Sitting

Sitting

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!

Sitting Still in School

Sitting Still in School

I came across this article recently and, although it’s a bit older, it got me thinking.  I too, like Angela Hanscom, an occupational therapist, have parents who have been getting feedback from their children’s teachers that they are concerned with ADHD and fidgeting in school.  I often get questions from parents on how long their child should be able to sit for during class.  And, vice versa, teachers who feel that children aren’t able to sit, pay attention, and participate appropriately.

In the article, Angela discusses observing a typical classroom (not special needs) at the end of the day and seeing that kids were tilting back in their chairs, fidgeting, chewing on pencils, etc.  From what I hear from my friends who are teachers, (a variety of elementary grade levels) this is pretty typical.  When I hear this, I can’t help but think that I don’t really remember that from when I was a kid in school.  Sure, there was the occasional kiddo who would play with a pencil, or lean back in their chair on the occasional day, but not the majority of the class on a daily basis.  So what happened?!?  Why is this happening?!

Angela touches on two things in her article, the first being our expectations for kids to sit for longer periods.  I know this will fluctuate from school to school and teacher to teacher, depending on how their classroom is structured.   However, the constraints of getting everything in that needs to be taught, as well as school policies, often means that kids are sitting for looonnng periods of time.

I was speaking to my family on the weekend and got asking my niece a bit about this.  In her school, the children don’t move class to class for different subjects (which we did as kids – at least specialty ones), they stay at their desks and the teachers come to them.

The second is that our kids are just not moving enough! From an occupational therapy perspective, she talks about how not having kids move is effecting their attention.  And I whole heartedly agree!!  But what really got me thinking, is how this all relates to the kids I see here in physio.

I have been seeing more and more kids in the last little while whose parents tell me that their teachers are concerned that they fidget constantly.  When I assess them, the trend tha I’m seeing more often than not is that they don’t have much core strength (*Check out my past blog posts to learn more about our core).  So, I have been paying close attention in sessions, as well as when I get them to come in from the waiting room, and I’m starting to think these kiddos fidget as a strategy to compensate for their lack of core strength. (Hence why this article seemed perfectly timed in a connect the dots kind of way!)  I would have typically described kids with poor core strength as those kids who melt into chairs and lay on their desks (and I do still hear about quite a few of those kids as well), however I like to think of these kids as a new breed of poor core strength kids.  These are the kiddos who parents might think are strong (“They have a six pack, how can they have a weak core?”), however, when you test them they have okay initial strength, but their endurance is not where it should be.  Again this goes back to kids not getting enough time being active – a sport two days a week for 45 mins is just not enough time!  So, instead of melting, they move constantly to recruit different muscles and to give those tired muscles a break.

I also keep thinking that the types of moving kids are doing now is also different to what we used to do as children, and that the issue is starting long before these kids get to school.  But this post is lengthy enough (these next two thoughts I could chat for hours about lol) and I don’t want us all sitting reading and not MOVING, so look forward to future blog posts on container babies (WHAT?! …just wait!) and why risky (and rough and tumble) play is important!

Core Strength in Kids

Core Strength in Kids

We have all heard the buzzword ‘core strength’ being thrown around with respect to health and fitness in adults, and know we should all be working on it. But, what most of us don’t think about is how important core strength is for children and their development. Let’s start at the beginning…

What is the ‘core’?

There is actually an inner core and an outer core set of muscles and they need to work together.  Our inner core is made up of the transversus abdominus, the pelvic floor, the respiratory diaphragm and the multifidus. These four muscles work together deep in the body to stabilize our spine and pelvis.  Our outer core includes the rectus abdominus, the erector spinae, the external obliques and the muscles that stabilize the shoulder blades and hips.  These are the larger muscles that do more of the moving.  The key is for both the inner and outer cores to work in harmony with each other.

Why is core important?

The core muscles primary role is to provide balance and stability – this is no different in children and is, in fact, more important than in adults, as it is the foundation of all skills.

Children should be developing strength from the inside, aka core, outwards to the arms and legs.  This starts with posture/alignment.  Children with weak cores often look like they are melting when sitting on the floor or in a chair, or will use compensation strategies such as W-sitting to keep more stable.  Without this foundation, children can have difficulty with balance, and the more complex gross motor functions such as running, jumping or even playing soccer.  Less often thought of consequences can include difficulty with fine motor tasks such as writing and speech concerns.

How do those relate, you ask?  With fine motor tasks it is important to have a solid trunk and shoulder control, ie. core strength, which then allows easier hand manipulation and more control.  Speech can be affected by a weak core, as one of the four inner core muscles is the respiratory diaphragm which controls our breathing.  Without a properly functioning inner core, controlling and timing our breathing becomes difficult, which then affects how we speak.  Amazing how important our core control is in so many different ways.

How do we work on core strength?

Of course, most of us know the traditional ab exercises, however, these are not the best way to work on both the inner and outer core muscles.  On top of that, for us to engage these muscles properly, we need be in good alignment.  In children it can be an even bigger challenge as, of course, they don’t want to do exercises and so it needs to be fun!

It’s important if you suspect your child has a weak core to see your paediatric physiotherapist to ensure your kiddo has ideal alignment and to work on increasing their core strength.