Transitions

Transitions

Transitions are a vital, but often overlooked, part of development for most parents. I know that when I talk to my other parent friends, the only time the term transition comes up is when we are talking about transitioning to one or no nap, or to daycare and school. But, those aren’t the transitions that I’m talking about.

What are transitions?

When physiotherapists talk about transitions, we are describing the movements between two positions. For example, going from sitting to crawling, or from sitting to standing.

Why am I talking about them?

The first reason is that they are often sadly overlooked!

We are so excited to see that next big milestone that our kiddos can achieve, that we don’t think about the middle bit!

The next reason is that in the last few years I have seen more and more children that have most of their milestones ‘checked off’, but can’t get there themselves. So, they can sit and stand, and perhaps walk (these kiddos typically don’t crawl), but their parents have to put them in those positions. In addition, the child often cries until the parent comes to move them into a different position.

The last reason is that the increase in Container Baby Syndrome (check out my last post, Container Babies) means that it can often be even harder for children to get to practice these transitions.

Why are they important?

Transitions are vitally important because they help build those building blocks for future skills.

Typically, a child has to achieve one skill, and work on the transition skills to then get to the next skill. The only real exception is sitting, as children learn to sit before they learn to get into sitting by themselves – us parents put them there!

These in-between movements also help to develop a childs protective reactions and balance reactions, which in turn makes the next skill easier!

Hopefully parents will have a greater appreciation for how important all those attempts and fails (and potential face plants) are.  While a child is learning to get into and out of positions, opportunities for practice are promoted, which is so, so important – no matter how excited we are to see the next ‘milestone’!

If your child is unable to transition between positions, or they are doing the milestone ahead but can’t get there by themselves, please reach out to me if you are in the KW area, or contact your local paediatric physiotherapist for an assessment!

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!

Rolling

Rolling

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!