…It might be more than behavior and attention

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.

By: Dr. Ali

This week is St. Patrick’s Day and with all of the green, Leprechaun fun, we wanted to add some fun moves to your family’s festivities! If you need a visual version of these exercises, click above to view the exercises in video form!!

  1. Leprechaun’s Jig: Jump together on two feet, then jump onto one, to two, then to one, and keep repeating this over and over again until you have done 10 one footed jumps total! Look, you’re doing a jig!
  2. Making the Rainbow: Go on your belly to start. Place your hands on the ground and your feet on the ground. Then push your tooshie up into the air and hold
  3. Creeping over the rainbow: Tip toe on a line with a sneaky expression, so you don’t “tip” the Leprechaun off that you are coming. SHHHHH its a surprise, you have to sneak up on him if you want his gold!
  4. Jumping in the Pot of Gold: Jump into your imaginary pot of gold but bringing one knee up close to your chest then jumping onto the leg that is up while bringing your opposite knee close to your chest. 
  5. Give gold coins to your friends: Squat low (because you are still up on the imaginary rainbow) and pass your friends coins by reaching down low. Pass the coins to 10 friends!

We hope you have fun getting JIGGY with it! We know you will all be the best rainbows, pot o’ gold jumpers, jig dancers, and gold coin sharers out there! Happy St. Patrick’s Day everyone!

Today’s Frequently Asked Question

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!

What is it and why do we PT’s care?

Hypermobility can be thought of as extra laxity in the joints, aka the joints are more flexible than is typical. In the clinic, we measure joints in degrees, and usually joints like elbows and knees are supposed to straighten to make the arm one line and the leg one line, which would measure to be 180 degrees. Hypermobility is really easy to see in the elbows and the knees especially because the angle will be visibly past straight, or past 180 degrees.  It is definitely harder to see in the spine, the hips, shoulders, ankles, wrists, feet, and hands but they can be hypermobile too! A couple of extra degrees is completely fine and is within what we call normal. But, when 10 or more extra degrees can be seen and measured, we start to consider this within our treatment planning in the clinic.

You might be thinking, so what, my child’s knee can bend a little backward, why does this matter? That is a great question! We will use the knee as an example. It really matters if you see them standing and “hanging out” on a hyperextended knee (a knee that is over straight) for prolonged periods of time. There are plenty of kids and adults who have hypermobility throughout their whole bodies who have learned through athletics, or just through life, to control their mobility and stand with “neutral joints”. But, at baseline it is harder for those with hypermobility to control their joints. Because of this, they have to train their muscles and ligaments to sense when they are in the right place.

There are many systems that come into play to learn how to control hypermobile joints, but simply put, the muscles and ligaments need to learn how to sense when the joints are aligned versus when they are hyperextended. Then the muscles need to be trained to hold the joints in the “good place”, gaining control and strength through frequent practice. When this is practiced A LOT, it will become a skill that the child doesn’t need to think about, and will happen automatically.

We PT’s care about hypermobility because it can make it harder for children to sense what their bodies are doing as they move and harder to control their bodies. Part of our awareness of what our bodies are doing as we move comes from signals the joints send to our brain. Sometimes with hypermobile joints, these signals are decreased unless the joint is at its “end range” aka when it is fully extended. This causes children with hypermobility to lock out their joints while completing movements, which can lead to abnormal movement patterns in early life. Constantly moving with abnormal patterns on joints that are over extended can also cause joint injury in later life. 

The other big factor that can be tied to hypermobility we also look for and treat is decreased coordination. When there is less control over the joints, it is hard to put movements together. This is especially so for movements that require standing on one leg, pushing through the arms, and moving the limbs, head, and/or trunk in different ways at the same time.


If your child shows signs of joint hypermobility and you believe it is affecting their ability to move easily and with control, call and inquire about our free Discovery Visits, where we can screen your child to see if physical therapy would be an appropriate option for him or her. If you have any questions about this article, feel free to contact us at info@kidpt.com .

Setting attainable goals & letting kids bask in their own successes!

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!

Happy Valentine’s Day! Today, we are going to keep it short and sweet! We know you are all probably having a blast sharing sweet messages with friends and family and eating chocolate, but you know what else is fun?! Valentine’s Day themed exercises, that’s what!! So become the best Cupid you can be today and share the love with these five sweet moves:

  1. Big Hug Jumps- start with your feet next to each other, arms by your sides. Then jump your feet and arms out at the same time! Next, jump back in so that your feet are together and your arms are wrapped around you, aka you are giving yourself a BIG HUG! Repeat this move for 20 seconds!
  2. Open valentines messages- Stand with arms and legs squished together while you squat. Then, open one leg and same side arm until your arms make two right angles and your knees make two right angles, as in the picture below. Now close the box by bringing your arms and legs together in front of you again. Do this with the same leg and arm 3 more times. Repeat to the other side.
  3. Unwrap the chocolate – Start with your back on the ground, with your legs and arms curled into a little ball. Slowly open up your legs and arms, lowering your body slowly to the ground to “unwrap” all the chocolate you want to eat! Unwrap chocolates 10 times!
  4. Give out flowers – Give all of your loved ones pretty flowers on Valentine’s day with a lunge and sway. To do this move, stand with your feet wide and lean onto your right leg, bending your right knee. Then keep your weight on your right leg and straighten your knee while raising your arms to the sky. Pretend you are holding one beautiful flower in your hands as they move to the sky! Repeat this to the left side, then do the move 7 more times to each side!
  5. Cupid’s Bow – Last but not least, be the best Valentine’s Day Cupid you can be by stepping into a lunge with your right foot forward, hips facing sideways (Aka warrior II if you know Yoga – in the picture below). Put your hands, with two fists, next to each other with arms straight in front of your nose. Then pull your left arm back like you are trying to shoot an arrow from your Cupid’s Bow while bending your right knee. Repeat this move 5 more times on this side then 6 times with the left foot forward.  

Need a better visual for what these moves should look like? Go visit our KidPT TikTok @kidpt_nj , our instagram @kidpt , or our facebook page @kidptnj to see Dr. Ali’s demonstrations for each of these lovely moves! We hope you have a happy Valentine’s Day with lots of chocolate to make the heart smile!

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. 

If you know what Physical Therapists do, you know one of the big things we focus on are MUSCLES! I’m sure you have heard all about your glutes and your abdominal muscles, but there is one group of muscles you may not have heard that much about, because it gets a little neglected sometimes. These muscles are the ones that help you BREATHE! Yes, there is a whole group of muscles that help you breathe, and just like every other muscle in the body, they can be EXERCISED to improve strength, endurance, and control. Normally, you don’t have to think when you breathe, which is really awesome because if we did have to think, we would probably not have the brain power to do anything else. But when we do think about breathing, we can teach the muscles to work in new and more efficient ways. Once you do train these muscles to work better, they start working like that for automatic breathing too! We miss doing these types of exercises at the clinic because of COVID, but that doesn’t mean they can’t be done in a safe, COVID free home environment!

Now, you might be asking yourself, why does this matter? Well, if you notice your child becoming out of breath while trying to walk and talk at the same time, they might have difficulty keeping their breathing efficient while they are moving around. If your child frequently becomes quiet or holds their breath when trying difficult things, they may have trouble coordinating breathing with complex motor and cognitive tasks. If this sounds like your child, here are some exercises that may be helpful for training their muscles for breathing for greater efficiency:

  1. Sipping through the imaginary straw (Breathing IN through pursed lips): That motion your lips make right before blowing a bubble or drinking through a straw, when you push them very tight together, that is what pursing your lips looks like! Breathing in through pursed lips (the imaginary straw) increases the resistance you have to breathe against, which means that your diaphragm, the large muscle at the bottom of your lungs whose main job is breathing, can work toward getting STRONGER!
  2. Blowing BIG imaginary bubbles (Breathing OUT SLOWLY): This one has a similar idea, but instead of strength, it’s all about CONTROL! When your child breathes out SLOWLY, they have to control the speed at which their diaphragm is relaxing back to its normal resting shape. If you add counting to this as well, the task involves even more control and coordination because they then have to match the speed of their exhale to an external rhythm, which adds motor COORDINATION into the mix as well! If this is too hard, start with a small mouth, which will help decrease speed naturally due to increased resistance.
  3. Singing: Singing is AMAZING for COORDINATION and CONTROL of breathing. Someone who is singing has to match the timing of inhales and exhales to maximize how many words they can sing before taking each breath, which involves using breath control to prevent the air from leaving too quickly. All of these features are wonderful, not to mention that singing is so fun it has the power to bring a smile to anyone’s face!
  4. Diaphragmatic Breathing: Diaphragmatic breathing is always a favorite because it works on breathing control, as in some of the exercises listed above, but it also increases relaxation. For this one, have your child lie down on the ground with their hand over their tummy and make sure you can feel see belly move up and down with each breath. Tell them to fill their belly with air while they count for 5 seconds, hold that breath for 3 seconds, then exhale for another 5 seconds. Adding counting to your diaphragmatic breathing again adds an extra coordination component because it requires them to control the rate their breathing muscles contract and relax to an external rhythm. If the specific times listed seem too long, they can always be adjusted to fit your child’s current ability so that the exercise is appropriate for you. 

If you found this information interesting and believe these concepts may apply to your child, but would like a second opinion, come on over to KidPT for a consultation with one of our Physical Therapists! And remember, inhale, exhale, and you will go places!

Disclaimer: All information in this post is for educational purposes only. If looking for medical advice, seek a doctor or related healthcare provider.

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:

Stressed about the challenges the new year will pose for your child with learning new skills and reaching new goals? Don’t worry, you’ve come to the right place. Here at KidPT, we’re here to help your child to reach and exceed their potential. Just like we use every tool at our disposal to help our kiddos become successful here in the clinic, we believe parents should be empowered to do the same at home! To help you to help your child on their path toward success, we’ve written down some helpful hacks and philosophies that we use in our PT sessions every day that you can start to implement at home: 

  1. Provide positive feedback for a job well done
    1. When you see your child is particularly good at something, or if you see them improving in an area they were previously less confident in, make sure to give them lots of positive reinforcement. This will help build their confidence! Confidence is a key driver to give them the agency to push themselves further and continue to reach new heights.
  2. Make sure feedback is specific
    1. For any feedback, whether it be positive or constructive, make sure you are letting your child know WHAT part of the task you are complimenting or wishing to tweak. A generic “Good Job” doesn’t give them the information they need to repeat the good thing they did or to adapt areas where they need more growth. A good example of specific feedback is “Nice job walking up the stairs using only one hand”, because you are telling them exactly what about the task they just did that you thought was stupendous, and then they know to do it again next time!
  3. Try breaking down challenging tasks
    1. For any task that is hard for your child, try breaking down the task and attempting to introduce small parts of it rather than having them try to achieve the whole task on their first go. Then continue to add on small parts until they have built up to the whole task. This concept is called “scaffolding” or “forward chaining” and is used by many teachers and therapists alike to set up a framework for new tasks to make them more attainable. Start with a part of the task the child has down, and build on that piece. If trying this with your child, make sure you demonstrate the whole task first, so they know what they are working toward. If you are not quite sure how to break down a certain task for success, ask your physical therapist where you should start, and we’ll be able to guide this process!
  4. Remember, everyone is different, and that is GOOD!
    1. Every single person on this earth is very different from the next, and that’s how the world was meant to be! Each individual person brings something new and diverse to the table, and this is how the world learns and grows. Your child’s strengths enhance this world and though they might have room to grow in other areas, so does the rest of the world!
  5. Breathe, you got this! 
    1. Don’t forget to take some time for yourself and to affirm to yourself that everything is going to be okay. Just by taking the time to be informed you are taking steps to supporting your child, and that is what is important.

You’ve got this, and so does your child, and together you can be a confidence boosting TEAM!