A common question parents have for their pediatrician’s and therapists regards toe walking in children. While toddlers look extra cute prancing around on their tippy toes like the next prima ballerina, many parents are concerned when their child walks on their tip toes. Toe walking is common and often is nothing to be worried about. However, how does a parent know whether to be concerned about toe walking?
Toe walking is extremely common in early walkers. For most children, there is no reason why they prefer to walk on their toes. The majority of toe walkers will resolve on their own without intervention. Most toe-walkers begin to normalize their gait pattern after two years old. If a child continues to toe walk after two, intervention may be considered.
What Causes Toe Walking?
Toe walking is most often strictly out of preference and habit. If a child is toe walking and all other causes are ruled out, physical therapists will need to work with the child to create a new habit of walking in a normal gait pattern. Occasionally, there can be potential underlying causes for toe walking. Neurological diseases such as cerebral palsy and muscular dystrophy can cause children to toe walk as they do not have the active flexion of the ankle. Children with autism are often toe walkers due to the same disruption in the vestibular system that causes them to seek sensory input from swinging or rocking.
According to the National Scoliosis Foundation, approximately six to nine million people in the United States are affected by scoliosis. Scoliosis is an abnormal curvature of the spine. Scoliosis primarily affects children and adolescents. When a child is diagnosed with scoliosis, it can be very overwhelming for the parents to work towards the best treatment plan for their child. We have created an easy guide to scoliosis for families to gain a better understanding of their child's condition and treatment options.
Types of Scoliosis
- Idiopathic: Idiopathic scoliosis simply means that the cause is unknown. The majority of cases of scoliosis are idiopathic and cannot be attributed to any specific reason or cause.
- Neuromuscular: Neuromuscular scoliosis is abnormal curvature of the spine as the result of a neurological and muscular diseases such as cerebral palsy, muscular dystrophy, and spina bifida. Neuromuscular scoliosis often is a more progressive type and has a higher incidence of surgical intervention.
- Congenital: Congenital scoliosis is a form of scoliosis that arises from abnormal developmental while in the mother's womb. Essentially, a child is born with scoliosis.
Diagnosis of Scoliosis
Scoliosis screening is an integral part of well child check-ups, especially as your child approaches puberty and adolescence. Scoliosis is usually first identified through a physical exam performed by your child's pediatrician. The provider will have the child stand up and lean forward while looking for abnormalities in the curvature of the spine. If your child's provider identifies a concern, imaging such as x-rays and MRI will be used to confirm the diagnosis and extent of the scoliosis.
The Cobb Angle is the angle used to measure the degree of curvature in the spine. The severity of scoliosis can be determined by the degrees of curvature the physician measures using the Cobb Angle. Curves can be either a single C shaped curve or two S shaped curves. Mild cases of scoliosis are usually those less than 20 degrees. Moderate scoliosis typically is categorized by curves that are between 25 and 50 degrees and severe scoliosis is classified by curves larger than 50 degrees.
Treatment of Scoliosis
There are many factors that are included in the treatment plan of a child with scoliosis. The age of the child and whether or not they have hit puberty and stopped growing are major considerations when determining what the most effective scoliosis treatment plan is. Additionally, gender plays a role as girls have been found to be more likely to have progression of scoliosis as they grow when compared to boys. The degree of scoliosis is also taken in to account.
The trunk is the center from which the rest of the body operates from. Strong core muscles are critical for both gross and fine motor development of a child. Lack of core stability can not only make certain motor skills difficult to perform but can also lead to pain as a teenager and adult. Fortunately, there are many activities that can encourage strong development of abdominal muscles.
What do Core Muscles Do?
The abdominal muscles are the center of the body. They are activated during all body movements. When a child is walking, running, or jumping, the core muscles provide stability to keep them upright and prevent falling. Core muscles are critical for balance. Walking the balance beam in gymnastics and sliding down the slides at the playground both require stability in the abdominals.
A function of core muscles that is often overlooked is the importance for posture and performing activities while sitting. Some children have difficulty playing in the floor or sitting for story time due to underdeveloped abdominal muscles. If a child has poor core control and posture sitting at a desk, fine motor activities such as writing and cutting can be extremely difficult. When a child's energy is focused on trying to maintain balance in sitting, it distracts from those fine motor skills that may require significant concentration as they are being learned.
How to Encourage Development of Core Muscles
Taking early initiative is important in core development. While new babies love to be held and cuddled, infants still need plenty of time to play supervised on the floor. By letting babies spend time on the floor, they will kick, scoot, and roll to begin to develop those all important abdominals. Those muscles will guide them through gross motor milestones such as crawling, standing, and walking.
As babies become toddlers and preschoolers, the best thing you can do to encourage core development is to provide plenty of playtime and minimize screen time. Watching television or playing on a tablet are often done slouched on a couch or chair. Encouraging other types of play keeps kids moving and developing, engaging those core muscles the entire time.
Want to go the extra mile to encourage core development in your child? Activities that require balance are the best developers of those abdominals. Riding a bicycle or balance bike, swinging on the playground, and sitting on a stability ball are all excellent activities to promote core development. Public libraries have began offering free preschool yoga classes which can be a fun way to both build core muscles and bond with your child.
Do you have questions about your child's core stability and motor development? Call one of our physical therapists today to discuss ways that you can facilitate core strength for your child.
Developmental dysplasia of the hip (DDH) is a condition in which the socket of the hip is too shallow, therefore, the thigh bone (femur), does not fit properly which leads to instability and even dislocation of the hip. Hip dysplasia is often present from birth. However, it can occasionally develop during the first year of life as a child's body is in a critical developmental stage.
Signs and Symptoms
Early detection is important for successful management of DDH. If you notice any of the following in your infant, it is important to bring it up with their pediatrician:
- Clicking or popping hips: While many normally developing infants have hips that click or pop, it is still important to bring this up with your provider.
- Difficulty spreading legs with diaper changes: With hip dysplasia, some muscles of the hip can become very tight to compensate for the instability at the hip. tiffness with spreading the legs apart can be a sign of DDH.
- Gait abnormalities: Early walkers and toddlers commonly have gait patterns that are odd when compared to older children or adults. However, if you notice that your toddler walks with a limp, it is important to mention it to your pediatrician.
- Uneven skin folds: Nothing is cuter than a little chunky baby with adorable fat rolls. However, if you notice that those sweet little rolls are not quite even on your little ones knees and rear, make sure to have the doctor take a look.
Screening and Detection
It is standard for every newborn to be screened for hip dysplasia at birth. It is not uncommon for a newborn to have a dislocated hip at birth and for it to be completely resolved by a two week check-up. After the newborn assessment, it is standard for all babies to be screened for hip dysplasia during each well child visit the first year of life. Have you ever notice your pediatrician bending and turning your babies legs? They are performing a couple of different provocative tests to check for instability at the hip.
If the pediatrician suspects your baby has hip dysplasia, they will likely order diagnostic imaging to visualize the hip. If your baby is under six months old, a diagnostic ultrasound is the best choice for imaging as the bones of the hip are not ossified enough to be visible by x-ray. After six months, x-rays are a highly reliable tool for diagnosing hip dysplasia.
Depending on the age of the child at the time of diagnosis and the severity of the dislocation, treatments can range from bracing and casting to surgical intervention.
- Pavlik Harness: The Pavlik harness is used when hip dysplasia is caught as a newborn up to approximately six months of age. It braces the hip into the correct alignment in the joint socket.
- Spica Cast: A spica cast is typically used on babies older than six months of age. A spica cast is a lower body cast that works to keep the hip aligned correctly in the joint. The length of time a child would need a spica cast varies.
- Surgical Intervention: Unfortunately, in children who are diagnosed late or who have not had success with conservative treatments, surgery is often required. The good news is that outcomes are very good following surgery.
A diagnosis of hip dysplasia can be very overwhelming for a parent. On a positive note, there are many resources available to parents and treatment options have a high success rate. Most children who have DDH can go on to live a full, active life without limitations following intervention.
Orthotics are a common part of the world of pediatric musculoskeletal and neuromuscular disorders. Orthotics can help increase functional mobility for a child by providing added support and placing the leg, ankle, and foot in an optimum position for walking. The abbreviations, choices, and rationale can often become very overwhelming for parents. However, by understanding why your child needs a certain type of orthotic, and how it will benefit them, you will set the stage for a smoother, more successful transition into your child wearing orthotics.
Why are Orthotics Used?
Orthotics are a useful tool in successfully increasing a child’s functional mobility. When a child has a physical impairment, there are parts of their body that do not function like they should. Orthotics can help compensate for muscles and structural deficits and help the child reach their highest functional potential.
Orthotics can also be very beneficial to decrease pain. Often times, structural deficits, muscle weakness, and joint contractures can cause significant pain with standing and walking. By using orthotics, joints can be provided with additional stability and structural deficits can be compensated for, thus reducing pain.
Common impairments that often benefit from orthotics include:
- Cerebral Palsy
- Spina Bifida
- Leg Length Discrepancy
- Muscular Dystrophy
- Tight Heel Cords
- Joint Contractures
Types of Lower Extremity Orthotics
Being hit with all the abbreviations can be overwhelming. What exactly does AFO stand for? Why does my child need that particular orthotic? Here is a quick breakdown of some of the most common types of orthotics:
- Ankle-Foot Orthotic (AFO): AFOs are very commonly used in children who have foot drop or tightness that prevents them from flexing the foot up. Being able to dorsiflex the foot is a critical component of a normal gait pattern. AFOs can help children who otherwise do not have the active flexion at the ankle achieve regular gait patterns.
- Supramalleolar Orthotic (SMO): SMOs are used often in young children with instability at the ankle. SMOs provide stability at the foot while allowing for freedom of plantarflexion and dorsiflexion at the ankle which is needed for early motor skills such as crawling and pulling to stand.
- Knee-Ankle Orthotic (KAFO): KAFOs help to stabilize at the knee, ankle and foot and are useful for children who have limited control below the hip. KAFOs often have mechanical or electrically controlled hinges.
- Hip-Knee-Ankle-Foot Orthotic (HKAFO): HKAFOs use hip bands to stabilize the hip and leg while maintaining a central knee position.
What if My Child Hates Their Orthotic?
Unfortunately, some children are not fans of their orthotics. It can be difficult to get them to wear them. The great news is, there are few tricks parents can use to increase compliance with orthotic use.
- Make them fun! Excite your child by allowing them to help choose colors and designs when possible. Let your child pick out a fun new pair of shoes that accommodate the orthotic.
- Check for a correct fit. If an orthotic does not fit properly or has been outgrown, they can be very uncomfortable and painful for a child. Making sure the orthotic fits correctly is crucial.
- Set up a schedule. Work with your therapist or orthotist to set-up a wear schedule for your child’s orthotic. By gradually introducing orthotics, you can decrease any discomfort that can happen initially as your child’s body adjusts to the new position. Reward your child with sticker charts or special treats for following their schedule.
While orthotics can be overwhelming, there are plenty of resources available to help parents and children. If you have questions about your child’s orthotics, a physical or occupational therapist can provide you with guidance and resources.
It's the most wonderful time of the year! Holidays bring lots of fun, family time, good food, and for a lot of parents—a multitude of toys that often end up forgotten and untouched after a few weeks. More parents are looking for toys with a purpose and those that can provide enrichment for their children. There are plenty of good toys on the market that can help enhance your child's motor development. Here are a few physical therapist recommended toys that can improve your child's motor development.
Fisher Price Think and Learn Smart Cycle
The fisher price think and learn smart cycle is recommended for ages 3-6. Combining exercise with educational video games your child will love—this is sure to be a hit. Perfect for climates that limit outside activity throughout certain seasons, your child can get physical activity racing through games that teach phonics and reading.
These chairs are excellent for developing core strength, balance, and can be a useful sensory tool. Manufacturer recommended ages for 24 months to 7 years old, these lightweight chairs can be easily sat in to twist, rock, and balance. Core muscle strength is critical for developing children. Good core stability is a necessary tool for things such as sitting in a desk chair with correct posture to facilitate good handwriting, as well as for recreational activities like riding a bike.
Scooters and Bicycles
Encourage active lifestyles by buying your child a bicycle or scooter this holiday season. Depending on your child's age, a tricycle is a great starting point for toddlers, and preschoolers can take off on a bike with training wheels or even a balance bike. Not only do bicycles, scooters, and balance bikes promote cardiovascular fitness and leg strengthening, they also help improve that important core strength. Just do not forget the helmet to protect those growing brains!
Build, Build, Build
Blocks, magnetic tiles, and Legos are not only great for fostering your child's imagination, but are also an excellent toy for promoting fine motor skills. The snapping, placing, and stacking help your child with both hand-eye coordination and fine motor skills that are important for things such as handwriting, cutting, and typing.
Puzzles can be fun for all ages from infants through adult. Your small children will enjoy practicing their pincer grasp with large peg puzzles while learning shapes, letters, and numbers. Older children can use critical thinking skills to piece together pictures of their favorite scenes or characters. Manipulating the small pieces and finding the perfect fit helps cultivate those very important fine motor skills.
This holiday season, step back from screens and look to buying your children lasting toys that encourage development of their bodies and minds. The early years are extremely critical to practice these skills that will carry them throughout a lifetime. Toys that encourage healthy minds and bodies are also lots of fun for your little one.
Parents work so hard bringing their children in to the world. From attending every prenatal appointment, fretting over the best vitamins, and researching the best gear—being a parent brings upon a world of wondering if a child is safe, healthy, and developing appropriately. Many first time parents are often concerned about their child’s motor development and whether they are hitting appropriate milestones. Parents with older children frequently compare babies to their older siblings and find themselves worried if their baby does not hit milestones at or before their siblings. Use this guide adapted from the CDC Milestone Moments to see if your child’s motor development is on track, and what you can do to help develop your child’s motor skills.
The importance of tummy time begins early—as soon as you bring your baby home! It is recommended that all infants be placed to sleep on their backs and babies do a lot of sleeping. Therefore, when your baby is awake, it is critical to their developing bones and muscles to be placed on their bellies, supervised, a few times each day, even if only for 2-3 minutes. At approximately two months of age, your baby should be able to bring its hands to the mouth and push its head up when placed on its belly. By four months old, your baby should be able to hold its head steady when the trunk is supported and push down with its legs when the feet are on a hard surface.
Around 5-6 months, a baby will be able to roll over—often times in both directions. Your baby should be able to roll over in at least one direction by the time it is six months old as well as reach for objects. Tummy time is again critical for developing the skill of rolling over. To facilitate reaching by your infant, use toys that make interesting noises to catch your baby’s attention. Most babies can supported sit around six months old and some are even able to sit independently. Do not worry if your baby cannot sit without support yet—that skill is often not developed until about 9 months.
Between six and nine months, things really start to get interesting as your baby becomes mobile! Most babies begin to scoot or crawl, some even pulling up to stand and transferring themselves from laying down to sitting all on their own. One way to help your baby achieve these milestones is giving them plenty of supervised floor play time to explore and build those muscles. If by nine months, your baby does not bear weight on its legs, transfer objects between its hands, or sit supported, then it is important to bring these concerns up with your physician.
During this time is also when most babies begin to exhibit the “pincer” grasp, which is picking up small objects between the thumb and index finger and putting everything in their mouth! Now is a great time to introduce small, dissolvable yogurts or puffs designed for babies to work on this important fine motor milestone.
By 12 months, your child should be crawling, cruising, and maybe even standing and walking. If your child is not crawling or standing with support, make sure to discuss with your child’s doctor. Around the first birthday, a lot of parents get antsy that their child is not walking yet. It is completely normal for children to not take their first steps until 14 or even 16 months of age. Using a push toy is a great tool to help your child get ready to take those first steps. There is a lot to think about when it comes to your child’s first year of life! If you have concerns about your baby’s motor development, speak with your physician and ask if physical or occupational therapy are appropriate for helping your child meet their developmental milestones.