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.

Shoes, Shoes, Shoes!!

Shoes, Shoes, Shoes!!

Let’s talk shoes!  I will admit, I’m a shoe girl, even the ones I know aren’t good for me.  BUT when it comes to my daughter’s footwear, I’m pretty strict with what I put her in.  Why?  Because her foot is still developing, the foot that will support her for the rest of her life.

When we are born, our bones are soft and malleable, and over the first two years of life the bones harden, until we have a firm foot.  But wait!  My kiddo is older than 2 and I’m still fussy about what shoes she wears…why?  Our foot, and gait (walking pattern) continues to develop up until 7 years of age when we have our adult gait pattern.  So, she has a few years yet before I will stop being picky about her shoes.

So, what do I put her in?

First let me say that the recommendations that will follow are for typical children (no neurological, sensory or developmental diagnosis) with NO foot or gait abnormalities.  *Look for future blog posts talking about atypical kiddos and abnormal gait patterns such as toe walking.

When we think that about our foot changing and maturing through until 7 years old, obviously our development and what we are doing is quite different throughout those years.  Therefore, our shoe recommendations change depending on what stage we are in.

Pre-walkers, ie babies and crawlers, do not need shoes.  They need booties or pre-walking shoes that do not bind their feet.  The shoe should be flexible rather than providing a rigid support, and it’s very important that the shoe be shaped like the child’s foot.  The function of a shoe at this age is warmth and protection

Toddlers, who tend to use a lot of energy walking, should have a lightweight flexible shoe. A leather or canvas tie shoe is more secure, will stay on the foot, and will fit fat little feet better.  I think this is a bit of change from what kiddos have worn in the past.  I know my first shoes were very stiff, firm leather high tops and I have had lots of comments from the older generations about not putting my child in “supportive” aka stiff shoes.  When we are learning to walk, we learn a lot from feeling the floor under our feet, so flexible is key!  Toddlers should have flat heels on any shoes and they ideally should go barefoot in a protected environment such as indoors.  I know this isn’t always possible – my daughter goes to a daycare where they are required to wear indoor “shoes”.  So she is that kiddo who is still wearing leather Robeez inside all day.

For school aged kiddos, style and shoe fit is important with the main function being shock absorption and protection.  At this age, they can choose from a variety of options, including athletic shoes, sandals, hiking shoes, etc.  It is very important to wear the right shoes for the right activity to prevent injury.  Look for reasonably priced, flexible, well-ventilated shoes that allow plenty of room for growth.

The American Academy of Pediatrics has some overarching recommendations on what to look for when buying shoes.  Shoes should be lightweight and flexible to support natural foot movement with a stable base; they should be made of leather or mesh to allow the foot to breathe and they should have good shock absorption with durable soles as children get into higher impact activities.  They shouldn’t be stiff or compressive, as this may cause deformity, weakness and loss of mobility. In general, base your shoe selection for children (*typical children) on the barefoot model.

I do get questions on what specific brands I recommend.  I honestly think it depends on the stage of development and what fits your child.  Robeez and Momobaby are great for infants and toddlers.  Pediped; Stride Rite; Keen; ASICS; New Balance and Saucony all have some great options for children.

If you have any concerns about your childs foot or walking pattern I urge you to speak to your paediatric physiotherapist as soon as possible. We want to ensure your child has the best foundation (their feet!) to support the rest of their development.

Accessing Private Physiotherapy Services and Benefits

Accessing Private Physiotherapy Services and Benefits

Accessing Private Physiotherapy Services

One of the first questions I typically receive from a parent who I meet in the community is “How do I get referred to a private physiotherapist?” It’s super easy, but for a lot of families who have never needed physiotherapy, it can seem almost too easy.

The biggest myth out there is that you need a doctor’s referral, which in Ontario is absolutely untrue. Physiotherapists are able to assess and treat without a doctors’ referral. You simply need to call or email and book an assessment. It really is as simple as that! Some of my families comment that, had they known it was that easy, they would have called a long time ago.

For some families, however, there is one exception to what I just said above – if you are planning on using extended health benefits to cover the cost of physiotherapy, (YES! You can do that!!) some health plans require a doctor’s note to be eligible. I always encourage my families to check their benefit coverage first before we start.

Using those benefits!

Lots of families have some sort of extended health benefit plans, typically through one or both of the parents’ places of employment. Most cover physiotherapy up to a certain amount each calendar year. Some people just think of those benefits for physiotherapy to recover from an injury such as a broken bone or sprained ankle; however they can absolutely be used to cover physiotherapy for conditions such as developmental delay, torticollis or plagiocephaly (flat head syndrome in infants).

Every clinic will operate slightly differently -here at New Horizons Rehabilitation Services, clients have to cover the cost of treatment up front and will immediately be given a receipt which they can submit to their extended health provider to be reimbursed. This is typical of private physiotherapy clinics in Ontario.

I always recommend that families let their therapist know if there is a constraint on funding, or if benefits are limited, so together you can plan the most appropriate way to use your funding. As well, ask your therapist if there are any other possible avenues for funding for physiotherapy – there are occasionally bursaries or charity funding that you might qualify for.
If you have any specific questions or concerns about how to access services or using your benefits, feel free to send me an email and I will help as best I can.