Let’s talk about sitting!

Sitting is often one of the big milestones that many parents look forward to – that and walking of course, but we will save that for another day!

Children often are excited to sit as well, as it opens up a new world for them to watch and interact with.

What does it take to sit?

Just like with rolling, in order to sit there are some fundamental skills a child needs to be able to do to sit independently.

Sitting requires control of flexion (bending) and extension (straightening) movement patterns, which start to develop during rolling.  Sitting also requires automatic postural reactions, which are made up of righting reactions (keeping head on body), protective reactions (putting our hands out if we are falling) and equilibrium reactions (balance).  These reactions also start to be developed during rolling and continue to progress with sitting.

So you can see why it’s important for children to achieve milestones in the right order, as they help develop skills that they need to complete the next one!

How sitting develops

Sitting is one of the only milestones that a child typically learns before they are able to get in and out of that position.  Parents typically put a child into sitting position and the child starts in what is called Tripod sitting – this is when a childs legs are out, often in a “V” position or a ring position, with their hands planted on the ground between their legs.  Once the child gains better control, they will start to come into a more upright position with the back in a c-shape and the child will start taking their hands off the ground to play briefly.

The child will then work on shifting directions and their body weight in the c-sit to gain more balance and control.  C-sitting should then continue to improve to nice upright sitting, with the child able to reach in front of themselves for toys, rotate to look the sides and reach up for higher toys.

When should my child be sitting?

Children can typically begin to tripod sit (within a parents legs) around 4 months of age.  C-sitting for brief periods (with lots of tipping over!) should start to develop just after 5 months.

I recommend parents stay close by, but allow their child to tip in order to help children develop those important reactions mentioned above.

You may also try propping pillows just beside and behind them (or use a breastfeeding pillow) so that you can be in front of your child to play and engage.

By 6 months, children should be starting to sit independently (working towards that tall sitting) with only the occasional loss of balance.  This typically coincides with introducing solids, as a child should be able to maintain good sitting posture in a high chair to ensure safe eating.

If your child is not showing the building blocks of sitting by 6 months, call your local pediatric physiotherapist for a consult.  As always, if you are in Kitchener-Waterloo or Perth County, give me a shout!

Back To School = Backpack Shopping

Back  To School = Backpack Shopping

It’s that time of year again – the littles (or not so littles in some cases!) are about to go back to school!  It’s the time of year when parents run around trying to get all those back to school supplies and prepare their kids for their return.

One of the biggest and most important purchases is a backpack.  Ill fitting backpacks can lead to back and shoulder pain, changes in walking and potential balance issues which could lead to injuries.

Here is a handy guide on what to look for in a backpack!

Things To Consider

As with any purchase, there are lots of things to consider and, unfortunately, sometimes the biggest consideration for many children/families is what the backpack looks like.  I know that it can be hard when your child has their heart set on a certain colour, character or style but, for the sake of their bodies, here are a few more things that you should you can consider:

1.  Bigger isn’t always better

Especially not for little kiddos!

Little ones should have a smaller backpack that fits well and, if needed, they can carry their lunch bag separately.

2.  Weight of the backpack

When I was a kid we had a ton of textbooks and I know that has changed with the growing amount of technology in classrooms – however, there is still lots of stuff that needs to go into a backpack!

The golden rule is that the backpack should weigh no more than 10-12% of the child’s weight.

3.  Ease of use for your child

Can your child put on and take off their backpack independently?  Can they easily carry it?

Practice if you need to!

This is a great opportunity to promote independence in younger children.  Have your child carry/wear their own backpack, whether getting on the bus or walking to school, right from the first day of school.

How To Choose The Right Backpack

Fit, fit and fit!

Only after finding a backpack that fits consider the internal features.

A good fitting backpack:

  • Should fit snuggly against the back
  • Have wide padded straps that can be adjusted for length
  • The bottom of the bag should be no more than 3-4 inches below the waist line (true waist NOT hips)
  • Has two straps!
  • If your child is older and carrying heavier loads, the backpack should have a clavicle strap and hip straps to help distribute the weight

Internal features should include different compartments, which help distribute the load – and stay organized!

Arrange the heaviest items closest to the back to help minimize the stress of their weight.

A water bottle pocket on the outside is always a good idea as well.

Hopefully this post helps guide you towards a great backpack for your child – happy shopping!!!

Rough and Tumble Play

Rough and Tumble Play

My last post was discussing risky play, the types of play that make up risky play and why they are important.  I promised a second post on rough and tumble play specifically, so here it is!

Rough and tumble play is a subtype of risky play that includes:



being swung

being bounced

being lifted

being thrown

It is spontaneous and fun!  This type of play, unlike some of the other risky play, is often done with both peers and parents/adults.

I believe this type of play is happening less and less, with parents/educators worried this type of play can get out of hand.

Often rough and tumble play is misinterpreted by adults as aggression and is discouraged.  It is interesting, however, to note that most children, even ones with learning disabilities, can distinguish the difference between rough and tumble play and aggression.  Research also shows that rough and tumble play rarely turns into real fighting (less than 1% of the time).

Why is it important?

From a physical standpoint, rough and tumble play helps build strength, improves gross motor skills, improves hand eye coordination, increases flexibility and is good cardiovascular work.

It also provides a ton of other developmental benefits!

Socially, children learn to adjust to changing social situations.

Emotionally, it helps develop self-regulation and compassion.

Cognitively, it assists with problem solving skills and behaviour correction in order to remain in the group of play.

Differences between Parents

Moms and dads typically engage in play differently with their children, regardless of the child’s gender.

Mom’s play tends to be more cautious, as mothers use more language and often use objects to engage in pretend play.

Dad’s play tends to be more physical, unpredictable and dads use less language (aka more rough and tumble).

As parents/adults what is our role?

Our role is, ultimately, to support our childrens development.  With respect to rough and tumble play, we need to ensure our children are getting enough.

That may mean taking a step back when children are engaged with their peers in this kind of play and, instead of stopping it, simply ensure that it remains safe (i.e. the play space in clear of hazards and everyone is enjoying playing).

A good general rule is “If the smiles stop, the play stops”.  It also means that we likely need to challenge ourselves to explore different types of play with our children, even if it’s outside our own comfort zone.

Lastly, the most important thing is to remember to have fun!

Risky Play

Risky Play


If you read the blog post about sitting still in school. you may remember me mentioning risky play – including rough and tumble – and that it is important.  As the weather gets warmer and the kids flock to the parks, I thought that now would be a great time to tackle the subject!

This will be a two part post – the first being about risky play and the second looking more at rough and tumble play specifically, so stay tuned!

What is Risky Play?

Risky play is a form of play that is thrilling, unpredictable, uncertain and has the potential for physical hazards and injury.

Researchers have identified six different types of risky play:

Great heights

Great heights type of play includes:

– climbing

– hanging

– jumping off of things

At the park, it’s all about monkey bars, tall climbing structures, including rope ladders, spider webs, parallel bars and rock climbers.

Climbing and hanging from our arms helps develop shoulder girdle strength, which is vital to fine motor control.  Opportunities to continue to strengthen our shoulder girdle typically decrease as we stop playing and get older (unless we specifically focus on it at the gym).

To be able to swing from the monkey bars or climb up to the top of the equipment, it also takes motor planning to figure out how to move our bodies to get where we want to go.  Hanging and jumping off of a height helps develop body awareness and spatial awareness.  All of these are building blocks in our physical development.

High speeds

High speeds type of play includes:

– sliding

– swinging

– biking and running at the edge of control

These types of activities serve a number of purposes, such as helping us continue to develop our vestibular system, which is responsible for giving us sensory information about motion, spatial orientation and equilibrium.  Additionally, high speeds typically means children are working on their overall fitness or cardiovascular work, leading to better endurance.

Rough and tumble

Check out our next blog post of this part of risky play.  There is just too much important stuff to fit in!

Getting lost

Getting lost sounds a bit scary, however this type of risky play includes playing alone and exploring unfamiliar environments independently.

The benefit of this type of play is much more psychological in nature rather than physical.  It allows our kiddos to develop resiliency and independence as well as a sense of self-security – that “I can do this!” mindset.

Of course, this type of play looks different at different ages.  A toddler may “hide” during hide and seek, however, the parents will know exactly where they are, whereas an older child might explore a forest while parents are nearby.

Dangerous tools

Dangerous tools play includes play with items that may cause harm, such as knives, hammers, screws and saws.

A child may help in the kitchen chopping veggies or build a birdhouse or fort.  Not only does this help reinforce creativity and planning, but it also helps develop hand eye coordination.

Dangerous elements

This type of play is in environments with an element of risk.

This might be near water, a steep drop off or fire.

The benefits of this kind of play are similar to getting lost.  From a physical perspective however, these environments can add an extra challenge.

Sand and rocky ground are unstable surfaces which can challenge balance, increase foot strength and in general take more energy to navigate – all great things from a physio point of view!

Growing and learning through Risky Play

All of these types of risky play allow children to grow and learn.  From a physiotherapy prospective, being physically active is of great importance, but it is also important to have the ability to continue our physical development with new challenges that we often don’t get an opportunity to experience otherwise.

From a global development perspective, children who engage in risky play foster greater self-esteem, build resiliency and learn to manage risks.

It can be hard to step back and let our little people try these things, as worry seems to be a natural part of parenting!

There is a fantastic website which can help parents/caregivers with the worry in order to encourage their child to experience more outdoor risky play.

Stay tuned for the second part on rough and tumble play!



A typical question for most physiotherapists who see children (and honestly one I think most moms ask themselves at one point or another) is ‘should my child be doing X by now?’  So, I thought I would take a few blog posts and write a little about each of the big gross motor milestones.

Let’s start with rolling, the same thing most kiddos will start with.  I know for my husband, that was when ours stopped being “a loaf of bread” and became a tiny human to him – suddenly they can move!

What does it take to roll?

Rolling can seem simple to us as adults but in reality is quite complex.  There are a LOT of components to rolling.  A child needs neck control, shoulder mobility and control, the beginning of core stability and, finally, hip and knee control.  Without all of these components, the child may not be able to initiate the movement, or they won’t be able to control the momentum.

To start learning all of those fundamental building blocks (especially the neck control and shoulder mobility/control), it takes practice, and that means TUMMY TIME!  Tummy time is so vital – more on this another day!

The start of rolling

The first part of rolling that parents typically see is when their child is on their back and they are able to roll to their side.  This usually starts to emerge around 2-3 months.  This either happens because they are looking at something to the side and up from them or because they put their feet in the air and they tipped over.

Then it progresses to a purposeful head movement and the body follows the head. When this starts, the body is quite stiff and tends to roll like a log, and the roll can be a bit uncontrolled sometimes, startling a baby.  But, as those fundamental skills improve with practice, we see rolling with rotation and bending through the trunk.

To roll from tummy to back, babies need to bring one knee up toward their chest and lift their pelvis slightly to start the roll.

When should my child roll?

Some children start rolling as early as 4 months, but a typically developing child should roll both directions by 6 months.

If your child is not showing the building blocks to rolling by 4 months or isn’t rolling by 6 months call your local pediatric physiotherapist!  As always, if you are in Kitchener-Waterloo or Perth County, give me a shout!

Private AND Public Therapy Services?

Private AND Public Therapy Services?

This is a big topic amongst a lot of my families and within the therapy community in general.  It’s a conversation I would say I have at least twice a month with a family, another physiotherapist or another therapist from a different discipline:

Can I use private therapy services even if I’m getting treatment through the public system?  Why would I see a private therapist if I’m being seen in the public setting?  Should I see one vs the other?

My answer is: do BOTH!

I encourage all of my families to call their local children’s treatment centre (in our area, you can get in touch with either KidsAbility or Thames Valley Children’s Treatment Centre) and put in a referral for services.  Parents can self-refer or a medical doctor/specialist can refer on behalf of a family.  This is a vital resource that can help get access to a variety of services, including therapy and, in the long term, planning transition to school.

The most important thing is to get the referral in early!  Some treatment centres only provide services until school age, at which time care is transferred into the school system.  As well, given the number of children requiring services, wait times for assessment and treatment can be lengthy.  The sooner you put in your referral, the better!

So, what is the role of the private therapist?

Treatment in the public system looks different for different families.  For some families it’s more consultation based – once every month, or six weeks to provide suggestions for exercises at home, providing equipment to increase a child’s function or ease of caregiving.  For other families, it may be blocks of treatment 2-3 times a year to work on specific goals.

This is where a private therapist comes in!  I have a number of families I have seen while they are waiting for public services and, in some instances, we are able to achieve their goals before they get their assessment.  For other families, a private therapist can provide more frequent, hands on treatment to supplement public services they may be receiving.

However, there are some guidelines we need to follow – the College of Physiotherapists of Ontario has a standard of care that lays out the expectations for a physiotherapist who is treating a client who is receiving care from another health care provider (including a physiotherapist).  The key is communication between the client/family and the other treating therapist.  We need to make sure the treatments are compatible, discuss how the therapists are dividing treatment and that there is nothing that interferes with the delivery of safe, quality care.

At the end of the day, I feel like the more help a child can get to accomplish their maximum potential, the better!  If a family can afford private physiotherapy (through benefits, bursaries or private pay) I think it can be a wonderful addition to public services.

The Truth About Toe Walking

The Truth About Toe Walking

Let’s talk about toe walking!  I recently went to a course solely focused on toe walking and was super excited to go.


Because I had been finding that these kiddos were hard to treat, I often wasn’t getting the gains I had been hoping to, and, when I did, they didn’t always last.

Let me tell you, this course changed EVERYTHING!

I will honestly admit I had been doing it wrong all along!  I had been taught in school (like most physios) that toe walking was the result of tight calf muscles.  So, we did things like stretches, night splints and surgery.  What we now know is that tight calves is the consequence, rather than the cause.

Idiopathic Toe Walking

It isn’t uncommon for children who toe walk to be diagnosed with idiopathic toe walking.  Idiopathic means that there was no known cause, but what has happened over the years is that is has morphed to people thinking there isn’t a cause.


There is always a cause.

Toe walking is super inefficient, and the only reason your body will do it is to meet a greater need.

Toe walkers of today are different then the toe walkers of previous generations.  We are using more equipment with our kids than we used to and more supportive toys when learning to walk.  We have more kids with sensory needs and/or autism.  All of these things make for fundamentally different toe walkers.

Which means that the assessment and treatment of these kids needs to go beyond looking at the calves!

Wait and See

I have come across some families that tell me they were informed that toe walking is normal and not to worry, as they will grow out of it.  Toe walking is NOT a normal part of development – if your child has just learned to walk in the last week or two and you see them up on their toes and then they go back down to the soles of their feet, and this happens less and less, then you likely don’t need to be concerned.  But studies show almost all 18 month olds step with their heel first.

Did you know our balance strategies during walking are developed by 3 years old and the bones in our foot are solidified by 4 years old?

AND it is possible for walking on the toes to actually deform the foot bones!

It’s a challenge to make changes to both of these things after that point.

Lastly, our adult walking pattern is solidified by 7 years old, so how a kiddo walks at 7, is how they will walk as an adult.

That’s why earlier is better to try to address these issues BEFORE our foot, balance and walk are all solidified!

Toe Walking as a Marker

Earlier in this post I talked about how toe walking is inefficient and that the only reason someone will do it is to meet a greater need.  A new study has shown that there’s a correlation between speech difficulties, learning disabilities and toe walking.  This likely explains the underlying reason the child is toe walking in the first place.  Because children typically start walking before they have much speech, toe walking can be a marker for other concerns that haven’t yet emerged, but should be monitored.

Long Term Consequences 

You may be thinking, what is the big deal?  Is it THAT important that my kiddo is up on their toes – they are walking, right?!


There are long term consequences!

Some long term consequences of toe walking include increased frequency of injuries, knee instability, difficulty finding shoes and early arthritis and joint pain.

But what about those kids that can, when asked, put their heels down?  A recent study found their calf strength and overall endurance was significantly less then their peers, which means they have a harder time keeping up!

There is an interesting video/interview here talking about the long term repercussions of toe walking.

So, the long and short of it is that toe walking is a complex issue, much more than most physiotherapist and doctors ever thought.  Treating it is possible without drastic measure such as night splints, botox or surgery.  However, as with most things, the earlier the issue is addressed, the better the likelihood of results.  So, if you have concerns regarding your child’s toe walking, book an appointment with a physiotherapist who has training in toe walking and will take a wider approach than  simply looking at their calves!  If you are in my area feel free to reach out to me at or (519) 291-5402.