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!

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.