By: Dr. Ali

Do you feel like your child never stops moving? Like they are here, there and everywhere, running in between destinations and fidgeting in their chair while eating a meal? Even if you have asked them to take a pause they seem to not listen, or be physically unable to follow the instructions you are giving to slow down, even if they are traditionally a very good listener? Being in constant motion can be related to certain diagnoses, like ADHD. ADHD often presents with additional signs and symptoms, like forgetfulness, difficulty staying on task, trouble listening while another is talking, excessive talking, unsafe and impulsive behavior, and/or trouble with turn taking. Regardless of whether your child has a diagnosis of ADHD or not, there may be another factor contributing to their need for constant motion.

That “thing” is something we PT’s call postural control. Postural control defined as the act of maintaining, achieving, or restoring a state of balance during any posture or activity (1). When someone has a very “fine tuned” postural system, their body, vestibular system (little balance center in the ears), and eyes are telling their brain where they are in space and what position their body has to hold. Then their brain sends signals to the muscles to hold that specific position. In order for all of this to work, the eyes, the vestibular system, and the body have to send accurate signals, the brain has to correctly process this information, and the body must be able to coordinate muscles on all sides to hold the position steady. Phew, even thinking about this long process can make someone tired! 

When there is misinformation, trouble processing the information, or trouble coordinating the body in response to the brain’s signals, it will show in the body. When this happens, the child’s body may sway back and forth while they are trying to sit still in a chair, they may need to continuously move their feet instead of standing still, or they may just keep changing position when the one they are currently in becomes too hard to hold. When children are in constant motion, it often shows us PT’s that they are stuck constantly “restoring” their state of balance, as opposed to “maintaining” as the definition says above. Their body feels like it is always at risk of falling, so they move to catch themselves and prevent this. It may not look like that is what is happening when they are step, step, stepping, but if they are stuck constantly restoring their balance with decreased postural control, this is what their body is telling them is happening. 

When we see kids who show us this constant need for motion, we help them improve their postural control so that they can achieve and maintain steady postures. This is important for so many reasons other than just giving them greater stability. Sometimes when postural control improves, a child has an easier time paying attention to tasks and school lessons, because part of their brain isn’t being used to keep them on balance. All of that brain energy that was being used to signal movement that would prevent them from falling can be allotted to other things, because their balance system is operating on autopilot!

If you see your child having difficulty staying still and want to get another opinion, come in to KidPT for a free discovery visit, and a PT can answer any questions you may have about this topic!

References: 

1. https://pubmed.ncbi.nlm.nih.gov/10945424/#:~:text=Postural%20control%20is%20defined%20as,change%2Din%2Dsupport%20response.

Parents often ask us the difference between school physical therapy and private physical therapy.

I mean, why should a parent pay for a service they can get for free at school??!!

I totally get that, so I thought I would explain more in a blog post.  Because If they were the same, you would be right!  There would be no reason to invest in therapeutic care for your child that is being provided for free at school.

Let’s get into how they’re the same and how they’re different beyond their location of services.  

Isn’t Physical Therapy, Physical Therapy?

Physical therapists are all licensed to provide physical therapy and to work with all ages and all settings.  However, not only do goals change depending on the setting and the individual, but the role does too.

The role of physical therapy in the school is to support a child’s access to education.  It is to support their ability to participate in the least restrictive environment and support the motor skills needed at school.  The services are determined by the student’s IEP, Individualized Education Plan, and is a related service based on education law.  

Private physical therapy can look outside of the child’s education to look at the bigger picture of a child’s life today and in the future.  Private physical therapy can focus on goals from all parts of a child’s life, from keeping up with the family at the park to protecting a child’s joints so that they will be strong, healthy and pain-free for the future.  

Many children will benefit from physical therapy services in both settings to help them achieve success at school while also being able to guide the child towards their own personal potential.  

If you have questions as to the best ways to support your child, reach out to us today and one of our physical therapists can hop on the phone with you and chat about your options.  We are here to support you and your child and to help guide you to know your options so that you can best advocate for and support your child on their journey!

If you’ve ever watched a pediatric physical therapy session, you will often see us putting a toy or desired object just out of a child’s grasp so they are inspired to roll, crawl, walk, scoot, or reach for it. Setting up the environment this way helps us to encourage kids to utilize emerging motor skills and strengthen those skills while building confidence. When we set our environment up, we are always thinking about where the “goalpost” is and whether or not the goal we are setting is attainable for the child at that time. If it seems too hard, we have to adjust the height, distance, or surface where the toy is located so that the child we are working with is working hard but can still be successful!

Setting attainable goals is so important when kids are learning new skills because we want them to build confidence as they are building skill and we want them to enjoy practicing and learning. One way we see kids get really frustrated or discouraged when learning a new skill is when the goalpost is frequently changing as they are working to reach it. An example of the “changing goalpost” that often causes our kiddos to get upset is when they are a new walker, taking unsteady steps to reach mom, dad, or a toy, and who or what they are trying to get to keeps moving backward. We TOTALLY understand the desire to do this, it gets them to walk more, which is good right? While the easy answer would be “Yes, they are walking more”, it is more complex than this. While they are chasing the desired person or object, they are thinking “Gee, I only had to walk that short distance to mom when I started, and I definitely thought I could do this, but now she is getting farther and farther away, and I am getting tired. I don’t know if I can do this anymore.” Even though they definitely CAN do the skill for short distances, their confidence is then starting to decrease, and they may not want to try again because it takes SO MUCH effort to be successful. 

Don’t worry, this is a very easy fix! Say they are a new walker, have them start with a short distance first. Let them reach the object or person they are walking to and then let them play with the toy, hug mom or dad, and revel in the joy of their success with that mobility. Let them feel that joy for a few minutes while playing with the toy or hugging a parent. Then, once they have played for a short time, move the toy and redirect their attention to have them practice the skill again. Maybe even try to place the goalpost a little further next time, building on their ability as their confidence grows. Now they are learning that they can be successful with that motor skill, they are building confidence in it, while also learning that it is a new way of mobility they can use to reach things they want (a win, win, win)! Learning new motor skills takes a lot of patience, but overall the success your child will experience when moving and reaching each goal is worth the wait!

If you’re reading this post, it is probably because you have a really little guy or girl at home and are curious about how they should be developing as they grow through their first year. There are many sources out there that say a lot of different things, and you might feel like some have SO MUCH information and some have too little. We wanted to write this blog post to give you a comprehensive list of motor milestones that we as Physical Therapists find important within a range of months. FYI, we like to give ranges of months because all babies are different and need different amounts of time to learn new movement skills. We feel for our parents out there and don’t like when strict benchmarks for each milestone cause you added stress. If your baby does not have all of these skills mastered when at the younger end of the range, don’t worry, they have time! With that said, here is a checklist that you can use to track which milestones you are seeing in your baby from month to month! 

1 – 3 months old

• Lifting and holding head up while lying on tummy
• Pushing up on forearms while lying on tummy (3 mo)
• Able to move fists from closed to open
• Able to bring hands to mouth
• Moves legs and arms off of surface when excited

4 – 6 months old

• Using hands to support self while sitting
• Rolling from back to tummy and tummy to back
• Reaching for nearby toys while on tummy
• Pushing up to straighten arms and lift head while on tummy
• Reaching both hands to play with feet while lying on back

7 – 9 months old

• Sitting without support
• Sitting and reaches for toys without falling
• Moving from tummy or back into sitting
• Starting to creep or crawl using alternating leg and arm movements
• Showing greater stability in sitting
• Turning head to visually track objects while sitting

10 – 12 months

• Pulling to stand
• Standing alone
• Cruising along furniture
• Taking several steps on their own
• Moving in and out of different positions to explore environment and reach toys
• Maintaining balance in sitting when throwing objects

If you want more specific milestone information for each month range, check us out on instagram @kidpt or on tiktok @kidpt_nj , where we upload informational posts and videos weekly regarding motor milestones and what to look for! You can also REPLY here to request a copy of our free report, “6 Keys to Gross Motor Development.” If you are currently concerned about your baby reaching motor milestones, come in for a free Discovery Visit where a Physical Therapist can screen your child and see if PT is the right option for you. 

We’re all back in the swing on school after a nice holiday break off! With the transition back to school comes a shift in priorities, back to classes and schoolwork, and we know all you want to do is set your child up for success in the new year! Many kids have trouble keeping their posture upright throughout the day, and good, supported posture is one of the key elements leading to good focus while in school. Though you might not be able to do much about this while they are in person, you can adapt their environment to support them while they are remote learning. Here are some things to look for and tips to get you started:

1. When nice posture turns into not so nice posture
   1. If you see your child starting the day with nice posture but then see their spine taking on a C curvature throughout the day, they may be having a difficult time sustaining activation of their postural musculature and they may have trouble with ENDURANCE of these muscles. If this is the case, try placing a small towel roll behind their lower back for additional support when you see them starting to get tired. Then, when some time has passed, you can try removing it and seeing if their muscles have gotten the rest break they needed to work efficiently again!
2. When nice posture is hard to find
   1. If you see that finding a nice, supported spine with good posture is hard for your child to figure out, they may have trouble ACTIVATING their postural musculature. This may be the case if when you have told your child “sit with nice posture” in the past, they assume a Military-esque posture that would be impossible and uncomfortable for anyone to maintain OR they simply can’t find that upright position you’ve seen in blogs and pictures. Often these kids have a pelvis that is tipped very far back and pushed away from the back of their chair. Try placing a small wedge under their pelvis, with the taller end close to the back of the chair and the shorter end toward the front of the chair. This wedge will help place them in a more appropriate position to learn how to activate their musculature, so that when you ask them to try “good posture” again, it isn’t such a big ask. 
3. When they find many different slouched positions
   1. For the child that seems to never sit still but also never sit with supported posture, using a balance disk under their bottom is a great tool to encourage activation of postural musculature on both the front and back sides of their body. Sitting on a balance disk creates the need for the body to sit with active, supported posture to stay upright and on balance. If you are trying this, don’t forget to test it out with supervision to make sure that your child can stay on balance while sitting on the disk so that they do not fall out of their chair.
4. Make sure they are supported by the floor
   1. This one is SO important. Many people don’t know how difficult it is to sit with supported posture if your feet are not flat on the ground. Using the ground can help activate your whole body from the feet upward and creates more stability in sitting because you are not just relying on your bottom to keep you upright (but your legs too)! A nice clue to look for to see if they are supported from the ground up is the presence of 90 degree angles at their ankles, knees, and hips, if you see these angles AND they are sitting upright, you are good to go!

Remember, it is hard for anyone to focus when they are having trouble staying on balance or trouble activating their muscles for the long virtual school day. But, with these tips you can have your child on the path to postural support while learning in no time! You got this parents!

If you liked these tips or want to watch the video for this post, click here: