Let's talk about how OT can help support you and your infant and toddler!
Often times, parents will bring their child in feeling frustrated and discouraged because they feel in their gut that something is"off" with their child's development; but professionals, family, and even friends are telling them "it is normal" or "just give it time!". Meanwhile, their child has fallen even further behind and they finally follow their gut and come to us for a consultation or evaluation.
Other times, parents will bring their child in to us due to a recommendation from a pediatrician, friend, or family member noticing some delays. The parents feel horrible that they didn't know that these certain things were not "normal". Maybe the older sibling did the same thing, or maybe they are a first time parent, or maybe they just didn't notice. And you know what? That is ok! Because we are all just trying to navigate this whole parenting thing without a handbook and we all are doing the best we can with the knowledge we have in this moment. Knowledge is power, though, and I hope that sharing some information about these red flags will help parents feel confident in making a decision on whether to "wait it out" or get some professional advice from an occupational therapist.
So, Here we go!
1. Your Child is Not Meeting a Motor Milestone
This one may be the most obvious signs, but I find many parents get mixed information about this. Why? Well, because there is a typically a window of time, or a range, that the powers that be say each milestone is to be met. And they are not wrong - every child does develop within their own timeframe and no two children meet milestones at exactly the same time. However, there is a window of time for each milestone that we want your baby or toddler to be at least showing signs of "readiness" for these milestones. For example: Your baby is 9 months old and is not crawling yet. (No, this is no longer a CDC Milestone, but it is one of the most important milestones your baby should be demonstrating.... that soapbox is for another day....). Your pediatrician, family, friends or other mothers may advise you to just give it time and wait and see- which may be good advice, as they are still within that window of "typical" development, right? But, those well-intended advisors may not be looking to see if your baby is tolerating tummy time, pushing up with their arms or getting up on all fours. If they are at 9 months of age and not starting to demonstrate these pre-requisite tasks, then chances are they may have some underlying challenges that are inhibiting them from progressing to crawling on all fours. These factors can include body tension, low muscle tone, weakness or other neurological or muscular issues. The same goes for all of the other milestones. We want to see that they are showing signs of readiness within that window of time to ensure we are catching any potential issues that could be limiting their progress. If we can catch some of these factors early, we can often catch them up and get them back on track!
2. They Are Showing Signs of Asymmetry
Asymmetry simply means the absence of symmetry. We want both sides of the body and brain to develop the same. If we are showing signs of asymmetry, this often means there is increasedTENSION in the body. Imagine an elastic band going down both sides of the body from the head to the big toe. If one of those elastic bands has normal tension, but the other is thicker and tighter, we will see that tighter side shorten. This is essentially what is happening with your baby if they are demonstrating signs of asymmetry. One of the first indicators of asymmetry in the body can be when they are infants and prefer to look only to one side. Another early sign is that your child will only roll to one side independently. This is often because that tight side is pulling that hip up into flexion and promoting them to roll only in that direction. These signs can often get overlooked early on. (I mean, how many of us actually pay attention to which direction they are looking, rolling, etc?!) We just get excited they are doing the action! But the reality is, symmetry matters, and if we can catch and treat the body tension early, we often can get a child caught up on their milestones AND have them demonstrate them with symmetry!
3. Torticollis
Torticollis is caused by muscle tightness in the neck (specifically the sternocleidomastoid muscle) and impacts our whole body down through our pelvis and hips. Signs and symptoms of torticollis include a head tilt, asymmetry, preferring to look only to one side, and preferring to roll only to one side. Remeber that analogy above about the elastic band? Well, because this "elastic band" starts at the jaw and goes all the way down to our big toe, Torticollis can, and WILL, cause whole body tension and asymmetries. Torticollis can cause problems with head shape and development, delays in motor milestones, and challenges with feeding. Symptoms can be mild and often getting overlooked, or they can be severe with very obvious signs. Regardless of the severity, and regardless of what people say, it can not simply be "outgrown". Body work NEEDS to happen to stretch out the entire tight side, including the neck, shoulders, pelvis and hips. OT's will also give you lots of positioning advice, play ideas and environmental set-up tips to help support you and your child. It is so important that Torticollis be treated as early as possible! Not only to prevent further delays in milestones, but also to decrease the duration of therapy services needed.
4. They Are Not Tolerating Tummy Time
This is often caused by weakness, low muscle tone, or that pesky tension we keep talking about! Muscle tone is the amount of tension in our muscles at rest and is something that we are born with. Although we can not really change the muscle tone itself, we can work on strengthening to decrease any adverse effects of the low muscle tone in the body. Why is muscle tone important? Well, Muscle tone and core strength are the foundation for all of our motor milestones; both Gross and Fine Motor.
If we have low muscle tone or weakness throughout our core, it is more challenging for us to sit upright, hold our head up, stand up with balance, etc. While these are concerns all by themselves, it also leads to decreased ability to control our fine motor movements like self-feeding, holding a writing utensil, throwing a ball, holding toys, and the list goes on!
If a child is not tolerating tummy time because of tension in the body, then we would need to address the tension first. For example, a child has tension in the neck area. When on their belly for tummy time, they are having to extend their head and neck back to be able hold their head at midline and look around. If they have tension, this is uncomfortable and often times impossible to do with full range of motion. Try this: sit up straight in your chair and look up to the ceiling. Now, suction your tongue to the roof of your mouth while opening your mouth. Do you feel any tension in your neck?! Try this laying down on your stomach, too! Children with tension in their body are going to feel this with even more intensity, causing them to avoid these tasks because they are just so difficult and uncomfortable for them. Occupational Therapists can not only help to address tension in the body, but we can also provide strategies to increase tolerance through strengthening, positioning and different play tasks.
5. They Have Difficulty with Feeding
Challenges with nursing, bottle feeding, or moving to solids can often be due to oral motor deficits, myofunctional disorders, or sensory challenges. If a child presents with decreased range of motion in their tongue or lips, they may not be able to create a good suction while nursing or bottle feeding and have poor intake, fatigue easily when nursing, develop reflux or other potential issues.
If a child presents with decreased strength or mobility in their tongue, they may not be able to move the food that they have chewed to the back of their throat to swallow. This will often lead to children avoiding foods or chewing them and spitting them back out.
If a child presents with decreased jaw strength or malocclusions, they may not be functionally chewing the food to swallow safely. This can cause a child to aspirate, choke, or avoid certain foods that require a lot of chewing.
Now let's discuss one of the more challenging issues: Sensory! If a child has sensory challenges, they may not like the feeling of certain textures on their hand or body. Most of the time, children who do not like the feeling of textures on their hand or body will also not like the feeling of textures on their tongue. These are often known as our "picky eaters" and they will typically stick to the foods that are "safe". Have you ever eaten a blueberry and thought it was the most delicious thing you have eaten, just to turn around and grab another one and have it be sour? Or how about a grape that was perfect, but the next one was mushy? Well, children with sensory processing challenges can experience the same thing, but instead of being able to just try a new one, their brains get the message that the food is not safe and it will put them into "fight or flight" mode. This will cause them to avoid that berry or grape in the future because their brain's security system is telling "alert, alert!" when they even just LOOK at that food again. These kiddos tend to stick to the "safe" foods like crackers, chicken nuggets, chips, etc because they are consistent in texture and taste and their brain labels them as safe foods for their sensory system. Working on this type of feeding challenges takes lots of patiences and safe experiences with foods, typically not even near their mouth to start!
Final Thoughts
So, although there are many other areas that occupational therapists can address with infants and toddlers, these are some of the most common reasons we may see an infant/toddler for occupational therapy. I hope this gives you a little more information to help you make the most informed decision for your sweet child. Remember, we are not here to judge you! We are here to educate you and empower you to help your child be the best that they can be. We are always honored when a parent trusts us to guide them in their journey.
I will leave you this: Follow your gut! If you feel something is not right, if you feel your child is behind even when others are telling you to wait, or if you simply just want to make sure your child is on the right track... reach out to a pediatric occupational therapists. There is never any harm in getting a second opinion, advice, or just some peace of mind! And remember, you are doing an amazing job- keep advocating for your child!
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