We’ve all been there as first-time moms. We have one, maybe two young children and they are who we know. It may not be until we encounter their cousins, other children on playdates or in a daycare setting, or maybe a pointed question from our pediatrician that we even consider their development in comparison to other children.
On this podcast episode, our guests are Dr. Courtney Parsons, DPT and Gladys Harms, MS, OTR/L. Dr. Parsons has experience working with children with Down Syndrome, spina bifida, cerebral palsy, hyper/hypotonia, gait issues, orthopedic impairments, and developmental delay. Gladys Harms has practiced in the field of pediatrics as an occupational therapist for more than 10 years. She has experience in an array of areas, including early childhood intervention, acute care, inpatient rehab and outpatient care, treating children with various medical diagnoses as well as those with fine and visual motor delays, sensory processing issues, and self-regulation deficits. Both are mothers with their own young children.
Dr. Courtney Parsons, DPT, and her family 
Gladys Harms, MS, OTR/L
For those who are unfamiliar with the professions, occupational therapy (OT) deals with helping clients perform activities of daily living (as you might imagine from a stroke recovery). Physical therapy (PT) focuses on the ability to move the body: stretches, balance, strength, flexibility (as you might imagine in an adult knee replacement). The two do overlap some, and both provide hands-on care tailored to each child.
The CDC has a list of developmental milestones for children ages 2 months to 5 years. It’s printable. And they have a milestone tracker app on Google and Apple’s App Store. https://www.cdc.gov/ncbddd/actearly/milestones/index.html
If you or the doctor is still concerned:
- Ask for a referral to a specialist.
- Call your state or territory’s early intervention program to find out if your child can get services to help.
- Learn more and find the number at cdc.gov/FindEI. For more information, go to cdc.gov/Concerned.
For kids, play is their job. While they’re playing, they’re learning and developing. This is your cue to watch what they’re doing and how they’re doing it.
- Difficulty reaching age-appropriate milestones; if your 1 year old isn’t crawling or your 2 yr old doesn’t walk steadily (or on tip toes only).
- Fine motor skills—strength, control of small hand muscles; trouble using scissors, stringing beads, drawing
- Gross motor skills—sensory processing, also under-sensitivity, seeking sensation by touching everything constantly
Walking, jumping, tying shoes, balance, posture, hand-eye coordination…Renee knew a teen who went undiagnosed for years because he was at home and his parents weren’t comparing his behavior to age-appropriate milestones. They just thought he was “quirky.” EARLY INTERVENTION IS CRITICAL and can accelerate progress exponentially or ensure that it happens at all.
University of Utah’s Health website has a good list of the various challenges a child can experience. https://healthcare.utah.edu/life-skills-clinic/does-my-child-need-occupational-therapy.php
Developmental Delay: Developmental delay means that a child is behind in developing skills that are common during a particular age or during a particular time period. A developmental delay, however is more than being a little behind other children in a skill; it is being behind in a combination of skills or not meeting development milestones.
Fine Motor Skills: Fine motor skills are small movements made with fingers, toes, wrists, lips, and tongue, like holding a small object or picking up a spoon. If you notice your child drooling excessively, this might be an indication that there’s an area that may need a boost. Letting it go might be fine, or it may affect speech development later.
Gross Motor Skills: Gross motor skills help us move and coordinate our arms, legs, and other body parts. They involve larger muscles that help us control our body. A child who is behind in movement, strength, and/or balance may appear clumsy or uncoordinated.
Visual Processing: Visual processing is the process we use to make sense of what we see. It is a process in our brain that interprets visual information.
Oral Motor or Sensory: Oral motor or oral sensory skills are control of muscle movements in the face and oral area, such as the lips, jaw, tongue, and soft palate.
Sensory Processing: Sensory processing is making sense of information that we receive through our senses, like sound and smell.
Social Interaction Skills: Social interaction skills are skills that help us have relationships and understand those around us. They help us bond with other people in our life.
Learning Challenges: Learning challenges, sometimes called learning disabilities, are another type of developmental delay.
Play Skills: Play skills are skills that can help a child make sense of the world around them. A child can gain self-confidence, learn problem solving, and develop social skills through play.
Typically, children get referred to an OT/PT by a pediatrician or teacher. In many cases, the school system or insurance can cover the cost of therapy. Depending on the severity and cause of the issues, therapists can work with a child just until the issue is resolved/corrected or over a period of many months or years. A critical component of success is the continued therapy “homework” parents must do at home since a therapist typically only sees a child for a limited time each week.
Here are some best practices Dr. Parsons and Ms. Harms advise parents to do:
Instead of laying your baby face down for tummy time, start out on her back and roll into it.
Use towel rolls and modifications to make tummy time more pleasant and engaging.
Towel rolls can be used to modify seats, boppies, and other devices to position your baby best.
Challenge your child’s skills (walking/crawling) by adding a balance portion. Allow them to crawl/walk outside, in sand, over blankets or cushions.
Avoid prolonged standing in the first 6 months. Limit time is 15-20 min for 2-3 times/day
Make sure baby gets more play time on the floor than in a seat or container (e.g., exersaucer, activity chair, swing) in a stationary position.
Baby wearing: rotate head when laying on your chest and alternate which side head is turned to
When you lay them in crib to sleep, alternate which end of crib their head rests on
If you breast feed, you know to switch sides. If you’re bottle feeding, remember to alternate which way you hold baby when giving a bottle. It may feel awkward to you but it helps with development of symmetry and pressure on baby’s skull.
If you don’t begin using exersaucers and other stationary standing practices until 6 months old, you greatly decrease your baby’s risk for hip dysplasia
Try encouraging to sit in an M position instead of a W position
For car seats, swings, strollers, and other containers, if they fall asleep, be sure to use towel rolls to check they’re in midline position and their head isn’t flopped to the side or forward. Prop their head and body up.
Place your child or baby in the position you’re aiming for and look for products that most model how they would look if they were sitting on the floor. (i.e., high chairs or floor seats that are not tilted forward or back; high chairs with feet support).
Allow barefoot walking as much as possible.
For first shoes, opt for flexible soles and light weight options with a wide fore-foot. Good choices are StrideRite, See Kai Run, some Nike tennis shoes, Robeez, or a velcro sock with anti slip grip on bottom for in the house during winter.
When helping your child walk, try not to keep their hands up super high over their head. Think of how they’d walk using a walker and mimic that. The lower your hands are, the more your child’s body keep its weight shifted behind on their heels and uses strategies for balance.
Products that Support Good Development
boppy pillow
upseat (floor seat)
Abiiebaby (high chair)
Fisher Price Step Up Static Stand (use towel rolls under feet to support)
Products that Offer Less Optimal Support
Bumbo seat
Sit-Me-Up seat
Exersaucer with walking feature
Flags/Signs for Therapy
The following are some things that you should ask your pediatrician about if you notice them.
- Poor head/neck control after 8 weeks old
- Torticollis (head tilt in one direction with rotation toward opposite shoulder; flat spots on skull, asymmetry in facial features)
- hip dysplasia (during diaper changes or changing clothes if you hear/feel a clunk or click at hip)
- floppy/low tone or high tone/stiffness
- W-sitting (hip and core weakness)
- regression of skills
- Poor progression of motor skills or significantly below typical range for development
