Motor Monday: Stomping Sandcastles for Single-leg Stance

How's that for alliteration?! Last weekend we had a gogreous sunny and suprisingly sunny Saturday so we took the triplets to the beach. (There I go with the S's again!) About 25 minutes from our house there is a little lake with a small beach that we have heard people talk about, but never actually been to. It was so sunny and nice that Michelle decided to play hookey from PhD Land and just spend the day with us. We wanted to do something fun and outside so we decided to check out Whipple Dam. We left a little after nine and hoped that the kiddos might take a little car nap on the way. Naturally they fell asleep about ten minutes before we got there! We folllowed a handful of other cars into the park and thought that was odd, but we were blown away by how packed it was. We got out of he car and at first glance it looked like the entire lake was surrounded by fishermen standing practically shoulder to shoulder and we were ready to bail. But we were meeting a friend there so we decided to stay and after a little investigation we found out that it was opening day of trout fishing season! Thankfully, there was no fishing from the beach so it worked out just fine.

While we were playing in the sand I stumbled on a fun and super easy balance activity for toddlers and thought I'd share. You know how toddlers just LOVE to knock down block towers, and basically destroy just about anything?! Well, they also LOVE to stomp on and destroy sandcastles! Their initial instinct was to just squat down and smash them with their hands, but with a bit of prompting and just a little support at first they got the hang of stomping on them and then that was all they wanted to do. I just used one of their little stacking cups that we brought to the beach and kept scooping up sand and making mini castles and they would just follow me around stomping on them left and right. 

Oops, he missed...

And Avery jumped in & stomped it before he could

Why do I like this activity? Well, in order to stomp on the castles they have to briefly stand on one foot. And while most of us don't spend much time each day standing like flamingos, we do stand on one foot at least a few times most days. If you stand up to put on your pants or your socks or shoes, you are standing on one foot. By the age of three most children should be able to stand on one foot for at least three seconds with a stable trunk and hands on their hips. If you don't get to the beach as often as you'd like you can also work on single leg balance by having kids kick balls, knock down block towers with their feet, try to pop bubbles with their toes, or stand up to put their feet in shoes (even if you have to help a little.)  Just being at the beach is great for working on balance especially for toddlers who have been walking for a few months because just walking on the uneven sand and in shallow water is a great balance challenge!

Ellie mid stomp

Loving this game!

Motor Monday-And we have walkers!!

Well, I have a post already started about pulling to stand and cruising, but have been struggling to get pictures and videos to go with it. And this one just can't wait!  We now have walkers!! Well, to be fair, Avery has been taking steps since October 7th, but she really stepped it up a level today and Ellie is really starting to take off too.

 Isaiah has been working really hard on standing and is getting pretty good at it.  Check out this face when he was standing in the grass a couple weeks ago. He's so proud of himself!

He has taken a step or two, but usually it looks more like this video. In this video you can see him standing by himself and preparing to take a step.  Watch how he shifts his weight forward onto his toes a couple of times and shifts his hips sideways just a bit before he actually takes a step.  Babies have to learn to shift their weight forward and also to the side to be able to lift a foot. That weight shift is so tricky!

Here's one where he only gets the forward weight shift.  Little dude is trying so hard!  He'll get it, but sometimes the process is just exhausting as you can see!

Here's a video of Avery the first day she took steps by herself.

You can see in this video that walking is basically just controlled falling (as opposed to Isaiah just falling).  She shifts her weight, takes a few steps and just dives into me. And that is pretty typical for kids, who are more confident trying something new and different going towards their mom or dad because they know someone will catch them.  Once she is in motion she just keeps going until she falls, never able to regain her balance.

 For comparison, here's Ellie walking tonight before bed.  She took her first step two weeks ago and until today has only taken about 4 steps at a time. In this video, the first time she takes more steps than Avery in the video above, but it still looks fairly similar in that she is just going straight & dives at the end, but in the second one you can see her catch her balance a couple of times before continuing on.

 I think today is the day that Avery crossed over into being "a walker." She has been taking steps to us for close to a month now, but now she will just take off walking whenever she feels like it!  And tonight she pushed herself up to stand all by herself in the middle of the room.  Check this girl out!

Don't get me wrong, she still crawls the majority of the time because it is so much faster for her right now, but you can tell she is really working to master this walking business.  Notice how in the video above she is now able to turn while she is walking!  New walkers are so fun to watch because you can practically see the learning happening.  This last video is a silly one because it is way too fast (it's a timelapse), but it gives you a quick glimpse of the amount of persistence Avery has when it comes to learning a new skill.  Tonight was the first time she pushed up to stand and in this video she did it like six times in a row before she finally got it and took off walking.

Motor Monday-Babywearing

A friend of ours from Seattle, whose baby girl is due any minute, asked a long time ago for me to do a Motor Monday post about baby wearing.  Here you go Molly!  As you can probably tell from other posts and pictures, I am a big fan of baby wearing.  We were lucky enough to have a number of different types of carriers and such that people gave us or loaned to us.  It took a lot of trial and error to figure out which carriers I liked best for different activities or different stages.  I think different carriers work well for different people so I'm not writing this to say "buy this carrier" but rather to say "wear your babies!" I'm also not coming at this from an attachment parenting stance of "don't put your baby down," which I'm sure you also know if you have read other posts about tummy time!

When I'm out & about with babies it's a good bet I'm wearing one

or more!
(note, this twin carrier was great when they were
  teeny tiny but is terrible on my body now!)

So why do I think new parents should wear their babies?

There are a ton of great reasons to wear your baby like reducing crying, increasing bonding, having the baby involved in activities, exposed to more language, etc. but my focus, as usual, is on the motor related aspects! Here are three sensory-motor related reasons to wear your baby:

1. Head and trunk control: being held in this upright position is good for developing head control.  And as you move they learn to control their heads during that movement.  As babies get older and depending on the carrier it can also help with upper trunk control such that as you lean over a bit your baby may activate trunk muscles to try to stay more upright.  Many babies also start to use their forearms to push off of mom or dad's chest which is a good start for developing those arm and trunk muscles.

2. Vestibular activity: as you move through space with your baby he or she gets a lot of vestibular input. You know that feeling in your head when you get on a playground swing for the first time in a while or go on a roller coaster? That's your vestibular system getting a lot of input! In our inner ears we have these teeny tiny crystals and when we tilt our heads, turn, lean, etc. those little crystals move a bunch of itsy bitsy hairs and that movement sends a message to our brain that we are moving.  The great thing about baby wearing is that you can get things done and every time you lean over to reach something, squat down to pick something up, etc. your baby is getting great practice learning about movement.

3. No flat baby heads: In the US we are big on baby "equipment" and a lot of babies spend a lot of time in swings, infant carriers (car seats), and bouncy seats.  Between that and sleeping on their backs, lots of babies spend the vast majority of their day putting pressure on the back of their head leading to positional plagiocephaly (or flat spots on the baby's head).  Wearing babies gets them in a more upright position and gives them a much needed break from pressure on the back of their head.

No pressure on this baby's head! This should also help the hair
grow back in her bald spot! (Note to self...wear Ellie more!)

There has been a bit of hub bub about babywearing, specifically Baby Bjorns, and hip dysplasia.  I did a little searching and as it turns out there really isn't any research on this in the literature.  The concern with Baby Bjorns and other similar carriers that allow/encourage babies to face out and/or only have a narrow piece of fabric through the crotch (AKA crotch danglers) is that they don't support the babies hips in a natural position and could worsen the hips of in an infant/child with hip dysplasia.  (For more info on hip dysplasia, check out the International Hip Dysplasia Institute website)  There might not be any research on this, but it does make sense that we want to support babies in the best possible position for their hips.  The treatment for infants with hip dysplasia is often a Pavlik harness. Check out this picture of the Pavlik harness which places the infant's hips in flexion and abduction, which seats the femoral head (top of the thigh bone) in the acetabulum (hip socket).  In my opinion, good babywearing emulates this position perfectly, placing the baby's hips in an M position with the carrier supporting the baby's thighs.  

So, overall, I agree that the Baby Bjorn is not the best option for baby wearing.  Now that being said, we did use a couple of Bjorns when the babies were teeny tiny because that thin fabric through the crotch was actually wide enough to keep their hips spread. And with newborns, you actually keep their legs in the carrier in a froggy position. (you can google/youtube tons about this)  Now that they are bigger though I don't like their positioning in the Bjorns at all, even facing in. Not to mention that I personally feel like the Bjorn is hard on me now that they are bigger!  I passed a woman on the street the other day and I seriously wanted to stop her and ask if I could take her picture for my "how NOT to wear your baby" example, but I chickened out!

teeny tiny Avery in a ring sling
(you can't see it, but her legs are frogged inside the sling)

There are LOTS of other options for babywearing that let you get the proper M position of the legs to support the babies hips.  We have a nice "stash" of different carriers including ring slings, a Seven sling, a couple of mei tais, two Ergos, and a Beco.  All of these will work to properly support the baby's hips.  Here are a few pics of our babies in a couple of these different carriers.  (please note I don't claim to be an expert baby wearer and there are LOTS of different and perfectly great ways to wear babies not demo'd here) 

You can see how the fabric goes out to her knees on both sides
Avery is in the Beco in this pic

Isaiah in a ring sling front carry
With less support up his trunk he has to work more as I move

Ring sling hip carry

My current favorites are the soft structured carriers like the Beco, the Ergo, and the Tulas we borrowed from friend for our Hawaii trip. For me they are the simplest/quickest and also the easiest on my body. I wear one of our babies pretty much every time we go out and sometimes, especially around the house, I wear two babies so comfort for both me and the babies is important! I've tried a LOT of combinations of carriers for duo babywearing & at the moment my favorite is the Beco & and Ergo.

Here are some fun babywearing pics through the months:

Baby wearing frees up your hands for cooking dinner....

or eating dinner

or drinking wine!

Grandmas can get in on the babywearing too!

And uncles too!

 Here's a series of double baby wearing experiments!

ring in front, mei tai in the back

ring in front, ergo in the back

Bjorn in front, Ergo back
 (notice, already Ellie's legs aren't well supported in the Bjorn)

Baby wearing is good for airplane naps

and taking babies through security!
The TSA agent was very confused when I handed
her 3 boarding passes!  She said "where's the other baby?"
(back carrying is stealthy!)

"So, are you gonna wear your baby or what?!"

Motor Monday: Rollin' rollin' rollin'

One of the most interesting things for me as a mom of triplets and pediatric PT is watching our three babies develop motor skills on their own timeline.  It is also probably the most aggravating thing, at times, because sometimes it feels like nothing I do is helping Avery get this rolling thing down!  Isaiah and Ellie have both been rolling from belly to back for a long time now. Avery HAS rolled, but only a few times in front of me (& a handful of times when we weren't looking) and she really doesn't seem interested in trying even when I let her get really frustrated.  I figure she's just trying to teach me patience and make me a better therapist. :)

What's also interesting is that Isaiah and Ellie roll in completely different ways. Occasionally each of them will use the other method for rolling, but I'd say at least 90% of the time they stick with their go-to pattern. Isaiah uses his big noggin' to lead the charge in his roll, shifting his weight over one shoulder, as you can see in this video. (you also get to hear his happy squeals!)

Ellie on the other hand uses her legs to do the heavy lifting and leads the roll with her bum. She puts her head down and gets mobility from her hips rather than her shoulders.  When Ellie first started rolling she did it the same way as Isaiah but since she's learned to lead with her hips that's the way she does it pretty much every time.

And here's Avery during two of her rare moments of glory. On the first one, leading with her head, I positioned her on her elbows with them tucked in tight. In the second it was all her and I just barely caught it as you can see. That day she rolled three times in a row and then despite trying over and over she couldn't get it again.

We made a new friend last week and their daughter, who is a month older than Avery, is stubborn about rolling too. She did it for a week or so and then hasn't done it since, but is sitting by herself and looks great on her tummy. So, we'll see. I'm not giving up though! To practice rolling, both belly to back and back to belly I like to have the babies act out the song Ten in the Bed minus actually falling out of bed part!  We play it on the floor and I help them initiate the roll from their shoulders or hips and then let them finish it. I roll one baby each time I sing "roll over." Because it's to a song they all seem to enjoy this game and it's a great way to get a lot of rolling practice in. 

Motor Monday: Baby Sit-ups

Tonight's post is going to be quick and "off the cuff" because I had another post written and then realized I was missing a key video!  So I'm whipping this up before heading to bed.  Just like us, babies should be doing sit ups as part of their regular exercise routine.  Baby sit ups are a great way to work on head control and abdominal strength.  Here's a video of Avery doing baby sit-ups, or pull to sit, at about three and a half months.

In this second video, she has already done 3 or 4 reps of baby sit ups and you can see the muscle fatigue set in.  One tip for doing baby sit ups is to try to get your baby to look at your face before you start (making silly faces, talking, and singing can help).  Most babies will be motivated to keep that eye contact and will work harder to lift their head so they can keep seeing mom or dad.  Avery wasn't cooperating with that for this video.  She was too busy looking around which didn't help with her head control!

If your baby isn't ready for this version of baby sit ups, you can start with a modified version where you support your baby behind her shoulders rather than grasping her hands/arms.  If your baby's head is dropping back like Avery's in the second video right from the start, try the modified version.  If it seems like your baby is having trouble getting started, you can start at the top and slowly lower baby down to the floor/bed/changing table.  Just like grown up sit ups, babies are working both on the way up and on the way down so take your time both directions. You may notice that at first the baby will be able to hold her head until just before reaching the bed and then it will flop back.  You can keep your fingers positioned just an inch or two behind baby's head when doing this so you can "catch" her head if it flops.  A more advanced version is to hold just the baby's hands rather than her whole forearm as I do in this video.

Baby sit ups are super easy to integrate into daily routines, which is one thing I love about them.  Our babies do them almost every time they get up from the changing table or floor.  You can also do the reverse sit up every time you put them on the changing table for a diaper change for double duty.  Just doing these at diaper changes means they're doing a minimum of eight sit ups over the course of a day, and as we can attest, often many more times than that!  If you want to work on endurance you can do multiple sit ups in a row until your baby shows signs of fatigue.

Did you know that a study was published in 2012 showing an association between head lag (where the babies head lolls backward) during pull to sit and autism spectrum disorders in high risk infants (siblings of children with ASD)?  They showed an association, which is very different than causality, so this does NOT mean that all infants with head lag at 6 months will have autism, but head lag at 6 months may be indicative of some type of neurodevelopmental problem.  Pull to sit is only one indication of the development of postural control, but if your baby is struggling with it at 6 months of age, it is worth bringing up with your pediatrician!  

Motor Monday: Look Both Ways

If you read my first Motor Monday post you might remember me talking about how one issue for babies in the NICU is that they often turn their heads to the right?  Well side preferences don't just happen with preemies and in fact I just got a question today from a friend with a newborn who prefers to look to the left.  She said "He pretty much is always looking that way.  We have tried noise and visual stimulus to get him to turn and stay on the non-preferred side.  Do you have any more suggestions?"

So although I had another post started, I figured this was a perfect Motor Monday topic and wanted to get suggestions to my friends sooner rather than later!  At my request they sent me pictures of the back and top of his head and said I could share them here.

In the picture from the top you can see a VERY mild flattening on the left side (really, the right just looks a little rounder/fuller in the back).  On the picture of the back can you see how his right ear is tilted down towards his right shoulder?  Having never met this little guy I certainly can't and would never diagnose him, but I wouldn't be at all surprised, based on the pictures and his moms' descriptions of him, if he had a mild torticollis, or tight neck muscle on the right side of his neck.  When this happens, kiddos prefer to look to the left and tilt their head to the right.  So, what can his moms do to help him?  Here are a few tips for any parents who notice that their baby has a favorite side.  I'm going to write this for our friends' kiddo who looks left, but if your kiddo prefers to look right, just flip the sides!

1. Everything interesting is on his right!  This little guy is only a couple weeks old so his moms are probably the most interesting thing to him right now but lights, noise, other people might also work.  The big thing is just to be mindful of his positioning throughout his day.  Place him in the crib so that he would have to look to the right to see you when you come to pick him up after naptime.  This goes for the changing table too.  It might feel awkward for you to have to switch to using the other side but do it for your baby!  Same thing applies to being on the floor or in a bouncy seat...everything cool is to the right.  It's even better if you or the toys can be just a bit behind to encourage the baby to look up and right because that stretches out the tight neck muscle even more.

2. The side carry stretch.  This was apparently the best way to calm me down as an infant and it works like a charm for our little hothead Avery too.  Have the baby face away from you on his side with his right ear on your right arm.  Place your left arm between the baby's legs to support his body.  The idea here is to gently stretch his right ear away from his right shoulder. (i.e. moving his left ear closer to his left shoulder)

Here's an example of a version of the side carry with Avery

3. Tummy time.  Our friends are already working on this (I know this because I've seen adorable pics on Facebook!) but their little man, who keep in mind is only two week old, manages to turn his head back to his favorite left side when they put him down facing right. In this case, You could try tummy time on mom's chest with his head gently blocked from turning left by mom's head or hand.

I could move my hand up to his head if he started to turn
his head the other way.

4. Sidelying with a boppy. This is the same idea as the side carry, getting the right ear away from the right shoulder. Just like with the side carry, the focus for this stretch is on the tilt part versus the turn.  So you are stretching the right side of his neck by increasing the distance between his right shoulder and right ear. Here's a picture of Isaiah in this position.

Right shoulder away from right ear for a kiddo who prefers to turn left

5. Body Block!  Use your body to block the baby from turning his head to his favorite side.  You can do this having the baby's body facing you and head looking up when held in a cradle position or use your hand or head to block the preferred side when held at your shoulder.  Here's Michelle with Isaiah using her arm to block him from turning to the right.

I hope these tips are helpful for our friends and other babies who are favoring one side. Once babies start turning their heads both ways equally and moving more, their heads will gradually even out in most cases.  In the meantime, while he is awake I would hold him and wear him as much as possible and do lots of tummy time to avoid more time with pressure on the same spot on the head.  Your baby will be spending a lot of time on his back already just while he's sleeping so minimize time in equipment like the carseat, swing, etc and laying on his back on the floor.  When he is sleeping, if you have a sound sleeper, I'd recommend turning his head to the non-preferred side once he is asleep!  (That said, Isaiah used to consistently sleep with his head to one side and I was rarely willing to risk waking him up by turning his head so I understand the value of sleep!!)

Big thanks to our new mom friends in Boston for their question!  Do you have any motor development questions (about a certain age or disability) that have been rattling around in your brain?  If so, leave it in the comments and I'll add it to my list!

Motor Monday- What time is it?! Tummy time!!

As an early intervention therapist, one of my standard first visit questions for parents of babies is to ask about daily routines including how much time the baby spends on his or her tummy. So when we'd been home with the triplets for a couple weeks and settling into some routines I was appalled to realize how little tummy time our babies were getting. I know, I know, they were only a couple weeks old and you know, we were first time moms with TRIPLETS so I should cut us a little slack.  But I resolved to "walk the walk" when it came to tummy time and started introducing Michelle to a bunch of different ways we could sneak in tummy time. So for today's Motor Monday post I'd just show you the "many shades of tummy time" in the Therrien house.  Here are a bunch of the ways we've incorporated tummy time and pseudo tummy time activities into the lives of our little trio over the past five months.  Tummy time is good for all sorts of things!

Like regulating your breathing in the NICU...

or bonding with mommy at home.

Early on tummy time was just good for a snooze...

any which way you happen to land...

especially with your best buds.

Tummy time is also good for showing off your ruffle butt...

or your monkey & froggy butts...

or your festive Santa butt!

Tummy time is great when you want to stare adoringly at your mommy...

or that adorable, if slightly distorted, baby in the mirror!

Tummy time is good for spending quality time with your sibling...

but it gets pretty boring if he falls asleep!

Tummy time is good for waiting to eat...

eating your brother's finger...

or knawing on your sister's head!

Tummy time makes for a cute brotherly photo shoot...

until your brother starts sniffing your butt that is!

Tummy time is good for showing little friends what to do...

or "one upping" your sister!

Tummy time is good for watching your siblings...

reading a book...

or watching the Olympics!

Tummy time is good for playing by yourself...

or with Mama

which is really soooo fun!

But let's be honest...tummy time can bring out a range of emotions...

bewilderment...

surprise...

sorrow...

and especially frustration!

Tummy time looks a little different month by month and day by day...

and we all do it a little differently.

But even though it is hard work (note the drool!)...

 it always helps make us stronger...

and, well, let's be honest...it's not like we have a choice when our mom is a PT!!