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Category: Tummy Time

What are primitive reflexes?

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A reflex is an automatic and instantaneous response to a sensory stimulus. Remember when you were a child at the doctor’s office and they tapped your knee with a small mallet to check if your leg kicked upwards? You didn’t decide to kick your leg, it just kicked. From infancy, reflexes are vitally important for proper development of the brain, nervous system, body and sensory systems. Some reflexes are meant to stay with us our whole lives. Others are designed to be dormant after their function is fulfilled – also called integration. Check out this awesome resource from Tools to Grow to learn more about specific reflexes and how they impact a child’s function during their daily life. Primitive reflexes are adaptive responses that develop before birth and typically integrate as the brain matures. Primitive reflexes are important for survival and development early in life; however, it is also important that they become integrated as the child grows. Retained reflexes can cause sensory issues, postural disorders, decreased motor skills, and attention/behavioral issues.

What causes retention of primitive reflexes?

Some potential causes of retention of primitive reflexes include c-sections, trauma during birth, exposure to toxins, decreased tummy time during infancy, decreased time crawling, chronic ear infections, or head injuries during infancy among many other unknown causes.

Five Commonly Retained Primitive Reflexes and their Impact on Occupations

1. Moro Reflex

The Moro Reflex is known as the “startle” reflex. This reflects is a fight or flight reaction. It is present at birth and should be integrated by four months. Common effects of retention include emotional outburst, motion sickness, and difficulties with vision, reading, and writing.

2. Asymmetric Tonic Neck Reflex (ATNR) 

The Asymmetric Tonic Neck Reflex (ATNR) is known as the “Fencer’s pose”. It assists in the birthing process. It appears at birth and should be integrated by nine months. Common effects of retention include decreased eye-hand coordination, poor handwriting, poor balance, difficulty with reading and math, and difficulty focusing.

3. Symmetric Tonic Neck Reflex (STNR) 

The Symmetric Tonic Neck Reflex (STNR) is an essential foundation for crawling. It appears at six to eight months and should be integrated by nine to eleven months. Common effects of retention include poor posture, W sitting position, poor eye-hand coordination, messy eater, and low muscle tone.

4. Tonic Labyrinthine Reflex (TLR) 

The Tonic Labyrinthine Reflex (TLR) is commonly seen in children with ADHD diagnoses. It appears before birth and should be integrated by three and a half years of age. Common effects of retention include decreased balance, poor spatial awareness, toe walking, weak muscles, poor posture, and difficulty with climbing.

5. Spinal Galant 

The Spinal Galant Reflex also assists in the birthing process. It appears at birth and should be integrated by three to nine months. Common effects of retention include bed wetting after potty training, hyperactivity, postural issues including scoliosis, attention issues, and decreased endurance.

What are integrated reflexes?

Integrated reflexes are important for developing motor control. A child needs motor control to maintain proper posture at a desk in school, ride a bike, read a book, cross midline, write, and get dressed. A child with integrated reflexes has normal movement patterns to complete these functional tasks at home and at school. A child with unintegrated reflexes could benefit from skilled reflex integration therapy which will essentially train a child’s brain by establishing an efficient movement pattern that supports higher level motor skills or cognitive tasks.

How do you know whether or not your child has integrated these reflexes?

There are many common areas of difficulty that may suggest a retained reflex including the following:

  • “Bouncing” Child: Constantly moving, can’t sit still on a chair, hyperactive
  • “Noodle” Child: Leans on everything, rests head on table
  • “Shirt Chewers”: Constantly chewing on shirts or pencils, and touches everything
  • “Emotional Child”: Challenges with regulating emotions, easily frustrated or upset, difficulty with utilizing age appropriate coping strategies to calm body
  • School Performance Challenges: difficulty with reading, handwriting, language/speech, poor sitting balance and immature grasp on writing utensils
  • Coordination Challenges: Chronic body aches, poor endurance, fatigue, muscle weakness, poor concentration, fidgeting, disorganization

How do I know If My Child Has Retained Primitive Reflexes and What Can I Do?

Once your Occupational Therapist suspects a retained reflex, he/she will educate the caregiver on the importance of carryover for treatment recommendations. Caregivers play an important role in seeing progression in their child’s everyday activities. It is typically recommended that the child completes a set of tailored exercises to meet your child’s needs, 5-10 minutes per day, for 30 consecutive days in order to see any progress. Your therapist may recommended a reward or sticker chart in order to keep your child motivated towards an end goal. Progress can be noted short term and over 9-12 months. In addition to exercises, your Occupational Therapist will make recommendations for modifications in the school and home environments which may include changing positioning during school work, movement breaks, sensory techniques, relaxation techniques, decreasing auditory and visual stimulation, and organizational skills, just to name a few!

In order to determine whether your child would benefit from direct treatment for Reflex Integration, it is recommended that your child be evaluated or screened by an Occupational Therapist at Carolina Therapy Connection. Give us a call at 252-341-9944 today to schedule your FREE occupational therapy screening with one of our experienced and knowledgable OT’s. 

Helping Your Child Learn to Walk

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Concerns About Your Child’s Ability to Walk

Are you concerned that your child hasn’t started walking yet? Development and achievement of motor milestones happens at a pace unique to each child. However, if your child has not yet started walking independently by 18 months it may be time to reach out to your local Physical Therapist for an evaluation. The Centers for Disease Control and Prevention (CDC) acknowledges that these walking-related physical milestones are typically met by age 1:

  • pulling up to stand
  • walking while holding on to furniture
  • may be taking a few independent steps
  • standing holding on and may stand alone

Delayed walking can occur for a variety of reasons – core weakness, lower extremity weakness, vestibular dysfunction, gravitational sensitivities, impairments in the motor plan or coordination for walking, and balance deficits to name a few. During a Physical Therapy evaluation we will assess your child’s strength, movement of their extremities and trunk, and balance. We will also screen for any neurological and vestibular concerns, as well as keep an eye out for any sensory involvement or gravitational sensitivities.

How can you begin helping your child learn to walk?

Here are some activity ideas that may be used by your Physical Therapist and that you can try at home to jump start those unsupported steps and help your child walk:

    1. Activities to promote weight shifting between lower extremities, as well as single leg stance balance needed for unsupported walking. Cruising laterally (side to side), across corners, around corners, and pivoting between surfaces. This can be done at a horizontal surface (i.e. coffee table or couch) or a vertical surface (wall, window, mirror, etc.). As your child masters pivoting between two surfaces, increase the distance between the surfaces to promote unsupported standing and stepping to reach the other side.
    2. While standing supported at the couch, coffee table, wall, window, etc. offload one of your child’s lower extremities. You can prop their foot on a pillow, stool, etc. or simply hold their foot up off the ground. As your child masters this while standing supported, try while they are standing unsupported and interacting with a toy with both hands. Shift their weight over one leg while stabilizing their knee on that side. Lift their other leg to prop on a stool, pillow, your leg, or simply hold their foot off the ground.
    3. Supported walking for increased duration and distance. You can start by having your child walk while holding your hands. Progress them from holding 2 hands to just holding 1 hand. Move from holding hands up, overhead to holding hands, forearms, or elbows at shoulder height. They can also engage in supportive walking using a walker/push-toy. Note: Always provide supervision when having your child use a push walker/toy. It is recommended to only use push toys and NOT a walker that your baby has to be physically placed inside of. 
    4. Walking while standing in a small hula hoop/ring to promote reduced support and more variable support. Have your child hold on to the ring with both hands while you support the front or back of the ring. As they master this, wean away your support.
    5. Walking while holding a toy (ring, action figure, etc.) to promote walking with less support and eventually no support. Walk with your child while holding the toy together. As your child’s confidence increases, wean away your hold on the toy to promote walking with less support.
    6. Supported walking with a rubber band or hair tie to promote walking with more variable support. If your child will maintain a grasp on a rubber band or hair tie, try walking with them while holding the rubber band or hair tie together.
    7. Supported walking (hand hold or upper extremity support on a wall) while stepping over uneven surfaces (i.e. a pillow of blankets, couch cushions, pillows, etc.).
    8. Initiating unsupported stepping. Situate your child in standing with their back against the wall. Stand in front of your child and hold out an incentivizing toy, food, etc. to promote weight shift forward away from the wall, transition into unsupported standing, and progression to unsupported steps forward to reach you.

How can Carolina Therapy Connection help your child learn to walk?

Pediatric physical therapy promotes independence, increases participation, facilitates motor development and function, improves strength and endurance, enhances learning opportunities, and eases challenges with daily caregiving. When developmental progress is brought into question, it can be difficult for a parent. We know there is nothing as stressful as seeing other children advance quicker than your child, leaving them left behind as they develop at a slower pace than expected. It is important to understand that slower does not mean never! In fact, there are many late walkers who are able to overcome the delay and catch up with other children their age without concern.

If you have concerns about your child’s ability to walk, motor development or anything else, call Carolina Therapy Connection at 252-341-9944 or email us at info@carolinatherapyconnection.com to get started today! We accept all major insurances and would love to help your family and kiddo maximize their independence and potential to grow healthy and strong!

Blog Written By: Joann Flaherty, PT, DPT

Joann Carolina Therapy Connection Blog Greenville NC

Helping your child learn to walk Carolina Therapy Connection Greenville and New Bern NC

Tummy Time Tips

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What is Tummy Time and why is it important?

Tummy Time is one of baby’s first exercises—and the most important! It is any period of the day where the child is placed on his or her stomach to play. It is a crucial exercise for baby’s motor, visual, and sensory development. Practicing tummy time helps babies develop the muscles necessary to lift their heads and, eventually, to sit up, crawl and walk. Tummy time is not an activity for sleep! Your baby should always be awake and supervised when lying on their tummy.

Tummy time is important because it:

  • Helps prevent flat spots on the back of your baby’s head
  • Makes your baby’s head, neck and shoulder muscles stronger so they can start to sit up, crawl, and walk
  • Improves your baby’s motor skills (using muscles to move and complete an action)
  • Alleviates gas and gastrointestinal pain
  • Helps master head control
  • Exposes your baby to different sensory environments
  • Engages and promotes bonding between you and your baby

When should Tummy Time start and how long does it last?

The American Academy of Pediatrics recommends parents start tummy time early. In fact, babies born at full term with no health issues can start tummy time as soon as their first day home from the hospital. As a new born, your baby can benefit from 2-3 tummy time sessions every day, lasting around 3-5 minutes each. As they get older and become more able to tolerate tummy time, your baby should gradually practice more each day. When your baby is 3-4 months old, aim to achieve at least an hour total per day. You should continue doing this with them until they are at least 7-9 months old when they begin crawling. At this age, they will be getting the developmental benefits of tummy time while moving, and it is not as essential to have them do it, however, it is still beneficial to have your baby lying on their stomach during play.

Why doesn’t my baby like Tummy Time?

Some babies may not like the tummy time position at first, particularly when they have not yet developed the muscles to lift their head and neck. Eventually, your baby should enjoy lying on their tummy and begin to enjoy play in this position.

Tips for making tummy time more enjoyable:

  • Place yourself or a toy in reach for him or her to play with.
  • Lie on your bellies together, side-by-side or face-to-face, on a comfy surface.
  • Put your baby tummy-down on your chest while you do your sit-ups. Add some funny faces and silly noises with each rep.
  • Change locations, giving your baby a different view to look at each session.
  • Entertain your baby with colorful toys that make noises and have lights while lying on their tummy.
  • Use a pillow or folded towel under your baby’s arms to slightly elevate them when lying on their tummy.

Tummy Time Abilities

At 2 weeks your baby:

  • Using tummy-to-tummy with you, tummy down carrying positions, and lap soothing positions
  • Working towards lying on the floor on their tummy
  • May become irritated when placed on their tummy, especially on the floor

After 1 month, your baby:

  • Should attempt turn their head while lying on their stomach
  • Attempting to lift head up, even if they are unsuccessful

At 2 months, your baby:

  • Spending at least 1-2 minutes lying on their stomach without becoming upset
  • Doing most exercises on the floor
  • Tilting their head to one side (Note: ensure they are tilting their head to both sides and watch for early signs of Torticollis)

At 3 months, your baby:

  • Is beginning to put some weight in their arms, with elbows behind their shoulders
  • Gaining more head control for longer periods of time
  • Spending a total of 1 hour total each day lying on their stomach
  • Visually tracks toys and objects in front of them

At 4 months, your baby:

  • Lifting their head to a 90 degree angle and keeping it centered
  • Pushing up on their arms to bring chest off the floor
  • Lifting head and moving neck simultaneously to visually track you and toys in front of them

At 5 months, your baby:

  • Beginning to push up on hands with straight elbows
  • Starting to reach for toys placed nearby and moving/scooting forward

At 6+ months, your baby:

  • Initiates lying on tummy on their own during play
  • Reaching and grabbing toys
  • Pivoting in a circle while on their stomach
  • Rolling from their tummy to their back and vice versa
  • Prefers being on their stomach to allow for easier play, movement, and exploring

How can Carolina Therapy Connection help?

We often have parents ask us about tummy time, so our amazing physical therapist, Emily Tower, is here to help! Watch this video to learn more about how you can engage your child in tummy time. 

If you have any questions about tummy time or your child’s development, contact Carolina Therapy Connection!

  • Our email is info@carolinatherapyconnection
  • Our phone number is 252-341-9944
  • We will be happy to do a FREE screening!
Tummy Time Tips