort of your voice, smell and begin to see your face and smile.
• Place interesting toys (but not too loud to startle them) in front of your child; moving the toys will sustain their interest.
• Place a rolled up towel under their chest to support them and make it easier to be on their tummy initially. Once stronger you can take this away.
• Use your legs to place your child on their tummy, keeping one leg higher to make it easier to hold their head up.
• Lie on your tummy to interact with your child while they are on their tummy. Use soft blankets, but firm surfaces while on their tummy.
• Gradually move toys further away as they get older to encourage your child to move, roll or scoot forward on their tummy.
• LIMIT time spent in infant seats, bouncy chairs, swings, car seats, or lying on their back. These are all similar activities. Spend time DAILY playing with your child on their tummy and they will begin to like it.
• Start with short periods on their tummy and build up the time. You can spend several times in short duration to help your child learn to enjoy tummy time.

Fitting tummy activities into the routines of the day will help parents find success.

Photo Credit: M_Eriksson

How do you ensure that your baby gets tummy time? Have you found other ways to make tummy time more fun for your child?

To get started grab a large sized zip lock bag and add some pudding (the pre-made pudding packs work great). Tip: filling the bag too full or having the pudding too cold may make it harder to use. Finish by flattening all of the air out and sealing the bag (you might want to put tape over the seal just to make sure). That’s it, let the creativity began!

If you have small children they will enjoy making hand-prints or just squishing the pudding around. With older children you can make it into a fun learning experience. Ask them to write numbers or letters, make shapes or draw pictures using their fingers. This works great for kids who have trouble gripping a pencil or marker.

This activity is portable, take it along on car rides to keep your child busy or bring it to doctor’s appointments for them to play with while in the waiting room. It’s also a great activity to do while standing. Place the bag on the tray of your child’s standing frame and see what fun ideas you can come up with together.

With many kids activities the clean up can be a challenge, but clean up here is a breeze. Simply toss the bag away when your child is finished playing or store it in the refrigerator and play with it again and again. If you want to get real brave with letting them play with their food, clip the corner off of the bag and let them squeeze the pudding into their mouth. Caution: this portion of the activity may not be mess free.

Other fun activities to try:
Creating a unique sensory experience
5 fun Autumn leaf projects
Sensory sand tray (video)
Make a volcano (video)

What sensory activities does your child enjoy doing?

The “back to sleep” program was initiated in 1992 in efforts to reduce the incidence of sudden infant death syndrome (SIDS). The initiation of this campaign was proven to reduce the incidence of SIDS as much as 40% in some studies (Persing, James, Swanson, Kattwinkel 2003). A not so desirable effect of the “back to sleep” campaign is the increased prevalence of delays in gross motor milestones, increased incidence of positional torticollis and positional plagiocephaly (Persing et al 2003, Jones 2004, Freed & O’Berry 2004). Reports of increased plagiocephaly or positional deformities of the skull are up by as much as 5-6X since 1992 (Persing et al 2003, Hummel & Fortado 2005).

Education to parents on the importance of “tummy time” for playing could prevent the occurrence of positional torticollis and positional plagiocephaly.  How do reach these parents? You might say, it is really the physicians’ job to educate the parents about tummy time.  As physical therapists, we can contribute to the public health of young infants by educating parents and caregivers on the importance of proper positioning and handling of their infant too! Now more than ever, we need to get the word out to prevent the costly fabrication of helmets and prevent developmental delays.

How do we help parents to understand how important “tummy time” is? Fully understanding the secondary complications could lead to better compliance and prevention of deformities. Instructing parents in methods to help their child tolerate or enjoy the tummy position better, would be more appropriate than avoiding prone positioning all together. A simple towel roll similar to a bolster shape could be placed under the child’s chest to assist and facilitate neck and trunk extension, enabling the child to maintain the position more readily. Fitting tummy activities into the routines of the day will help parents find success.

Research also points to use of infant car seats, bouncy seats, infant carriers, and infant swings as having an impact on positional plagiocephaly and positional torticollis. Frequent use of infant equipment (greater than 4 hours per day) resulted in a higher frequency and severity of plagiocephaly (Littlefield 2003).  Head control improves as a child matures, increasing the importance of educating parents to limit the time spent in infant equipment such as car seats, carriers, bouncy seats and swings when their child is younger and has limited head control.

We need to be the voice to educate others on placing limits on infant equipment. We also need to be the voices to promote tummy time. After all, babies are fun to play with and hold! Yes, there will be times when we need the car seat or stroller, but let’s remember to carve out time to play on those tummies while we are young!

Wondering how to keep your baby happy during tummy time? Read my post ”Making Tummy Time A Pleasant Experience” with several tummy time activity ideas.

References

Freed S, O’Berry C. Identification and treatment of congenital muscular torticollis in infants. JPO. 2004 Vol. 16 (4): 18-23.

Hummel P, Fortado D. Impacting Infant Head Shapes. Adv Neonatal Care. 2005; 5(6): 329-340.

Jones MW. Supine and Prone infant positioning: A winning combination. J Perinat Educ. 2004 Winter; 13(1): 10-20.

Littlefield T. Car Seats, Infant Carriers, and Swings: Their Role in Deformational Plagiocephaly. JPO. 2003 Vol. 15 (3):102-106.

Persing J, James H, Swanson J, Kattwinkel J. Prevention and Management of Positional Skull Deformities in Infants. Ped. 2003 vol. 112 (1):199-202.

Sultz H, Young G. (2007). Healthcare USA: Understanding its organization and delivery (5^th ed). Gaitherburg, MD: Aspen. www.physicaltherapy.com. Accessed on July 14, 2008.

Photo courtesy of dogs & music

What have you seen in regards to use of infant equipment and skull deformities? How have you been successful in educating parents about tummy time?

Anaiah Rucker is a nine-year-old girl with a zest for life. She has always been a creative artist, dedicated student, determined basketball player, and a wonderful big sister. Now hero can be added to that list!

February 4, 2011, was just a normal school day for the Rucker family, until tragedy struck. Anaiah and her five-year-old sister Camry were crossing the busy street to their bus stop when Anaiah noticed a truck coming toward them. She reacted without hesitation and saved her sister’s life by pushing her out of the oncoming truck’s path. Sadly, Anaiah was struck instead leaving her with massive, life-threatening injuries.

Anaiah Rucker shoots hoops with Katie Holloway and her favorite NBA star Dwight Howard.

Anaiah went though several surgeries including the amputation of her left leg and many hours of rehab. She primarily uses a wheelchair for mobility, but with her prosthetic leg she is able to use her walker as well. Despite everything she has been through, she has never given up on making her dreams come true!

After her accident Anaiah was unable to return to her home because it was not accessible or safe for her to live in. Her family was temporarily living in a rental home provided by their community. They dreamed of a home where Anaiah could get back to being her independent self and continue her growth and recovery. An anonymous, generous donor provided the land for a new home. Then “Extreme Makeover: Home Edition” rolled in and built the Rucker family their dream home.

Watch Ty and the rest of the crew welcome the Rucker family to their new home this Sunday, October 9th (8:00-9:00 p.m. ET/PT) on the ABC Television Network or watch the full espoide online after it airs. Grab a box of tissues and prepare to be inspired!

EasyStand has been featured in five past episodes of “Extreme Makeover: Home Edition”. Meet the deserving families, who received our standing frames.

Did you get a chance to watch this episode? What were your feelings about this powerful story?

Photo courtesy of “Extreme Makeover: Home Edition“

“Where’s Waldo?” Everyone loves the “Where’s Waldo?” books, where you find Waldo in a huge picture. Waldo wears a red and white striped top and a red hat and he can be very hard to find. Now you can play “Where’s Waldo?” on the internet. All you have to do is register, and you’re ready to start looking for Waldo. They have four pictures for searching for Waldo, and they make it extra fun by giving you a checklist so you can find a bunch of things in the picture along with your hunt for Waldo.

“Where the Sidewalk Ends” games: The book, “Where the Sidewalk Ends” was written by Shel Silverstein. This book has tons of great poems and is one of the most beloved kid books in the world. You can visit his website for free games and puzzles. There’s a memory game, a Cryptogram word puzzle and poetry writing tips. Kid poets will really love this site. And if you have a printer, you can print their drawing and activity booklet or how-to-write poetry kit. You can also create your own bookmark and print it out. Love it

Panda Cam: Love Panda Bears? Then you’ll love the PandaCam at the San Diego Zoo. When you visit their website you can see the adorable Pandas – Yun Zi and Bai Yun – any time of day. You can watch them eat their lunch, watch them cuddle, watch them sleep, even watch them wrestle! You’ll also find information on how you can save Pandas from going extinct.

Online Coloring: Crayola Crayons have created an online coloring book. With their Digi-Color coloring pad, you can use hundreds of crayon colors, mini-stampers, coloring pencils, markers, even virtual paint brushes. After your creation is complete, you can print it out to put it on your fridge. Check it out!

Webkinz: Taking care of pets is a lot of work. With Webkinz, you create your very own virtual pet and must login to the site each day to care for it. This game is one of the most popular games online for kids.

The internet has so many fun sites waiting to be discovered. Remember, as long as you have a computer, more fun than you can handle is waiting for you. Have fun exploring!

What are some of your favorite games?

Photo Courtesy of Ivan T